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Other Studies of Interest to Midwives
the U.S. Food and Drug Administration stipulates that all future studies of hormonal contraceptives must adequately represent the population of women who will be using them, thus ensuring that greater percentages of obese women will be appropriately included. REFERENCES 1. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA 2006;295(13):1549–55. 2. Robinson HE, O’Connell CM, Joseph KS, McLeod ML. Maternal outcomes in pregnancies complicated by obesity. Obstet Gynecol 2005;106:1357–64. 3. Zhang HF, LaGuardia KG, Creanga DL. Higher body weight and body mass index are not associated with reduced efficacy in Ortho Tri-Cyclen Lo users. Obstet Gynecol 2006;107:50S. 4. Chuang CH, Chase GA, Bensyl DM, Weisman CS. Contraceptive use by diabetic and obese women. Womens Health Issues 2005;15:167–73.
OTHER STUDIES OF INTEREST TO MIDWIVES Use of Metronidazole to Treat Trichomoniasis in Pregnancy Not Associated With Preterm Birth Mann JR, McDermott S, Zhou L, Barnes TL, Hardin J. Treatment of trichomoniasis in pregnancy and preterm birth: An observational study. J Womens Health 2009;18:493–7. Reviewed by: Sharon Bond, CNM, PhD, APRN-BC. Trichomoniasis remains an important sexually transmitted infection in the United States, with an incidence of 7.4 million cases annually.1 Studies cited in this article show that trichomoniasis has been associated with adverse pregnancy outcomes such as preterm birth, premature rupture of membranes, and low birth weight, possibly due to the infection’s ability to induce both a vaginal and systemic inflammatory immune response. An earlier randomized controlled trial showed that women treated with metronidazole during pregnancy had an increased risk of preterm birth.2 This study by Mann et al. examined associations between treatment of trichomoniasis in pregnancy and preterm birth. Using Medicaid and birth certificate data, researchers studied records of 144,737 live births in South Carolina from 1996 to 2002. Three percent of women had a diagnosis of trichomoniasis, the majority diagnosed prior to 35 weeks’ gestation. Forty percent of those filled a prescription for metronidazole within 2 weeks (defined as treated). Of women treated, 12.7 % gave birth before 37 weeks compared with 15.3% who were not treated (i.e., did not fill a prescription within 14 days). In models developed by the authors, treatment appeared to offer protection from preterm birth for women with trichomoniasis who were Journal of Midwifery & Women’s Health www.jmwh.org
not found to have another genitourinary infection at some time during pregnancy. When those women who gave birth prior to 14 days of diagnosis were excluded from the analysis (these represent women who either were not treated or may not have completed therapy), findings were no longer statistically significant that women diagnosed with trichomoniasis during pregnancy were significantly more likely to deliver preterm (relative risk = 1.21). Authors conclude that a distinction between symptomatic and asymptomatic infection is important because the inflammatory response for symptomatic infection may be greater, and thus effects of treatment may differ between symptomatic versus asymptomatic cases. Limitations to this study include questions regarding accuracy of diagnosis, whether diagnosis was determined following another complication of pregnancy, and whether women who filled a prescription actually completed therapy. Potential difficulties associated with randomization of symptomatic women to treatment versus no treatment to more accurately determine associations between treatment and preterm birth require observational studies alone to resolve this question. Midwives recognize that the Centers for Disease Control and Prevention recommends that women with symptomatic trichomoniasis at any time during pregnancy be treated with a 2-g dose of metronidazole, which is classified as a category C drug.3 REFERENCES 1. Sexually transmitted diseases: Trichomoniasis. Centers for Disease Control and Prevention. Available from www.cdc.gov/std/ trichomonas/ [Accessed May 16, 2009]. 2. Klebanoff MA, Carey JC, Hauth JC, Hillier SL, Nugent RP, Thom EA, et al. Failure of metronidazole to prevent preterm delivery among pregnant women with Trichomonas vaginalis infection. N Engl J Med 2001;345:487–93. 3. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2006. MMWR Morb Mortal Wkly Rep 2006;55(RR-11):52–4.
