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in category sexual and reproductive health

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1: Effect of SARS-CoV-2 infection upon male gonadal function: A single center-based study
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Posted 24 Mar 2020

Effect of SARS-CoV-2 infection upon male gonadal function: A single center-based study
36,390 downloads medRxiv sexual and reproductive health

Ling Ma, Wen Xie, Danyang Li, Lei Shi, Yanhong Mao, Yao Xiong, Yuanzhen Zhang, Ming Zhang

Since SARS-CoV-2 infection was first identified in December 2019, it spread rapidly and a global pandemic of COVID-19 has occurred. ACE2, the receptor for entry into the target cells by SARS-CoV-2, was found to abundantly express in testes, including spermatogonia, Leydig and Sertoli cells. However, there is no clinical evidence about whether SARS-CoV-2 infection can affect male gonadal function so far. In this study, we compared the sex-related hormones between 81 reproductive-aged men with SARS-CoV-2 infection and 100 age-matched healthy men, and found that serum luteinizing hormone (LH) was significantly increased, but the ratio of testosterone (T) to LH and the ratio of follicle stimulating hormone (FSH) to LH were dramatically decreased in males with COVID-19. Besides, multivariable regression analysis indicated that c-reactive protein (CRP) level was significantly associated with serum T:LH ratio in COVID-19 patients. This study provides the first direct evidence about the influence of medical condition of COVID-19 on male sex hormones, alerting more attention to gonadal function evaluation among patients recovered from SARS-CoV-2 infection, especially the reproductive-aged men.

2: First case of placental infection with SARS-CoV-2
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Posted 05 May 2020

First case of placental infection with SARS-CoV-2
17,873 downloads medRxiv sexual and reproductive health

Hillary Hosier, Shelli Farhadian, Raffaella Morotti, Uma Deshmukh, Alice Lu-Culligan, Katherine Campbell, Yuki Yasumoto, Chantal Vogels, Arnau Casanovas-Massana, Pavithra Vijayakumar, Bertie Geng, Camila Odio, John Fournier, Anderson Brito, Joseph Fauver, Feimei Liu, Tara Alpert, Reshef Tal, Klara Szigeti-Buck, Sudhir Perincheri, Christopher Larsen, Aileen Gariepy, Gabriela Aguilar, Kristen Fardelmann, Malini Harigopal, Hugh Taylor, Christian Pettker, Anne Wyllie, Charles Dela Cruz, Aaron M. Ring, Nathan Grubaugh, Albert Ko, Tamas Horvath, Akiko Iwasaki, Uma Reddy, Heather Lipkind

Background: The effects of Covid-19 in pregnancy remain relatively unknown. We present a case of second trimester pregnancy with symptomatic Covid-19 complicated by severe preeclampsia and placental abruption. Methods: We analyzed placenta for the presence of SARS-CoV-2 through molecular and immunohistochemical assays and by and electron microscopy, and we measured the maternal antibody response in blood to this infection. Results: SARS-CoV-2 localized predominantly to syncytiotrophoblast cells at the maternal-fetal interface of the placenta. Histological examination of the placenta revealed a dense macrophage infiltrate, but no evidence for vasculopathy typically associated with preeclampsia. Conclusion: This case demonstrates, for the first time, SARS-CoV-2 invasion of the placenta, highlighting the potential for severe morbidity among pregnant women with Covid-19.

3: Changes in Solo and Partnered Sexual Behaviors during the COVID-19 Pandemic: Findings from a U.S. Probability Survey
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Posted 11 Jun 2020

Changes in Solo and Partnered Sexual Behaviors during the COVID-19 Pandemic: Findings from a U.S. Probability Survey
8,885 downloads medRxiv sexual and reproductive health

Devon J. Hensel, Molly Rosenberg, Maya Luetke, Tsung-chieh Fu, Debby Herbenick

Background: Research demonstrates that pandemics adversely impact sexual and reproductive health (SRH), but few have examined their impact on participation in sex. We examined self-reported changes in solo and sexual behaviors in U.S. adults during early stages of the public health response to COVID-19. Methods: We conducted an online, nationally representative, cross-sectional survey of U.S. adults (N=1010; aged 18-94 years; 62% response rate) from April 10-20, 2020. We used weighted multinomial logistic regression to examine past month self-reported changes (decreased, stable or increased) in ten solo and partnered sexual behaviors. Predictor variables included: having children at home, past month depressive symptoms, (ACHA 3-item scale), past month loneliness (UCLA 3-Item Loneliness scale), COVID-19 protection behaviors (adapted 12-item scale), perceived COVID-19 consequences (adapted 10-item scale) and COVID-19 knowledge (adapted 10-item scale). Findings: Nearly half of all adults reported some kind of change, most commonly, a decrease, in their sexual behavior in the past month. Having elementary aged children at home, past month depressive symptoms and loneliness and enacting more COVID-19 protective behaviors were associated with both reduced partnered bonding behaviors, such as hugging, cuddling, holding hands and kissing, as well as reduced partnered sexual behaviors, such as oral sex, partnered genital touching and vaginal sex. Greater COVID19 risk perception and greater COVID19 knowledge were associated with mixed effects in behavior outcomes. Interpretations: Our data illustrate the very personal ways in which different pandemic-associated factors may create or inhibit opportunities for solo and partnered sex. The centrality of sexuality to health and well-being, even during pandemics, means that a critical piece of public health prevention and management responses should is ensuring that services and resource that support positive sexual decision making remain open and available.

