Thereisgrowinginterestinthepossiblehealththreatposedbyendocrine-disruptingchemicals (EDCs), which are substances in our environment, food, and consumer products that interfere with hormone biosynthesis, metabolism, or action resulting in a deviation from normal homeostatic control or reproduction. In this first Scientific Statement of The Endocrine Society, we present the evidence that endocrine disruptors have effects on male and female reproduction, breast development and cancer, prostate cancer, neuroendocrinology, thyroid, metabolism and obesity, and cardiovascular endocrinology. Results from animal models, human clinical observations, and epidemiological studies converge to implicate EDCs as a significant concern to public health. The mechanisms of EDCs involve divergent pathways including (but not limited to) estrogenic, antiandrogenic, thyroid, peroxisome proliferator-activated receptor , retinoid, and actions through other nuclear receptors; steroidogenic enzymes; neurotransmitter receptors and systems; and many other pathways that are highly conserved in wildlife and humans, and which can be modeled in laboratory in vitro and in vivo models. Furthermore, EDCs represent a broad class of molecules such as organochlorinated pesticides and industrial chemicals, plastics and plasticizers, fuels, and many other chemicals that are present in the environment or are in widespread use. We make a number of recommendations to increase understanding of effects of EDCs, including enhancing increased basic and clinical research, invoking the precautionary principle, and advocating involvement of individual and scientific society stakeholders in communicating and implementing changes in public policy and awareness. (Endocrine Reviews 30: 293–342, 2009)

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Endocrine-Disrupting Chemicals: An Endocrine Society Scientific Statement

Background: Thyroid disease in pregnancy is a common clinical problem. Since the guidelines for the management of these disorders by the American Thyroid Association (ATA) were first published in 2...

https://www.thyca.org/download/document/486/PregnancyandPostpartum.pdf

2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum

Centers for Disease Control and Prevention (CDC) : Advisory Committee on Immunization Practices (ACIP) : Quadrivalent human papillomavirus vaccine : recommendations of the Advisory Committee on Immunization Practices (ACIP)

CONTEXT: Many pregnancies are unintended, particularly in certain population groups. Determining whether unintended pregnancy rates and disparities in rates between subgroups are changing may help policymakers target reproductive health services to those women most in need.

METHODS: To calculate rates of unintended pregnancy and related outcomes, data on pregnancy intendedness from the 2002 National Survey of Family Growth were combined with birth, abortion and population data from federal, state and nongovernmental sources.

RESULTS: In 2001, 49% of pregnancies in the United States were unintended. The unintended pregnancy rate was 51 per 1,000 women aged 15–44, meaning that 5% of this group had an unintended pregnancy. This level was unchanged from 1994. The rate of unintended pregnancy in 2001 was substantially above average among women aged 18–24, unmarried (particularly cohabiting) women, low-income women, women who had not completed high school and minority women. Between 1994 and 2001, the rate of unintended pregnancy declined among adolescents, college graduates and the wealthiest women, but increased among poor and less educated women. The abortion rate and the proportion of unintended pregnancies ending in abortion among all women declined, while the unintended birth rate increased. Forty-eight percent of unintended conceptions in 2001 occurred during a month when contraceptives were used, compared with 51% in 1994.

CONCLUSIONS: More research is needed to determine the factors underlying the disparities in unintended pregnancy rates by income and other characteristics. The findings may reflect a need for increased and more effective contraceptive use, particularly among high-risk groups.

Disparities in rates of unintended pregnancy in the United States, 1994 and 2001.

This survey of sexual practices in the United States has been combed by the media for items of interest to the public: monogamous sex is much more widespread in this country than has been thought; infidelity is less frequent than presumed; vaginal intercourse is the defining experience of heterosexual behavior; watching one's partner undress is stimulating to many people; married couples have more sex than single people (unmarried, cohabiting couples have the most sex of all); the majority of couples experience sex twice a week to several times a month; 2.8% of men identify themselves as homosexual and 1.4% of women do so, but a higher percentage of people consider a same-gender experience to have some appeal; 75% of men always experience orgasm compared with 28.6% of women, but more nearly equal numbers of men and women declare themselves satisfied with their sexual experiences. The book is, in fact, a

The Social Organization of Sexuality: Sexual Practices in the United States

OBJECTIVE This report presents national estimates of fertility, family planning, and reproductive health indicators among females 15-44 years of age in the United States in 2002 from Cycle 6 of the National Survey of Family Growth (NSFG). For selected indicators, data are also compared with earlier cycles of the NSFG. METHODS Descriptive tables of numbers and percentages are presented and interpreted. Data were collected through in-person interviews of the household population 15-44 years of age in the United States between March 2002 and March 2003. The sample included 7,643 females and 4,928 males, and this report focuses on data from the female sample. The overall response rate for the Cycle 6 NSFG was 79 percent, and the response rate for women was 80 percent. RESULTS Given the range of topics covered in the report, only selected findings are listed here. About 14 percent of recent births to women 15-44 years of age in 2002 were unwanted at time of conception, an increase from the 9 percent seen for recent births in 1995. Among recent births, 64 percent occurred within marriage, 14 percent within cohabiting unions, and 21 percent to women who were neither married nor cohabiting. The overall rate of breastfeeding initiation among recent births increased from 55 to 67 percent between 1995 and 2002. About 50 percent of women 15-44 had ever cohabited compared with 41 percent of women in the 1995 survey; the percentage of women currently cohabiting also increased, from 7 to 9 percent between 1995 and 2002.

