Mi Health Mi Choice: Improving Contraceptive Care for Women With Medical Conditions
Justine P. Wu, M.D., M.P.H., Principal Investigator
Funded by National Institutes of Health (read more on Dr. Wu's award)
Adult women with chronic conditions have a higher rate of unintended pregnancy than adult women without chronic conditions. Chronic conditions and unintended pregnancy are both associated with pregnancy-related complications and adverse maternal and child health outcomes. Prior studies show that women with chronic conditions are not receiving adequate contraceptive counseling, particularly regarding highly effective contraceptive methods. There is an urgent need to improve contraceptive counseling and services for women with chronic conditions in order to decrease the rate of unintended pregnancy and improve reproductive health outcomes among this population.
This mixed methods, multi-phase study will first 1.) identify key factors on the patient-, provider-, and practice-level that are critical to the design of a contraceptive intervention for women with chronic conditions in primary care. The research team, led by Wu, will then develop an interactive, web-based contraceptive decision aid for women with chronic conditions, their PCPs, and implementation in primary care. Finally, a pilot randomized controlled trial (RCT) will be conducted to measure the feasibility of the decision aid as a potential large-scale intervention.
Protocol Citation: Wu JP, Damschroder LJ, Fetters MD, et al. A Web-Based Decision Tool to Improve Contraceptive Counseling for Women With Chronic Medical Conditions: Protocol For a Mixed Methods Implementation Study. JMIR Research Protocols. 2018;7(4). doi:10.2196/resprot.9249.
Maternal Mental and Physical Health Outcomes After Stillbirth and Infant Death
Katherine J. Gold, M.D., M.S.W., M.S., Principal Investigator
Funded by National Institutes of Health/National Institute of Mental Health
Little is known about the long-term impact of perinatal loss on surviving mothers, its effect on subsequent prenatal health behaviors and its impact on outcomes of their subsequent pregnancies. Findings may potentially help to identify populations of women at highest risk for mental illness after such a loss, measure the impact of hospital care on maternal psychiatric morbidity, quantify the economic costs of maternal health care in the years following such a loss, and improve fetal outcomes in subsequent pregnancies.
Health Check-Up for Expectant Moms: Computer Intervention for HIV/STI Risk and Drug Use During Pregnancy
Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
HIV and other sexually transmitted infections (STIs) risk and alcohol/drug use during pregnancy are interconnected problems - both are associated with numerous negative consequences for the woman and the developing fetus. Yet, virtually no interventions have been developed or tested to target both of these serious health concerns during pregnancy. This study will:
Design and develop Health Check-up for Expectant Moms (HCEM), a computer-delivered brief intervention that targets both the risk for HIV/STIs and alcohol/drug use among low-income pregnant women
Determine the effect of HCEM in two-group, RCT
Inform the development of integrated HIV/STI and substance use interventions that are cost-effective, high-reaching, and widely disseminable within prenatal care.
The Mindful Health Study: A three-group randomized feasibility trial of an online yoga intervention for mothers after stillbirth
Katherine J. Gold, M.D., M.S.W., M.S., Senior Investigator
Funded by National Institutes of Health and the National Center for Complementary and Integrative Health (NCCIH)
In the USA, stillbirth (in utero fetal death ≥20 weeks gestation) is a major public health issue. Women who experience stillbirth, compared to women with live birth, have a nearly sevenfold increased risk of a positive screen for post-traumatic stress disorder (PTSD) and a fourfold increased risk of depressive symptoms. Because the majority of women who have experienced the death of their baby become pregnant within 12-18 months and the lack of intervention studies conducted within this population, novel approaches targeting physical and mental health, specific to the needs of this population, are critical. Evidence suggests that yoga is efficacious, safe, acceptable, and cost-effective for improving mental health in a variety of populations, including pregnant and postpartum women. To date, there are no known studies examining online-streaming yoga as a strategy to help mothers cope with PTSD symptoms after stillbirth.
This study will explore the feasibility and acceptability of a 12-week, home-based, online-streamed yoga intervention, with varying doses among mothers after a stillbirth. If feasible, the findings from this study will inform a full-scale trial to determine the effectiveness of home-based online-streamed yoga to improve PTSD. Long-term, health care providers could use online yoga as a non-pharmaceutical, inexpensive resource for stillbirth aftercare.
