Comparing perceptions of long-acting reversible contraception among women during periods of incarceration and women attending a local clinic: An exploratory study.

OBJECTIVES: The objective of this study was to understand perceptions of long-acting reversible contraception (LARC) among incarcerated women. We compared survey responses specific to IUDs and implants between a convenience sample of incarcerated women to a sample of women attending a local ob/gyn clinic. STUDY DESIGN: We conducted a cross-sectional survey among two groups: (1) incarcerated women receiving medical care at the state correctional facility, and (2) women receiving care at an ob/gyn clinic in the same community. The anonymous survey included questions about demographic variables, current and past contraceptive use, and perception of IUDs and implants. RESULTS: Almost half of the total sample stated that they might consider an IUD or implant for contraception. Incarcerated women tended to be less likely to give an affirmative answer to current or future use of an IUD or implant (29% vs 39%, p = 0.19). Concerns about pain and side effects were similar between the groups, but more incarcerated women cited concerns about device removal (72% vs 57%, p = 0.02) and the level of training of the provider inserting the device (68% vs 53%, p = 0.02). Incarcerated women interested in using the IUD or implant were more comfortable with device placement in the community than in the correctional setting (42% to 30%, p < 0.001). CONCLUSIONS: Incarcerated women have concerns about LARC that may be specific to their experience of incarceration. Providers working with incarcerated women should consider these when counseling patients on contraceptive choices. Options for post-release follow-up care and device removal should be included in this discussion. IMPLICATIONS: Incarcerated women should receive comprehensive reproductive health care, including contraceptive services if desired. However, incarceration itself may introduce fundamental concerns regarding contraception and these concerns need to be better understood to balance the provision of services with the potential for reproductive coercion.

Comparing Glucose Challenge Test Screening Thresholds in Obese and Overweight Gravidas.

OBJECTIVE: Given the paucity of contemporary data examining glucose challenge test (GCT), thresholds for gestational diabetes (GDM) screening in obese and overweight women, we sought to compare the sensitivity and testing characteristics of different screen positive GCT cut-offs in women with a prepregnancy body mass index (BMI) ≥ 25 kg/m2. STUDY DESIGN: This is a retrospective cohort study of obese and overweight women with singleton pregnancies who underwent GCT between 24 and 296/7 weeks and had a value between 130 and 199 mg/dL necessitating a 3-hour glucose tolerance test (GTT). Exclusion criteria were pregestational diabetes mellitus, multigestation, use of diabetes medications, and bariatric surgery. RESULTS: Between August 2015 and January 2016, 19% (n = 496) of women with a BMI ≥ 25 kg/m2 required a GTT to test for GDM, 27.8% (n = 138) of whom were diagnosed with GDM. Mean age was 30 years, mean BMI = 31.6 kg/m2, and 30.4% were Hispanic. The 130 mg/dL threshold compared with 140 mg/dL was more sensitive (absolute increase: 11.3%, 95% confidence interval [CI]: 6.7-17%), but less specific (absolute decrease: 6.4%, 95% CI: 5.5-7.5%). CONCLUSION: Shared decision making should be used to determine GCT cut-offs as some patients may prefer to undergo a GTT rather than miss a diagnosis of GDM.