Cervical cytology in vulnerable pregnant women.
OBJECTIVE
To identify the prevalence of abnormal Papanicolau (Pap) smears in pregnancy in a vulnerable urban family practice, determine the percentage of abnormal Pap smears that persist into the postpartum period, and identify associated risk factors.


METHODS
A retrospective chart review of all prenatal patients (N = 192) from a large urban family practice in upstate New York from 2000 to 2004. Descriptive statistic analysis was performed on demographic information, risk factors for abnormal Pap smears, and disposition of the patients.


CONCLUSIONS
This study provides information on the risk factors associated with abnormal Pap smears in pregnancy in a population at high risk. A significant relationship was seen between a positive marijuana toxicology screen and an abnormal Pap smear. In addition, the younger the patient age, the higher the probability of having a positive toxicology result. As expected, human papillomavirus (HPV) was the only sexually transmitted infection associated with an abnormal Pap smear in those that had reflex testing with liquid based cytology. Patients with primary care providers were much more likely to return for cervical cancer screening within 1 year of previous testing.


CONCLUSIONS
There are many barriers to screening and prevention for cervical cancer in vulnerable populations. Newer technologies with HPV testing have helped to identify those women at highest risk for cervical cancer. Implementing strategies among healthcare providers to avoid missed opportunities for screening, assessment and education of risk factors, and offering vaccination against HPV are needed. Empowering women may begin to reduce disparities through the development of educational programs that reduce cultural and linguistic barriers to screening and awareness that socioeconomic factors may be impediments to care and adherence.
University at Buffalo, Kimball Tower Room 805, 3435 Main Street, Buffalo, NY 14214-3079, USA. dmloomis@buffalo.edu
Dianne M
DM
Loomis
Patricia A
PA
Pastore
Karol
K
Rejman
Karen L
KL
Gutierrez
Bridget
B
Bethea
D000293:Adolescent; D000328:Adult; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008403:Mass Screening; D009518:New York / Q000453:epidemiology; D009722:Nurse Practitioners; D065006:Papanicolaou Test; D030361:Papillomavirus Infections / Q000150:complications / Q000453:epidemiology; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D018566:Pregnancy, High-Risk; D011295:Prenatal Care; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014504:Urban Health / Q000706:statistics & numerical data; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D014626:Vaginal Smears / Q000706:statistics & numerical data; D035862:Vulnerable Populations / Q000706:statistics & numerical data*; D055815:Young Adult