Speaking Their Language: Using Social Media And Texting To Create An Adolescent-centered Approach To Healthy Weight Gain During Pregnancy
Tammy Chang, M.D., M.P.H., M.S., Principal Investigator
Funded by the National Institutes of Health, Eunice Kennedy Shriver National Institute Of Child Health & Human Development
This study utilizes qualitative and quantitative methods to understand adolescent women's perceptions of and knowledge about pregnancy weight gain. Excess pregnancy weight gain has a significant negative impact on the health of the adolescent mother, increases the risk of dangerous complications during delivery, and contributes to long-term obesity for both mother and child. Leading a team of researchers, including experts in nutrition, adolescent health, health informatics and social media mining, and primary care, Dr. Chang will:
- Conduct analyses using nationally representative data from the Fragile Families and Wellbeing Study
- Carry out social media mining and corresponding qualitative interviews with pregnant and postpartum adolescents
- Design, implement, and evaluate an adolescent- centered and tailored eHealth (tailored text-messaging) intervention
Longitudinal Population-Based Study of Vulvodynia
Funded by Health and Human Services and National Institutes of Health
The purpose of this study is to evaluate the prevalence, incidence, persistence, and remission rates of vulvodynia among a group of 2500 women. Results from this study will substantially augment our understanding of the combined role of genetics and hormone exposure in the onset, maintenance and remission of vulvodynia, facilitating future studies on pathophysiology, treatment and prevention.
Improving Contraceptive Care for Women with Breast Cancer: An Interprofessional Collaborative Practice Approach
Justine P. Wu, M.D., M.P.H., assistant professor, Primary Investigator
Funded by the University of Michigan Health Sciences Council
It has been estimated that cancer survivors have a threefold greater risk of unintended pregnancy than those without cancer. However, family planning efforts for women with breast cancer have primarily focused on fertility preservation, with much less attention devoted to pregnancy prevention and contraception. This new work aims to address the unmet need of premenopausal women with breast cancer. It will develop a prototype web-based decision aid that enables women to make preference-sensitive informed decisions within the context of their cancer status and treatment. The work builds upon and expands Dr. Wu’s recently funded K23 NIH study to develop a contraceptive decision aid for women with medical conditions such as diabetes.
As a first-round recipient of an interprofessional exchange (IP-X) pilot grant, the project is unique in its approach to the research and development process. The project aims to formally develop an interprofessional Collaborative Practice Model of care. Dr. Wu will lead a team of collaborators, representing the complementary disciplines of breast oncology, oncology nursing, oncology social work, and primary care and family planning. The research and implementation team will utilize mixed methods to collect and analyze qualitative and quantitative data to inform both the decision aid intervention and the Collaborative Practice Model.
Pregnancy Outcomes And Experiences Among Deaf And Hard Of Hearing Women
Michael M. McKee, M.D., M.P.H., Co-Primary Investigator
Funded by the National Institutes of Health
Along with the the Lurie Institute for Disability Policy at Brandeis University, co-Principal Investigator Michael M. McKee will lead a five-year NIH-funded study of perinatal care and pregnancy outcomes for women who are Deaf and Hard of Hearing (DHH). This pioneering study seeks to fill a critical knowledge gap. While women who are Deaf and hard of hearing are equally likely to be pregnant as women with other disabilities and women without disabilities, almost no research exists about their pregnancy experiences, maternal and birth outcomes, or associated healthcare costs.
This study will provide the first-ever systematic understanding of pregnancy care costs and health outcomes for DHH women. With it, Mitra and McKee hope to establish the foundational knowledge necessary to develop future interventions to improve outcomes. They also plan to generate practice recommendations for clinicians to deliver improved perinatal health to DHH mothers and their infants.
Media and Infographics
- Wu J, Zhang J, Mitra M, Parish SL, Reddy GKM. Provision of Moderately and Highly Effective Reversible Contraception to Insured Women With Intellectual and Developmental Disabilities. Obstetrics & Gynecology. August 2018:1. doi: 10.1097/aog.0000000000002777.
- Li H, Mitra M, Wu JP, Parish SL, Valentine A, Dembo RS. Female Sterilization and Cognitive Disability in the United States, 2011–2015. Obstetrics & Gynecology. August 2018:1. doi: 10.1097/aog.0000000000002778.
Wu JP, Moniz MH, Ursu AN. Long-acting Reversible Contraception—Highly Efficacious, Safe, and Underutilized. JAMA. Published online July 06, 2018. doi:10.1001/jama.2018.8877
- Wojcieszek AM, Shepherd E, Middleton P, Gardener G, Ellwood DA, McClure EM, Gold KJ, et al. Interventions for investigating and identifying the causes of stillbirth. Cochrane Database of Systematic Reviews. 2018. doi: 10.1002/14651858.cd012504.pub2.
