To describe female adolescents’ reproductive health needs and subspecialists’ teratogenic counseling at initiation of mycophenolate as well as use of reproductive health care and contraception after ...mycophenolate initiation.
We searched health records for female patients aged 12-20 years prescribed mycophenolate from 2010 to 2019. We included 125 subjects, 72 with systemic lupus erythematosus, 27 with transplants, and 26 with other conditions. We reviewed all encounters with pediatric subspecialists and reproductive clinicians. We recorded counseling by subspecialists at mycophenolate initiation and compared rates pre- and post-Risk Evaluation and Mitigation Strategy (REMS). We recorded subjects’ menstrual, sexual and pregnancy history, type of first highly effective contraceptive method used, and duration of use over the decade.
At mycophenolate initiation, mean age was 16.8 ± 2.6 years; 72% Hispanic/Latina or Black. In total, 80% were postmenarchal, 28% ever had sex, 18% ever had a reproductive health care visit, 14% used highly effective contraception, and 7% were ever pregnant. Post-REMS vs pre-REMS, we found greater rates of counseling for teratogenicity (68% vs 32%, P < .001) and contraception (62% vs 32%, P < .001) and pregnancy testing (51% vs 24%, P < .01). Over the mean 4.9 ± 3.3 years’ follow-up, 56% ever had sex; 59% ever attended a reproductive health care visit; 38% used highly effective contraception; and 10% had a pregnancy.
Adolescents prescribed mycophenolate have ongoing unmet reproductive health care needs. Although many are sexually active, fewer use effective contraception. Teratogenicity counseling rates improved over the decade but not rates of referral for reproductive health care.
The female athlete triad is often found in sports that value leanness and aesthetics and can lead to adverse health effects. We aimed to compare knowledge and risk of the triad among adolescent ...figure skaters, dancers, and runners.
We advertised our survey on social media platforms: sports-specific forums; Facebook; and Instagram. We received 928 responses. We included female figure skaters, dancers, and runners aged 25 years or younger (N = 712). We asked participants to name the triad components and dichotomized knowledge scores as high or low. We developed a 6-question triad risk scale and defined “at risk” if participants endorsed 3 or more questions.
Of 712 participants: 60% were figure skaters; 28% dancers; 12% runners; 78% were adolescents (≤17 years of age); 22% young adults (18-25 years); 12% had heard of the triad. A higher proportion of runners than figure skaters and dancers had high knowledge of the triad (16% vs 6% vs 5%, P < .01). Overall 60% of athletes were “at risk” of the triad, 25% skipped a period for 3 or more months, and 34% had a history of stress fractures or shin splints. Young adults vs adolescents and dancers vs figure skaters and runners had nearly twice the odds of triad risk.
Most athletes were at risk of the triad but few knew about it. Dancers were at higher risk compared with figure skaters and runners. Efforts should be made to raise awareness of the triad among athletes, parents, and coaches, with special attention paid to the dance community.
Purpose: LARCs are the most effective forms of reversible contraception currently on the market, yet uptake is still quite low among adolescents. As weight concerns are frequently considered by ...adolescents choosing a contraceptive method, we sought to compare BMI changes within the first two years of use in girls using nonhormonal (copper) and levonorgestrel (LNG) intrauterine devices (IUDs) as well as etonogestrel (ENG) contraceptive implants and to examine the influence of baseline BMI prior to LARC insertion on BMI changes after insertion. Methods: We queried electronic records in our large, urban, health care system to identify girls aged 14-19 who had LARC inserted from 2010-2016. We excluded those with conditions potentially affecting weight, e.g. childbirth, bariatric surgery, systemic illness, etc. We reviewed medical charts and included 216 girls who had complete BMI data; 35% using copper IUD; 32% LNG IUD, 33% ENG implant. We compared baseline BMI (up to 12 months before LARC insertion) to first recorded BMI taken 6 to 24 months after insertion. We used ANOVA with post-hoc SNK tests to compare BMI changes based on type of LARC used. We used Chi-square to compare girls with baseline BMI<85%ile vs. 85-94%ile vs. ≥95%ile by LARC type and examined differences in BMI change by LARC type and baseline BMI category using two-way ANOVA. Results: Of the 216 girls, mean age at LARC insertion was 17.2± 0.2 years; 58% Hispanic; 28% black; 25% obese (BMI≥95%ile); 24% overweight (BMI85-94%ile). Over 6 to 24 months follow up, mean BMI increase for all 216 girls was +0.771 kg/m2, with no difference among the three LARC types. When examining the 146 girls with a follow up BMI recorded within 6 to 12 months after LARC insertion, we found a smaller change in mean BMI for users of copper IUDs (+0.019 kg/m2) than for users of LNG IUDs (+0.607 kg/m2) or ENG implants (+0.840 kg/m2), p <0.01. In the two-way ANOVA of BMI change by baseline BMI category and LARC type, we found a difference by BMI category (p<0.01), with mean BMI increasing more in obese (+1.39 kg/m2) than overweight (+0.74 kg/m2) or normal weight (+0.49 kg/m2) girls. We also found an interaction of LARC type X BMI category (p<0.01) specifically in obese girls, with mean BMI increasing more in hormonal than non-hormonal users LNG IUD (+1.95 kg/m2); ENG implant (+2.07 kg/m2); copper IUD (+0.58 kg/m2) Conclusions: We found a significantly larger BMI increase over the first year of use for adolescents using hormonal LARCs as compared with non-hormonal cooper IUDs. In addition, girls who were obese at initiation of LARC had a significantly larger BMI increase if they used a hormonal LARC compared to those using a non-hormonal copper IUD.