4: Short-term outcomes of pubertal suppression in a selected cohort of 12 to 15 year old young people with persistent gender dysphoria in the UK
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Posted 02 Dec 2020

Short-term outcomes of pubertal suppression in a selected cohort of 12 to 15 year old young people with persistent gender dysphoria in the UK
5,759 downloads medRxiv sexual and reproductive health

Polly Carmichael, Gary Butler, Una Masic, Tim J. Cole, Bianca L De Stavolta, Sarah Davidson, Elin M. Skageberg, Sophie Khadr, Russell Viner

Background In adolescents with severe and persistent gender dysphoria (GD), gonadotropin releasing hormone analogues (GnRHa) are used from early/middle puberty with the aim of delaying irreversible and unwanted pubertal body changes. Evidence of outcomes of pubertal suppression in GD is limited. Methods We undertook an uncontrolled prospective observational study of GnRHa as monotherapy in 44 12-15 year olds with persistent and severe GD. Prespecified analyses were limited to key outcomes: bone mineral content (BMC) and bone mineral density (BMD); Child Behaviour CheckList (CBCL) total t-score; Youth Self-Report (YSR) total t-score; CBCL and YSR self-harm indices; at 12, 24 and 36 months. Semistructured interviews were conducted on GnRHa. Results 44 patients had data at 12 months follow-up, 24 at 24 months and 14 at 36 months. All had normal karyotype and endocrinology consistent with birth-registered sex. All achieved suppression of gonadotropins by 6 months. At the end of the study one ceased GnRHa and 43 (98%) elected to start cross-sex hormones. There was no change from baseline in spine BMD at 12 months nor in hip BMD at 24 and 36 months, but at 24 months lumbar spine BMC and BMD were higher than at baseline (BMC +6.0 (95% CI: 4.0, 7.9); BMD +0.05 (0.03, 0.07)). There were no changes from baseline to 12 or 24 months in CBCL or YSR total t-scores or for CBCL or YSR self-harm indices, nor for CBCL total t-score or self-harm index at 36 months. Most participants reported positive or a mixture of positive and negative life changes on GnRHa. Anticipated adverse events were common. Conclusions Overall patient experience of changes on GnRHa treatment was positive. We identified no changes in psychological function. Changes in BMD were consistent with suppression of growth. Larger and longer-term prospective studies using a range of designs are needed to more fully quantify the benefits and harms of pubertal suppression in GD.

5: Voices from the frontline: findings from a thematic analysis of a rapid online global survey of maternal and newborn health professionals facing the COVID-19 pandemic
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Posted 11 May 2020

Voices from the frontline: findings from a thematic analysis of a rapid online global survey of maternal and newborn health professionals facing the COVID-19 pandemic
3,419 downloads medRxiv sexual and reproductive health

Aline T Semaan, Constance Audet, Elise Huysmans, Bosede B Afolabi, Bouchra Assarag, Aduragbemi Banke-Thomas, Hannah Blencowe, Severine Caluwaerts, Oona M R Campbell, Francesca L Cavallaro, Leonardo Chavane, Louise Tina Day, Alexandre Delamou, Therese Delvaux, Wendy Graham, Giorgia Gon, Peter Kascak, Mitsuaki Matsui, Sarah G Moxon, Annettee Nakimuli, Andrea B Pembe, Emma Radovich, Thomas van den Akker, Lenka Benova

Objective To prospectively document experiences of frontline maternal and newborn healthcare providers during the COVID-19 pandemic. Design Cross-sectional study via an online survey disseminated through professional networks and social media in 12 languages. We analysed responses using descriptive statistics and qualitative thematic analysis disaggregating by low- and middle-income countries (LMICs) and high-income countries (HICs). Setting 81 countries, between March 24 and April 10, 2020. Participants 714 maternal and newborn healthcare providers. Main outcome measures Preparedness for and response to COVID-19, experiences of health workers providing care to women and newborns, and adaptations to 17 outpatient and inpatient care processes during the pandemic. Results Only one third of respondents received training on COVID-19 from their health facility and nearly all searched for information themselves. Half of respondents in LMICs received updated guidelines for care provision compared with 82% in HICs. Overall, only 47% of participants in LMICs, and 69% in HICs felt mostly or completely knowledgeable in how to care for COVID-19 maternity patients. Facility-level responses to COVID-19 (signage, screening, testing, and isolation rooms) were more common in HICs than LMICs. Globally, 90% of respondents reported somewhat or substantially higher levels of stress. There was a widespread perception of reduced use of routine maternity care services, and of modification in care processes, some of which were not evidence-based. Conclusions Substantial knowledge gaps exist in guidance on management of maternity cases with or without COVID-19. Formal information sharing channels for providers must be established and mental health support provided. Surveys of maternity care providers can help track the situation, capture innovations, and support rapid development of effective responses.

6: Basic emergency Obstetric and Neonatal Care Knowledge retention and Skills of Health Professionals in Burundi following an ALARM International Program Training: A pilot study
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Posted 18 May 2020

Basic emergency Obstetric and Neonatal Care Knowledge retention and Skills of Health Professionals in Burundi following an ALARM International Program Training: A pilot study
3,062 downloads medRxiv sexual and reproductive health

Anifa Luyinga Kalay, Veronique Mareschal, Juma Ndereye, Jocelyn Cook

Background : This study describes the immediate and short-term improvement in basic emergency obstetric and neonatal care (BEmONC) knowledge and skills after ALARM International Programme (AIP) training in Burundi. Subjects and Method: In 2017, sixteen health professionals participated in a 5-day AIP training. They completed pre and post course tests. At the end of the training, they did objective structured clinical examinations (OSCE) on postpartum hemorrhage (PPH), shoulder dystocia and neonatal resuscitation.In 2018, a refresher course was offered to participants who scored the highest in the 2017 post-training test. Pre and post tests were administered.Mean pre- and post-test scores and t-paired test was performed to determine the knowledge change and retention between 2017 and 2018. Mean OSCE scores were calculated to describe acquired clinical skills at the 2017 training. A one-way ANOVA test was performed to assess the differences between cadres in the tests and the OSCEs. Results: In 2017, pre and post scores were significantly different within cadres except imidwives : physicians t(5)=8.77(p<0.05), midwives t(1)=5,29 (p=0,11) and nurses t(7)=7,91(p<0.05)A gain of 25% was observed between the scores obtained in 2017 and the ones recorded in 2018. The difference was significant (t(7)=4.80, p<0.05). Scores were significantly different between cadres in PPH [F=(2,13)=6.17 , p <0.05)] and dystocia [F=(2,13)=3.92, p <0.05)] . Conclusion: An immediate gain in knowledge and acquisition of critical skills was observed in all cadres. Knowledge significantly decreased eight months following AIP training. Supervision, mentoring of trainees and continuing medical education are needed following the initial training.