- Wu JP, Damschroder LJ, Fetters MD, et al. A Web-Based Decision Tool to Improve Contraceptive Counseling for Women With Chronic Medical Conditions: Protocol For a Mixed Methods Implementation Study. JMIR Research Protocols. 2018;7(4). doi:10.2196/resprot.9249.
- Reed BD, Plegue MA, Sen A, Haefner HK, Siddiqui J, Remick DG. Nerve Growth Factor and Selected Cytokines in Women With and Without Vulvodynia. Journal of Lower Genital Tract Disease. 2018;22(2):139-146. doi:10.1097/lgt.0000000000000377.
- Reinebrant HE, Leisher SH, Coory M, Henry S, Wojcieszek AM, Gardener G, Lourie R, Ellwood D, Teoh Z, Allanson E, Blencowe H, Draper ES, Erwich JJ, Frøen JF, Gardosi J, Gold K. Making stillbirths visible: a systematic review of globally reported causes of stillbirth. BJOG. 2018 Jan;125(2):212-224. doi: 10.1111/1471-0528.14971. Epub 2017 Nov 29.
- Gold KJ, Sen A, Leon I. Whose Fault Is It Anyway? Guilt, Blame, and Death Attribution by Mothers After Stillbirth or Infant Death. Illness, Crisis and Loss. 2017 Nov. Illness, Crisis & Loss. 26(1).
- Hughey KL, Llanes M, Plegue M, et al. Risk for Unintended Pregnancy Among Latino Men and Women in a Nonmetropolitan County in Michigan. PRiMER. 2017;1. doi:10.22454/primer.2017.651218.
- Tzilos Wernette G, Plegue M, Kahler CW, Sen A, Zlotnick C. A Pilot Randomized Controlled Trial of a Computer-Delivered Brief Intervention for Substance Use and Risky Sex During Pregnancy. J Women's Health. 2017 Oct 5, ePub ahead of print. doi: 10.1089/jwh.2017.6408 (press release here)
- Moniz MH, McEvoy AK, Hofmeister M, Plegue M, Chang T. Family Physicians and Provision of Immediate Postpartum Contraception: A CERA Study. Fam Med. 2017 Sep;49(8):600-606. PMID: 28953291.
- Gold KJ, Treadwell MC, Mieras ME, and Laventhal NT. Who tells a mother her baby has died? Communication and staff presence during stillbirth delivery and early infant death. Journal of Perinatology, (ePub ahead of print: 31 August 2017, doi: 10.1038/jp.2017.125
- Reed BD. Candida Vulvovaginitis and Vulvodynia: The Mystery Continues. Journal of Women's Health. August 2017, ahead of print. doi: 10.1089/jwh.2017.6620
- Berman BA, Jo AM, Cumberland WC, Booth H, Wolfson AA, Stern C, Zazove P, et al. D/deaf Breast Cancer Survivors: Their Experiences and Knowledge. Journal of Health Care for the Poor and Underserved. 2017 Aug; 28(3): 1165-1190. doi: 10.1353/hpu.2017.0104. (press release here)
- Harlow SD, Karvonen-Gutierrez C, Elliott MR, Bondarenko I, Avis NE, Bromberger JT, Brooks MM, Miller JM and Reed BD. It is not just menopause: symptom clustering in the Study of Women’s Health Across the Nation. Women's Midlife Health. 2017;3(2). doi: 10.1186/s40695-017-0021-y
- Huberty J, Matthews J, Leiferman J, Cacciatore J, Gold KJ. A study protocol of a three-group randomized feasibility trial of an online yoga intervention for mothers after stillbirth (The Mindful Health Study). Pilot Feasibility Stud., 4:12, 2017. DOI: 10.1002/14651858.CD012504
- Mahmoudi E, Lu Y, Metz AK, et al. Association of a Policy Mandating Physician-Patient Communication With Racial/Ethnic Disparities in Postmastectomy Breast Reconstruction. JAMA Surgery. (ePub ahead of print 31 May 2017) doi:10.1001/jamasurg.2017.0921
- Wu JP, McKee KS, McKee MM, Meade MA, Plegue MA, Sen A. Use of Reversible Contraceptive Methods Among U.S. Women with Physical or Sensory Disabilities. Perspect Sex Reprod Health. 2017 May 17. doi: 10.1363/psrh.12031.
