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Article ; Online: Tuberculosis in Pregnancy.

Miele, Kathryn / Bamrah Morris, Sapna / Tepper, Naomi K

2020 Volume 135, Issue 6, Page(s) 1444–1453

Abstract: Tuberculosis (TB) in pregnancy poses a substantial risk of morbidity to both the pregnant woman and the fetus if not diagnosed and treated in a timely manner. Assessing the risk of having Mycobacterium tuberculosis infection is essential to determining ... ...

Abstract	Tuberculosis (TB) in pregnancy poses a substantial risk of morbidity to both the pregnant woman and the fetus if not diagnosed and treated in a timely manner. Assessing the risk of having Mycobacterium tuberculosis infection is essential to determining when further evaluation should occur. Obstetrician-gynecologists are in a unique position to identify individuals with infection and facilitate further evaluation and follow up as needed. A TB evaluation consists of a TB risk assessment, medical history, physical examination, and a symptom screen; a TB test should be performed if indicated by the TB evaluation. If a pregnant woman has signs or symptoms of TB or if the test result for TB infection is positive, active TB disease must be ruled out before delivery, with a chest radiograph and other diagnostics as indicated. If active TB disease is diagnosed, it should be treated; providers must decide when treatment of latent TB infection is most beneficial. Most women will not require latent TB infection treatment while pregnant, but all require close follow up and monitoring. Treatment should be coordinated with the TB control program within the respective jurisdiction and initiated based on the woman's risk factors including social history, comorbidities (particularly human immunodeficiency virus [HIV] infection), and concomitant medications.
MeSH term(s)	Antitubercular Agents/adverse effects ; Antitubercular Agents/therapeutic use ; Female ; HIV Infections/epidemiology ; Humans ; Latent Tuberculosis/diagnosis ; Latent Tuberculosis/drug therapy ; Pregnancy ; Pregnancy Complications, Infectious ; Risk Factors ; Tuberculosis/diagnosis ; Tuberculosis/drug therapy
Chemical Substances	Antitubercular Agents
Language	English
Publishing date	2020-05-04
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	207330-4
ISSN	1873-233X ; 0029-7844
ISSN (online)	1873-233X
ISSN	0029-7844
DOI	10.1097/AOG.0000000000003890
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Article ; Online: Lifetime Medical Costs of Genital Herpes in the United States: Estimates From Insurance Claims.

Eppink, Samuel T / Kumar, Sagar / Miele, Kathryn / Chesson, Harrell W

Sexually transmitted diseases

2021 Volume 48, Issue 4, Page(s) 266–272

Abstract: Background: The purpose of this study was to estimate the lifetime direct medical costs per incident case of genital herpes in the United States.: Methods: We used medical claims data to construct a cohort of people continuously enrolled in insurance ...

Abstract	Background: The purpose of this study was to estimate the lifetime direct medical costs per incident case of genital herpes in the United States. Methods: We used medical claims data to construct a cohort of people continuously enrolled in insurance for at least 48 consecutive months between 2010 and 2018. From this cohort, we identified initial genital herpes diagnoses as well as the cost of related clinical visits and medication during the 36 months after an initial diagnosis. Lifetime costs beyond 36 months were estimated based on treatment use patterns observed in the 36 months of follow-up. Results: The present value of lifetime direct medical costs of genital herpes was estimated to be $972 per treated case or $165 per infection (2019 dollars), not including costs associated with prevention or treatment of neonatal herpes. The clinical visit at which genital herpes was first diagnosed accounted for 27% of lifetime costs. Subsequent clinical visits and medications related to genital herpes accounted for an additional 13% and 60% of lifetime costs, respectively. Conclusions: The results from this study can inform cost-effectiveness analysis of genital herpes control interventions as well as help quantify the cost burden of sexually transmitted infections in the United States.
MeSH term(s)	Cost-Benefit Analysis ; Female ; Health Care Costs ; Herpes Genitalis/drug therapy ; Herpes Genitalis/epidemiology ; Humans ; Infant, Newborn ; Insurance ; Pregnancy ; Pregnancy Complications, Infectious ; Sexually Transmitted Diseases ; United States/epidemiology
Language	English
Publishing date	2021-02-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	435191-5
ISSN	1537-4521 ; 0148-5717
ISSN (online)	1537-4521
ISSN	0148-5717
DOI	10.1097/OLQ.0000000000001371
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Article ; Online: The Postpartum Period: An Opportunity for Alcohol Screening and Counseling to Reduce Adverse Health Impacts.

