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  • March 02, 2017 11:23 AM | Deleted user

    Immunization Resources for Providers

    The resources below will assist midwives in providing immunizations to their clients:

    Get a professionally printed version of this poster for your office or clinic through ShopACNM for just the cost of shipping. CLICK HERE for more information. 


    ACNM Resources

    ACNM Talking Points

    ACNM Signs on to Influenza and Pregnancy Dear Colleague Letter

    Letter to Providers from ACNM President

    ACNM Position Statements

    Resources for Ordering and Administering Vaccines

    American Academy of Pediatrics Report on Immunizing Close Family Contacts in the Office Setting

    Share with Women from the Journal of Midwifery & Women's Health

    "Be a SuperMom" Materials

    Developed by ACNM through a grant from ASTHO and the CDC, these downloadable resources feature colorful superhero characters and succinct information on the benefits of immunizations to engage your clients.


    Download 18x24-inch Be a SuperMom full color poster, in English and Spanish (Order a printed version from ShopACNM by clicking HERE)

    Download 18x24-inch Be a SuperMom full color poster, in Arabic

    Download 11x17-inch Be a SuperMom full color poster, in English and Spanish 

    Download 11x17-inch Be a SuperMom full color poster, in Arabic


    Questions Women Have About Vaccines—Overview

    Understanding Vaccines During Pregnancy

    Frequently Asked Questions about the Whooping Cough (Pertussis) Vaccine 

    Frequently Asked Questions about the Flu Vaccine

    Measles, Mumps, and Rubella (MMR) Get the Facts!

    Get the Facts on HPV!

    Be a SuperMom Coloring Pages—You can download a PDF with 8 pages of Superhero-themed illustrations featuring the benefits of vaccinations to share with your young artist. [ENGLISH VERSION] | [SPANISH VERSION]

    Curriculum on Immunization for midwifery students and other health care professionals

    ACNM created an evidence based curriculum that is free, measured with a pre- and post-test, and a passing score of 80. The curriculum can be found by clicking here.

    CDC Resources

    ACOG Resources

    Additional Spanish-Language Resources

    Additional Resources

    National Medical Association Immunization Resources for African Americans

    Immunization Action Coalition (IAC) - a non-profit organization with a vast array of materials to help health providers with vaccines

    Patient Brochure on Influenza: This pamphlet was created by Pamela Meharry, PhD, CNM, University of Connecticut, and Marietta Vázquez, MD, Yale University, and is available for public use in English and Spanish.

    Global Child Health and Vaccine Safety - an issue brief from the American Academy of Pediatrics

    Association of American Indian Physicians Waiting room videos free for download -

    National Hispanic Medical Association Toolkit on Adult vaccines -

    National Medical Association Immunization Toolkit -

    Understanding Vaccinations -

  • February 28, 2017 9:15 AM | Deleted user
    Pelvic inflammatory disease often caused by sexually transmitted infections, CDC experts say

    Friday, February 3, 2017

    HealthDay news image

    FRIDAY, Feb. 3, 2017 (HealthDay News) -- About 2.5 million American women have had pelvic inflammatory disease, an often-symptomless infection of the reproductive tract that can cause infertility and lasting abdominal pain, a new U.S. government report shows.

    Scientists also found that those who had 10 or more male sex partners experienced pelvic inflammatory disease three times as often as women with a single partner.

    The culprits in most cases of pelvic inflammatory disease, or PID, are the sexually transmitted diseases (STDs) chlamydia and gonorrhea, researchers said. Overall, about 4.4 percent of American women said they'd been diagnosed with PID.

    Pelvic inflammatory disease tends to be a later "complication of having a prior sexually transmitted infection, and given that there are such high numbers of chlamydia and gonorrhea infections in the U.S., it means a lot of women are at risk," said study author Kristen Kreisel. She's an epidemiologist with the Division of STD Prevention at the U.S. Centers for Disease Control and Prevention.

    "Pelvic inflammatory disease can be treated, as well as the STD that caused it, but the structural damage that occurs because of PID is often irreversible," Kreisel said. "That's why it's important to stay on top of it."

