Mary D. Nettleman

Michigan State University, Ист-Лансинг, Michigan, United States

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Publications (88)482.2 Total impact

  • Adejoke B Ayoola · Mary D Nettleman · Manfred Stommel
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    ABSTRACT: To examine the relationship between newborn outcomes and late prenatal care initiation after recognition of pregnancy. Secondary data analysis of the Pregnancy Risk Assessment and Monitoring System (PRAMS) data for the United States. Twenty-nine states. Women of childbearing age (135,623) who resided in 29 states in the PRAMS study who received prenatal care and had live births. Population-based survey from 2000 through 2004 that examined four newborn outcomes: prematurity, low birth weight (LBW), admission into Neonatal Intensive Care Unit (NICU), and infant mortality. The average time lag (difference between the time of pregnancy recognition and initiation of prenatal care) for the study was 3.2 weeks (99% CI [3.12, 3.21]). Women who recognized their pregnancies before 6 weeks had a longer lag time (3.5 weeks, 99% CI [3.43, 3.53]) than women who recognized their pregnancies later (2.1 weeks, 99% CI [1.96, 2.15]). After adjusting for confounders including the timing of pregnancy recognition, longer time lag was associated with reduced risks of prematurity (odds ratio [OR]=0.99, 99% Confidence Interval [CI] [0.97, 1.00], p<.01), LBW (OR=0.98, 99% CI [0.97, 0.99], p<.01) and NICU admission (OR=0.99, 99% CI [0.98, 1.00], p<.01) but not with infant mortality (OR=1.00, 99% CI [0.95, 1.05], p>.01). Average time lag from pregnancy recognition to prenatal care was not associated with poor newborn outcomes once results were adjusted for time of pregnancy recognition and other confounders.
    No preview · Article · Sep 2010 · Journal of Obstetric Gynecologic & Neonatal Nursing
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    Mary D Nettleman · Jennifer Brewer · Misty Stafford
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    ABSTRACT: The purpose of this study was to evaluate the office-based component of delayed entry into prenatal care. Phone numbers for all obstetrics offices in a single state were obtained from a commercial list. A research assistant who posed as a newly pregnant, fully insured woman asked each clinic when she should come in for her first prenatal visit. Information was provided by 239 of the 279 (86%) offices. The recommended appointment times ranged from immediately (4 weeks of gestation) to 10.6 weeks, which averaged 6.37 weeks. Twenty-five percent of clinics recommended a first appointment at >/=8 weeks. Scheduling calls were not a source of prenatal advice: <5% of clinics asked about smoking, alcohol, or medical condition; 88% of clinics did not mention vitamins. Office-based delays in scheduling the first prenatal visit occur in a substantial proportion of clinics, even for fully insured women. There is a need for a standard source of advice in early pregnancy.
    Preview · Article · Sep 2010 · American journal of obstetrics and gynecology
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    Adejoke B. Ayoola · Mary D. Nettleman · Manfred Stommel