- Moniz MH, Chang T, Heisler M, Admon L, Gebremariam A, Dalton VK, Davis MM. Inpatient Postpartum Long-Acting Reversible Contraception and Sterilization in the United States, 2008-2013. Obstet Gynecol. 2017 May 5. doi: 10.1097/AOG.0000000000001970
- Chang T, Moniz MH, Plegue MA, Sen A, Davis MM, Villamor E, Richardson CR. Characteristics of women age 15-24 at risk for excess weight gain during pregnancy. PLoS ONE 12(3): e0173790. doi: 10.1371/journal.pone.0173790
- Flenadya V, Wojcieszeka AM, Ellwood D, Hopkins Leishera S, b, Erwich JJ, Drapere ES, McClure EM, Reinebranta HE, Jeremy Oats J, McCowan L, Kent AL, Gardenera G, Gordon A, Tudehope D, Siassakos D, Storey C, Zuccollo J, Dahlstrom JE, Gold KJ, et al. Classification of causes and associated conditions for stillbirths and neonatal deaths. Seminars in Fetal & Neonatal Medicine. Available online 9 March 2017 (in-press). doi: 10.1016/j.siny.2017.02.009
- Wojcieszek AM, Shepherd E, Middleton P, Gardener G, Ellwood DA, McClure EM, Gold KJ, Khong TY, Silver RM, Erwich JJHM, Flenady V. Cochrane Protocol: Interventions for investigating and identifying the causes of stillbirth. 2017 (Accepted, in press)
- Mitro SD, Harlow SD, Randolph JF, Reed BD. Chronic vulvar pain in a cohort of post-menopausal women: Atrophy or Vulvodynia? Womens Midlife Health. 2016;2. DOI: 10.1186/s40695-016-0017-z
- Wu JP, McKee MM, Mckee KS, Mead, MA, Plegue M, Sen A. Female sterilization is more common among women with physical and/or sensory disabilities than women without disabilities in the United States. Disability and Health Journal. 2017 Jan. DOI: 10.1016/j.dhjo.2016.12.020
- Verma BA, Nichols LP, Plegue MA, Moniz MH, Rai M, Chang T. Advice given by community members to pregnant women: a mixed methods study. BMC Pregnancy Childbirth. 2016 Nov 9;16(1):349. DOI: 10.1186/s12884-016-1146-y
- Reed BD, Plegue MA, Harlow SD, Haefner HK, Sen A. Does degree of vulvar sensitivity predict vulvodynia characteristics and prognosis?. J Pain. 2016 Oct 24. DOI: 10.1016/j.jpain.2016.10.006
- Reed BD, Sen A, Harlow SD, Haefner HK, Gracely RH. Multimodal Vulvar and Peripheral Sensitivity Among Women With Vulvodynia: A Case-Control Study. J Low Genit Tract Dis. 2016 Oct 7. DOI: 10.1097/LGT.0000000000000267
- Gold KJ, Andrew LB, Goldman EB, Schwenk TL. "I would never want to have a mental health diagnosis on my record": A survey of female physicians on mental health diagnosis, treatment, and reporting. Gen Hosp Psychiatry. 2016;43:51-57. PMID: 27796258
- Mozurkewich EL, Greenwood M, Clinton C, Berman D, Romero V, Djuric Z, et al. Pathway Markers for Pro-resolving Lipid Mediators in Maternal and Umbilical Cord Blood: A Secondary Analysis of the Mothers, Omega-3, and Mental Health Study. Front Pharmacol. 2016;7:274. DOI: 10.3389/fphar.2016.00274
- Patton EW, Moniz MH, Hughes LS, Buis L, Howell J. National network television news coverage of contraception - a content analysis. Contraception. 2016 Jul 8. DOI: 10.1016/j.contraception.2016.07.005
- Zick SM, Sen A, Wyatt GK, Murphy SL, Arnedt JT, Harris RE. Investigation of 2 Types of Self-administered Acupressure for Persistent Cancer-Related Fatigue in Breast Cancer Survivors: A Randomized Clinical Trial. JAMA Oncol. 2016 Jul 7. DOI: 10.1001/jamaoncol.2016.1867
- Gold KJ, Normandin MM, Boggs ME. Are participants in face-to-face and internet support groups the same? Comparison of demographics and depression levels among women bereaved by stillbirth. Arch Womens Ment Health. 2016 Aug 25. DOI: 10.1007/s00737-016-0657-x
- Petrites AD, Mullan P, Spangenberg K, Gold KJ. You have no Choice but to go on: How Physicians and Midwives in Ghana Cope with High Rates of Perinatal Death. Matern Child Health J. 2016;20(7):1448-55. DOI: 10.1007/s10995-016-1943-y