    Chlamydia and gonorrhea are the most commonly reported STDs in the United States. About 1.5 million chlamydia and 400,000 gonorrhea infections were reported in 2015. These infections often don't cause symptoms and may go undiagnosed and untreated, according to the study.

    When symptoms do appear, they may include abnormal vaginal discharge or a burning sensation during urination.

    Pelvic inflammatory disease symptoms may include persistent abdominal pain, fever, abnormal vaginal discharge, or pain or bleeding during sexual intercourse, Kreisel said.

    PID poses long-term hazards such as infertility, chronic pelvic pain and ectopic pregnancy. Ectopic pregnancies occur when an embryo implants in the fallopian tube instead of the uterus.

    No single test can diagnose PID, so doctors often rely on symptom reporting. But PID often doesn't cause symptoms, Kreisel explained. "That's one of the scariest things because you may not know it's even happening," she said.

    The researchers used information from the U.S. National Health and Nutrition Examination Survey from 2013 to 2014. This survey included nearly 1,200 women between the ages of 18 and 44.

    The study didn't find any significant differences in PID prevalence by age, race, ethnicity or socioeconomic factors.

    Pelvic inflammatory disease prevalence, however, was significantly higher among women whose sexual behaviors placed them at greater risk for contracting STDs. These behaviors included having sex with multiple partners and not using condoms.

    Dr. Matthew Hoffman is chair of obstetrics and gynecology at Christiana Care Health System in Wilmington, Del.

    Hoffman said that, in addition to using condoms, progesterone-containing birth control pills or intrauterine devices (IUDs) can also help reduce the risk of developing pelvic inflammatory disease. He wasn't involved in the study.

    Hoffman explained that progesterone-containing birth control pills or IUDs can help thicken cervical mucus, hindering bacteria from moving further into the reproductive tract.

    Kreisel and Hoffman agreed that sexually active women under age 25 should be screened annually for STDs. That process usually involves a vaginal swab or a urine test. Treatment for gonorrhea and chlamydia typically includes antibiotics.

    "There's some data that if symptoms are treated early, it may result in better fertility outcomes," Hoffman added.

    The study findings was published Jan. 27 in the CDC's Morbidity and Mortality Weekly Report.

    SOURCES: Kristen Kreisel, Ph.D., epidemiologist, Division of STD Prevention, U.S. Centers for Disease Control and Prevention, Atlanta; Matthew Hoffman, M.D., M.P.H., Marie E. Pinizzotto, M.D., Endowed Chair of Obstetrics and Gynecology, Christiana Care Health System, Wilmington, Del.; Jan. 27, 2017, Morbidity and Mortality Weekly Report


    Copyright (c) 2017 HealthDay. All rights reserved.

    News stories are written and provided by HealthDay and do not reflect federal policy, the views of MedlinePlus, the National Library of Medicine, the National Institutes of Health, or the U.S. Department of Health and Human Services.

  • February 28, 2017 9:14 AM | Deleted user

    Benefit was greatest in women who were obese and achieved a normal weight, study suggests

    By Robert Preidt

    Monday, February 6, 2017

    HealthDay news image

    THURSDAY, Feb. 2, 2017 (HealthDay News) -- Weight loss may lower older women's risk of cancer of the endometrium, the lining of the uterus, a new study suggests.

    "Many older adults think it's too late to benefit from weight loss, or think that because they are overweight or obese, the damage has already been done. But our findings show that's not true," study author Juhua Luo said a news release from the American Society of Clinical Oncology (ASCO).

    "It's never too late, and even moderate weight loss can make a big difference when it comes to cancer risk," Luo added. She's an associate professor of epidemiology and biostatistics at Indiana University Bloomington's School of Public Health.

    Endometrial cancer is the most common gynecologic cancer and the fourth most common cancer among women in the United States, the researchers said. More than 75 percent of endometrial cancers occur in women aged 55 and older.

    The researchers reviewed data from more than 35,000 American women between the ages of 50 and 79. The study included an average of more than 10 years of follow-up.

    Though the study didn't prove cause and effect, losing weight was associated with a significantly lower risk of endometrial cancer, and that benefit was greatest in obese women, the researchers said.