    Full-text · Article · Sep 2010 · Journal of Obstetric Gynecologic & Neonatal Nursing
  • Adejoke B Ayoola · Mary D Nettleman · Manfred Stommel · Renee B Canady
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    ABSTRACT: A woman who does not recognize her pregnancy early may not initiate prenatal care early. This study examined the relationship between the time of pregnancy recognition and the time of initiation of prenatal care, and the number of prenatal visits among women of childbearing age. This study analyzed the Pregnancy Risk Assessment and Monitoring System (PRAMS) data for the United States. The analysis sample was representative of resident women of childbearing age in 29 U.S. states who had live births within 2 to 6 months before being contacted. The data were weighed to reflect the complex survey design of the PRAMS, and binary and multinomial logistic regressions were used for the analyses. Most (92.5%) of the 136,373 women in the study had recognized their pregnancy by 12 weeks of gestation, and 80 percent initiated prenatal care within the first trimester. Early pregnancy recognition was associated with significantly increased odds of initiating prenatal care early (OR = 6.05, p < 0.01), after controlling for sociodemographic and prior birth outcome data, and was also associated with lower odds of having fewer than the recommended number of prenatal visits and higher odds of having more than the recommended prenatal visits (OR: <11 visits = 0.71 and >15 visits = 1.17, p < 0.01). Early pregnancy recognition was associated with improved timing and number of prenatal care visits. Promotion of early pregnancy recognition could be a means of improving birth outcomes by encouraging and empowering women to access prenatal care at a critical point in fetal development.
    No preview · Article · Mar 2010 · Birth
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    Adejoke B Ayoola · Manfred Stommel · Mary D Nettleman
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    ABSTRACT: We examined the relationship between the time of recognition of pregnancy and birth outcomes, such as premature births, low birthweight (LBW), admission to the neonatal intensive care unit (NICU), and infant mortality. A secondary analysis was performed using the Pregnancy Risk Assessment and Monitoring System (PRAMS) multistate data from 2000-2004. The sample consisted of 136,373 women who had a live childbirth. Analysis involved multiple logistic regression models, appropriately weighted for point and variance estimation to reflect the complex survey design of the PRAMS using STATA 9.2 (Stata Corp, College Station, TX). Approximately 27.6% recognized their pregnancy late (after 6 weeks of gestation). Late recognition was significantly associated with an increased odds of having premature births (odds ratio [OR], 1.09; 99% confidence interval [CI], 1.01-1.19), LBW (OR, 1.08; 99% CI, 1.01-1.15), and NICU admissions (OR, 1.12; 99% CI, 1.03-1.21). These results provide a rationale and an impetus for developing interventions that promote early recognition of pregnancy.
    Full-text · Article · Sep 2009 · American journal of obstetrics and gynecology
  • Mary D Nettleman

    No preview · Article · Sep 2009 · The American journal of medicine
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    Kara Jacobs Slifka · Mary D Nettleman · Leslie Dybas · Gary E Stein