Board, Amy / D'Angelo, Denise V / von Essen, Beatriz Salvesen / Denny, Clark H / Miele, Kathryn / Dunkley, Janae / Park, Youngjoo / Kim, Shin Y

Journal of addiction medicine

2023 Volume 17, Issue 5, Page(s) 528–535

Abstract: Objectives: The postpartum period presents an opportunity to engage in discussions about alcohol consumption and related health harms. This study examined the prevalence of alcohol consumption among a sample of postpartum persons with a recent live ... ...

Abstract	Objectives: The postpartum period presents an opportunity to engage in discussions about alcohol consumption and related health harms. This study examined the prevalence of alcohol consumption among a sample of postpartum persons with a recent live birth and screening and brief intervention (alcohol SBI) or counseling by their providers. Methods: We analyzed 2019 data from a telephone survey conducted 9 to 10 months postpartum among individuals who responded to the standard Pregnancy Risk Assessment Monitoring System survey in 6 states. Weighted prevalence estimates were calculated for alcohol consumption and alcohol SBI after birth through up to 10 months postpartum. Results: Among 1790 respondents, 53.1% reported consuming alcohol postpartum. Among those who drank postpartum, 70.8% reported being asked about alcohol use by a healthcare provider. Slightly more than half of respondents who drank postpartum and were trying to get pregnant (52.4%) or were not using birth control at the time of the survey (59.8%) reported being asked about alcohol use. Approximately 25% of respondents who drank alcohol postpartum were advised about risky alcohol levels by a healthcare provider. Small proportions of individuals who drank alcohol postpartum and were pregnant or trying to get pregnant at the time of the survey were advised to reduce or stop drinking alcohol (10.6% and 2.3%, respectively). Conclusions: These findings suggest missed opportunities to promote health and prevent adverse alcohol-related health outcomes during the postpartum period through evidence-based tools such as alcohol SBI.
MeSH term(s)	Pregnancy ; Female ; Humans ; Health Promotion ; Postpartum Period ; Alcohol Drinking/epidemiology ; Alcohol Drinking/prevention & control ; Risk Assessment ; Counseling
Language	English
Publishing date	2023-03-31
Publishing country	Netherlands
Document type	Journal Article ; Research Support, N.I.H., Intramural
ISSN	1935-3227
ISSN (online)	1935-3227
DOI	10.1097/ADM.0000000000001169
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Article ; Online: Notes from the Field: Undiagnosed Tuberculosis During Pregnancy Resulting in a Neonatal Death - United States, 2021.

Miele, Kathryn / Rock, R Bryan / LaCourse, Sylvia M / Ashkin, David / Armitige, Lisa Y / Pomputius, William / Goswami, Neela D

MMWR. Morbidity and mortality weekly report

2023 Volume 72, Issue 49, Page(s) 1331–1332

MeSH term(s)	Infant, Newborn ; Pregnancy ; Female ; Humans ; United States/epidemiology ; Perinatal Death ; Tuberculosis/diagnosis ; Tuberculosis/epidemiology
Language	English
Publishing date	2023-12-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	412775-4
ISSN	1545-861X ; 0149-2195
ISSN (online)	1545-861X
ISSN	0149-2195
DOI	10.15585/mmwr.mm7249a4
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Article ; Online: CDC's New Hepatitis C Virus Testing Recommendations for Perinatally Exposed Infants and Children: A Step Towards Hepatitis C Elimination.

Panagiotakopoulos, Lakshmi / Miele, Kathryn / Cartwright, Emily J / Kamili, Saleem / Furukawa, Nathan / Woodworth, Kate / Tong, Van T / Kim, Shin Y / Wester, Carolyn / Sandul, Amy L

Journal of women's health (2002)

2024

Abstract: New U.S. Centers for Disease Control and Prevention (CDC) guidelines for hepatitis C virus (HCV) testing of perinatally exposed infants and children released in 2023 recommend a nucleic acid test (NAT) for detection of HCV ribonucleic acid ( ...

Abstract	New U.S. Centers for Disease Control and Prevention (CDC) guidelines for hepatitis C virus (HCV) testing of perinatally exposed infants and children released in 2023 recommend a nucleic acid test (NAT) for detection of HCV ribonucleic acid (
Language	English
Publishing date	2024-03-13
Publishing country	United States
Document type	Journal Article
ZDB-ID	1139774-3
ISSN	1931-843X ; 1059-7115 ; 1540-9996
ISSN (online)	1931-843X
ISSN	1059-7115 ; 1540-9996
DOI	10.1089/jwh.2023.1114
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Article ; Online: Polysubstance use during pregnancy: The importance of screening, patient education, and integrating a harm reduction perspective.