7: Utilization of Family Planning and Associated Factors among Reproductive Age Women with Disability in Arba Minch , Southern Ethiopia
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Posted 06 Dec 2019

Utilization of Family Planning and Associated Factors among Reproductive Age Women with Disability in Arba Minch , Southern Ethiopia
1,708 downloads medRxiv sexual and reproductive health

Yibeltal Mesfin Yesgat, Feleke G/Meskel, Wubshet Estifanous, Yordanos Gizachew, Seid Jemal, Natneal Atnafu, Keyirden Nuriye

Introductionglobally, one type of contraceptive was used by around 63 percent of women. Women with disabilities account for 10 percent of all women and make up three-quarters of the disabled people in low and middle-income countries. Objectiveto assess utilization of family planning and associated factors among reproductive-age women with disability group in Arba Minch town, southern Ethiopia from 1st March to April 15, 2019. Methodscommunity-based cross-sectional study with simple random sampling was used to select 4l8 reproductive age women with disabilities. Data were collected using a structured questionnaire and interview by eight trained females who completed grade twelve two of which communicate by speaking and sign language. Data were entered using Epi info 7 and exported to SPSS version 20 for analysis. A statically significant variable in the final model was declared by AOR, 95%CI and p-value <0.05. Resultin the current study family planning utilization among all reproductive-age women with disabilities was 33.7%. Family planning utilization was 2.2 times higher among those who have employed compared with those with not employed (AOR2.2 95% CI, 1.77-4.15). Women who had a positive attitude were 2.3 times more likely to use family planning than negative attitudes (AOR 2.3:95% CI, 1.21- 3.87). Besides these women who got married were almost four times more likely to use family planning methods than unmarried (AOR 3.9:95% CI, 2.31-6.63). ConclusionThe level of family planning utilization was low among reproductive women with disabilities and factors associated were attitude, marital status, & employed status, therefore governmental and non-governmental organization should promote for women with disabilities to change the attitude and creating job opportunities.

8: Love during lockdown: findings from an online survey examining the impact of COVID-19 on the sexual practices of people living in Australia
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Posted 12 Aug 2020

Love during lockdown: findings from an online survey examining the impact of COVID-19 on the sexual practices of people living in Australia
1,658 downloads medRxiv sexual and reproductive health

Jacqueline Coombe, Fabian Kong, Helen Bittleston, Hennie Williams, Jane Tomnay, Alaina Vaisey, Sue Malta, Jane Goller, Meredith Temple-Smith, Louise Bourchier, Andrew Lau, Eric Chow, Jane S Hocking

Introduction: Australia recorded its first case of COVID-19 in late January 2020. On 22 March 2020, amid increasing daily case numbers, the Australian Government implemented lockdown restrictions to help flatten the curve. Our study aimed to understand the impact of lockdown restrictions on sexual and reproductive health. Here we focus on sexual practices. Methods: An online survey was open from the 23 April 2020 to the 11 May 2020. Participants were recruited online via social media and other networks and were asked to report on their sexual practices in 2019 and during lockdown. Logistic regression was used to calculate the difference (including 95% confidence intervals) in the proportion of sex practices between time periods. Results: Of the 1187 who commenced the survey, 965 (81.3%) completed it. Overall 70% were female and 66.3% were aged 18 to 29 years. Most (53.5%) reported less sex during lockdown than in 2019. Compared with 2019, participants were more likely to report sex with a spouse (35.3% vs 41.7%; difference=6.4%; 95%CI: 3.6, 9.2) and less likely to report sex with a girl/boyfriend (45.1% vs 41.8%; diff=-3.3%; 95%CI: -7.0, -0.4) or with casual hook-up (31.4% vs 7.8%; 95%CI:-26.9, -19.8). Solo sex activities increased, 14.6% (123/840) reported using sex toys more often and 26.0% (218/838) reported masturbating more often. Dating app use decreased during lockdown compared with 2019 (42.1% vs 27.3%; difference= -14.8%; 95%CI: -17.6, -11.9). Using dating apps for chatting/texting (89.8% vs 94.5%; diff=4.7%; 95%CI:1.0, 8.5) and for setting up virtual dates (2.6% vs 17.2%; diff=14.6%; 95%CI:10.1, 19.2) increased during lockdown. Conclusion: Although significant declines in sexual activity during lockdown were reported, people did not completely stop engaging in sexual activities during the pandemic, highlighting the importance of ensuring availability of normal sexual and reproductive health services during global emergencies.

9: Early indirect impact of COVID-19 pandemic on utilization and outcomes of reproductive, maternal, newborn, child and adolescent health services in Kenya
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Posted 09 Sep 2020

Early indirect impact of COVID-19 pandemic on utilization and outcomes of reproductive, maternal, newborn, child and adolescent health services in Kenya
1,508 downloads medRxiv sexual and reproductive health

DUNCAN N SHIKUKU, Irene Nyaoke, Sylvia Gichuru, Onesmus Maina, Martin Eyinda, Pamela Godia, Lucy Nyaga, Charles Ameh

