Staff Scientist Meleah Boyle, PhD MPH, co-senior author of the study, said addressing period poverty, as the issue has been called, is a growing area of research in the United States

“Our study highlights the widespread nature of period poverty and the need for broad actions – both locally and nationally – to increase the affordability and accessibility of these products for youth,” Boyle said.

Menstrual equity means that every person who menstruates should have equal access to affordable and quality menstrual products. Unfortunately, many people do not have access to these necessary products. In the study, researchers found that 30% of adolescents do not have the products they need with no differences based on measures of socioeconomic status, such as insurance and community opportunity, or individual differences, such as race and ethnicity.

Prior research estimates that of those who menstruate, 11.9 million struggle to find access to menstrual products. This lack of access can lead to absences from school and/or work as well as negative health outcomes such as urinary tract infections and bacterial vaginosis.

Boyle said the research highlights the need for public health programs and policy changes to ensure youth have access to the products they need to avoid negative impacts on their health and engagement.

“Ensuring access to healthy and appropriate menstrual health products should be a public health priority,” Boyle said.

Study co-author Riya Metha is scheduled to present the research from 5:15-6:15 pm ET Saturday, Sept. 28

In addition, Monika Goyal, MD, MSCE, co-senior author, will be among highlighted abstract authors who will give brief presentations and be available for interviews during a press conference from noon-1:30 pm ET Saturday, Sept. 28 in the National Conference Press Room, W208 AB. During the meeting, you may reach AAP media relations staff at 407-685-5401.

Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal.

ABSTRACT

Program Name: 2024 AAP National Conference-Abstracts

Submission Type: Council on Adolescents and Young Adults

Abstract Title: Prevalence of Period Poverty in a Pediatric Emergency Department

# of Newsworthy Nominations: 2

Gia Badolato

Washington DC, DC, United States

Their study recently published in the journal JAMA Health Forum shows that policies requiring coverage of a 12-month supply of short-acting hormonal contraception — most commonly the birth control pill — have not been fully implemented, resulting in no substantial increases nationally in year-long prescription orders. This leaves many patients at an increased risk for unintended pregnancy.

A common cause for decreased effectiveness with the pill is breaks in use, often due to running out of a prescription or a lapse in obtaining a refill. However, dispensing a longer-term supply of contraception — six or 12 months — is linked to improved continuous use, fewer breaks in coverage and health system savings.

“The decision of when or if to become pregnant is deeply personal,” said Maria Rodriguez, M.D., M.P.H., professor of obstetrics and gynecology in the OHSU School of Medicine and director of the OHSU Center for Reproductive Health Equity. “It shouldn’t be impacted by a delay in getting to your pharmacy for a refill, or a pill package running out while on vacation.”

To address this barrier, policymakers in 19 states have enacted 12-month contraceptive supply policies, which require insurers to cover the cost of dispensing a full year of coverage at once per prescription. However, OHSU researchers found that these policies have not been fully implemented and have failed to change current prescribing practices.

Using a difference-in-difference model, which compares changes in outcomes over time between populations, researchers looked at oral pill, patch and ring contraception prescriptions among nearly 4.8 million female Medicaid enrollees ages 18 to 44 in 36 states — 11 states with the 12-month supply policy, and 25 without. Researchers found that in 10 of the 11 states with the policy, an increase in the proportion of contraception dispensed was smaller than one percentage point — meaning just a nominal improvement in year-long prescription orders.

“Our findings suggest a significant gap in knowledge both for patients and prescribers, and we hope this serves as a call to action to make 12-month supplies the standard prescribing practice,” Rodriguez said. “This is low-hanging fruit for improving birth control access, especially for people who live in states with more restrictions on reproductive health care.”

For coverage policies to be effective, insurance companies must comply with and be held accountable for following the revised coverage guidelines, Rodriguez said. Similarly, clinicians would need to change their standard prescribing patterns to write for an extended supply of contraception, and pharmacists would need to dispense the full supply.

The research team says full implementation of these policies will require outreach to contraceptive users, prescribers, pharmacists and payers, as well as enforcement from state governments. A federal policy mandating coverage of a 12-month supply is another strategy to support access, as it would require all insurers, including private payers, to cover 12-month contraception supplies.

Rodriguez encourages patients to feel empowered to ask about their contraceptive options and advocate for choices that are the best fit their personal preferences, lifestyle and family planning goals.

“In our current health care landscape, where reproductive rights are constantly under attack, it’s critical to remove barriers and ensure broad access to contraception,” Rodriguez said. “We need providers to be following this prescribing practice as their default and patients to know that it’s their right to ask for it.”

The new study found that the pandemic didn’t lead to increases in postpartum depression or anxiety diagnoses. But it did prompt a 15% increase in the number of privately insured new moms filling prescriptions for antianxiety medications like Valium, Xanax, Ativan and Klonopin.

The researchers didn’t find an increase in SSRI prescriptions, though.

SSRIs, or selective serotonin reuptake inhibitors, are the gold standard for treating both depression and anxiety disorders. But these drugs, which include medications like Zoloft, Prozac and Lexapro, take time to work.