Board, Amy / D'Angelo, Denise V / Salvesen von Essen, Beatriz / Denny, Clark H / Miele, Kathryn / Dunkley, Janae / Baillieu, Robert / Kim, Shin Y

Drug and alcohol dependence

2023 Volume 247, Page(s) 109872

Abstract: Background: Substance use during pregnancy is associated with poor health outcomes. This study assessed substance use, polysubstance use, and use of select prescription medications during pregnancy.: Methods: We analyzed 2019 data from the Pregnancy ... ...

Abstract	Background: Substance use during pregnancy is associated with poor health outcomes. This study assessed substance use, polysubstance use, and use of select prescription medications during pregnancy. Methods: We analyzed 2019 data from the Pregnancy Risk Assessment Monitoring System in 25 United States jurisdictions that included questions on prescription medications, tobacco, and illicit substance use during pregnancy. Alcohol and electronic cigarette use were assessed during the last three months of pregnancy, and all other substances and medications were assessed throughout pregnancy. Weighted prevalence estimates and 95% confidence intervals (CIs) were calculated. Results: Nearly one-fifth of respondents who reported use of any substance reported use of at least one other substance during pregnancy. Cigarettes (8.1%; 95% CI 7.6-8.7%) and alcohol (7.4%; 95% CI 6.7-8.1%) were the most frequently reported substances, followed by cannabis (4.3%; 95% CI 3.9-4.7%). Substance use was higher among individuals who reported having depression or using antidepressants during pregnancy compared with those who did not report depression or antidepressant use. Illicit drug use prevalence was low (0.5%, 95% CI 0.4-0.7%); however, respondents reporting heroin use also frequently reported use of illicit stimulants (amphetamines: 51.7%, 95% CI 32.1-71.3% or cocaine: 26.5%, 95% CI 11.9-41.1%). Although prenatal clinician screening for alcohol and cigarette use was approximately 95%, fewer respondents (82.1%) reported being screened for cannabis or illicit substance use during pregnancy. Conclusions: One in five individuals who reported use of any substance during pregnancy engaged in polysubstance use, highlighting the importance of comprehensive screening and evidence-based interventions including harm reduction.
MeSH term(s)	Female ; Pregnancy ; Humans ; United States/epidemiology ; Electronic Nicotine Delivery Systems ; Harm Reduction ; Patient Education as Topic ; Substance-Related Disorders/diagnosis ; Substance-Related Disorders/epidemiology ; Tobacco Products ; Cannabis
Language	English
Publishing date	2023-04-14
Publishing country	Ireland
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	519918-9
ISSN	1879-0046 ; 0376-8716
ISSN (online)	1879-0046
ISSN	0376-8716
DOI	10.1016/j.drugalcdep.2023.109872
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Article ; Online: Missed Opportunities for Prevention of Congenital Syphilis - United States, 2018.

Kimball, Anne / Torrone, Elizabeth / Miele, Kathryn / Bachmann, Laura / Thorpe, Phoebe / Weinstock, Hillard / Bowen, Virginia

MMWR. Morbidity and mortality weekly report

2020 Volume 69, Issue 22, Page(s) 661–665

Abstract: Congenital syphilis is an infection with Treponema pallidum in an infant or fetus, acquired during pregnancy from a mother with untreated or inadequately treated syphilis. Congenital syphilis can cause miscarriage, stillbirth, or early infant death, and ... ...