    Women over 50 who lost 5 percent or more of their body weight had a 29 percent lower risk of endometrial cancer, regardless of their age or how much weight they lost, according to the researchers.

    Obese women who lost 5 percent or more of their body weight had a 56 percent reduction in their risk. Overweight or obese women who achieved a normal body mass index (BMI -- an estimate of body fat based on weight and height) had the same risk as women who maintained a normal BMI, the study authors said.

    The researchers also found that women who gained more than 10 pounds had a 26 percent increased risk of endometrial cancer.

    The study was published online Feb. 6 in the Journal of Clinical Oncology.

    "There have been more than a thousand studies linking obesity to an increased risk of endometrial and other cancers, but almost none that look at the relationship between weight loss and cancer risk," said Dr. Jennifer Ligibel, an ASCO expert in cancer prevention.

    "This study tells us that weight loss, even later in life, is linked to a lower risk of endometrial cancer. The findings also support the development of weight loss programs as part of a cancer prevention strategy in overweight and obese adults," she said.

    SOURCE: Journal of Clinical Oncology, news release, Feb. 6, 2017


    Copyright (c) 2017 HealthDay. All rights reserved.

    News stories are written and provided by HealthDay and do not reflect federal policy, the views of MedlinePlus, the National Library of Medicine, the National Institutes of Health, or the U.S. Department of Health and Human Services.

  • February 28, 2017 9:13 AM | Deleted user


    A daily low dose of aspirin may help a subgroup of women, those who have previously lost a pregnancy, to successfully conceive and carry a pregnancy to term, according to an analysis by researchers at the National Institutes of Health. The women who benefited from the aspirin treatment had high levels of C-reactive protein (CRP), a substance in the blood indicating system-wide inflammation, which aspirin is thought to counteract. The study appears in the Journal of Clinical Endocrinology and Metabolism.

    Researchers at NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) analyzed data originally obtained from the Effects of Aspirin in Gestation and Reproduction (EAGeR) trial. The trial sought to determine if daily low-dose aspirin could prevent subsequent pregnancy loss among women who had one or two prior losses.

    For the current study, researchers classified the women into 3 groups: low CRP (below .70 mg per liter of blood), mid CRP (from .70 to 1.95) and high CRP (at or above 1.95). Women within each group received either daily low-dose aspirin or a placebo. In their analysis, researchers found no significant differences in birth rates between those receiving aspirin and those receiving placebo in both the low CRP and mid CRP groups. For the high CRP group, those taking the placebo had the lowest rate of live birth at 44 percent, while those taking daily aspirin had a live-birth rate of 59 percent — a 35-percent increase. Aspirin also appeared to reduce CRP levels in the high CRP group when measured during weeks 8, 20, and 36 of pregnancy. 

    The authors concluded that more research is needed to confirm the findings and to examine the potential influence of inflammation in becoming pregnant and maintaining pregnancy.


    Lindsey A. Sjaarda, Ph.D., staff scientist in the NICHD Division of Intramural and Population Health Research, is available for interviews.

    To arrange an interview, call Robert Bock or Meredith Daly at 301-496-5133 or e-mail sends e-mail).

    About the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD): NICHD conducts and supports research in the United States and throughout the world on fetal, infant and child development; maternal, child and family health; reproductive biology and population issues; and medical rehabilitation. For more information, visit NICHD’s website.

    About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit

    NIH…Turning Discovery Into Health®


    Sjaarda LA, et al. Preconception low-dose aspirin restores diminished pregnancy and live birth rates in women with low grade inflammation: a secondary analysis of a randomized trial(link is external). Journal of Clinical Endocrinology and Metabolism.  DOI: is external)


    On February 7, 2017, the headline was revised to more accurately reflect the study’s finding that aspirin improved pregnancy and live birth rates in women with high levels of C-reactive protein.

