Pub Date : 2026-01-01Epub Date: 2026-01-19DOI: 10.1097/01.ogx.0001179556.80297.a5
Jamie O Lo, Chelsea K Ayers, Snehapriya Yeddala, Beth Shaw, Shannon Robalino, Rachel Ward, Devan Kansagara
Over the last 20 years, rates of cannabis use among pregnant people have increased significantly, making cannabis the most commonly used illegal substance in the antenatal period. THC, the active ingredient in cannabis, crosses the placental barrier and binds to endocannabinoid receptors on fetal organs. However, because definitive data on the risks of prenatal cannabis use remain limited, many clinicians do not counsel patients on this topic. This study provides an updated assessment of the association between prenatal cannabis use and pregnancy, fetal, and neonatal outcomes, adjusting for tobacco use and other confounders. The authors updated their previous systematic review and meta-analysis to include cohort or case-control studies published between November 2021 and April 2024 in MEDLINE, CINAHI, PsycInfo, Global Health, and the Cochrane Database of Systematic Reviews. Studies were included if they compared cannabis use versus no or less use during pregnancy and adjusted for confounders. Two independent researchers assessed each study for eligibility, risk of bias, and certainty-of-evidence ratings. Primary outcomes were preterm birth (PTB), small for gestational age (SGA), low birth weight (LBW), and perinatal morbidity. The results were analyzed to determine effect sizes and adjusted odds ratios, incorporating frequency of cannabis use when possible. Fifty-one publications were included, 8 of which were new additions since the prior analysis, yielding a total sample of 21,146,938 patients. Among the 20 studies evaluating LBW (N=1,763,753), cannabis use was associated with higher odds of LBW (OR, 1.75; 95% CI, 1.41-2.18). In 5 studies reporting dosage, heavy users had an even greater risk (OR, 2.36; 95% CI, 1.50-3.7). Twenty studies evaluated PTB (N=20,938,125), showing increased risk among cannabis users (OR, 1.52; 95% CI, 1.26-1.83), with a stronger association among heavy users (OR, 1.95; 95% CI, 1.40-2.73). Six studies assessed perinatal mortality (N=16,868,920), finding elevated odds among users (OR, 1.29; 95% CI, 1.07-1.55), though this association was not significant in analyses restricted to heavy use, leading to a low certainty-of-evidence rating. Four studies evaluated SGA (N=4,520,474) and reported increased odds among cannabis users (OR, 1.57; 95% CI, 1.36-1.81), with similar findings in heavy-use analyses (OR, 1.63; 95% CI, 1.35-1.96). Overall, the findings suggest with moderate certainty that prenatal cannabis use increases the risk of LBW, PTB, and SGA, and with low certainty that it increases perinatal mortality. The addition of recent studies expanded the sample size and supported a dose-dependent association, strengthening confidence in the results. The strengths of the review include its clinically relevant outcomes, strict exclusion criteria, and adjustment for key confounders such as tobacco. The limitations included heterogeneity between studies and gaps in collected data.
{"title":"Prenatal Cannabis Use and Neonatal Outcomes: A Systematic Review and Meta-Analysis.","authors":"Jamie O Lo, Chelsea K Ayers, Snehapriya Yeddala, Beth Shaw, Shannon Robalino, Rachel Ward, Devan Kansagara","doi":"10.1097/01.ogx.0001179556.80297.a5","DOIUrl":"https://doi.org/10.1097/01.ogx.0001179556.80297.a5","url":null,"abstract":"<p><p>Over the last 20 years, rates of cannabis use among pregnant people have increased significantly, making cannabis the most commonly used illegal substance in the antenatal period. THC, the active ingredient in cannabis, crosses the placental barrier and binds to endocannabinoid receptors on fetal organs. However, because definitive data on the risks of prenatal cannabis use remain limited, many clinicians do not counsel patients on this topic. This study provides an updated assessment of the association between prenatal cannabis use and pregnancy, fetal, and neonatal outcomes, adjusting for tobacco use and other confounders. The authors updated their previous systematic review and meta-analysis to include cohort or case-control studies published between November 2021 and April 2024 in MEDLINE, CINAHI, PsycInfo, Global Health, and the Cochrane Database of Systematic Reviews. Studies were included if they compared cannabis use versus no or less use during pregnancy and adjusted for confounders. Two independent researchers assessed each study for eligibility, risk of bias, and certainty-of-evidence ratings. Primary outcomes were preterm birth (PTB), small for gestational age (SGA), low birth weight (LBW), and perinatal morbidity. The results were analyzed to determine effect sizes and adjusted odds ratios, incorporating frequency of