Benzodiazepines, also known as benzos, are sometimes used as a stopgap during the month or two it takes for an SSRI to start working. But they aren’t a substitute for SSRIs. And they carry significant risks of dependence and abuse.

“What concerns me the most is not what we found but what we didn’t find,” said Grace Bagwell Adams, lead author of the study and an associate professor in UGA’s College of Public Health. “You can’t tell me there wasn’t more depression and anxiety in this population during the pandemic. And historically, even pre-COVID, postpartum depression and anxiety has always been underdiagnosed. But we didn’t find an increase in diagnoses.”

Postpartum depression, anxiety largely underdiagnosed. The pandemic didn’t help.

One in 10 women experience postpartum depression or anxiety in the first six months after giving birth. The majority aren’t properly diagnosed and don’t receive treatment for the conditions.

The researchers analyzed data from more than 518,000 privately insured postpartum women from January 2016 through December 2020. Despite reported increases in anxiety and depression across the board after the onset of the pandemic, the researchers found no evidence of an increase in diagnoses of postpartum depression or postpartum anxiety.

This suggests that the underdiagnosis and undertreatment of these conditions was exacerbated by the pandemic-induced health care crisis, the researchers said.

Many insurers only cover one postpartum visit, typically at about six weeks after giving birth. Health care providers are supposed to screen for depression and anxiety at these visits.

But during COVID, it’s likely that many women didn’t have that appointment, Bagwell Adams said. Or if they did, it may have taken place via telehealth, which isn’t always ideal for discussing difficult mental health challenges.

“One of the top causes of maternal mortality is suicide,” Bagwell Adams said. “When these women don’t get diagnosed and they don’t receive proper treatment, they die. And it’s not that postpartum women didn’t see their doctor in time. It’s that they aren’t being listened to.”

Benzos aren’t a substitute for SSRIs when it comes to depression

After the birth of her son during the pandemic, Bagwell Adams experienced that lack of communication firsthand at her postpartum checkup.

“We had a chat, and I told him I was basically crippled by anxiety and depression,” she said. “He was like, ‘Let’s get you something to help calm you down.’ I thought he was going to send me home with an SSRI.”

Instead, her doctor prescribed a benzo.

As someone who’s dealt with anxiety for years, Bagwell Adams knew that wasn’t going to cut it. After some back and forth with her doctor, she was prescribed Lexapro. But many patients wouldn’t know to push back like she did.

“The thing I get really worried about it is that this is what we found for the cream of the crop in terms of insurance coverage,” Bagwell Adams said. “The women in this sample have private insurance. This is the best-case scenario for the United States, and that doesn’t look good.”

Combining opioids with benzos likely increased. That combination can be deadly.

Another concerning side effect of increased benzo prescriptions is interactions with other medications, particularly opioids.

More than seven out of every 10 women who give birth via C-section and one in four who deliver vaginally are prescribed opioids for pain management. And previous research shows that opioid prescriptions for postpartum women increased during the COVID-19 pandemic.

But combining opioids with benzos can be deadly. And the likelihood that some of the women who filled benzodiazepine prescriptions were simultaneously taking pain medications is high, the researchers said.

“For me, this study highlights more questions than answers,” Bagwell Adams said. “There’s something bigger happening here that is really disconcerting when it comes to treating women in general and postpartum women in particular.”

Published in Archives of Women’s Health, the study was funded in part by a grant from the National Institute on Drug Abuse. Co-authors include Emily Lawler and Amanda Abraham, from UGA’s School of Public and International Affairs; Shelby Steuart, a doctoral graduate of UGA’s School of Public and International Affairs who is now a postdoctoral researcher at the University of Chicago, and Hailemichael Shone, of Indiana University.

The five-year, multi-center study is funded by a $9.2 million National Institutes of Health grant and will compare the effectiveness of a recently approved medication, secnidazole, against the current standard treatment, metronidazole, using a 1,200-person cohort across Louisiana, Alabama and Florida. Despite decades of use as the primary trichomoniasis medication, treatment by metronidazole continues to have a 10% breakthrough rate.

“More than 10 percent of people who take the recommended treatment still have it. That is just unacceptable. We need better options” said Dr. Patty Kissinger, professor of epidemiology at Tulane School of Public Health and Tropical Medicine. “The problem is trichomoniasis is the most common treatable STI, but there are often no symptoms, and the CDC has not recommended screening among asymptomatic people, so the public doesn’t know about it.”

Trichomoniasis, which infects about 156 million people annually worldwide, is caused by trichomonas vaginalis, a parasite that thrives in the genital tract of both men and women and causes inflammation. Those infected have a 1.5 times higher susceptibility to HIV. For expecting mothers, it can cause pre-term birth and increase risk for perinatal morbidity. African American women are also four times more likely to have trichomoniasis.

“Trichomoniasis affects millions but remains a highly neglected STI,” Kissinger said. “We’re hoping this study leads to better treatment options and increased awareness that we hope will encourage more screening.”

Because of the lack of inclusion in STI screenings and scant symptoms, those infected can go years before realizing they have trichomoniasis.

This is the third in a series of studies funded by the NIH to refine treatment for trichomoniasis. This is the first study in the series to include men in its cohort and the first-ever study to compare the effectiveness of secnidazole with metronidazole.