Abstract	Congenital syphilis is an infection with Treponema pallidum in an infant or fetus, acquired during pregnancy from a mother with untreated or inadequately treated syphilis. Congenital syphilis can cause miscarriage, stillbirth, or early infant death, and infected infants can experience lifelong physical and neurologic problems. Although timely identification and treatment of maternal syphilis during pregnancy can prevent congenital syphilis (1,2), the number of reported congenital syphilis cases in the United States increased 261% during 2013-2018, from 362 to 1,306. Among reported congenital syphilis cases during 2018, a total of 94 resulted in stillbirths or early infant deaths (3). Using 2018 national congenital syphilis surveillance data and a previously developed framework (4), CDC identified missed opportunities for congenital syphilis prevention. Nationally, the most commonly missed prevention opportunities were a lack of adequate maternal treatment despite the timely diagnosis of syphilis (30.7%) and a lack of timely prenatal care (28.2%), with variation by geographic region. Congenital syphilis prevention involves syphilis prevention for women and their partners and timely identification and treatment of pregnant women with syphilis. Preventing continued increases in congenital syphilis requires reducing barriers to family planning and prenatal care, ensuring syphilis screening at the first prenatal visit with rescreening at 28 weeks' gestation and at delivery, as indicated, and adequately treating pregnant women with syphilis (2). Congenital syphilis prevention strategies that implement tailored public health and health care interventions to address missed opportunities can have substantial public health impact.
MeSH term(s)	Early Diagnosis ; Female ; Health Services Research ; Humans ; Infant, Newborn ; Maternal Health Services/organization & administration ; Pregnancy ; Pregnancy Complications, Infectious/diagnosis ; Pregnancy Complications, Infectious/therapy ; Syphilis/diagnosis ; Syphilis/therapy ; Syphilis, Congenital/epidemiology ; Syphilis, Congenital/prevention & control ; Time-to-Treatment ; United States/epidemiology
Keywords	covid19
Language	English
Publishing date	2020-06-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	412775-4
ISSN	1545-861X ; 0149-2195
ISSN (online)	1545-861X
ISSN	0149-2195
DOI	10.15585/mmwr.mm6922a1
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Article ; Online: Understanding the Impact of Mpox on Sexual Health Clinical Services: A National Knowledge, Attitudes, and Practices Survey-United States, 2022.

Schubert, Sara L / Miele, Kathryn / Quilter, Laura A S / Agnew-Brune, Christine / Coor, Alexandra / Kachur, Rachel / Lewis, Felicia / Ard, Kevin L / Wendel, Karen / Anderson, Teri / Nagendra, Gowri / Tromble, Erin

Sexually transmitted diseases

2023 Volume 51, Issue 1, Page(s) 38–46

Abstract: Background: During the 2022 mpox outbreak, most cases were associated with sexual contact, and many people with mpox sought care from sexual health clinics and programs. The National Network of STD Clinical Prevention Training Centers, in partnership ... ...

Abstract	Background: During the 2022 mpox outbreak, most cases were associated with sexual contact, and many people with mpox sought care from sexual health clinics and programs. The National Network of STD Clinical Prevention Training Centers, in partnership with the Centers for Disease Control and Prevention, conducted a survey of US sexual health clinics and programs to assess knowledge, practices, and experiences around mpox to inform a future public health response. Methods: Between August 31 and September 13, 2022, the National Network of STD Clinical Prevention Training Centers facilitated a web-based survey. Descriptive statistics were generated in R. Results: Among 168 responses by clinicians (n = 131, 78%) and program staff (n = 37, 22%), more than half (51%) reported at least somewhat significant mpox-related clinical disruptions including burdensome paperwork requirements for mpox testing (40%) and tecovirimat use (88%). Long clinic visits (51%) added additional burden, and the median mpox-related visit lasted 1 hour. Few clinicians felt comfortable with advanced pain management, and clinicians felt most uninformed about preexposure (19%) and postexposure (24%) prophylaxis. Of 89 respondents involved in vaccination, 61% reported using equity strategies; however, accounts of these strategies revealed a focus on guideline or risk factor-based screenings instead of equity activities. Conclusions: These findings highlight the substantial impact of the 2022 mpox outbreak on sexual health care in the United States. Critical gaps and barriers were identified that may inform additional mpox training and technical assistance, including challenges with testing, diagnosis, and management as well as a disconnect between programs' stated goal of equity and operationalization of strategies to achieve equity.
MeSH term(s)	United States/epidemiology ; Humans ; Health Knowledge, Attitudes, Practice ; Mpox (monkeypox) ; Sexual Health ; Ambulatory Care ; Ambulatory Care Facilities
Language	English
Publishing date	2023-10-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	435191-5
ISSN	1537-4521 ; 0148-5717
ISSN (online)	1537-4521
ISSN	0148-5717
DOI	10.1097/OLQ.0000000000001882
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Article ; Online: Congenital Syphilis Diagnosed Beyond the Neonatal Period in the United States: 2014-2018.

Kimball, Anne / Bowen, Virginia B / Miele, Kathryn / Weinstock, Hillard / Thorpe, Phoebe / Bachmann, Laura / McDonald, Robert / Machefsky, Aliza / Torrone, Elizabeth

Pediatrics

2021 Volume 148, Issue 3

Abstract: Background and objectives: During 2014-2018, reported congenital syphilis (CS) cases in the United States increased 183%, from 462 to 1306 cases. We reviewed infants diagnosed with CS beyond the neonatal period (>28 days) during this time.: Methods: ... ...