Background: The COVID-19 global pandemic is expected to result in 8.3-38.6% additional maternal deaths in many low-income countries. The objective of this paper was to determine the initial impact of COVID-19 pandemic on reproductive, maternal, newborn, child and adolescent health (RMNCAH) services in Kenya. Methods: Data for the first four months (March-June) of the pandemic and the equivalent period in 2019 were extracted from Kenya Health Information System. Two-sample test of proportions for hospital attendance for select RMNCAH services between the two periods were computed. Results: There were no differences in monthly mean ({+/-}SD) attendance between March-June 2019 vs 2020 for antenatal care (400,191.2{+/-}12,700.0 vs 384,697.3{+/-}20,838.6), hospital births (98,713.0{+/-}4,117.0 vs 99,634.5{+/-}3,215.5), family planning attendance (431,930.5{+/-}19,059.9 vs 448,168.3{+/-}31,559.8), post-abortion care (3,206.5{+/-}111.7 vs 448,168.3{+/-}31,559.8) and pentavalent 1 immunisation (114,701.0{+/-}3,701.1 vs 110,915.8{+/-}7,209.4), p>0.05. However, there were increasing trends for adolescent pregnancy rate, significant increases in FP utilization among young people (25.7% to 27.0%), injectable (short-term) FP method uptake (58.2% to 62.3%), caesarean section rate (14.6% to 15.8%), adolescent maternal deaths (6.2% to 10.9%) and fresh stillbirths (0.9% to 1.0%) with a reduction in implants (long-term) uptake (16.5% to 13.0%) (p<0.05). No significant change in maternal mortality ratio between the two periods (96.6 vs 105.8/100,000 live births, p=0.1023) although the trend was increasing. Conclusion: COVID-19 may have contributed to increased adolescent pregnancy, adolescent maternal death and stillbirth rates in Kenya. If this trend persists, recent gains achieved in maternal and perinatal health in Kenya will be lost. With uncertainty around the duration of the pandemic, strategies to mitigate against catastrophic indirect maternal health outcomes are urgently needed. Key words: COVID-19, maternal, reproductive, stillbirths, family planning, adolescent, mortality, Kenya.

10: Unmasking Seasonal Cycles in Human Fertility: How holiday sex and fertility cycles shape birth seasonality
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Posted 19 Nov 2020

Unmasking Seasonal Cycles in Human Fertility: How holiday sex and fertility cycles shape birth seasonality
1,341 downloads medRxiv sexual and reproductive health

Laura Symul, P. Hsieh, A. Shea, CRC. Moreno, Debra J Skene, Susan P Holmes, Micaela E Martinez

The mechanisms of human birth seasonality have been debated for over 150 years. In particular, the question of whether sexual activity or fertility variations drive birth seasonality has remained open and difficult to test without large-scale data on sexual activity. Analyzing data from half-a-million users worldwide collected from the female health tracking app Clue in combination with birth records, we inferred that birth seasonality is primarily driven by seasonal fertility, yet increased sexual activity around holidays explains minor peaks in the birth curve. Our data came from locations in both the Northern Hemisphere (UK, US, and France) and the Southern Hemisphere (Brazil). We found that fertility peaks between the autumn equinox and winter solstice in the Northern Hemisphere locations and shortly following the winter solstice in the Southern Hemisphere locations.

11: A prospective double-blinded non-selection trial of reproductive outcomes and chromosomal normalcy of newborns derived from putative low/moderate-degree mosaic IVF embryos
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Posted 08 Feb 2021

A prospective double-blinded non-selection trial of reproductive outcomes and chromosomal normalcy of newborns derived from putative low/moderate-degree mosaic IVF embryos
1,209 downloads medRxiv sexual and reproductive health

Antonio Capalbo, Maurizio Poli, Laura Francesca Rienzi, Laura Girardi, Danilo Cimadomo, Francesca Benini, Alessio Farcomeni, Juliana Cuzzi, Carmen Rubio, Elena Albani, Laura Sacchi, Alberto Vaiarelli, Ivan Vogel, Eva R. Hoffmann, Claudia Livi, Paolo Emanuele Levi Setti, Filippo Maria Ubaldi, Carlos Simon

Background Next generation sequencing (NGS) has increased detection sensitivity of intermediate chromosome copy number variations (CNV) consistent with chromosomal mosaicism. Recently, this methodology has found application in preimplantation genetic testing (PGT) of trophectoderm (TE) biopsies collected from IVF-generated human embryos. As a consequence, the detection rate of intermediate CNV states in IVF embryos has drastically increased, posing questions about the accuracy in identifying genuine mosaicism in highly heterogeneous biological specimens. The association between analytical values consistent with mosaicism and the reproductive potential of the embryo, as well as newborn's chromosomal normalcy, have not yet been thoroughly determined. Methods We conducted a multicentre, double-blinded, non-selection trial including 1,190 patients undergoing in a total of 1,337 IVF with preimplantation genetic testing for aneuploidies (PGT-A) treatment cycles. NGS was performed on clinical TE biopsies collected from blastocyst-stage embryos. All embryos were reported as euploid if all autosomes had a chromosomal copy number value below the threshold of 50% abnormal cells per sample. After embryo transfer, three comparative classes were analysed: uniformly euploid profiles (<20% aneuploid cells), putative low-degree mosaicism (20%-30% aneuploid cells) or putative moderate-degree mosaicism (30%-50% aneuploid cells). Primary outcome measure was live birth rate (LBR) per transfer and newborn's karyotype. Results LBR after transfer of uniformly euploid embryos, low-degree, and moderate-degree mosaic embryos were 43.4% (95% C.I. 38.9 - 47.9), 42.9% (95% C.I. 37.1 - 48.9) and 42% (95% C.I. 33.4 - 50.9), respectively. No difference was detected for this primary outcome between euploid and mosaic low/moderate categories (OR= 0.96; 95% CI 0.743 to 1.263; P=0.816). The non-inferiority endpoint was met as the confidence interval for the difference fell below the planned 7.5% margin (95% C.I. -5.7 - 7.3). Likewise, no statistically significant difference was observed comparing moderate versus low degree mosaic embryos (P=0.92). Neonatal karyotypes were also similar and no instances of mosaicism or uniparental disomies (UPDs) were detected in babies born following putative low or moderate-degree mosaic embryo transfer. Should the embryos with low or moderate-degree mosaic TE biopsies had been classified as chromosomally abnormal and thus discarded for clinical use, LBR per cycle would have decreased by 36% without any clinical benefit. Conclusions This prospective non-selection trial provides substantial evidence that reporting and/or not transferring embryos with low/moderate-degree mosaicism for whole chromosomes have no clinical utility. Moreover, dismissing these embryos from clinical use has the counterproductive effect of reducing overall embryo availability, thus reducing the chance of successful outcome derived from an IVF treatment without any clinical benefit. (Funded by Igenomix; ClinicalTrials.gov number, NCT03673592)

12: Intermittent Lactobacilli-containing Vaginal Probiotic or Metronidazole Use to Prevent Bacterial Vaginosis Recurrence: Safety and Preliminary Efficacy by Microscopy and Sequencing
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Posted 08 Jul 2019

