COVID-19 Vaccine Hesitancy in the Perinatal Period: A Survey Among Residents of Hawaii.

Introduction: This study describes the vaccination status among people in Hawaii who are attempting pregnancy, currently pregnant, recently delivered (<6 months), and/or breastfeeding and documents common concerns and information sources associated with vaccine decision making. Methods: We conducted a cross-sectional online survey between April and September 2022 throughout Hawaii. The anonymous surveys were disseminated through flyers and online links posted by physician offices and community partners throughout Hawaii. Results: Final analyses included 165 responses. Almost half of the respondents (n=75, 45%) were unvaccinated, 38% (n=62) were fully vaccinated, and 17% (n=28) were partially vaccinated. The most influential sources for vaccine decision making for vaccinated respondents were their healthcare providers (n=28, 45%) and official healthcare organizations (n=22, 36%), whereas unvaccinated respondents reported friends/family (n=28, 37%) and their healthcare providers (n=26, 35%) as their most influential sources. Top COVID-19 vaccine concerns for unvaccinated individuals were reactions to vaccine (n=78, 76%) and concerns for safety of the vaccine (n=75, 73%). Conclusions: Efforts should be made to increase and expand vaccine education about the benefits and safety of vaccines during pregnancy beyond the pregnant person to create more supportive social norms for COVID-19 vaccination in the perinatal period. Consistent and unequivocal support across medical specialties, including obstetrics, pediatrics, and family medicine, is also crucial for encouraging the uptake of the vaccine during pregnancy or when breastfeeding.

Primary Care Physician Perceptions of Female Pelvic Floor Disorders.

Primary care physicians (PCPs) play a major role in patient access to appropriate health care. This study examines PCPs' perceptions and management of female pelvic floor disorders. Surveys were mailed to family medicine and internal medicine physicians associated with the Hawai'i Medical Service Association. A total of 150 respondents were included. Only 34%, 38%, and 9% of respondents correctly identified the prevalence of urinary incontinence (UI), overactive bladder (OAB), and pelvic organ prolapse (POP), respectively. For disease-specific screening, the highest response was that PCPs "sometimes" screen for UI (36%) and OAB (45%) but "hardly ever" screen for POP (43%). With regards to management of UI and OAB, respondents would either treat (30% UI, 39% OAB) or start treatment then refer (53% UI, 49% OAB). For POP, nearly all of respondents (81%) would immediately refer. When consultation is necessary, there was a similar rate of referral to urology and urogynecology for UI (38% urology, 42% urogynecology), and a similar rate of referral to gynecology and urogynecology for POP (47% gynecology, 48% urogynecology). For OAB, PCPs would refer to urology (54.0%), then urogynecology (31%), and lastly gynecology (13%). A majority of respondents were "somewhat familiar" (56%) with urogynecology as a subspecialty, while 27% were "very familiar", 13% were "slightly unfamiliar", and 3% were "very unfamiliar". This study shows that most PCPs are not comfortable managing common urogynecologic problems and would likely benefit from education on how to diagnose, treat, and refer for these conditions in order to optimize patient care.

Pregnancy Intention and Contraceptive Use among Women by Class of Obesity: Results from the 2006-2010 and 2011-2013 National Survey of Family Growth.

