pregnancy

IMPORTANCE: Intimate partner violence (IPV) affects millions of US residents across the lifespan and is often unrecognized. Abuse of older or vulnerable adults by a caregiver or someone else they may trust is common and can result in significant injury, death, and long-term adverse health consequences.
OBJECTIVE: The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the benefits and harms of screening for IPV, abuse of older adults, and abuse of vulnerable adults.
POPULATION: The recommendation on screening for IPV applies to adolescents and adults who are pregnant or postpartum, and women of reproductive age. The recommendation on screening in older and vulnerable adults applies to persons without recognized signs and symptoms of abuse or neglect.
EVIDENCE ASSESSMENT: The USPSTF concludes that screening for IPV in women of reproductive age, including those who are pregnant and postpartum, and providing or referring those who screen positive to multicomponent interventions has a moderate net benefit. The USPSTF concludes that the benefits and harms of screening for caregiver abuse and neglect in older or vulnerable adults are uncertain and that the balance of benefits and harms cannot be determined.
RECOMMENDATION: The USPSTF recommends that clinicians screen for IPV in women of reproductive age, including those who are pregnant and postpartum. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for caregiver abuse and neglect in older or vulnerable adults.

Women in their late 30s to early 40s who have difficulty conceiving are often unaware that success rates of fertility treatment decline with age, most commonly due to declining ovarian function. Counseling about the high prevalence of infertility and miscarriage may be met with surprise and sadness. Reports of children born to high-profile women older than 50 years may contribute to misconceptions, but these births highlighted in the media were likely achieved with donor oocytes from a younger woman or with oocytes or embryos that were previously cryopreserved. Consistent with declining fertility rates worldwide,1 the fertility rate in the US has declined from 70.9 births per 1000 women in 1990 to 56.1 per 1000 in 2022.2 Simultaneously, the 2019 US Census reported that age at first birth had risen from 27 years in 1990 to 30 years in 2019 as more women postponed first birth.

Reasons for these trends may include lack of a partner, economic insecurity, career aspirations, and long work hours. Concerns about childbearing discrimination, including lack of pregnancy and postpartum support, and childcare challenges also likely influence decisions to delay pregnancy. Results of a questionnaire completed by 5692 US general surgery residents reported that more female than male residents delayed pregnancy because of training (46.8% vs 32.7%; P < .001) and experienced pregnancy/parenthood-based mistreatment (58.1% vs 30.5%; P < .001).3

This JAMA Pediatrics Patient Page describes what teens should consider when choosing contraception methods.

Introduction: Existing guidelines for primary care clinicians (PCCs) on the detection and management of perinatal depression (PD) contain important gaps. This review aims to provide PCCs with a summary of clinically relevant evidence in the field.

Methods: A narrative literature review was conducted by searching PubMed and PsycINFO for articles published between 2010 to 2023. Guidelines, systematic reviews, clinical trials, and/or observational studies were all examined.

Results: Screening with the Edinburgh Postnatal Depression Scale or Patient Health Questionnaire-9 followed by a diagnostic evaluation for major depressive disorder in probable cases can enhance PD detection. At-risk individuals and mild to moderate PD should be referred for cognitive behavioral therapy or interpersonal psychotherapy when available. Selective serotonin reuptake inhibitors should be used for moderate to severe PD, with sertraline, escitalopram, or citalopram being preferred first. Using paroxetine or clomipramine in pregnancy, and fluoxetine or doxepin during lactation is generally not preferred. Gestational antidepressant use is associated with a small increase in risk of reduced gestational age at birth, low birth weight, and lower APGAR scores, though whether these links are causal is unclear. Sertraline and paroxetine have the lowest rate of adverse events during lactation. Consequences of untreated PD can include maternal and offspring mortality, perinatal complications, poor maternal-infant attachment, child morbidity and maltreatment, less breastfeeding, and offspring developmental problems.

Conclusions: These clinically relevant data can support the delivery of high-quality care by PCCs. Risks and benefits of PD treatments and the consequences of untreated PD should be discussed with patients to support informed decision making.