Intermittent Lactobacilli-containing Vaginal Probiotic or Metronidazole Use to Prevent Bacterial Vaginosis Recurrence: Safety and Preliminary Efficacy by Microscopy and Sequencing
1,159 downloads medRxiv sexual and reproductive health

Janneke HHM van de Wijgert, Marijn C. Verwijs, Stephen K. Agaba, Christina Bronowski, Lambert Mwambarangwe, Mireille Uwineza, Elke Lievens, Adrien Nivoliez, Jacques Ravel, Alistair C. Darby

Bacterial vaginosis (BV) is associated with HIV acquisition and adverse pregnancy outcomes. Recurrence after metronidazole treatment is high. HIV-negative, non-pregnant Rwandan BV patients were randomized to four groups (n=17/group) after seven-day oral metronidazole treatment: behavioral counseling only (control), or counseling plus intermittent use of oral metronidazole, Ecologic Femi+ vaginal capsule (containing multiple Lactobacillus and one Bifidobacterium species), or Gynophilus LP vaginal tablet (L. rhamnosus 35) for two months. Vaginal microbiota assessments at all visits included Gram stain Nugent scoring and 16S rRNA gene qPCR and HiSeq sequencing. All interventions were safe. BV (Nugent 7-10) incidence was 10.18 per person-year at risk in the control group, and lower in the metronidazole (1.41/person-year; p=0.004), Ecologic Femi+ (3.58/person-year; p=0.043), and Gynophilus LP groups (5.36/person-year; p=0.220). In mixed effects models adjusted for hormonal contraception/pregnancy, sexual risk-taking, and age, metronidazole and Ecologic Femi+ users, each compared to controls, had higher Lactobacillus and lower BV-anaerobes concentrations and/or relative abundances, and were less likely to have a dysbiotic vaginal microbiota type by sequencing. Inter-individual variability was high and effects disappeared soon after intervention cessation. Lactobacilli-based vaginal probiotics warrant further evaluation because, in contrast to antibiotics, they are not expected to negatively affect microbiota or cause antimicrobial resistance.

13: The impact of COVID-19 infection on maternal and reproductive health care services in governmental health institutions of Dessie town, North-East Ethiopia, 2020 G.C.
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Posted 23 Sep 2020

The impact of COVID-19 infection on maternal and reproductive health care services in governmental health institutions of Dessie town, North-East Ethiopia, 2020 G.C.
1,060 downloads medRxiv sexual and reproductive health

Kibir Temesgen Assefa, Amare Workie Gashu, Tenagnework Dilnessa Mulualem

Background: The COVID 19 pandemic is causing huge stress on the health care system of all countries in the world. The impact of the pandemic is both social and economic. Pregnancy is an exciting and sometimes stressful experience. Being pregnant during a disease outbreak may add extra anxiety and concern for pregnant women and for those who provide care for them [1, 2]. During the initial stages of the pandemic, it appeared Africa would be spared the burden of COVID-19. However, by April 7th, a total of 45 countries within the WHO African region had reported over 7000 cases (although some place it at over 10 000), with at least 292 deaths and 612 people recovered. Ethiopia, being one of the developing countries trying to address the diverse needs of its people, is currently at the verge of the epidemic [5, 7]. Objectives: The general objective of this study was to assess the impact of COVID-19 infection on maternal and reproductive health care services among mothers getting service in governmental health institutions of Dessie town, 2020 G.C. Methods: Institution based cross sectional study design using mixed (quantitative supplemented with qualitative) method was employed to identify the impact of COVID-19 infection on maternal and reproductive health care services among women who get service in governmental health institutions of Dessie town. The study was conducted from July 1-15 / 2020. Result: According to this study, Six percent (6%) of antenatal care attendees, 18% of delivery care attendees and nearly half (46.7%) of postnatal care attendees reported inappropriate service delivery due to fear of health care providers, shortage medical supplies and staff work load. The study also showed that utilization of these services was decreased due to fear of clients to go to health institutions. Conclusion and recommendation: This study concluded that COVID-19 significantly affects the quality and utilization of maternal and reproductive health care services. The study also showed that utilization of these services was decreased due to fear of clients to go to health institutions. Ministry of health should continue maternity and reproductive health care services such as family planning to be prioritized as an essential core health service. Key words: COVID-19, impact, antenatal care, Dessie

14: Long-term effects of caesarean delivery on health and behavioural outcomes of the mother and child in Bangladesh
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Posted 16 Mar 2020

Long-term effects of caesarean delivery on health and behavioural outcomes of the mother and child in Bangladesh
869 downloads medRxiv sexual and reproductive health

Md Nuruzzaman Khan, Md. Mostafizur Rahman, Md Aminur Rahman, Mahmudul Alam, Md. Alam Khan

BackgroundIncreasing rate of unnecessary caesarean section (CS) is now reported worldwide that intensified the occurrence of adverse health outcomes for mother-child dyads. We investigated the association of CS with some basic health and behaviour outcomes of the mother-child dyads in Bangladesh. MethodsWe conducted a community based case-control study from May to August 2019. Total of 600 (300 had CS, and 300 had vaginal delivery (VD)) mother-child dyads were interviewed through a structured questionnaire. Method of delivery was the exposure variable classified as CS and VD. The outcome variables were a group of health and behaviour problems of the mothers and their children. A series of binary logistic regression models were carried out to examine the effects of the exposure variable on outcome variables. Mothers socio-demographic and reproductive characteristics were adjusted in the models. ResultsThe mean maternal age ({+/-}SD) and weight were 25.1 ({+/-}5.2) years and 53.1 ({+/-}7.2) kilogram, respectively. Higher likelihood of headache, after delivery hip pain, problem of daily activities, and breastfeeding problem were reported among mother had CS in their last birth than VD. Children born through the CS were reported a higher likelihood of breathing problem and frequent illness and a lower likelihood of food demand and sleeping. ConclusionThe occurrence of CS increases the risk of health and behaviour problems among mothers and their children. This suggests the need for polices to avoid unnecessary CS and to increase awareness of adverse effects of CS. Frequent health checkup following CS is also important.