Questions remain as to why metronidazole continues to have a high breakthrough rate. The prior NIH studies found that metronidazole is most effective when administered in multiple doses, but the breakthrough rate may be attributed to patients missing doses or having sex with partners before treatment is completed, creating a cycle of reinfection.

The secnidazole treatment would only require one dose, although some concerns remain about the cost of the medication, Kissinger said.

Trichomoniasis affects more than 3 million people in the United States and is particularly prevalent in the Deep South where the study is being conducted.

“We need better treatments for this STI,” Kissinger said. “If this is successful, we could control it and encourage more screening that could reduce perinatal morbidity and maybe even reduce the chances of some people getting HIV.”

A new study in JAMA Network Open found that an intervention involving automated appointment scheduling and reminder messages may improve post-partum health and well-being for these individuals.

The research was led by investigators at Massachusetts General Hospital, a founding member of the Mass General Brigham healthcare.

“Individuals with chronic and mental health conditions typically have frequent contact with obstetrical care providers while pregnant but often are largely left to navigate ongoing care needs on their own after delivery—referred to as the ‘postpartum cliff’,” explained lead author Mark Clapp, MD, MPH, a maternal-fetal medicine specialist in the Department of Obstetrics and Gynecology at Massachusetts General Hospital and an assistant professor of Obstetrics, Gynecology, and Reproductive Biology at Harvard Medical School. “Among other factors, this ‘cliff’ is caused by administrative burdens, such as appointment scheduling and navigating insurance, which make it difficult for individuals to seek care.”

To address this problem, Clapp and his colleagues evaluated the potential of auto scheduling appointments, along with tailored messages and nudge reminders, to improve primary care engagement within four months after delivery for postpartum individuals with diabetes, hypertension, mental illness, or obesity.

In the randomized clinical trial of 360 patients, those who received the intervention were more likely to have a primary care visit than those who did not, highlighting the potential of this low-cost intervention to transition ongoing care needs after pregnancy to primary care clinicians.

Specifically, the intervention increased postpartum primary care visits by 19 percentage points. It also resulted in more individuals receiving important screening tests and services, including blood pressure screening (42.8% versus 28.3%), weight assessment (42.8% versus 27.7%), and depression screening (32.8% versus 16.8%).

“Our findings indicate that a multifaceted and relatively low-resource behavioral economic intervention may improve postpartum health and well-being,” said Clapp.

“As a primary care physician, I have frequently observed how care is improved for individual patients by a careful transition between obstetrics and primary care,” says Alaka Ray, MD, a Mass General primary care physician and an author of the study. “It is wonderful that this study has now demonstrated the importance of that connection in the form of significant benefits for postpartum patients with high-risk conditions.”

“I would also note that this study population is comprised of patients who already had an established primary care physician. We all know, however, that many others cannot find a primary care physician,” says Ray. “It is my hope that this study will add further urgency to the call to address our worsening primary care shortage so that evidence-based interventions like this can be broadly implemented for all of our patients.”

Authorship: Mark A. Clapp, Alaka Ray, Pichliya Liang, Kaitlyn E. James, Ishani Ganguli, and Jessica L. Cohen.

Disclosures: Disclosure forms provided by the authors are available with the full text of this article.

Funding: This work was supported by the National Institute on Aging and the National Academy of Medicine.

About Massachusetts General Hospital

Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The Mass General Research Institute conducts the largest hospital-based research program in the nation, with annual research operations of more than $1 billion and comprises more than 9,500 researchers working across more than 30 institutes, centers and departments. MGH is a founding member of the Mass General Brigham healthcare system.

“It’s something that people don’t feel comfortable talking about, and that’s maybe an indication of why it hasn’t gotten enough attention,” said Hsu, assistant professor of biological sciences.

Matter, Hsu and his team, which includes postdoctoral associates Rogerio Bataglioli and Harsimran Kaur that led the project, have created an eco-friendly, blood absorbent biomaterial that improves the performance of menstrual products by minimizing blood leakage and spilling, while also helping prevent infection. Their work was published in the Cell Press journal.

Menstrual products have evolved little during the last century. The primary products available today were developed nearly 100 years ago: the disposable menstrual pad in 1888, the tampon in 1933, and the menstrual cup in 1937.

“Developing new products serves several purposes, including addressing women’s different needs and preferences, promoting sustainability, and addressing leakage and cost issues with current products,” said Carrie Champine, board-certified obstetrician and gynecologist who collaborated with the team.

An improvement in women’s sanitary products is beneficial to women’s health in general.

“There is very little awareness about the importance of good menstrual care, and poor practices can negatively affect women’s health. This is an area that impacts women but isn’t often given attention,” Kaur said.

Improved effectiveness

Hsu and the team used an alginate-glycerol powder formula that, when added to a traditional menstrual pad, allows the accumulated blood to turn into a gel. The pad can then absorb more blood and leak less than a traditional pad.

“A pad with the powder formula absorbs the blood, and if you squeeze it, it doesn’t come back out. But in a normal menstrual pad, if you do the same experiment, it comes right back out,” said Hsu, who is also an affiliate of the Fralin Life Sciences Institute. “Leakage occurs 1.2 times per cycle.”