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Fertility, family planning, and reproductive health of U.S. Women: Data from the 2002 national survey of family growth

This report presents data on wide range of topics from the 1995 National Survey of Family Growth including: pregnancy and birth marriage divorce cohabitation sexual intercourse contraception infertility use of family planning and other conditions and behavior. The data reported are based on in-person interviews with a national sample of 10847 women 15-44 years of age. The interviews lasted an average of 103 minutes. The response rate was 79% and the sample data are adjusted for nonresponse and are national estimates. Following large increases in the 1970s and 1980s the proportion of teenagers who have ever had sexual intercourse decreased slightly between 1990 and 1995; condom use both at first intercourse and currently has increased markedly since the 1970s. These changes may have contributed to the decrease in teen birth rate observed in the 1990s. For all women 15-44 years of age the number whose partner was currently using the condom (at the date of the interview) increased from 3.6 million in 1982 to 5.1 million in 1988 and to 7.9 million in 1995. About 8% of women reported that their first intercourse was not voluntary. This result is consistent with an earlier national survey. Furthermore about 20% reported that they have been forced by a man to have intercourse at some time in their lives. About 10% of births in 1990-95 were unwanted by the mother compared with 12% in 1984-88. The decrease of unwanted birth was particularly high for Black women.

Fertility, family planning, and women's health: new data from the 1995 National Survey of Family Growth.

OBJECTIVE: This report presents national estimates of contraceptive use and method choice based on the 1982, 1995, 2002, and 2006-2008 National Surveys of Family Growth (NSFG). METHODS: Data for 2006-2008 were collected through in-person interviews with 13,495 men and women 15-44 years of age in the household population of the United States. This report is based on the sample of 7,356 women interviewed in 2006-2008. The response rate for women in the 2006-2008 survey was about 76%. RESULTS: More than 99% of women 15-44 years of age who have ever had sexual intercourse with a male (referred to as "sexually experienced women") have used at least one contraceptive method. The percentage of women who have ever used emergency contraception, the contraceptive patch, and the contraceptive ring increased between 2002 and 2006-2008. Looking at contraceptive use in the month of interview, or current use, the leading method of contraception in the United States during 2006-2008 was the oral contraceptive pill, used by 10.7 million women; the second leading method was female sterilization, used by 10.3 million women. While contraceptive use is virtually universal in the United States, women with different characteristics make different choices of methods--for example, college educated women are much more likely to use the pill and less likely to use female sterilization than less educated women. Age, parity, marital status, and income are also closely related to the choice of method. These method choices are related to the risk of unintended pregnancy in these groups.

Use of contraception in the United States: 1982-2008.

Objective—This report presents national estimates of contraceptive use and method choice based on the 1982, 1995, and 2002 National Surveys of Family Growth (NSFG). It also presents data on where women obtained family planning and medical services, and some of the services that they received. Methods—Data were collected through in-person interviews with 12,571 men and women 15–44 years of age in the civilian noninstitutional population of the United States in 2002. This report is based on the sample of 7,643 women interviewed in 2002. The response rate for women in the study was about 80 percent. Results—The leading method of contraception in the United States in 2002 was the oral contraceptive pill, used by 11.6 million women; the second leading method was female sterilization, used by 10.3 million women. The condom was the third-leading method, used by about 9 million women and their partners. The condom is the leading method at first intercourse; the pill is the leading method among women under 30; and female sterilization is the leading method among women 35 and older. More than 98 percent of women 15–44 years of age who have ever had sexual intercourse with a male (referred to as ‘‘sexually experienced women’’) have used at least one contraceptive method. Over the 20 years from 1982 to 2002, the percent who had ever had a partner who used the male condom increased from 52 to 90 percent. The proportion who had ever had a partner who used withdrawal increased from 25 percent in 1982 to 56 percent in 2002. Another important measure of contraceptive use is use at the first premarital intercourse: before 1980, only 43 percent of women (or their partner) used a method of birth control at their first premarital intercourse. By 1999–2002, the proportion using a method at first premarital intercourse had risen to 79 percent.

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Use of contraception and use of family planning services in the United States: 1982-2002.

OBJECTIVE: This report presents national estimates of sexual activity, contraceptive use, and births among males and females 15-19 years of age in the United States in 2002 from the National Survey of Family Growth (NSFG). Data are also presented from the 1988 and 1995 NSFGs, and from the 1988 and 1995 National Survey of Adolescent Males (NSAM). METHODS: Descriptive tables of numbers and percents are presented and interpreted. Data were collected through in-person interviews of the civilian noninstitutionalized population in the United States. Interviews were conducted with 7,643 females, 1,150 of whom were teenagers, and 4,928 males, 1,121 of whom were teenagers. RESULTS: In 2002, about 47 percent of female teenagers (4.6 million), and about 46 percent of male teenagers (4.7 million) had had sexual intercourse at least once. For never-married males, there was a significant decline from 55 percent in 1995 to 46 percent in 2002. Among never-married females, for those aged 15-17 there was a significant decline in the percent sexually experienced, and for those aged 18-19 there was no significant change. Teenagers showed increases in the use of contraceptives. About 3 out of 4 teens used a method of contraception at their first intercourse. About 91 percent of males and 83 percent of females used a method at their last (most recent) sex. Hispanic teens are most likely to have a birth before age 20 and non-Hispanic whites are least likely, with non-Hispanic black teens in the middle. CONCLUSION: This report documents findings that may be helpful in understanding trends in teen birth and pregnancy, and STD rates.

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William D. Mosher

Papers

Fertility, family planning, and reproductive health of U.S. Women: Data from the 2002 national survey of family growth

Fertility, family planning, and women's health: new data from the 1995 National Survey of Family Growth.

Use of contraception in the United States: 1982-2008.

Use of contraception and use of family planning services in the United States: 1982-2002.

Teenagers in the United States: sexual activity, contraceptive use, and childbearing, 2002