15: The impact of COVID-19 on the reproductive health of people living in Australia: findings from an online survey
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Posted 11 Aug 2020

The impact of COVID-19 on the reproductive health of people living in Australia: findings from an online survey
771 downloads medRxiv sexual and reproductive health

Jacqueline Coombe, Fabian Kong, Helen Bittleston, Hennie Williams, Jane Tomnay, Alaina Vaisey, Sue Malta, Jane Goller, Meredith Temple-Smith, Louise Bourchier, Andrew Lau, Jane S Hocking

Introduction: Australia introduced lockdown measures to control COVID-19 on 22 March 2020. For two months, Australians were asked to remain at home and only leave for essential activities. We investigate the impact this had on sexual and reproductive health (SRH). Methods: Australians aged 18+ were eligible to participate in an online survey from 23 April-11 May 2020. Questions included contraceptive use, pregnancy intentions and access to SRH services. We report on the experiences of 518 female participants aged <50 years. Pregnancy intentions and contraceptive use were analysed using descriptive statistics. Odds ratios and 95% confidence intervals were calculated to investigate difficulty accessing SRH products and services. Qualitative data were analysed using descriptive thematic analysis. Results: Most participants (55.4%, 287/518) were aged 18-24 years. Most (76.1%, 379/498) indicated they were trying to avoid pregnancy. The oral contraceptive pill was the most common single method used (20.8%; 107/514). Nearly 20% (101/514) reported they were not using contraception. Older women (OR=0.4; 95%CI: 0.1, 0.9 for 25-34 vs 18-24 years) and those employed (OR=0.4; 95%CI: 0.2, 0.7) had less trouble accessing contraception during lockdown. Women aged 25-34 (OR=0.4; 95%CI: 0.3, 0.7) or 35-49 years (OR=0.3; 95%CI: 0.1, 0.6) were less likely to experience difficulty accessing feminine hygiene products. Qualitative analysis suggested that COVID-19 affected pregnancy plans, with participants delaying childbearing, or deciding to remain childfree. Conclusion: COVID-19 lockdown impacted the SRH of Australian women. Findings highlight the importance of continued access to SRH services and products during global emergencies.

16: Female genital schistosomiasis and reproductive tract infections. A cross-sectional study in rural adolescents in South Africa
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Posted 18 Oct 2019

Female genital schistosomiasis and reproductive tract infections. A cross-sectional study in rural adolescents in South Africa
728 downloads medRxiv sexual and reproductive health

Jilna Dilip Shukla, Elisabeth Kleppa, Sigve Holmen, Patricia D. Ndhlovu, Andile Mtshali, Motshedisi Sebitloane, Birgitte Jyding Vennervald, Svein Gunnar Gundersen, Myra Taylor, Eyrun Floerecke Kjetland

Background and objectivesThe aim of the current study was to establish the relative prevalences of Female Genital Schistosomiasis (FGS) and sexually transmitted infections (STIs). We hypothesised that due to the use of syndromic management for STIs it is possible that FGS is being misdiagnosed and mismanaged as an STI. We therefore wanted to examine the relationship between FGS and the individual STIs in schistosomiasis endemic areas. MethodsBetween 2011 and 2013, a cross-sectional study was performed in 32 randomly selected secondary schools in rural KwaZulu-Natal, South Africa, where each school had at least 300 pupils. In a research clinic, FGS diagnosis, STI testing, and face-to-face interviews were performed in sexually active, young women aged 16 - 22 years. ResultsFGS was the second most prevalent current genital infection (23%). There were significantly more women who had presented FGS among those who had detectable urinary schistosomiasis (35%), compared to those without (19%, p< 0.001). In the FGS positive group 35% were positive for HPV infection, compared to 24 % in the FGS negative group (p=0.010). In the FGS positive group 37% were sero-positive for HSV infection, compared to 30% in the FGS negative group (p=0.079). There were significantly fewer chlamydia infections amongst women with FGS (20%, p=0.018) compared with those who did not have FGS (28%). ConclusionsFGS was the second most common genital infection after HSV but the two were not significantly associated. HPV infection was significantly associated with FGS. Surprisingly Chlamydia infection were negatively associated with FGS. The results show the importance of the inclusion of FGS in the management protocols for genital infections in areas endemic for urinary schistosomiasis, and highlight the importance for more research on suitable differential diagnostic tools and disease management. Key messages boxO_LIFGS was the second most common genital infection in this rural population after HSV. C_LIO_LIFGS was positively associated with HPV. C_LIO_LIFGS was negatively associated with genital chlamydia infections. C_LIO_LIFGS should be included in the syndromic management of genital infections. C_LI

17: Genetic insights into the biological mechanisms governing human ovarian ageing
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Posted 15 Jan 2021

Genetic insights into the biological mechanisms governing human ovarian ageing
688 downloads medRxiv sexual and reproductive health