When the powder formula is added to a cotton coil and inserted into a menstrual cup or disc, the blood collected there also turns into a gel, eliminating the mess when removing or changing the cup or disc.

“Leakage is a fear for all users of menstrual hygiene products. All of us have experienced it, leading to embarrassment and missed school days and workdays,” said Champine, who is also an associate dean in the Edward Via College of Osteopathic Medicine. “Users of menstrual products are always looking for products that are comfortable and tailored to their body and flow patterns, with minimal risk of leakage or menstrual product failure.”

Preventive measure

When period products are not available or sanitary period products unaffordable, women may improvise with managing menstruation. Those substitutions may cause more harm than good by increasing vaginal infections.

Included in the powder formula is an antimicrobial polymer to impair the growth of Staphylococcus aureus, a bacterium associated with toxic shock syndrome. This is a rare but potentially fatal illness caused by a bacterial infection related to the use of period products.

Test results indicate the inclusion of the polymer was effective in inhibiting bacteria, while also not decreasing the blood absorption capability of the powder formula.

Biodegradable option

Derived from natural sources, seaweed, and sugar alcohol, the alginate-glycerol powder formulation is biodegradable and safe to use.

“It’s found everywhere in foods and it’s approved by the Food and Drug Administration, so it’s considered safe,” said Hsu, an affiliated faculty member of the Center for Emerging, Zoonotic, and Arthropod-borne Pathogens. “It is in the boba tea or the cheap sushi you get in restaurants.”

Most used period products take over 500 years to biodegrade, and each woman may use up to 15,000 period products in a lifetime, according to Hsu, who also said women’s menstrual product waste is one of the most frequently collected trash.

“In talking to patients, it has become evident that they are looking for more sustainable, eco-friendly and reusable options,” Champine said.

Women’s health progress

“Women are half the population and go through menstruation every month,” Hsu said. “It’s a natural process that dramatically affects quality of life. For some, it can be debilitating.”

According to Hsu, 46 percent of women in Virginia are of menstrual age, which is 26 percent of all Virginians,as of 2020 and roughly a fourth of the state’s total population. While menstruation is not a disease, it does impact absenteeism in the workplace and in school.

“A woman will have a period for approximately five days every 30 days throughout her lifetime, which is roughly 2,200 days, or 6.2 years of her life,” Hsu said. “For comparison, the average American spends 8.3 years watching television and 4.5 years eating.”

The research is funded by Virginia’s Commonwealth Health Research Board, and Hsu sees this as just the beginning of his venture into promoting women’s health issues. Bataglioli is hopeful for new opportunities in the design of menstrual products. “Using biomaterials can expand the potential functionality of these menstrual products. Women face an array of challenges related to menstrual health, and we think using advanced functional materials can help us come up with innovative solutions.”

“I think women’s health is becoming more and more something people want to research. This is kind of my first step in a series of things to take care of women,” Hsu said.

In addition to Hsu, Bataglioli, and Kaur, biological sciences undergraduate Elizabeth Geddes and John Muller, postdoctoral associate in the Department of Entomology were involved in the project.

IMAGE: (FROM LEFT) HARSIMRAN KAUR, BRYAN HSU, AND ROGERIO BATAGLIOLI ARE PART OF A TEAM THAT DEVELOPED AN ECO-FRIENDLY BIOMATERIAL, SHOWN HERE IN POWDERED FORM, TO IMPROVE THE PERFORMANCE OF CURRENT WOMEN’S SANITARY PRODUCTS, SUCH AS A MENSTRUAL CUP HSU IS HOLDING.

view more CREDIT: PHOTO BY JENISE JACQUES FOR VIRGINIA TECH.

“It was surprising to me that the prevalence was that high,” says Torri Metz, MD, vice chair of research of obstetrics and gynecology at University of Utah Health, who co-led the nationwide study. “This is something that does continue to affect otherwise reasonably healthy and young populations.”

Intersecting risks

Prior research had shown that COVID affects pregnant people in uniquely risky ways. A COVID infection during pregnancy is more likely to lead to hospitalization or death, compared to an infection outside of pregnancy. COVID also increases the risk of pregnancy-related complications such as preterm birth or stillbirth. But until this study, the risk to pregnant people of developing long COVID was unknown.

The researchers enrolled more than 1500 people nationwide who had been sick with COVID for the first time while pregnant, and assessed self-reported long COVID symptoms at least six months after infection. As part of the National Institutes of Health RECOVER project, a massive nationwide collaboration to understand and treat long COVID, the large size of the study established solid associations and provided a picture of risk that was accurate for pregnant people across demographic groups.

The researchers found that 9.3% of people who contracted COVID during pregnancy went on to experience long-term symptoms. Some of the most common long COVID symptoms participants experienced were fatigue, gastrointestinal issues, and feeling drained or exhausted by routine activities.

“This is a critical study as pregnancy and the post-partum period are one of the most vulnerable times in an individual’s life,” said David Goff, M.D., Ph.D., division director for the Division of Cardiovascular Sciences at the NIH’s National Heart, Lung, and Blood Institute. “By better understanding how individual characteristics interact with SARS-CoV-2 infection during pregnancy and lead to an increased risk of long COVID, this study yields important insights to potentially develop targeted interventions for this population.”

