Contemporary OB/GYN week in review: Breast cancer care, ondansetron use, and more

Thank you for visiting the Contemporary OB/GYN® website. Take a look at some of our top stories from last week (Monday, October 28 - Friday, November 1, 2024), and click each link to read and watch anything you may have missed.

Less guideline-concordant care reported among Black breast cancer patients

Non-Hispanic Black patients with early breast cancer experience increased risks of not receiving guideline-concordant care (GCC) and having less timely treatment initiation, according to a recent study published in JAMA Network Open.

When evaluating care within racial groups, GCC was not given to 18.1% of non-Hispanic Black patients and 15.2% of non-Hispanic White patients. This indicated an increased risk of not receiving GCC among non-Hispanic Black patients, with an odds ratio (OR) of 1.24. This remained in the adjusted model, with an adjusted OR of 1.13.

Death at last contact was reported in 20.7% of non-Hispanic Black patients and 17.4% of non-Hispanic White patients during the median 63.4-month follow-up period. Non-Hispanic Black had a significantly increased risk of mortality, with a hazard ratio of 1.26.

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Increasing ondansetron use reported against NVP in the United States

Ondansetron is the most common prescription antiemetic used to manage nausea and vomiting in pregnancy (NVP) among US patients, with an increase of use observed since 2006, according to a recent study published in JAMA Network Open.

Prescription monotherapy was reported in 1096 per 10,000 pregnancies, switching in 314 per 10,000 pregnancies, and combination therapy in 38 per 10,000 pregnancies. Ondansetron was the most common monotherapy, promethazine into ondansetron the most common switching, and promethazine-ondansetron the most common combination.

A link between ondansetron monotherapy and increased NPV severity was reported from 2005 to 2006. In 2007, patients using ondansetron monotherapy were more likely to have clinicians besides obstetrician-gynecologists, but this regimen was not linked to maternal NVP severity or other clinical characteristics.

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Understanding cardiovascular risk factors in women

In a recent interview with Contemporary OB/GYN, Martha Gulati, MD, professor of cardiology at Cedars Sinai, discussed the unique cardiovascular risks for women compared to men, emphasizing how sex-based differences impact these risks.

Gulati explained that while traditional risk factors for heart disease, such as diabetes and smoking, are common to both woman and men, they often affect women more severely. For instance, diabetes increases the risk of cardiovascular disease more in women than in men, and smoking causes greater vascular damage in women for the same number of cigarettes smoked.

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Preference for alternative contraceptive sources reported by many patients

Most patients using the pill, patch, or ring contraceptive prefer alternative sources to obtain their contraception, according to a recent study published in JAMA Network Open.

Of participants, 49.7% obtained their contraception from any preferred source and 39.8% through their primary preferred source. The most common method of obtaining contraception was in-person at the doctor’s office, clinic, or hospital with a rate of 73.8%.

Additional methods of obtaining contraception included by an online service in 9% asynchronous telehealth in 7.9%, synchronous telehealth in 5.2%, and prescribed by a pharmacist in 2.2%. SARC was used for pregnancy prevention by 84.2% of participants, menstrual regulation by 71.6%, and period pain alleviation by 46.2%.

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Prenatal cannabis use not linked to offspring ASD development

There is no link between maternal cannabis use in early pregnancy and autism spectrum disorder (ASD) in offspring, according to a recent study published in JAMA Network Open.

A positive screening for cannabis was identified in 4.7% of pregnancies, with a self-reported frequency of use of monthly or less reported in 1.1%, weekly in 0.5%, daily in 0.4%, and unknown in 2.7%. Prenatal substance use screening occurred at a median gestational age of 8 weeks.

A hazard ratio (HR) of 1.25 was reported for ASD risk in children of mothers with cannabis use during early pregnancy, indicating an increase in risk. However, this effect was mediated by adjustments for maternal sociodemographic characteristics. With an HR of 1.10, this indicated a non-statistically significant increase in risk.

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