Katherine S Ruth, Felix R. Day, Jazib Hussain, Ana Martinez-Marchal, Catherine E Aiken, Ajuna Azad, Deborah J. Thompson, Hironori Abe, Jane L Tarry-Adkins, Javier Martin Gonzalez, Annique Claringbould, Olivier B. Bakker, Patrick Sulem, Sandra Turon, N. Charlotte Onland-Moret, Emil Peter Trane Hertz, Pascal N Timshel, Vallari Shukla, Rehannah Borup, Kristina W Olsen, Monica Ferrer-Roda, Yan Huang, Stasa Stankovic, Paul Timmers, Thomas U. Ahearn, Behrooz Z. Alizadeh, Elnaz Naderi, Irene L. Andrulis, Alice M Arnold, Kristan J. Aronson, Annelie Augustinsson, Stefania Bandinelli, Caterina M. Barbieri, Robin N Beaumont, Heiko Becher, Matthias W. Beckmann, Stefania Benonisdottir, Sven Bergmann, Murielle Bochud, Eric Boerwinkle, Stig E Bojesen, Manjeet K. Bolla, Dorret I Boomsma, Nicholas Bowker, Jennifer A. Brody, Linda Broer, Julie E Buring, Archie Campbell, Harry Campbell, Jose E. Castelao, Eulalia Catamo, Stephen J. Chanock, Georgia Chenevix-Trench, Marina Ciullo, Tanguy Corre, Fergus J. Couch, Angela Cox, Simon S. Cross, Francesco Cucca, Kamila Czene, George Davey-Smith, Eco JCN de Geus, Renee de Mutsert, Immaculata De Vivo, Ellen W Demerath, Joe Dennis, Alison M Dunning, Miriam Dwek, Mikael Eriksson, Tonu Esko, Peter A. Fasching, Jessica D. Faul, Luigi Ferrucci, Nora Franceschini, Timothy M Frayling, Manuela Gago-Dominguez, Massimo Mezzavilla, Montserrat Garcia-Closas, Christian Gieger, Graham G Giles, Harald Grallert, Daniel F. Gudbjartsson, Vilmundur Gudnason, Pascal Guenel, Christopher A. Haiman, Niclas Hakansson, Per Hall, Caroline Hayward, Chunyan He, Wei He, Gerardo Heiss, Miya K Hoffding, John L Hopper, Jouke J. Hottenga, Frank Hu, David Hunter, Mohammad A Ikram, Rebecca D Jackson, Micaella DR Joaquim, Esther M. John, Peter Joshi, David Karasik, Sharon LR Kardia, Robert Karlsson, Cari M. Kitahara, Ivana Kolcic, Charles Kooperberg, Peter Kraft, Allison W. Kurian, Zoltan Kutalik, Martina La Bianca, Genevieve LaChance, Claudia Langenberg, Lenore J Launer, Joop S.E. Laven, Deborah A Lawlor, Loic Le Marchand, Jingmei Li, Annika Lindblom, Sara Lindstrom, Tricia Lindstrom, Martha Linet, YongMei Liu, Simin Liu, Jianan Luan, Reedik Magi, Patrik K.E. Magnusson, Massimo Mangino, Arto Mannermaa, Brumat Marco, Jonathan Marten, Nicholas G Martin, Hamdi Mbarek, Barbara McKnight, Sarah E. Medland, Christa Meisinger, Thomas Meitinger, Cristina Menni, Andres Metspalu, Lili Milani, Roger L. Milne, Grant W Montgomery, Dennis O. Mook-Kanamori, Antonella Mulas, Anna M. Mulligan, Alison E. Murray, Mike A Nalls, Anne Newman, Raymond Noordam, Teresa Nutile, Dale R Nyholt, Andrew F Olshan, Hakan Olsson, Jodie N Painter, Alpa V Patel, Nancy Pedersen, Natalia Perjakova, Annette Peters, Ulrike Peters, Paul DP. Pharoah, Ozren Polasek, Eleonora Porcu, Bruce M Psaty, Iffat Rahman, Gad Rennert, Hedy S. Rennert, Paul M Ridker, Susan M. Ring, Antonietta Robino, Lynda M. Rose, Frits R Rosendaal, Jacques Rossouw, Igor Rudan, Rico Rueedi, Daniela Ruggiero, Cinzia F Sala, Emmanouil Saloustros, Dale P Sandler, Serena Sanna, Elinor J. Sawyer, Chloe Sarnowski, David Schlessinger, Marjanka K. Schmidt, Minouk J. Schoemaker, Katharina E Schraut, Christopher Scott, Saleh Shekari, Amruta Shrikhande, Albert V. Smith, Blair H. Smith, Jennifer A. Smith, Rossella Sorice, Melissa C Southey, Tim D. Spector, John J. Spinelli, Meir Stampfer, Doris Stockl, Joyce B.J. van Meurs, Konstantin Strauch, Unnur Styrkarsdottir, Anthony J. Swerdlow, Toshiko Tanaka, Lauren R Teras, Alexander Teumer, Unnur Thorsteinsdottir, Nicholas J. Timpson, Daniela Toniolo, Michela Traglia, Melissa A. Troester, Therese Truong, Jessica Tyrrell, Andre G Uitterlinden, Sheila Ulivi, Celine M. Vachon, Veronique Vitart, Uwe Völker, Peter Vollenweider, Henry Volzke, Qin Wang, Nicholas J. Wareham, Clarice R. Weinberg, David R. Weir, Amber N. Wilcox, Ko Willems van Dijk, Gonneke Willemsen, James F Wilson, Bruce HR Wolffenbuttel, Alicja Wolk, Andrew R. Wood, Wei Zhao, Marek Zygmunt, Biobank-based Integrative Omics Study (BIOS) Consortium, eQTLGen Consortium, kConFab Investigators, The LifeLines Cohort Study, The InterAct consortium, Lude Franke, Stephen Burgess, Patrick Deelen, Tune H Pers, Marie Louise Grondahl, Claus Yding Andersen, Anna Pujol, Andres J Lopez-Contreras, Jeremy A Daniel, Kari Stefansson, Jenny Chang-Claude, Yvonne T. van der Schouw, Kathyrn L Lunetta, Daniel I. Chasman, Douglas F. Easton, Jenny A Visser, Susan E. Ozanne, Satoshi H Namekawa, Joanne M Murabito, Ken K. Ong, Eva R. Hoffmann, Anna Murray, Ignasi Roig, John R.B. Perry

Reproductive longevity is critical for fertility and impacts healthy ageing in women, yet insights into the underlying biological mechanisms and treatments to preserve it are limited. Here, we identify 290 genetic determinants of ovarian ageing, assessed using normal variation in age at natural menopause (ANM) in ~200,000 women of European ancestry. These common alleles influence clinical extremes of ANM; women in the top 1% of genetic susceptibility have an equivalent risk of premature ovarian insufficiency to those carrying monogenic FMR1 premutations. Identified loci implicate a broad range of DNA damage response (DDR) processes and include loss-of-function variants in key DDR genes. Integration with experimental models demonstrates that these DDR processes act across the life-course to shape the ovarian reserve and its rate of depletion. Furthermore, we demonstrate that experimental manipulation of DDR pathways highlighted by human genetics increase fertility and extend reproductive life in mice. Causal inference analyses using the identified genetic variants indicates that extending reproductive life in women improves bone health and reduces risk of type 2 diabetes, but increases risks of hormone-sensitive cancers. These findings provide insight into the mechanisms governing ovarian ageing, when they act across the life-course, and how they might be targeted by therapeutic approaches to extend fertility and prevent disease.