Because the symptoms of long COVID can overlap with the symptoms of pregnancy itself, Metz says that it’s especially important for obstetricians to be vigilant for them. “I doubt most obstetric clinicians are as aware of long COVID as perhaps we should be,” Metz says. “But people are having these symptoms, and we need to make sure that we’re not forgetting that these could be long-term manifestations of their SARS-CoV-2 infection.”

To ensure that the reported long COVID symptoms weren’t symptoms of pregnancy, the researchers did a secondary analysis that was restricted to people who reported symptoms more than 12 weeks after giving birth. The estimated risk of long COVID remained similar, confirming the initial findings.

Metz says that while the rate of long COVID observed was surprisingly high, it could underestimate the actual risk of long COVID for pregnant people. On average, people reported whether or not they had symptoms of long COVID 10 months after their initial infection, which means that the study could have missed people whose symptoms resolved earlier.

Several factors were associated with an increased risk of long COVID. People with anxiety or depression prior to their infection, as well as people with obesity, were more likely to experience lasting symptoms. Self-reported financial hardship was also associated with higher rates of long COVID, although the study could not determine whether financial difficulties were a cause or a consequence of extended symptoms.

“Our results highlight that people who were pregnant when they got COVID may have significant long-term symptoms after pregnancy, like fatigue even after simple activities that they did before the infection,” says senior author Vanessa Jacoby, MD, MAS, director of the Clinical and Translational Science Institute at UCSF, and a professor of obstetrics, gynecology, and reproductive sciences as well as Associate Vice Chancellor for Clinical Research. “We encourage people to speak with their healthcare provider about persistent symptoms to connect with appropriate support and care,” she says.

A continued concern

Previous estimates of long COVID rates following infection in the general population range from 10% to over 20%, putting the researchers’ results on the lower end of the risk spectrum. Metz says that this could be because pregnant people’s immune systems tend to react less strongly to infection. This puts pregnant people at higher risk of severe symptoms during the infection, but may put them at lower risk of long-term organ damage that can lead to persistent symptoms. Pregnant people tend to be overall younger and healthier than other populations, which could also contribute to the difference.

But the high prevalence of long COVID, including in pregnant populations, emphasizes that health practitioners should keep an eye out for its symptoms, Metz says. “We need to have this on our radar as we’re seeing patients. It’s something we really don’t want to miss. And we want to get people referred to appropriate specialists who treat long COVID.”

U of U Health’s Long COVID Clinic specializes in caring for patients with prolonged symptoms of COVID-19. Learn more about the clinic here.

About RECOVER: The National Institutes of Health Researching COVID to Enhance Recovery (NIH RECOVER) Initiative brings together clinicians, scientists, caregivers, patients, and community members to understand, diagnose, and treat long COVID. RECOVER has created one of the largest and most diverse groups of Long COVID study participants in the world. In addition, RECOVER clinical trials are testing potential interventions across five symptom focus areas. For more information, please visit recoverCOVID.org.

This research was published as “Post–Acute Sequelae of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) After Infection During Pregnancy” in Obstetrics and Gynecology.

The study was funded by the National Institutes of Health (NIH) Agreements OTA OT2HL161847, OT2HL161841 and OT2HL156812 as part of the Researching COVID to Enhance Recovery (RECOVER) Research Initiative.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

The findings, published in the Journal of Pain Research, reveal that some women not only experience cramps when no egg is released, but that cramps can be more severe and last longer during these anovulatory cycles.

“I was surprised to see significant cramps in menstrual cycles with or without ovulation, which challenges current thinking” said co-author, Dr. Paul Yong, associate professor of obstetrics and gynecology at UBC and Canada Research Chair in Endometriosis and Pelvic Pain.

Menstrual cramps are very common, but not always well-treated by currently recommended ibuprofen therapy and may cause teen and young adult women to miss education or work.

It has long been believed that menstrual cramps are triggered by falling progesterone levels at the end of ovulatory cycles, which prompts the release of hormone-like substances, prostaglandins, that cause uterine muscle contractions.

“Since 1938, when a small research study found no cramps in anovulatory studies, no one has questioned the belief that cramps only occur in ovulatory cycles,” said co-author Dr. Sewon Bann, internist and endocrinology fellow at UBC.

For the study, the researchers monitored 75 women aged 19-35 through a single menstrual cycle. The women recorded their experiences with cramp presence and intensity in a daily diary.

“We compared cramps in the 35 cycles without ovulation with 40 cycles that were normally ovulatory in this study. We found cramps were more painful, lasted longer and had a higher Cramp Score in anovulatory cycles” said first author Gurleen Mann, a UBC medical student. Mann reports that cycle lengths were the same; fewer than one of 10 cycles in each ovulation-related group lasted longer than 35 days.

The researchers also looked at several past studies of cramps that tracked ovulation. “In a meta-analysis of the four eligible studies, all found cramps in both ovulatory and anovulatory cycles. However, in support of the current understanding, cramps were twice as likely to occur in ovulatory cycles,” said Dr. Sonia Shirin, a researcher working for UBC’s Centre for Menstrual Cycle and Ovulation Research (CeMCOR).