  • February 28, 2017 9:12 AM | Deleted user

    Cervical cancer is a disease in which malignant (cancer) cells form in the tissues of the cervix. Most cases are caused by long-lasting infections with certain types of human papillomavirus (HPV). These infections lead to genetic changes that raise the risk for cervical cancer. Different types of HPV can cause different genetic changes, which vary in their association with cancer risk. HPV vaccination before sexual activity can reduce the risk of HPV infection and thus cervical cancer. If found and treated in its early stages, cervical cancer can usually be cured, but new therapeutic approaches are needed.

    To gain new insights into cervical cancer, researchers with The Cancer Genome Atlas (TCGA) Research Network analyzed the genomes of 178 primary cervical cancers. The study was supported by NIH’s National Cancer Institute (NCI) and National Human Genome Research Institute (NHGRI). Results appeared on January 23, 2017, in Nature.

    The scientists identified 3 general clusters of cervical cancer based on the presence of different HPV and other genomic features. The team found that more than 70% of the tumors had genomic alterations in either one or both of the PI3K/MAPK and TGF-beta signaling pathways. These might thus serve as future targets for potential therapies. Two genes that code for known immunotherapy targets were amplified within many tumors: CD274 and PDCD1LG2. This insight may lead to ways to predict whether a tumor will respond to immunotherapy.

    The researchers associated several previously unidentified genetic mutations with cervical cancer, including MED1ERBB3CASP8HLA-A, and TGFBR2. These may serve as potential therapeutic targets. Several tumors showed aberrations involving the BCAR4 gene, which has been tied to estrogen-resistant breast cancer. Lapatinib, an oral drug that inhibits a key pathway in breast cancer, might be effective against cervical cancers with this alteration.

    A unique set of 8 cervical cancers showed molecular similarities to endometrial cancers. These endometrial-like cancers were mainly HPV-negative, and they all had high frequencies of mutations in the KRASARID1A, and PTEN genes. The findings provide potential therapeutic targets for these types of cervical cancers.

    “Most women who will develop cervical cancer in the next couple of decades are already beyond the recommended age for vaccination and will not be protected by the vaccine,” explains NCI Acting Director Dr. Douglas Lowy. “Therefore, cervical cancer is still a disease in need of effective therapies, and this latest TCGA analysis could help advance efforts to find drugs that target important elements of cervical cancer genomes in addition to the HPV genes.”

    References: Integrated genomic and molecular characterization of cervical cancer. Cancer Genome Atlas Research Network. Nature. 2017 Jan 23. doi: 10.1038/nature21386. [Epub ahead of print]. PMID: 28112728.

    Funding: National Cancer Institute (NCI); National Human Genome Research Institute (NHGRI)

  • February 28, 2017 9:10 AM | Deleted user

    Study participants were fitter, felt better -- and were less bothered by hot flashes

    Thursday, February 16, 2017

    HealthDay news image

    THURSDAY, Feb. 16, 2017 (HealthDay News) -- After menopause, moderate exercise can help women manage hot flashes, become more fit and feel better, a new study suggests.

    Researchers found that a 20-week exercise program helped women boost their fitness levels, lose a little weight and give higher ratings to their physical and mental well-being.

    That included a reduction in hot flashes and night sweats -- two of the most bothersome symptoms of menopause.

    Researchers led by Debora Godoy-Izquierdo, of the University of Grenada in Spain, reported the findings online Feb. 15 in the journal Menopause.

    The study offers good news to women who want alternatives to hormones for managing menopause symptoms, according to Dr. JoAnn Pinkerton, executive director of the North American Menopause Society.

    Hot flashes and night sweats are the most common reasons that women seek treatment for menopause symptoms, said Pinkerton, who was not involved in the study.

    For some, she said, the problems are severe enough to warrant hormone therapy. But most women can find relief in other ways.

    "Exercise, stress reduction and adequate sleep are very important for women who are becoming menopausal," Pinkerton said. "For a majority of women, lifestyle changes may be enough to get the hot flashes to be less bothersome, as well as help prevent the weight gain and mood changes common during this time."

    For the new study, the researchers recruited 234 women who were at least one year past menopause. Overall, 166 women were sedentary, and half of them were assigned to stick with their usual lifestyle, while the other half started the 20-week exercise program.

    The rest of the women were already physically active, and they served as a second comparison group.