    Full-text · Article · Sep 2009 · Clinical Infectious Diseases
  • Mary D Nettleman · Adejoke B Ayoola · Jennifer R Brewer
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    ABSTRACT: We sought to determine whether a brief intervention increased home pregnancy test utilization among women at risk for unintended pregnancy. The intervention included education, consultation with a nurse, and the provision of a free home pregnancy test kit. Participants were 35 women aged 18-39 years from a Medicaid population who were having unprotected intercourse and who were not trying to conceive. The women received education on pregnancy testing and the importance of early recognition of pregnancy. All women received a free home pregnancy test kit. The main outcome measures were pregnancy test use and appropriateness of use. During the 3-month follow-up period, 62% of participants used the home pregnancy test kit, which was approximately 3 times higher than the self-reported testing rate before the study (p < .001). The most common reason for use was a late period (median 5 days late when test was done). Women also purchased additional kits to confirm the initial test result (median 2 kits per episode of use). The intervention increased utilization of home pregnancy test kits among women at risk of unintended pregnancy. All study participants used the test appropriately. These results can serve as a framework for interventions to improve early pregnancy recognition.
    No preview · Article · Jul 2009 · Women s Health Issues
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    Mary D Nettleman · Jennifer Brewer · Adejoke Ayoola
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    ABSTRACT: To reduce unintended pregnancy, it is necessary to understand why women have unprotected intercourse when they do not desire pregnancy. We devised a survey of 42 potential reasons why women have unprotected intercourse based on the responses of a focus group we had previously convened. We administered the survey to women between the ages of 18 and 39 years who were visiting primary care clinics and were not trying to get pregnant. Of the 151 respondents, 84 (56%) were having unprotected intercourse. Women gave an average of 9 reasons for having unprotected intercourse. The most common reasons fell into 3 categories: lack of thought/preparation (87% of respondents), being in a long-term or strong relationship (70%), and concerns about side effects of contraception (80%). Eighty-three of the 84 women (99%) chose at least 1 of these categories. Basing survey questions on focus group responses provided important insights into the reasons women risk unintended pregnancy. A deeper understanding of this issue is critical to reducing unintended pregnancy.
    Full-text · Article · May 2009 · The Journal of family practice
  • Mary D Nettleman · Jennifer R Brewer · Adejoke B Ayoola
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    ABSTRACT: The timing of pregnancy recognition affects early pregnancy and the timing of prenatal care. Little research has been done on how to make women at risk more alert to the possibility of pregnancy. The study was an RCT performed and analyzed between 2006 and 2007. Participants were low-income, adult women who were having unprotected intercourse and were not actively trying to conceive. Women in the intervention group received a free home-pregnancy test kit and were able to order more kits as needed. Six-month follow-up information was obtained. The main outcome measures were suspicion and testing for pregnancy. Ninety-one percent of the 198 participants completed the study. Women in the intervention group suspected pregnancy 2.3 times during the 6-month period compared to 1.2 times for women in the control group (p<0.0001). Women in the intervention group tested for pregnancy 93% of the time when they suspected pregnancy. Women in the control group tested for pregnancy only 64% of the time when they suspected pregnancy (p<0.0001). Women who were having unprotected intercourse were more likely to suspect and test for pregnancy if they were supplied with a free home-pregnancy test kit.
    No preview · Article · Feb 2009 · American journal of preventive medicine