This single-cycle study was funded by a contract with Health Canada to collect urine to measure environmental contaminants. Recruitment took place during the early days of the SARS-CoV-2 pandemic.

“It is likely because of the multiple stresses during this difficult time that almost a third of all participants’ cycles were anovulatory,” speculated senior author Dr. Jerilynn C. Prior, a professor of endocrinology at UBC and scientific director at CeMCOR.

The researchers say this new information about menstrual cramps and ovulation has several important implications:

• We can no longer assume a cycle is ovulatory just because it has menstrual cramps
• It is unlikely to be the decreasing levels of progesterone before flow, as is currently understood, that trigger menstrual cramps
• New research is necessary to understand what other changes trigger cramps
• Learning more about why cramps occur will help with treatment of cramps that are severe or cause absence from school or work.

Animal studies examined whether the treatment for preeclampsia could be applied to flu infections – and the results, according to the research team, were very promising.

Lead researcher and RMIT Post-Doctoral Research Fellow, Dr Stella Liong, said flu infections during pregnancy can resemble preeclampsia, a pregnancy complication that causes inflammation to the aorta and blood vessels.

Low-dose aspirin is commonly taken to prevent preeclampsia, as it stops the body from creating chemicals that cause inflammation.

“When the vascular system is inflamed, it leads to poor blood flow and affects the aorta’s function,” she said.

“This is especially a problem during pregnancy where good blood flow to the placenta is crucial to the development of the fetus.”

The research, led by RMIT University in collaboration with Trinity College Dublin, Ireland Professor John O’Leary and University of South Australia Professor Doug Brooks, found fetuses and placenta from mice with influenza A were smaller than those from uninfected mice.

Markers of low oxygen to the blood and poor blood vessel development were also evident in the fetuses.

However, mice treated daily with low-dose aspirin had less inflammation and improved fetal development and offspring survival.

While the research was still awaiting human clinical trials, Liong said low-dose aspirin was already recognised as safe to take during pregnancy.

However, the research team recommended pregnant people seek medical advice before taking new medications.

Brooks said influenza A infections during pregnancy was a big concern as every pregnancy overlaps with part of a flu season.

“There are long term implications for both the mother and the fetus, and aspirin might provide a simple solution for preventing this influenza associated pathology,” Brooks said.

Why flu infection is dangerous during pregnancy  

O’Leary said the research findings had huge implications for pregnancy and seasonal influenza virus infections for pregnant people.

“This study shines a light, for the first time, on the role of vascular inflammation associated with influenza virus and the potential dramatic effect of the disease-modifying drug aspirin, in low dosage, in pregnant women with co-morbid influenza,” O’Leary said.

While there weren’t many studies of the impacts of flu infections during pregnancy, project lead and RMIT Professor Stavros Selemidis said it was clear that pregnancy changed how the body responded to the virus.

Liong and Selemidis’ earlier breakthrough research found the flu virus during pregnancy could trigger a damaging hyperactive immune response, causing the virus to spread around the body from the lungs through the blood vessels.

“We used to think the flu virus just stayed in the lungs, but during pregnancy it escapes from the lungs to the rest of the body,” Selemidis said.

“This infection could set you up for cardiovascular disease later in life, but also set up cardiovascular disease in the offspring later in life.”

While vaccination was still the considered the best way to prevent flu infection during pregnancy, Selemidis pointed out vaccination rates were generally low in the pregnant population.

“Low vaccination rates aside, the flu shot may not generate the perfect immune response, especially if someone is pregnant or has an underlying medical condition,” he said.

“That’s why it’s useful to have a potential back up in low-dose aspirin to help prevent vascular dysfunction during pregnancy and improve fetal development.”

“Low dose aspirin prevents endothelial dysfunction in the aorta and foetal loss in pregnant mice infected with influenza A virus” was published in Frontiers in Immunology (DOI: 10.3389/fimmu.2024.1378610 ).

Madison Coward-Smith, Stella Liong, Osezua Oseghale, Jonathan R. Erlich, Mark A. Miles, Felicia Liong, Kurt Brassington, Steven Bozinovski, Ross Vlahos, Robert D. Brooks , Doug A. Brooks, John J. O’Leary and Stavros Selemidis are co-authors.

The Texas law prohibiting abortions after a fetal heartbeat could be detected—as early as five or six weeks—went into effect September 1, 2021. At the time, the law—Senate Bill 8, or S.B. 8—was the most stringent state abortion law in the country. It did not allow exemptions for congenital anomalies.

The researchers’ analysis of monthly death certificate data in Texas and the rest of the United States found that between 2021 and 2022, infant deaths in Texas rose from 1,985 to 2,240, a year-over-year increase of 255 deaths. This corresponds to a 12.9 percent increase in infant deaths in Texas versus a 1.8 percent increase in infant deaths in the rest of the U.S. during the same period. The study defines infants as under 12 months old.

The study was published online June 24 in JAMA Pediatrics.

The findings come as more U.S. states enact stricter abortion laws following the U.S. Supreme Court’s 2022 Dobbs decision, the landmark ruling that overturned Roe v. Wade and returned abortion policymaking to the states.

