Impact of emergency contraception status on unintended pregnancy: observational data from a women’s health practice / Impacto del estado de los contraceptivos de emergencia en el embarazo indeseado: datos observacionales de una clínica de medicina de mujer

Objective: This study aimed to determine if non-prescription emergency contraception (EC) availability impacted self-reported unintended pregnancy rates and to assess women's knowledge and awareness of EC prior to and after non-prescription availability. Methods: A survey regarding contraception use and knowledge was verbally administered to a cross-sectional, convenience sample of 272 pregnant women receiving prenatal care at a large urban community women's clinic between August 2003 and October 2008. Statistical analyses determined the differences between two groups (before [BA] and after, [AA] non-prescription EC availability in the U.S. drug market) in terms of self-reported unintended pregnancy rates, knowledge and awareness of EC. Results: The AA group reported higher incidence of unintended pregnancy when compared to the BA group (90.7% vs. 72.7%, P = 0.0172). The majority of both groups reported that they were not using any contraception at the time of conception (BA-84.4%; AA-83.3%). There was no significant difference in the participants' awareness of EC between the two groups (BA-46.8% vs. AA-43.0%) nor was there a significant difference between the two groups in the self-reported willingness to use EC in the future (BA-53.1% vs. AA-63.4%). However, among participants who were unaware of EC, 61% reported they would consider using it in the future after receiving brief EC counseling from a pharmacist or student pharmacist. Neither age nor pregnancy intention was associated with self-reported EC awareness but there was an association with income (P = 0.0410) and education (P = 0.0021). Conclusion: The change from prescription-only to non-prescription status of EC in the U.S. drug market did not impact the unintended pregnancy rate in this patient population. Lack of knowledge and awareness is still a major barrier to widespread EC use (AU)

Objetivo: Este estudio trató de determinar si la disponibilidad sin receta de la contracepción de emergencia (CE) impactó en la proporción auto-reportada de embarazos no deseados y evaluar el conocimiento y consciencia de las mujeres sobre la CE antes y después de la disponibilidad sin receta. Métodos: Se administró verbalmente un cuestionario sobre uso y conocimiento a una muestra transversa de conveniencia de 272 mujeres embarazadas que recibían atención prenatal en una gran clínica urbana de mujeres entre agosto 2003 y octubre 2008. Los análisis estadísticos determinaban las diferencias entre dos grupos (antes [BA] y después [AA] de la disponibilidad de la CE sin receta en el mercado de medicamentos de Estados Unidos) en términos de tasas reportadas de embarazo no deseado, conocimiento y consciencia de la CE. Resultados: El grupo AA reportó mayor incidencia de embarazo no deseado en comparación con el grupo BA (90,7% vs. 72.7%, P=0,0172). La mayoría en ambos grupos informó que no estaban utilizando ningún contraceptivo en el momento de la concepción (BA-84,4%; AA-83,3%). No había diferencia significativa en la consciencia de los participantes sobre la CE entre ambos grupos (BA-46,8% vs. AA-43,0%) ni había diferencia significativa en la voluntad auto-.reportada de utilizar CE en el futuro (BA-53,1% vs. AA-63,4%). Sin embargo, entre los participantes que no eran conocedores de la CE, el 61% reportó que considerarían utilizarla en el futuro después de haber recibido un breve consejo de un farmacéutico o un estudiante de farmacia. Ni la edad, ni la intención de embarazo estaba asociada con la consciencia auto-reportada de la CE, pero había asociación con los ingresos (P=0,0410) y la educación (P=0,0021). Conclusión: El cambio del estado de prescripción a sin receta de la CE en el mercado de medicamentos de los Estados Unidos no impactó en la tasa de embarazos indeseados en esta población de pacientes. La falta de conocimiento y consciencia de la CE es la mayor barrera para la diseminación del uso de CE (AU)

Immunoglobulin G antisperm antibodies and prediction of spontaneous pregnancy.

OBJECTIVE: To investigate the predictive capacity of immunoglobulin G ASA (direct MAR test) for spontaneous ongoing pregnancy in subfertile couples. DESIGN: Prospective cohort study. SETTING: Nine fertility centers in The Netherlands. PATIENT(S): Consecutive ovulatory subfertile couples. INTERVENTION(S): A basic fertility workup, including a mixed agglutination reaction test for IgG (MAR test) at first semen analysis. MAIN OUTCOME MEASURE(S): Spontaneous conception resulting in ongoing pregnancy. RESULT(S): We included 1,794 couples, of which 283 (16%) had a spontaneous ongoing pregnancy within 1 year. When a threshold 50% was used for an abnormal test result, the MAR test was positive in 3% of the couples. In the univariable analysis, a positive MAR test >or=50% reduced, albeit not statistically significant, the probability of spontaneous pregnancy (hazard ratio [HR] 0.76, 95% confidence interval [CI] 0.34 to 1.7). In the multivariable analysis, a positive MAR test >or=50% had no contribution in the prediction of spontaneous pregnancy (HR 0.99, 95% CI 0.40 to 2.4). CONCLUSION(S): This large cohort study shows that the MAR test is not able to predict spontaneous pregnancy chances. Its routine use in the basic fertility workup for identification of couples with low spontaneous pregnancy chances is not justified.