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    ABSTRACT: Risk drinking, especially binge drinking, and unprotected sex may co-occur in college women and increase the risks of STI exposure and pregnancy, but the relationships among these behaviors are incompletely understood. A survey was administered to 2012 women of ages 18-24 enrolled in a public urban university. One-quarter of the college women (23%) drank eight or more drinks per week on average, and 63% binged in the past 90 days, with 64% meeting criteria for risk drinking. Nearly all sexually active women used some form of contraception (94%), but 18% used their method ineffectively and were potentially at risk for pregnancy. Forty-four percent were potentially at risk for STIs due to ineffective or absent condom usage. Ineffective contraception odds were increased by the use of barrier methods of contraception, reliance on a partner's decision to use contraception, and risk drinking, but were decreased by the use of barrier with hormonal contraception, being White, and later age to initiate contraception. In contrast, ineffective condom use was increased by reliance on a partner's decision to use condoms, the use of condoms for STI prevention only, and by risk drinking. Thirteen percent of university women were risk drinkers and using ineffective contraception, and 31% were risk drinkers and failing to use condoms consistently. Risk drinking is related to ineffective contraception and condom use. Colleges should promote effective contraception and condom use for STI prevention and consider coordinating their programs to reduce drinking with programs for reproductive health. Emphasizing the use of condoms for both pregnancy prevention and STI prevention may maximize women's interest in using them.
    Full-text · Article · Oct 2008 · Psychology and Health
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    Full-text · Article · Nov 2007 · Contraception
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    ABSTRACT: This study was conducted to identify reasons why women had unprotected intercourse that led to an unintended pregnancy. As part of the Pregnancy Risk Assessment Monitoring System (PRAMS) survey, women with a recent unintended viable pregnancy were asked after the birth why they had not used birth control. Of 7856 respondents, 33% felt they could not get pregnant at the time of conception, 30% did not really mind if they got pregnant, 22% stated their partner did not want to use contraception, 16% cited side effects, 10% felt they or their partner were sterile, 10% cited access problems and 18% selected "other." Latent class analysis showed seven patterns of response, each identifying strongly with a single reason. Almost half of women with viable unintended pregnancies ending in a birth felt they could not/would not get pregnant at the time of conception. Most women identified with a single reason for having unprotected intercourse.
    No preview · Article · Jun 2007 · Contraception
  • Adejoke B Ayoola · Mary Nettleman · Jennifer Brewer
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    ABSTRACT: Despite the increased availability of contraception, unprotected intercourse and unintended pregnancy are common among adult women. We sought to identify reasons why adult women at risk of unintended pregnancy have unprotected intercourse. A comprehensive search of electronic databases of MEDLINE, CINAHL, and PSYCHOINFO, from 1995 to 2005, was conducted. Reference lists from relevant published papers and reviews related to contraceptive practices and pregnancy intendedness were also hand searched. The Bronfenbrenner ecological framework was used as a guide in the discussion of the findings. There were 16 studies that met inclusion criteria, and these provided numerous reasons why adult women had unprotected intercourse. Reasons were found at the individual, interpersonal, and societal levels. Individual reasons included concerns with contraceptive side effects, a low perceived risk for pregnancy, lack of knowledge, and attitudes and beliefs. Interpersonal reasons included partners, families, or friends who discouraged the use of contraception. Societal reasons included access problems, inconvenience, and cost. There are multiple reasons why women have unprotected intercourse. These reasons were located in overlapping domains of influence. Factors in a woman's environment at the interpersonal and societal level may significantly influence her contraceptive use behavior.
    No preview · Article · May 2007 · Journal of Women's Health
  • Mary Nettleman · Barbara L Schuster