To approximate the causal impact of S.B. 8, the authors narrowed their analysis to examine changes in the expected number of infant deaths in Texas from March to December 2022—the time period that captures the first set of pregnancies under S.B. 8. The researchers estimate there were 216 excess infant deaths in Texas that would most likely not have occurred from March to December 2022 had the state’s abortion law not been in place. This is equivalent to a 12.7 percent increase above the expected 1,697 infant deaths for this time period. There were 1,913 observed deaths in Texas from March to December 2022.

An analysis of neonatal deaths—deaths in the first 28 days—found similar patterns, with an estimated 145 excess deaths in the post-policy period. These results were not observed in other states.

The new study is thought to be the first to examine how the Texas abortion ban may have impacted infant deaths in the state and is among the first to present evidence evaluating recent abortion bans and pre-viability restrictions. Prior research has shown that states with more abortion restrictions see more infant deaths than those without. The authors note that these earlier studies evaluate fundamentally different and less severe abortion restrictions and primarily examine correlation.

“Our study is particularly relevant given the June 2022 Dobbs Supreme Court decision that returned abortion lawmaking to states and subsequent rollbacks of reproductive rights in many states,” says Alison Gemmill, PhD, assistant professor in the Bloomberg School’s Department of Population, Family and Reproductive Health and one of the study’s lead authors. “These findings suggest that restrictive abortion policies may have important unintended consequences in terms of infant health and the associated trauma to families and medical costs.”

For their month-by-month causal analysis, the researchers drew from infant death certificates in Texas and 28 comparison states from 2018 through 2022. They excluded the District of Columbia and several states that had fewer than 10 infant deaths in any month from 2018 to 2022, as the exact counts are not provided in currently publicly available data. The researchers selected March 2022 as the first cohort exposed to the Texas abortion policy because these infants, if born full term, would have been approximately 10 to 14 weeks gestation when the Texas law went into effect in September 2021. Before S.B. 8’s enactment, people would have been able to seek termination in the event a fetal issue was detected during screening prior to 20 weeks gestation.

In an analysis of cause of death using all 2021 and 2022 death certificate data, the researchers found that Texas had atypical increases in infant deaths due to congenital anomalies, the leading cause of infant death. Infant deaths attributable to congenital anomalies increased 22.9 percent in Texas between 2021 and 2022 versus a decrease of 3.1 percent in the rest of the U.S. during the same period. Another divergent cause of death pattern in Texas was infant deaths from accidents, which increased by 21 percent in Texas versus a one percent increase in the rest of the U.S.

“Our results suggest that restrictive abortion policies that limit pregnant people’s ability to terminate pregnancies, particularly those with fetal abnormalities diagnosed later in pregnancy, may lead to increases in infant mortality,” says Suzanne Bell, PhD, MPH, assistant professor in the Bloomberg School’s Department of Population, Family and Reproductive Health and one of the study’s lead authors. “These findings make clear the potentially devastating consequences abortion bans can have on pregnant people and families who are unable to overcome barriers to this essential reproductive health service.”

The authors note that the data did not include maternal and clinical characteristics of infant deaths, thus limiting the authors’ ability to explore potential mechanisms behind these findings.

The researchers are currently studying the impact across socioeconomic groups that abortion bans have on live births and infant mortality in Texas and other states that banned abortion following Dobbs.

This study was supported by the Hopkins Population Center from the National Institute of Child Health and Human Development (P2CHD042854).

“Infant Deaths After Texas’ 2021 Ban on Abortion in Early Pregnancy” was written by Alison Gemmill, Claire Margerison, Elizabeth Stuart, and Suzanne Bell.

In a study published in the journal Science, researchers at Baylor College of Medicine and collaborating institutions show in animal models that a novel, non-hormonal sperm-specific approach offers a promising option for reversible human male contraception.

“Although researchers have been investigating several strategies to develop male contraceptives, we still do not have a birth control pill for men,” said corresponding author Dr. Martin Matzuk, director of the Center for Drug Discovery and chair of the Department of Pathology and Immunology at Baylor. “In this study we focused on a novel approach – identifying a small molecule that would inhibit serine/threonine kinase 33 (STK33), a protein that is specifically required for fertility in both men and mice.”

Previous research has shown that STK33 is enriched in the testis and is specifically required for the formation of functional sperm. In mice, knocking out the Stk33 gene renders the mice sterile due to abnormal sperm and poor sperm motility. In men, having a mutation in the STK33 gene leads to infertility caused by the same sperm defects found in the Stk33 knockout mice. Most importantly, mice and men with these mutations have no other defects and even have normal testis size.

“STK33 is therefore considered a viable target with minimal safety concerns for contraception in men,” said Matzuk, who has been on faculty at Baylor for 30 years and is Baylor’s Stuart A. Wallace Chair and Robert L. Moody, Sr. Chair of Pathology and Immunology. “STK33 inhibitors have been described but none are STK33-specific or potent for chemically disrupting STK33 function in living organisms.”

Finding an effective STK33 inhibitor

“We used DNA-Encoded Chemistry Technology (DEC-Tec) to screen our multi-billion compound collection to discover potent STK33 inhibitors,” said first author Dr. Angela Ku, staff scientist in the Matzuk lab. “Our group and others have used this approach before to uncover potent and selective kinase inhibitors.”

