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ObjectivesTo evaluate the association between preconception contraceptive use and miscarriage. DesignProspective cohort study. SettingResidents of the United States of America or Canada, recruited from 2013 until the end of 2022. Participants13 460 female identified participants aged 21-45 years who were planning a pregnancy were included, of whom 8899 conceived. Participants reported data for contraceptive history, early pregnancy, miscarriage, and potential confounders during preconception and pregnancy. Main outcome measureMiscarriage, defined as pregnancy loss before 20 weeks of gestation. ResultsPreconception use of combined and progestin-only oral contraceptives, hormonal intrauterine devices, copper intrauterine devices, rings, implants, or natural methods was not associated with miscarriage compared with use of barrier methods. Participants who most recently used patch (incidence rate ratios 1.34 (95% confidence interval 0.81 to 2.21)) or injectable contraceptives (1.44 (0.99 to 2.12)) had higher rates of miscarriage compared with recent users of barrier methods, although results were imprecise due to the small numbers of participants who used patch and injectable contraceptives. ConclusionsUse of most contraceptives before conception was not appreciably associated with miscarriage rate. Individuals who used patch and injectable contraceptives had higher rates of miscarriage relative to users of barrier methods, although these results were imprecise and residual confounding was possible.
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Physical activity and heat stress shape water needs in pregnant endurance athletes
Abstract Background and objectivesPregnancy, heat stress, and physical activity (PA) are all known to independently increase human water requirements. We hypothesize that climate conditions and behavioral strategies interact to shape water needs in highly active pregnancies. MethodologyWe recruited 20 female endurance runners who were pregnant (8–16 weeks gestational age; n = 13) or planning to be pregnant (n = 7) for an observational, prospective cohort study. At three timepoints in the study (preconception, 8–16 weeks, and 32–35 weeks), we measured water turnover (WT) using the deuterium dilution and elimination technique, PA using ActiGraph wGT3X-BT accelerometers, and heat index (HI) using historical temperature and humidity data. We also compared athletes to nonathletes from a previously published study. ResultsAthletes maintained high WT from preconception through the end of pregnancy. PA was positively associated with WT among athletes for preconception and early pregnancy time periods but not for the third trimester. HI weakly moderated the relationship between PA and WT in predicting a more positive slope in hotter and more humid weather conditions. WT in athletes was higher than in nonathletes, but this difference attenuated during the third trimester, as nonathletes increased their WT. Conclusions and implicationsAthletes experience higher WT with greater levels of PA, and this relationship is somewhat stronger in higher HI conditions. With the threat of climate change expected to exacerbate extreme heat conditions, evidence-based, global policies are required for particularly vulnerable populations.
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- Award ID(s):
- 2316583
- PAR ID:
- 10575225
- Publisher / Repository:
- Oxford University Press
- Date Published:
- Journal Name:
- Evolution, Medicine, and Public Health
- Volume:
- 13
- Issue:
- 1
- ISSN:
- 2050-6201
- Format(s):
- Medium: X Size: p. 25-34
- Size(s):
- p. 25-34
- Sponsoring Org:
- National Science Foundation
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