To determine the prevalence of reproductive coercion, a form of intimate partner violence (IPV) including contraceptive sabotage and pregnancy pressure, among urban high school-aged girls and to ...examine its associations with reproductive health risks.
A self-administered survey completed by high school-aged girls living in high-poverty neighborhoods while awaiting medical care in a pediatric emergency room, inpatient service, school-based, and hospital-based clinic.
One hundred forty-nine sexually active girls aged 14-17 years.
To determine the prevalence of reproductive coercion and to examine associations with unprotected sex, sexually transmitted infections, physical IPV, and risk factors for abusive relationships.
Twenty-nine of 149 (19%) of girls reported reproductive coercion, most frequently that a romantic or sexual partner had ever: “told them not to use any birth control” (n = 23; 79%); “took off a condom during sex so they would get pregnant” (n = 12; 43%); and “said he would leave them if they didn't get pregnant” (n = 6; 21%). Girls reporting reproductive coercion were nearly 3 times more likely than those not coerced to have had chlamydia (odds ratio OR, 2.7; 95% confidence interval CI, 1.01-7.19) and nearly 5 times more likely to report IPV (OR, 4.8; 95% CI, 2.0-11.8). In addition, girls reporting coercion were less likely to have high recognition of abusive behaviors (OR, 0.10; 95% CI, 0.01-0.8) and less likely to have high comfort communicating with their sexual partners (OR, 0.32; 95% CI, 0.1-0.7) than girls not reporting coercion.
Reproductive coercion is experienced by 1 in 5 high school-aged girls in a high-poverty community and is associated with chlamydia infection and IPV. Awareness of the high prevalence and health risks of coercion might allow for intervention.
To compare body mass index (BMI) changes in adolescents using long-acting reversible contraceptives (LARCs), specifically, the etonogestrel subdermal implant (ENG-implant), levonorgestrel ...intrauterine device (LNG-IUD), and copper IUD (Cu-IUD), by initial BMI category from the time of LARC insertion to within 6-18 months after insertion.
This was a single-center retrospective cohort study.
We reviewed electronic health records from our large health system to identify and follow a cohort of 196 adolescents aged 14-19 years with LARCs inserted from 2010 to 2016. We excluded adolescents with conditions or medications affecting weight, including childbirth.
BMI change from LARC insertion to first BMI documented after 6-18 months
Mean age was 17.2 ± 0.2 years; 59% of the cohort was Hispanic and 29% Black. Mean BMI was 26.4 ± 7.1 kg/m2. Of the total cohort of adolescents, 51% were underweight/normal, 24% overweight, and 25% obese. Mean time to first BMI documented after LARC insertion was 10.1 ± 3.2 months. Mean BMI change for the total cohort was +0.73 ± 1.8 kg/m2, indicating weight gain. Mean BMI change for the ENG-implant + LNG-IUD users (n = 127) was larger than for Cu-IUD users (n = 69) (+0.92 ± 1.9 kg/m2 vs +0.37 ± 1.6 kg/m2, respectively, P < .05). Two-way analysis of variance showed that both initial BMI category (P = .001) and type of LARC (P = .011) had an independent significant main effect on BMI change. A significant interaction effect (P = .017) showed that obese adolescents had a larger increase in BMI when they were using a progestin-releasing LARC, either ENG-implant or LNG-IUD, as compared to a Cu-IUD (P < .05).
Adolescents using progestin-releasing LARCs had a larger increase in BMI within 6-18 months after device insertion than those using Cu-IUDs. The disproportionate increase in BMI with progestin-releasing LARCs was primarily contributed by obese users.
To explore whether sexting by young adolescent girls and boys is associated with adverse life experiences including exploitative or violent sexual relationships.
Cross-sectional, anonymous survey of ...a convenience sample of minor adolescents younger than age 18 years recruited while waiting for care in clinics affiliated with a children's hospital in a low-resource, high-poverty, urban community.
Five hundred fifty-five adolescents aged 14-17 years, 63% girls and 37% boys.