The researchers uncovered potent STK33-specific inhibitors, from which they successfully generated modified versions to make them more stable, potent and selective. “Among these modified versions, compound CDD-2807 turned out to be the most effective,” Ku said.

“Next, we tested the efficacy of CDD-2807 in our mouse model,” said co-author Dr. Courtney M. Sutton, postdoctoral fellow in the Matzuk lab. “We evaluated several doses and treatment schedules and then determined sperm motility and number in the mice as well as their ability to fertilize females.”

Compound CDD-2807 effectively crossed the blood-testis barrier and reduced sperm motility and numbers and mice fertility at low doses. “We were pleased to see that the mice did not show signs of toxicity from CDD-2807 treatment, that the compound did not accumulate in the brain, and that the treatment did not alter testis size, similar to the Stk33 knockout mice and the men with the STK33 mutation,” Sutton said. “Importantly, the contraceptive effect was reversible. After a period without compound CDD-2807, the mice recovered sperm motility and numbers and were fertile again.”

“In our paper, we also present the first crystal structure for STK33,” said co-author Dr. Choel Kim, associate professor of biochemistry and molecular pharmacology and member of the Dan L Duncan Comprehensive Cancer Center at Baylor. “Our crystal structure showed how one of our potent inhibitors interacts with STK33 kinase in three dimensions. This enabled us to model and design our final compound, CDD-2807, for better drug-like properties.”

“This study was a tour de force by our team in the Center for Drug Discovery at Baylor and our collaborators,” said co-author Dr. Mingxing Teng, assistant professor of pathology and immunology and of biochemistry and molecular pharmacology at Baylor. Teng also is a Cancer Prevention Research Institute of Texas Scholar and a member of the Dan L Duncan Comprehensive Cancer Center at Baylor. “Starting with a genetically validated contraceptive target, we were able to show that STK33 is also a chemically validated contraceptive target.”

“In the next few years, our goal is to further evaluate this STK33 inhibitor and compounds similar to CDD-2807 in primates to determine their effectiveness as reversible male contraceptives,” Matzuk said.

Additional co-authors of the paper affiliated with Baylor College of Medicine are Kiran L. Sharma, Hai Minh Ta, Kurt M. Bohren, Yong Wang, Srinivas Chamakuri, Ruihong Chen, John M. Hakenjos, Ravikumar Jimmidi, Katarzyna Kent, Feng Li, Jian-Yuan Li, Lang Ma, Chandrashekhar Madasu, Murugesan Palaniappan, Stephen S. Palmer, Xuan Qin, Zhi Tan, Yasmin M. Vasquez, Jian Wang, Zhifeng Yu, Qiuji Ye and Damian W. Young. Co-authors Matthew B. Robers and Jennifer Wilkinson are affiliated with Promega Corp., and Banumathi Sankaran is affiliated with Lawrence Berkeley National Laboratory.

For financial support for this work, see the publication.

Now, two European clinical trials have shown limited success with a different type of medication used to treat BV called dequalinium chloride (DQC). DQC—an antiseptic—has been in use for several decades in countries throughout Europe as an alternative treatment for BV. It is not currently approved by the U.S. Food and Drug Administration. In a commentary published May 2 in JAMA Network Open, researchers from the Institute for Genome Sciences (IGS) within the University of Maryland School of Medicine (UMSOM) and Johns Hopkins University School of Medicine (JHUSOM) have called for more robust clinical trials in the United States to confirm if DQC is as good or better than existing BV treatments.

“For women suffering from BV, there is a critical need for more effective treatments,” said corresponding author Rebecca Brotman, PhD, MPH, a researcher at IGS and UMSOM Professor of Epidemiology and Public Health. “We need more robust clinical trials to fill in the knowledge gaps of what we know about DQC from the European studies.”

In the commentary, the authors discuss three main knowledge gaps from the European trials.

“First, we know that vaginal microbiota may vary regionally and the DQC clinical trials so far have only been conducted in Europe,” said first author Kayla Carter, PhD, MPH, a postdoc in the Brotman Lab at IGS. “In addition, the trials did not last longer than five weeks, so we don’t know long-term outcomes after DQC treatment; and, finally, there’s very limited data on its use and its safety during pregnancy.”

DQC works differently than current treatments because it is an antiseptic with antibacterial and antifungal activity, rather than an antibiotic. It also is an intravaginal tablet, not an oral treatment. The antibiotic treatments currently available to U.S. women are metronidazole and clindamycin as first-line medications, with alternatives of secnidazole and tinidazole. While these treatments are generally effective in the short term, as many as 50 percent of women will have a BV recurrence by six months after treatment.

“We’ve seen a growing investment in innovative BV treatments in recent years, including live biotherapeutics and vaginal microbiome transplants, but those are still in relatively early stages of development,” said Dr. Brotman. “In the meantime, the European trials indicate that DQC could be a viable, well-tolerated alternative BV treatment. That’s why it deserves further investigation with well-funded clinical trials.”

Susan Tuddenham, MD, MPH, Associate Professor of Medicine at the Johns Hopkins University School of Medicine also contributed to this commentary.