18: Dyspareunia in their own words: A comprehensive qualitative description of endometriosis-associated sexual pain
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Posted 12 Sep 2019

Dyspareunia in their own words: A comprehensive qualitative description of endometriosis-associated sexual pain
644 downloads medRxiv sexual and reproductive health

Kate J Wahl, Shermeen Imtiaz, KS Joseph, Kelly B Smith, Paul J Yong, Susan M. Cox

BackgroundDyspareunia is a classic symptom of endometriosis but is neglected in research and clinical contexts. This study explored the experience of this endometriosis-associated sexual pain. MethodsThis was a qualitative descriptive study that included people who had experienced endometriosis-associated dyspareunia alone or with a partner. Data collection involved semi- structured interviews with a female researcher that began with an open-ended question about dyspareunia and included interview prompts related to the nature of sexual pain. Interviews were recorded, transcribed verbatim, and analysed for themes. Results17 participants completed interviews. The mean participant age was 33.3 (SD=7.2) and most participants identified as white (82%), were college-educated (71%), identified as heterosexual (65%), and were partnered (59%). Location, onset, and character emerged as important, interrelated features of endometriosis-associated dyspareunia, as did severity and impact. Dyspareunia occurred at the vaginal opening (n=7) and in the abdomen/pelvis (n=13). Pain at the vaginal opening began with initial penetration and had pulling, burning and stinging qualities. Pain in the pelvis was typically experienced with deep penetration or in certain position and was described as sharp, stabbing and/or cramping. Dyspareunia ranged from mild to severe, and for some participants had a marked psychosocial impact. ConclusionsDyspareunia is a heterogeneous symptom of endometriosis that ranges in severity and impact. Disaggregating dyspareunia into superficial and deep types may better reflect the etiologies of this pain, thereby improving outcome measurement in intervention studies and clinical care.

19: Determinants of Short Birth Intervals among married women in Karachi, Pakistan
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Posted 14 Aug 2020

Determinants of Short Birth Intervals among married women in Karachi, Pakistan
607 downloads medRxiv sexual and reproductive health

Sidrah Nausheen, Maria Bhura, Kristy Hackett, Imtiaz Hussain, Zainab Shaikh, Arjumand Rizvi, Uzair Ansari, david canning, Iqbal Shah, Sajid Bashir Soofi

Introduction: Birth spacing is a critical pathway to improving reproductive health. The World Health Organization recommends a minimum of 33-month interval between two consecutive births to reduce maternal, perinatal, and infant morbidity and mortality. Our study evaluated factors associated with short birth intervals (SBIs) of less than 33 months between two consecutive births, in three peri-urban municipalities in Karachi, Pakistan. Methods: We used data from a cross-sectional study among married women of reproductive age (MWRA) who had at least one live birth in the six years preceding the survey (N=2394). Information regarding their sociodemographic characteristics, reproductive history, fertility preferences, family planning history, and a six-year reproductive calendar were collected. To identify factors associated with SBIs, we fitted simple and multiple Cox-proportional hazards models and computed hazard ratios (HR) with their 95% confidence intervals (CI). Results: The median birth interval was 25 months (IQR: 14-39 months), with 22.9% of births occurring within 33 months of the index birth. Women increasing age [25-29 years (aHR=0.64, 95% CI: 0.54-0.77), 30+ years (aHR=0.30, 95% CI: 0.23-0.40) compared to <25 years]; secondary education [aHR 0.78. 95% CI: 0.65-0.93], intermediate education [aHR 0.63, 95% CI: 0.49-0.82], higher education (aHR=0.71, 95% CI: 0.53-0.96) compared to no education, and a male child of the index birth (aHR=0.79, 95% CI: 0.68-0.92) reduced the likelihood of SBIs. Women younger age <20 years [aHR 1.32, 95% CI 1.03-1.70] compared to 20-24 years, and those who did not use contraception within 9-months of the index birth had a higher likelihood for SBIs for succeeding birth compared to those who used contraception (aHR=2.33, 95% CI: 2.01-2.70). Conclusion: This study evaluates factors associated with birth spacing practices among married women of childbearing age in urban settlements of Karachi. Our study shows that birth intervals in the study population are lower than the national average. To optimize birth intervals, programs should target child spacing strategies and counsel MWRA on the benefits of optimal birth spacing, family planning services and contraceptive utilization.

20: Healthy ageing men have normal reproductive function but display germline-specific molecular changes
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Posted 16 Sep 2019

Healthy ageing men have normal reproductive function but display germline-specific molecular changes
573 downloads medRxiv sexual and reproductive health

Sandra Laurentino, J.-F. Cremers, B. Horsthemke, Frank Tuettelmann, K. Czeloth, M. Zitzmann, E. Pohl, S. Rahmann, C. Schröder, S. Berres, K. Redmann, C. Krallmann, Stefan Schlatt, Sabine Kliesch, J. Gromoll

Children of older fathers have higher risk for certain diseases. Nevertheless, how ageing specifically affects male germ cells is so far not completely understood. In a cohort of 197 healthy men (18-84 years), we found that semen and reproductive parameters remained normal over six decades. Along with an age-dependent increase in telomere length in sperm (r=0.41, p>0.001), we found accelerated DNA fragmentation, more prominent after the sixth decate of life, and with around 60% of men older than 66 showing abnormal levels of DNA breaks. At the epigenetic level, by whole genome bisulfite sequencing we identified 236 sperm-specific differentially methylated regions between the youngest and oldest group, affecting mostly regions associated with homeobox genes and nervous system development. Therefore, we propose that during ageing, male germ cells are affected by an intrinsic and specific ageing process, distinguishable from the soma. These age-dependent changes might have consequences for fertility and offspring of older men.

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