Abstract	Background and objectives: During 2014-2018, reported congenital syphilis (CS) cases in the United States increased 183%, from 462 to 1306 cases. We reviewed infants diagnosed with CS beyond the neonatal period (>28 days) during this time. Methods: We reviewed surveillance case report data for infants with CS delivered during 2014-2018 and identified those diagnosed beyond the neonatal period with reported signs or symptoms. We describe these infants and identify possible missed opportunities for earlier diagnoses. Results: Of the 3834 reported cases of CS delivered during 2014-2018, we identified 67 symptomatic infants diagnosed beyond the neonatal period. Among those with reported findings, 67% had physical examination findings of CS, 69% had abnormal long-bone radiographs consistent with CS, and 36% had reactive syphilis testing in the cerebrospinal fluid. The median serum nontreponemal titer was 1:256 (range: 1:1-1:2048). The median age at diagnosis was 67 days (range: 29-249 days). Among the 66 mothers included, 83% had prenatal care, 26% had a syphilis diagnosis during pregnancy or at delivery, and 42% were not diagnosed with syphilis until after delivery. Additionally, 24% had an initial negative test result and seroconverted during pregnancy. Conclusions: Infants with CS continue to be undiagnosed at birth and present with symptoms after age 1 month. Pediatric providers can diagnose and treat infants with CS early by following guidelines, reviewing maternal records and confirming maternal syphilis status, advocating for maternal testing at delivery, and considering the diagnosis of CS, regardless of maternal history.
MeSH term(s)	Delayed Diagnosis/statistics & numerical data ; Female ; Humans ; Infant ; Infant, Newborn ; Infectious Disease Transmission, Vertical ; Pregnancy ; Pregnancy Complications, Infectious/microbiology ; Syphilis, Congenital/diagnosis ; Syphilis, Congenital/epidemiology ; Undiagnosed Diseases/epidemiology ; United States/epidemiology
Language	English
Publishing date	2021-05-18
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, P.H.S. ; Video-Audio Media
ZDB-ID	207677-9
ISSN	1098-4275 ; 0031-4005
ISSN (online)	1098-4275
ISSN	0031-4005
DOI	10.1542/peds.2020-049080
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Article ; Online: COVID-19 and family planning service delivery: Findings from a survey of U.S. physicians.

Zapata, Lauren B / Curtis, Kathryn M / Steiner, Riley J / Reeves, Jennifer A / Nguyen, Antoinette T / Miele, Kathryn / Whiteman, Maura K

Preventive medicine

2021 Volume 150, Page(s) 106664

Abstract: Equitable access to contraception is critical for reproductive autonomy. Using cross-sectional data from the DocStyles survey administered September-October 2020 (68% response rate), we compared changes in family planning-related clinical services and ... ...

Abstract	Equitable access to contraception is critical for reproductive autonomy. Using cross-sectional data from the DocStyles survey administered September-October 2020 (68% response rate), we compared changes in family planning-related clinical services and healthcare delivery strategies before and during the COVID-19 pandemic and assessed service provision issues among 1063 U.S. physicians whose practice provided family planning services just before the pandemic. About one-fifth of those whose practices provided the following services or strategies just before the pandemic discontinued these services during the pandemic: long-acting reversible contraception (LARC) placement (16%); LARC removal (17%); providing or prescribing emergency contraceptive pills (ECPs) in advance (18%); and reminding patients about contraception injections or LARC removal or replacement (20%). Many practices not providing the following services or strategies just before the pandemic initiated these services during the pandemic: telehealth for contraception initiation (43%); telehealth for contraception continuation (48%); and renewing contraception prescriptions without requiring an office visit (36%). While a smaller proportion of physicians reported service provision issues in the month before survey completion than at any point during the pandemic, about one-third still reported fewer adult females seeking care (37%) and technical challenges with telehealth (32%). Discontinuation of key family planning services during the COVID-19 pandemic may limit contraception access and impede reproductive autonomy. Implementing healthcare service delivery strategies that reduce the need for in-person visits (e.g., telehealth for contraception, providing or prescribing ECPs in advance) may decrease disruptions in care. Resources exist for public health and clinical efforts to ensure contraception access during the pandemic.
MeSH term(s)	Adult ; COVID-19 ; Contraception ; Cross-Sectional Studies ; Family Planning Services ; Female ; Health Services Accessibility ; Humans ; Pandemics ; Physicians ; SARS-CoV-2
Language	English
Publishing date	2021-06-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	184600-0
ISSN	1096-0260 ; 0091-7435
ISSN (online)	1096-0260
ISSN	0091-7435
DOI	10.1016/j.ypmed.2021.106664
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