- Papoutsis D, Haefner HK, Crum CP, Opipari AW, Reed BD. Vestibular Mast Cell Density in Vulvodynia: A Case-Controlled Study. J Low Genit Tract Dis. 2016;20(3):275-9. DOI: 10.1097/LGT.0000000000000221
- Wu JP, Gundersen DA, Pickle S. Are the Contraceptive Recommendations of Family Medicine Educators Evidence-Based? A CERA Survey. Fam Med. 2016;48(5):345-52. PMID: 27159092
- Wu JP, Kusunoki Y, Ela EJ, Barber JS. Patterns of Contraceptive Consistency among Young Adult Women in Southeastern Michigan: Longitudinal Findings Based on Journal Data. Womens Health Issues. 2016;26(3):305-12. DOI: 10.1016/j.whi.2016.02.007
- Moniz MH, Chang T, Davis MM, Forman J, Landgraf J, Dalton VK. Medicaid Administrator Experiences with the Implementation of Immediate Postpartum Long-Acting Reversible Contraception. Womens Health Issues. 2016;26(3):313-20. DOI: 10.1016/j.whi.2016.01.005
Opoku CA, Browne EN, Spangenberg K, Moyer C, Kolbilla D, Gold KJ. Perception and risk factors for cervical cancer among women in northern Ghana. Ghana Med J. 2016;50(2):84-9. PMID: 27635096(link is external)
- Hryniuk W, Jenkins I, Djuric Z. Psychiatric Disorders Impeding Weight Loss in Obese Breast Cancer Survivors. J Clin Oncol. 2016;34(10):1152-3. DOI: 10.1200/JCO.2015.65.5639
- Heazell AE, Siassakos D, Blencowe H, Burden C, Bhutta ZA, Cacciatore J, Dang N, Das J, Flenady V, Gold KJ, et al. Stillbirths: economic and psychosocial consequences. Lancet. 2016;387(10018):604-16. PMID: 26794073
- Chang T, Verma BA, Shull T, et al. Crowdsourcing and the Accuracy of Online Information Regarding Weight Gain in Pregnancy: A Descriptive Study. J Med Internet Res. 2016;18(4):e81. DOI: 10.2196/jmir.5138
- Chang T, Moniz MH, Plegue MA, Shaffer KS, Vance HB, Gold KJ. Patient or Clinician: Duration of Use of Intrauterine Devices Based on Who Initiated Discussion of Placement. J Am Board Fam Med. 2016;29(1):24-8. DOI: 10.3122/jabfm.2016.01.150192
- Reed BD, Harlow SD, Plegue MA, Sen A. Remission, Relapse, and Persistence of Vulvodynia: A Longitudinal Population-Based Study. J Womens Health (Larchmt). 2016;25(3):276-83. DOI: 10.1089/jwh.2015.5397
- Reed BD, Plegue MA, Williams DA, Sen A. Presence of Spontaneous Pain and Comorbid Pain Conditions Identifies Vulvodynia Subgroups. J Low Genit Tract Dis. 2016;20(1):57-63. DOI: 10.1097/LGT.0000000000000166
- Gold MA, Tzilos GK, Stein LA, et al. A Randomized Controlled Trial to Compare Computer-assisted Motivational Intervention with Didactic Educational Counseling to Reduce Unprotected Sex in Female Adolescents. J Pediatr Adolesc Gynecol. 2016;29(1):26-32. DOI: 10.1016/j.jpag.2015.06.001
- Zlotnick C, Tzilos G, Miller I, Seifer R, Stout R. Randomized controlled trial to prevent postpartum depression in mothers on public assistance. J Affect Disord. 2016;189:263-8. DOI: 10.1016/j.jad.2015.09.059
- Moniz MH, Dalton VK, Davis MM, Forman J, Iott B, Landgraf J, Chang T. Characterization of Medicaid policy for immediate postpartum contraception. Contraception. 2015;92(6):523-31. DOI: 10.1016/j.contraception.2015.09.014
- Gold KJ, Leon I, Boggs ME, Sen A. Depression and Posttraumatic Stress Symptoms After Perinatal Loss in a Population-Based Sample. J Womens Health (Larchmt). 2016;25(3):263-9. DOI: 10.1089/jwh.2015.5284
Collaborative Partners & External Affiliates
- Associate of Reproductive Health Professionals - Justine P Wu, MD, MPH, was appointed Board Chair for ARHP in 2016, after serving on the Executive Committee for many years
- University of Michigan Adolescent Health Initiative
University of Michigan Host Microbiome Initiative (HMI) & Microbiome Explorer Program - Kimberly McKee, PhD, MPH, postdoctoral fellow, currently collaborates with Jason Bell (Bell Lab) Christine Bassis, and Vince Young at the HMI core, on a pilot supported by the Microbiome Explorer Program to examine psychosocial stress and the vaginal microbiome as risk factors for preterm birth.
- University of Michigan Addiction Center