Sexual Behavior of Virginity Pledgers Same as Nonpledgers, but Pledgers Less Likely to Use Precautions Rosenbaum JE. Patient teenagers? A comparison of the sexual behavior of virginity pledgers and matched non-pledgers. Pediatrics 2009;123:e110–20. Reviewed by: Sharon Bond, CNM, PhD, APRN-BC. In the wake of more than $200 million the United States government spends annually on abstinence programs that include virginity pledging, Rosenbaum sought to compare the sexual behaviors of adolescent virginity pledgers with matched nonpledgers. Previous studies found that virginity pledging delayed sexual activity but 419
OTHER STUDIES OF INTEREST TO MIDWIVES Use of Metronidazole to Treat Trichomoniasis in Pregnancy Not Associated With Preterm Birth Mann JR, McDermott S, Zhou L, Barnes TL, Hardin J. Treatment of trichomoniasis in pregnancy and preterm birth: An observational study. J Womens Health 2009;18:493–7. Reviewed by: Sharon Bond, CNM, PhD, APRN-BC. Trichomoniasis remains an important sexually transmitted infection in the United States, with an incidence of 7.4 million cases annually.1 Studies cited in this article show that trichomoniasis has been associated with adverse pregnancy outcomes such as preterm birth, premature rupture of membranes, and low birth weight, possibly due to the infection’s ability to induce both a vaginal and systemic inflammatory immune response. An earlier randomized controlled trial showed that women treated with metronidazole during pregnancy had an increased risk of preterm birth.2 This study by Mann et al. examined associations between treatment of trichomoniasis in pregnancy and preterm birth. Using Medicaid and birth certificate data, researchers studied records of 144,737 live births in South Carolina from 1996 to 2002. Three percent of women had a diagnosis of trichomoniasis, the majority diagnosed prior to 35 weeks’ gestation. Forty percent of those filled a prescription for metronidazole within 2 weeks (defined as treated). Of women treated, 12.7 % gave birth before 37 weeks compared with 15.3% who were not treated (i.e., did not fill a prescription within 14 days). In models developed by the authors, treatment appeared to offer protection from preterm birth for women with trichomoniasis who were Journal of Midwifery & Women’s Health www.jmwh.org
not found to have another genitourinary infection at some time during pregnancy. When those women who gave birth prior to 14 days of diagnosis were excluded from the analysis (these represent women who either were not treated or may not have completed therapy), findings were no longer statistically significant that women diagnosed with trichomoniasis during pregnancy were significantly more likely to deliver preterm (relative risk = 1.21). Authors conclude that a distinction between symptomatic and asymptomatic infection is important because the inflammatory response for symptomatic infection may be greater, and thus effects of treatment may differ between symptomatic versus asymptomatic cases. Limitations to this study include questions regarding accuracy of diagnosis, whether diagnosis was determined following another complication of pregnancy, and whether women who filled a prescription actually completed therapy. Potential difficulties associated with randomization of symptomatic women to treatment versus no treatment to more accurately determine associations between treatment and preterm birth require observational studies alone to resolve this question. Midwives recognize that the Centers for Disease Control and Prevention recommends that women with symptomatic trichomoniasis at any time during pregnancy be treated with a 2-g dose of metronidazole, which is classified as a category C drug.3 REFERENCES 1. Sexually transmitted diseases: Trichomoniasis. Centers for Disease Control and Prevention. Available from www.cdc.gov/std/ trichomonas/ [Accessed May 16, 2009]. 2. Klebanoff MA, Carey JC, Hauth JC, Hillier SL, Nugent RP, Thom EA, et al. Failure of metronidazole to prevent preterm delivery among pregnant women with Trichomonas vaginalis infection. N Engl J Med 2001;345:487–93. 3. Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2006. MMWR Morb Mortal Wkly Rep 2006;55(RR-11):52–4.
Sexual Behavior of Virginity Pledgers Same as Nonpledgers, but Pledgers Less Likely to Use Precautions Rosenbaum JE. Patient teenagers? A comparison of the sexual behavior of virginity pledgers and matched non-pledgers. Pediatrics 2009;123:e110–20. Reviewed by: Sharon Bond, CNM, PhD, APRN-BC. In the wake of more than $200 million the United States government spends annually on abstinence programs that include virginity pledging, Rosenbaum sought to compare the sexual behaviors of adolescent virginity pledgers with matched nonpledgers. Previous studies found that virginity pledging delayed sexual activity but 419