We measured sexting by asking, “Have you ever sent a sexually suggestive or naked picture of yourself to another person through text or e-mail?” The survey also measured risk behaviors, sexual abuse, intimate partner violence (IPV), and arrest and included a validated depression scale.
Mean age was 15.6 ± 1.1 years; 59% were Hispanic, 28% were black; 44% of girls and 46% of boys ever had sex; 24% of girls and 20% of boys ever sent a sext. More girls than boys reported sexual abuse (16% vs 3%; P < .01), IPV victimization (15% vs 7%; P < .01), and depression (33% vs 17%; P < .01). More boys than girls reported arrest (15% vs 7%; P < .01). Independent associations with sexting for girls were: ever had sex (odds ratio OR, 4.59; 95% confidence interval CI, 2.29-9.19; P < .001); sexual abuse (OR, 3.81; 95% CI, 1.80-8.05; P < .001); IPV victim (OR, 2.72; 95% CI, 1.11-6.62; P < .05), and for boys: ever had sex (OR, 4.26; 95% CI, 1.47-12.32; P < .01); sexual abuse (OR, 38.48; 95% CI, 1.48-999.46; P < .05); IPV perpetration (OR, 16.73; 95% CI, 1.64-170.75; 95% CI, P < .05), as well as cannabis use, older age, other race, and arrest.
For young adolescents, sexting is independently associated with exploitative and abusive sexual relationships including sexual abuse and IPV with similarities and differences in predictors of sexting for girls and boys.
To evaluate ovarian morphology using three-dimensional magnetic resonance imaging (MRI) in adolescent girls with and without polycystic ovary syndrome (PCOS). Also compare the utility of MRI versus ...ultrasonography (US) for diagnosis of PCOS.
Cross-sectional study.
Urban academic tertiary-care children's hospital.
Thirty-nine adolescent girls with untreated PCOS and 22 age/body mass index (BMI)-matched controls.
Magnetic resonance imaging and/or transvaginal/transabdominal US.
Ovarian volume (OV); follicle number per section (FNPS); correlation between OV on MRI and US; proportion of subjects with features of polycystic ovaries (PCOs) on MRI and US.
Magnetic resonance imaging demonstrated larger OV and higher FNPS in subjects with PCOS compared with controls. Within the PCOS group, median OV was 11.9 (7.7) cm(3) by MRI compared with 8.8 (7.8) cm(3) by US. Correlation coefficient between OV by MRI and US was 0.701. Due to poor resolution, FNPS could not be determined by US or compared with MRI. The receiver operating characteristic curve analysis for MRI demonstrated that increasing volume cutoffs for PCOs from 10-14 cm(3) increased specificity from 77%-95%. For FNPS on MRI, specificity increased from 82%-98% by increasing cutoffs from ≥ 12 to ≥ 17. Using Rotterdam cutoffs, 91% of subjects with PCOS met PCO criteria on MRI, whereas only 52% met criteria by US.
Ultrasonography measures smaller OV than MRI, cannot accurately detect follicle number, and is a poor imaging modality for characterizing PCOs in adolescents with suspected PCOS. For adolescents in whom diagnosis of PCOS remains uncertain after clinical and laboratory evaluation, MRI should be considered as a diagnostic imaging modality.
A 2014 American Academy of Pediatrics (AAP) policy statement identified long-acting reversible contraceptives (LARCs) as first-line choices for adolescents, but pediatricians' current knowledge and ...practices about intrauterine devices (IUDs) and subdermal contraceptive implants (Implants) is unknown. We aimed to characterize pediatricians' knowledge and practices about LARCs for adolescents.
Cross-sectional online survey emailed to a convenience sample of AAP member pediatricians in New York, Utah, Illinois, and Kansas in 2015 and 2016. The study included 561 practicing pediatricians.
We measured knowledge about the suitability of IUDs and Implants for adolescents using two 7-item scales; a score of 7 indicates all correct. We dichotomized participants' scores as high and low knowledge if they scored ≥85% correct or <85%, respectively.
Mean age was 47.4 (±11) years; 73% were female; and 72% general pediatricians. Almost all, 88%, counsel about contraception; 64% counsel about IUDs, and Implants, but only 4.1% insert them; 72% prescribe short-acting hormonal contraceptives; 44% had read the AAP policy statement. Mean score on the knowledge scale was lower for IUDs than for Implants (4.2 vs 5.1, respectively; P < .001). Multivariable regression analysis indicated that female pediatricians, adolescent medicine subspecialists, agreeing that pregnancy is a serious problem for adolescents in their practice, and having read the AAP policy statement predicted high knowledge about IUDs as well as Implants for adolescents.
Most pediatrician respondents provided reproductive health care for adolescents and counseled about LARCs, but few inserted the devices. We identified knowledge deficits about suitability of IUDs for adolescents.
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