cannabis use when possible. Fifty-one publications were included, 8 of which were new additions since the prior analysis, yielding a total sample of 21,146,938 patients. Among the 20 studies evaluating LBW (N=1,763,753), cannabis use was associated with higher odds of LBW (OR, 1.75; 95% CI, 1.41-2.18). In 5 studies reporting dosage, heavy users had an even greater risk (OR, 2.36; 95% CI, 1.50-3.7). Twenty studies evaluated PTB (N=20,938,125), showing increased risk among cannabis users (OR, 1.52; 95% CI, 1.26-1.83), with a stronger association among heavy users (OR, 1.95; 95% CI, 1.40-2.73). Six studies assessed perinatal mortality (N=16,868,920), finding elevated odds among users (OR, 1.29; 95% CI, 1.07-1.55), though this association was not significant in analyses restricted to heavy use, leading to a low certainty-of-evidence rating. Four studies evaluated SGA (N=4,520,474) and reported increased odds among cannabis users (OR, 1.57; 95% CI, 1.36-1.81), with similar findings in heavy-use analyses (OR, 1.63; 95% CI, 1.35-1.96). Overall, the findings suggest with moderate certainty that prenatal cannabis use increases the risk of LBW, PTB, and SGA, and with low certainty that it increases perinatal mortality. The addition of recent studies expanded the sample size and supported a dose-dependent association, strengthening confidence in the results. The strengths of the review include its clinically relevant outcomes, strict exclusion criteria, and adjustment for key confounders such as tobacco. The limitations included heterogeneity between studies and gaps in collected data.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"81 1","pages":"9-10"},"PeriodicalIF":3.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146011437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2026-01-19DOI: 10.1097/01.ogx.0001179564.81631.80
Katherine C Bergus, Brenna Rachwal, Lindsey Asti, Lesley L Breech, Yuan Y Gong, S Paige Hertweck, Holly R Hoefgen, Anne H Horne, Ashli Lawson, Seema Menon, Kathleen E O'Brien, Shashwati Pradhan, Yolanda R Smith, Priya Suvarna, Sarah Van Son, Geri Hewitt
<p><p>Endometriosis affects an estimated 25% to 75% of adolescent patients with chronic pelvic pain; the diagnosis is made surgically and treatment typically consists of hormone suppression and pain management strategies. The methods to address symptoms can vary from hormonal contraceptives, levonorgestrel-releasing intrauterine systems, and gonadotropin-releasing hormone therapy to nonhormonal medications for pain, pelvic floor physical therapy, and psychological support. Previous studies of endometriosis in adolescent patients have mainly been case series or single-institution studies, and there is little evidence surrounding preoperative management. This study was designed to characterize demographics and preoperative management of patients who underwent laparoscopy and were diagnosed with pathologically confirmed endometriosis. This was a multi-institutional retrospective cohort study. The inclusion criteria were patients under the age of 22, who had undergone laparoscopic surgical biopsy and had a diagnosis of endometriosis based on pathologic findings between January 1, 2011, and December 31, 2021. A total of 305 patients were included in this descriptive study, with a median age of 15.6 years at the time of first presentation to a pediatric and adolescent gynecology (PAG) clinic. The median age at first menstruation was 12 years, and a large proportion of patients had a family history of endometriosis (45.3%), many of these in first-degree relatives (68.1%). In terms of medical history, the median number of providers seen before presentation to PAG was 1, and these providers ranged from primary care physicians and adolescent medicine specialists to adult gynecologists, gastroenterologists, and physical therapists. Abnormalities in menstrual cycle patterns were uncommon, with only 15% reporting frequent cycles and 11% reporting infrequent cycles. Heavy bleeding was reported in 50.8% of cases, and 50.5% of individuals reported cramping before bleeding, with 58.2% reporting severe pain during menstruation. Progressive dysmenorrhea was reported in 76.7% of cases. More than half of patients missed school or activities due to dysmenorrhea, and many reported other symptoms, including nausea/vomiting, diarrhea, appetite changes, and headaches. The management before surgery consisted of several approaches, with many patients trying one or more methods before surgical diagnosis. These included hormonal menstrual suppression (70.8%), including combined hormonal contraception, medroxyprogesterone acetate injection, progestin-only oral medication, hormonal intrauterine devices, contraceptive implants, and gonadotropin-releasing hormone analogs. Comorbidities in this patient population included psychiatric (mood or anxiety) disorders and neurologic, gastrointestinal, and musculoskeletal comorbidities, with most patients reporting at least one (73.4%). Physical examination in this cohort primarily showed a presentation of pelvic pain or bilateral lower q