    The exercise program consisted of three one-hour workouts per week. Each session was supervised and involved moderate aerobic exercise, like fast walking, along with strength training.

    The women in this program also received psychological counseling, aimed at helping them with "self-regulation" and behavior changes.

    After 20 weeks, the study found, women in the exercise program had lost a small amount of weight, on average. But the bigger changes were seen in their fitness levels, blood pressure and "health-related quality of life."

    In general, the women gave higher ratings to their physical and mental health, and said they were less bothered by hot flashes and other menopause symptoms.

    Those benefits were still apparent at the one-year mark. At that point, the researchers said, the women looked more like the group that had been active all along, rather than those who'd remained sedentary.

    There was one exception: After initially losing a little weight, women in the program typically went back to their starting weight.

    But regardless of weight, improvements in fitness levels are critical, according to Dr. Chip Lavie, medical director of cardiac rehabilitation and prevention at the John Ochsner Heart and Vascular Institute in New Orleans.

    "Improving fitness is one of the most important things that any person, including a postmenopausal woman, can do to reduce their mortality and mortality from cardiovascular disease," said Lavie, who was not involved in the study.

    In this study, the women's fitness levels were gauged by, among other things, their resting heart rate and how fast they could walk 1 kilometer.

    Those measures reflect how well the heart and blood vessels are working. But, Lavie said, studies have tied fitness to other health benefits, too -- including improvements in stress and depression symptoms.

    "And only small improvements in fitness are needed to induce these benefits," Lavie said.

    As for why exercise might help with hot flashes, Pinkerton pointed to a couple reasons.

    Exercise, she said, is thought to boost levels of certain brain chemicals, such as dopamine and serotonin -- which are important for mood, sleep and other functions. And those chemicals are sometimes lower during the hormonal fluctuations that come with menopause.

    And one study, Pinkerton said, found that women who exercised were better able to "regulate their body heat."

    The program in this study did involve psychological and behavioral counseling -- which may also have helped the women manage their menopause symptoms, according to Pinkerton.

    But that does not necessarily mean women need such a comprehensive program.

    Other research, Pinkerton said, has found that simpler exercise routines can help women manage hot flashes. It took only 30 minutes of any aerobic exercise -- like walking, jogging, bicycling or swimming -- three or more times per week, she noted.

    SOURCES: JoAnn Pinkerton, M.D., executive director, North American Menopause Society, and professor, obstetrics and gynecology, University of Virginia Health System, Charlottesville; Chip Lavie, M.D., medical director, cardiac rehabilitation and prevention, and director, exercise laboratories, John Ochsner Heart and Vascular Institute, New Orleans; Feb. 15, 2017, Menopause, online


    Copyright (c) 2017 HealthDay. All rights reserved.

    News stories are written and provided by HealthDay and do not reflect federal policy, the views of MedlinePlus, the National Library of Medicine, the National Institutes of Health, or the U.S. Department of Health and Human Services.

  • February 28, 2017 9:09 AM | Deleted user

    Prevalence of Pelvic Inflammatory Disease in Sexually Experienced Women of Reproductive Age — United States, 2013–2014

    Pelvic inflammatory disease (PID) is a clinical syndrome of the female reproductive tract characterized by inflammation of the endometrium, fallopian tubes, or peritoneum. CDC assessed the burden of self-reported PID in a nationally representative sample using data from the National Health and Nutrition Examination Survey (NHANES) 2013–2014 cycle.

  • February 23, 2017 9:45 AM | Deleted user
    • by Molly Walker 
      Staff Writer, MedPage 

    Overall fertility rates and reproductive rates have fallen among U.S. women from 1990 to 2014, despite a 10-year spike from the mid-1990s to the mid-2000s, said CDC researchers.

    The total fertility rate, which measures the potential impact of current fertility patterns on reproduction or completed family size, declined approximately 10% from 2,081.0 births per a hypothetical cohort of 1,000 women in 1990 to 1,862.5 per 1,000 in 2014, reported Brady E. Hamilton, PhD, and Sharon E. Kirmeyer, PhD [deceased], of the CDC Division of Vital Statistics.