OBJECTIVE: Conflicting research findings on the association of obesity and pregnancy intention may be due to their collective definition of obesity at a body mass index of 30 kg/m2 or greater. However, obese women with a BMI of 40 kg/m2 or greater may be both behaviorally and clinically different from obese women with a lower BMI. This study reexamines this relationship, stratifying by class of obesity; the study also explores variations in contraceptive use by class of obesity given their potential contribution to the incidence of unintended or unwanted pregnancy. METHODS: This study combined data from the 2006 through 2010 and 2011 through 2013 US National Survey of Family Growth. Pregnancy intention (intended, mistimed, unwanted) and current contraceptive use (no method, barrier, pill/patch/ring/injection, long-acting reversible contraceptive, sterilization) were compared across body mass index categories: normal (18.5-24.9 kg/m kg/m2), overweight (25.0-29.9), obese class 1 (30.0-34.9 kg/m2), class 2 (35.0-39.9 kg/m2), and class 3 (≥40 kg/m2, severe obesity). Weighted multinomial logistic regressions were refined to determine independent associations of body mass index class and pregnancy intention, as well as contraceptive method, controlling for demographic, socioeconomic, and reproductive factors. RESULTS: Body mass index data were available for 9,848 nonpregnant, sexually active women who reported not wanting to become pregnant. Women with class 3 obesity had significantly greater odds of mistimed (adjusted odd ratio [aOR], 1.67; 95% confidence interval [CI], 1.02-2.75) or unwanted (aOR, 1.96; 95% CI, 1.15-3.32) pregnancy compared with normal weight women. Women with class 2 or 3 obesity were more likely to not be using contraception (aOR, 1.53-1.62; 95% CI, 1.04-2.29). Although women with class 2 obesity were more likely to be using long-acting reversible contraceptive methods and sterilization over short-acting hormonal methods (aOR, 1.67; 95% CI, 1.08-2.57; aOR, 2.05; 95% CI,1.44-2.91), this association was not observed among women with class 3 obesity. CONCLUSIONS: Women with class 3 obesity are at greater risk of unintended pregnancy and are less likely to be using contraception than normal weight women. Whether these findings are related to patient and/or provider barriers that are not as visible among women with class 1 and class 2 obesity warrants further investigation.

Levonorgestrel Intrauterine Device Use in Overweight and Obese Women.

The levonorgestrel intrauterine device (LNG-IUD) is a safe, effective, long-acting, reversible contraceptive that reduces unintended pregnancy and decreases heavy menstrual bleeding. Many procedures such as IUD insertion are more challenging in overweight and obese women. The objective of this study was to describe LNG-IUD insertion, continuation, and complications in overweight and obese women in an ethnically diverse population in Hawai'i. A retrospective cohort study of women who had a LNG-IUD inserted at the University of Hawai'i, Department of Obstetrics and Gynecology Resident and Faculty practice sites between January 2009 and December 2010 was performed. A total of 149 women were followed. The most commonly reported races were Asian (32%), Native Hawaiian (26%), and non-Hawaiian Pacific Islander (20%). The mean BMI of the study population was 28.4 (standard deviation 7.2) with 37% classified as normal weight, 30% as overweight, and 33% as obese. Overall, 76% of women continued the LNG-IUD 12 months after insertion. No statistically significant difference emerged in 12-month IUD continuation between the BMI groups. Difficult (5%) and failed (3%) IUD insertions were rare for all BMI groups. IUD complications occurred in 9% of women and included expulsion and self-removal. In this diverse population, the majority of women continued to use the LNG-IUD one year after insertion with low rates of difficult insertions and complications.

Effect of delivery route on natural history of cervical dysplasia.

OBJECTIVE: This study was undertaken to determine the (1) impact of delivery route on the natural history of cervical dysplasia and (2) overall regression rates of cervical dysplasia in pregnant women. STUDY DESIGN: A retrospective analysis was performed on 705 pregnant women with abnormal Papanicolaou tests who presented for prenatal care at the Kapiolani Medical Center Women's Clinic in Honolulu, Hawaii, between 1991 and 2001. Data collection included demographics, delivery route, and cervical pathology. RESULTS: Two hundred one patients met the inclusion criteria. Regression rates for vaginal and cesarean section groups were as follows: atypical squamous cells (64% vs 70%, P = .32), low-grade squamous intraepithelial lesion (58% vs 42%, P = .073), and high-grade squamous intraepithelial lesion (53% vs 25%, P = .44). Of the total population, 30% of lesions persisted postpartum, 58% regressed, and 12% progressed. CONCLUSION: Mode of delivery does not influence the natural history of dysplastic lesions. Gravid and nongravid women have similar regression rates.