{"title":"Characteristics and Preoperative Management of Adolescent Patients With Pathology-Confirmed Endometriosis: A Multi-Institutional Study.","authors":"Katherine C Bergus, Brenna Rachwal, Lindsey Asti, Lesley L Breech, Yuan Y Gong, S Paige Hertweck, Holly R Hoefgen, Anne H Horne, Ashli Lawson, Seema Menon, Kathleen E O'Brien, Shashwati Pradhan, Yolanda R Smith, Priya Suvarna, Sarah Van Son, Geri Hewitt","doi":"10.1097/01.ogx.0001179564.81631.80","DOIUrl":"10.1097/01.ogx.0001179564.81631.80","url":null,"abstract":"<p><p>Endometriosis affects an estimated 25% to 75% of adolescent patients with chronic pelvic pain; the diagnosis is made surgically and treatment typically consists of hormone suppression and pain management strategies. The methods to address symptoms can vary from hormonal contraceptives, levonorgestrel-releasing intrauterine systems, and gonadotropin-releasing hormone therapy to nonhormonal medications for pain, pelvic floor physical therapy, and psychological support. Previous studies of endometriosis in adolescent patients have mainly been case series or single-institution studies, and there is little evidence surrounding preoperative management. This study was designed to characterize demographics and preoperative management of patients who underwent laparoscopy and were diagnosed with pathologically confirmed endometriosis. This was a multi-institutional retrospective cohort study. The inclusion criteria were patients under the age of 22, who had undergone laparoscopic surgical biopsy and had a diagnosis of endometriosis based on pathologic findings between January 1, 2011, and December 31, 2021. A total of 305 patients were included in this descriptive study, with a median age of 15.6 years at the time of first presentation to a pediatric and adolescent gynecology (PAG) clinic. The median age at first menstruation was 12 years, and a large proportion of patients had a family history of endometriosis (45.3%), many of these in first-degree relatives (68.1%). In terms of medical history, the median number of providers seen before presentation to PAG was 1, and these providers ranged from primary care physicians and adolescent medicine specialists to adult gynecologists, gastroenterologists, and physical therapists. Abnormalities in menstrual cycle patterns were uncommon, with only 15% reporting frequent cycles and 11% reporting infrequent cycles. Heavy bleeding was reported in 50.8% of cases, and 50.5% of individuals reported cramping before bleeding, with 58.2% reporting severe pain during menstruation. Progressive dysmenorrhea was reported in 76.7% of cases. More than half of patients missed school or activities due to dysmenorrhea, and many reported other symptoms, including nausea/vomiting, diarrhea, appetite changes, and headaches. The management before surgery consisted of several approaches, with many patients trying one or more methods before surgical diagnosis. These included hormonal menstrual suppression (70.8%), including combined hormonal contraception, medroxyprogesterone acetate injection, progestin-only oral medication, hormonal intrauterine devices, contraceptive implants, and gonadotropin-releasing hormone analogs. Comorbidities in this patient population included psychiatric (mood or anxiety) disorders and neurologic, gastrointestinal, and musculoskeletal comorbidities, with most patients reporting at least one (73.4%). Physical examination in this cohort primarily showed a presentation of pelvic pain or bilateral lower q","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"81 1","pages":"19-20"},"PeriodicalIF":3.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146011406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2026-01-19DOI: 10.1097/OGX.0000000000001488
Jeffrey N Bone, K S Joseph, Laura A Magee, Chantal Mayer, Sarka Lisonkova