    These rates declined 5% from 1990 to 1997, with a 8% spike from 1997 to 2007, before falling 12% from 2007 to 2014 -- with a less than 1% increase from 2013 to 2014.

    Writing in National Vital Statistics Reports, the authors said that from 1990 to 2014, the total fertility rate was "below replacement level" -- which is defined as the level that a given generation can exactly replace itself -- in every year except 2006 and 2007. It is defined as 2,100 births per 1,000 women.

    Total fertility rates and gross reproduction rates fell among all races and Hispanic subgroups during the examined time period with the exception of Cuban American women, they noted.

    The total gross reproduction rate (defined as the average number of daughters per 1,000 births, assuming none of them were to die) also exhibited a 10% decline -- dropping from 1,015 per 1,000 in 1990 to 909 per 1,000 births in 2014. The authors noted that the gross reproduction rate closely parallels the total fertility rate because of the "narrow variability of female births relative to male births."

    With a decline in birth rates comes a decline in population. If the intrinsic rate of natural increase, or the rate of change of population size resulting from the continuance of age-specific birth and mortality rates over a given year of time, is negative, that indicates a population decline. The rate in 2014 was -3.7 per 1,000. In fact, the authors noted that the rate has been negative every year from 1990 to 2014, except for 2006 and 2007.

    This was also the first time that the report examined reproduction and intrinsic rates by race and Hispanic origin of the mother for non-Hispanic white, non-Hispanic black, and Hispanic groups, said the authors.

    These trends varied by demographic groups. Total fertility rates for Hispanic women exceeded replacement every year during the examined time period, but rates for non-Hispanic and Asian/Pacific Islander women were "consistently below replacement" during that time.

    But the largest declines in gross reproduction rate from 1990 to 2014 were seen among American Indian/Alaska Native women (-41%), Hispanic women (-28%), and non-Hispanic black women (-26%). By contrast, the gross reproduction rate among non-Hispanic white women fell 5% during that time. The net reproduction rate (which incorporates mortality rates into the estimates) saw similar, albeit slightly smaller declines among these groups.

    The authors noted that the difference between gross reproduction rate and the net reproduction rate has "diminished considerably over the year, reflecting the decline in age-specific mortality rates of women in childbearing years."

  • February 22, 2017 7:53 AM | Deleted user

    The awards process is the single most important means that APAOG has for recognizing PAs who have made significant contributions in women's health. Awards can be nominated at any time throughout the course of the year, but will be presented at the APAOG Reception at the AAPA National Conference (more information to come). 

    2017 Awards - Nominations due March 15, 2017!

    View the 2017 Awards Grid for full award details.

    • Preceptor Award

    • Outstanding PA in Women's Health Award
    • Student Award

    Questions concerning the awards process should be submitted to

  • February 22, 2017 7:27 AM | Deleted user

    Thank you to all that attended last night's webinar!

    Opiate Use Disorder and Women's Health
    Presented on February 21, 2017
    Presented by Cresta Jones, MD

    View webinar recording and handouts here

    Special thank you to our speaker, Cresta Jones, MD, from the Medical College of Wisconsin. 

    Plan to join us for our next webinar on June 20, 2017. 

    June 20, 2017
    Topic: Menopause: Where are we now?
    Speaker: Elyse Watkins, DHSc, PA-C
    7 PM CT/8 PM ET/5 PM PT

    Presentation Objectives:

    • Describe the Women’s Health Initiative study and its subsequent effect on exogenous hormone utilization during menopause.
    • Discuss the current evidence-based guidelines on hormone therapy for menopausal women.
    • Differentiate the various treatment options currently available for vasomotor symptoms and vulvovaginal atrophy due to menopause.
    • Describe the risks and benefits of hormone therapy during menopause. 

    Register Today!

    This program has been reviewed and is approved for a maximum of 1.00 AAPA Category 1 CME credits by the PA Review Panel. PAs should claim only the credit commensurate with the extent of their participation in the activity. 

    This program was planned in accordance with AAPA's CME Standards for Live Programs and for Commercial Support of Live Programs. 

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