    No preview · Article · Mar 2007 · The American journal of medicine
  • Mary Nettleman · Jennifer Brewer · Adejoke Ayoola
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    ABSTRACT: Despite the focus on adolescents, most unintended pregnancies occur in adults. The objective of this study was to identify reasons why adult women have unprotected intercourse when they do not desire pregnancy. We held 4 focus groups to explore reasons for unprotected intercourse. Participants were adult women aged 18 to 39 who were unmarried, fertile, not currently pregnant, not desiring pregnancy, and who had recently had intercourse without using effective contraception. Sessions were audiotaped and transcripts were analyzed thematically. Women gave 146 reasons for unprotected intercourse. Four major categories emerged: method-related, user-related, partner-related, and cost/access-related reasons. The reasons for unprotected intercourse were numerous, but could be organized into a logical framework. The results suggest that multidimensional interventions may be needed to effectively reduce the rate of unintended pregnancy.
    No preview · Article · Mar 2007 · Journal of midwifery & women's health
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    ABSTRACT: Prenatal alcohol exposure is a leading preventable cause of birth defects and developmental disabilities in the United States. A randomized controlled trial (2002-2005; data analyzed 2005-2006) of a brief motivational intervention to reduce the risk of an alcohol-exposed pregnancy (AEP) in preconceptional women by focusing on both risk drinking and ineffective contraception use. A total of 830 nonpregnant women, aged 18-44 years, and currently at risk for an AEP were recruited in six diverse settings in Florida, Texas, and Virginia. Combined settings had higher proportions of women at risk for AEP (12.5% overall) than in the general population (2%). Participants were randomized to receive information plus a brief motivational intervention (n=416) or to receive information only (n=414). The brief motivational intervention consisted of four counseling sessions and one contraception consultation and services visit. Women consuming more than five drinks on any day or more than eight drinks per week on average, were considered risk drinkers; women who had intercourse without effective contraception were considered at risk of pregnancy. Reversing either or both risk conditions resulted in reduced risk of an AEP. Across the follow-up period, the odds ratios (ORs) of being at reduced risk for AEP were twofold greater in the intervention group: 3 months, 2.31 (95% confidence interval [CI]=1.69-3.20); 6 months, 2.15 (CI=1.52-3.06); 9 months, 2.11 (CI=1.47-3.03). Between-groups differences by time phase were 18.0%, 17.0%, and 14. 8%, respectively. A brief motivational intervention can reduce the risk of an AEP.
    Full-text · Article · Feb 2007 · American Journal of Preventive Medicine
  • Adejoke B Ayoola · Jennifer Brewer · Mary Nettleman
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    ABSTRACT: Despite recent declines, the United States continues to have higher rates of adolescent pregnancy, birth, and abortion than other industrialized countries. Over a million pregnancies occur each year in adolescents in the United States. Many factors contribute to the sexual risk behaviors among adolescents. These include characteristics of the adolescents themselves, including age at sexual initiation, and contraceptive use; and influence of peers, partners, families, and the community Effective interventions to encourage responsible sexual behaviors among adolescents need to provide clear and consistent information and advice on safe and responsible sexual behavior, and to promote life skill-building among adolescents.
    No preview · Article · Jul 2006 · Primary Care Clinics in Office Practice
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    ABSTRACT: To evaluate demographic and behavioural characteristics of sexually active women compared to those who had abstained from intercourse in the past 6 months. The study participants were women of childbearing age from six sites in three states in the USA. Survey questions were asked of women who were not surgically sterile and who had not gone through menopause. The main outcome measures were correlates of sexual abstinence. Of the 1801 respondents, 244 (14%) reported abstaining from intercourse in the past 6 months. Univariate analysis revealed that abstinent women were less likely than sexually active women to have used illicit drugs [odds ratio (OR) 0.47; 95% CI 0.35-0.63], to have been physically abused (OR 0.44, 95% CI 0.31-0.64), to be current smokers (OR 0.59, 95% CI 0.45-0.78), to drink above risk thresholds (OR 0.66, 95% CI 0.49-0.90), to have high Mental Health Inventory-5 scores (OR 0.7, 95% CI 0.54-0.92) and to have health insurance (OR 0.74, 95% CI 0.56-0.98). Abstinent women were more likely to be aged over 30 years (OR 1.98, 95% CI 1.51-2.61) and to have a high school education (OR 1.38, 95% CI 1.01-1.89). Logistic regression showed that age >30 years, absence of illicit drug use, absence of physical abuse and lack of health insurance were independently associated with sexual abstinence. Prolonged sexual abstinence was not uncommon among adult women. Periodic, voluntary sexual abstinence was associated with positive health behaviours, implying that abstinence was not a random event. Future studies should address whether abstinence has a causal role in promoting healthy behaviours or whether women with a healthy lifestyle are more likely to choose abstinence.
    Full-text · Article · Jan 2006 · Journal of Family Planning and Reproductive Health Care
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    Atul A Khasnis · Mary D Nettleman
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    ABSTRACT: Global warming has serious implications for all aspects of human life, including infectious diseases. The effect of global warming depends on the complex interaction between the human host population and the causative infectious agent. From the human standpoint, changes in the environment may trigger human migration, causing disease patterns to shift. Crop failures and famine may reduce host resistance to infections. Disease transmission may be enhanced through the scarcity and contamination of potable water sources. Importantly, significant economic and political stresses may damage the existing public health infrastructure, leaving mankind poorly prepared for unexpected epidemics. Global warming will certainly affect the abundance and distribution of disease vectors. Altitudes that are currently too cool to sustain vectors will become more conducive to them. Some vector populations may expand into new geographic areas, whereas others may disappear. Malaria, dengue, plague, and viruses causing encephalitic syndromes are among the many vector-borne diseases likely to be affected. Some models suggest that vector-borne diseases will become more common as the earth warms, although caution is needed in interpreting these predictions. Clearly, global warming will cause changes in the epidemiology of infectious diseases. The ability of mankind to react or adapt is dependent upon the magnitude and speed of the change. The outcome will also depend on our ability to recognize epidemics early, to contain them effectively, to provide appropriate treatment, and to commit resources to prevention and research.
    Preview · Article · Nov 2005 · Archives of Medical Research

Publication Stats

2k Citations
482.20 Total Impact Points


  • 2003-2010
    • Michigan State University
      • • Department of Medicine
      • • Department of Internal Medicine
      Ист-Лансинг, Michigan, United States
  • 1996-2007
    • Virginia Commonwealth University
      • • Department of Internal Medicine
      • • School of Medicine
      Richmond, Virginia, United States
  • 1990-1994
    • University of Iowa Children's Hospital
      Iowa City, Iowa, United States
  • 1991
    • University of Barcelona
      Barcino, Catalonia, Spain