<p><p>Obesity is an important risk factor for adverse birth outcomes. Its prevalence has steadily increased over the past decades, with nearly half of pregnant women in the United States considered overweight or obese in 2019. A higher pre-pregnancy body mass index (BMI) is associated with an elevated risk of stillbirth, and obesity is associated with chronic hypertension, diabetes mellitus, and other comorbidities that are independent risk factors for stillbirth and perinatal death. Because of these risks, earlier delivery for women with high BMI is being considered; however, the data on specific risks related to gestational age (GA) are limited. Currently, recommendations for women with high BMI differ across professional bodies. The Canadian Society of Obstetricians and Gynaecologists recommends delivery at 39 to 40 weeks' gestation for women with extreme obesity and at 38 to 40 weeks' gestation for those with chronic hypertension. In contrast, the American College of Obstetricians and Gynecologists and the Royal College of Obstetricians and Gynaecologists provide no GA-specific recommendations for obesity. The aim of this study was to evaluate the association between pre-pregnancy BMI and GA-specific risk of stillbirth, and whether chronic hypertension modifies these associations.This was a retrospective cohort study, using data from the National Center for Health Statistics on women who had a singleton live- or stillbirth at ≥20 weeks' gestation between 2016 and 2017. Excluded were live births and fetal deaths at <20 or ≥43 weeks of gestation and women with missing data on pre-pregnancy BMI. The primary and secondary outcomes were stillbirth and perinatal death, respectively. The primary exposure was pre-pregnancy BMI. BMI categories included underweight (BMI <18.5 kg/m2), normal weight (18.5 to <25 kg/m2), overweight (25 to <30 kg/m2), obesity class I (30 to <35 kg/m2), obesity class II (35 to <40 kg/m2), and obesity class III (≥40 kg/m2). Chronic hypertension was evaluated as a modifier on the relationship between BMI and GA-specific stillbirth.A total of 7,365,797 women were included in the study, with 3.5% classified as underweight, 43.9% as normal weight, 26.1% as overweight, 14.5% as obesity class I, 7% as class II, and 5% as class III. Women with elevated BMI had higher rates of chronic hypertension and pre-pregnancy diabetes mellitus. They were also more likely to deliver at an earlier GA. While the stillbirth rate among those at normal weight was 3.86 per 1000 total births, the rate increased with elevated BMI both with and without hypertension. Overall, women who also had chronic hypertension had a higher stillbirth rate in all BMI categories, with the highest rate of perinatal death among underweight women (27.6 per 1000 total births).Women without hypertension saw an increase in the GA-specific risk of stillbirth and perinatal death after 37 weeks of gestation. Regardless of whether hypertension was present, the differences in th
{"title":"Relationship Between Pre-Pregnancy Body Mass Index and Gestational Age-Specific Risk of Stillbirth and Perinatal Death in Women With Chronic Hypertension.","authors":"Jeffrey N Bone, K S Joseph, Laura A Magee, Chantal Mayer, Sarka Lisonkova","doi":"10.1097/OGX.0000000000001488","DOIUrl":"https://doi.org/10.1097/OGX.0000000000001488","url":null,"abstract":"<p><p>Obesity is an important risk factor for adverse birth outcomes. Its prevalence has steadily increased over the past decades, with nearly half of pregnant women in the United States considered overweight or obese in 2019. A higher pre-pregnancy body mass index (BMI) is associated with an elevated risk of stillbirth, and obesity is associated with chronic hypertension, diabetes mellitus, and other comorbidities that are independent risk factors for stillbirth and perinatal death. Because of these risks, earlier delivery for women with high BMI is being considered; however, the data on specific risks related to gestational age (GA) are limited. Currently, recommendations for women with high BMI differ across professional bodies. The Canadian Society of Obstetricians and Gynaecologists recommends delivery at 39 to 40 weeks' gestation for women with extreme obesity and at 38 to 40 weeks' gestation for those with chronic hypertension. In contrast, the American College of Obstetricians and Gynecologists and the Royal College of Obstetricians and Gynaecologists provide no GA-specific recommendations for obesity. The aim of this study was to evaluate the association between pre-pregnancy BMI and GA-specific risk of stillbirth, and whether chronic hypertension modifies these associations.This was a retrospective cohort study, using data from the National Center for Health Statistics on women who had a singleton live- or stillbirth at ≥20 weeks' gestation between 2016 and 2017. Excluded were live births and fetal deaths at <20 or ≥43 weeks of gestation and women with missing data on pre-pregnancy BMI. The primary and secondary outcomes were stillbirth and perinatal death, respectively. The primary exposure was pre-pregnancy BMI. BMI categories included underweight (BMI <18.5 kg/m2), normal weight (18.5 to <25 kg/m2), overweight (25 to <30 kg/m2), obesity class I (30 to <35 kg/m2), obesity class II (35 to <40 kg/m2), and obesity class III (≥40 kg/m2). Chronic hypertension was evaluated as a modifier on the relationship between BMI and GA-specific stillbirth.A total of 7,365,797 women were included in the study, with 3.5% classified as underweight, 43.9% as normal weight, 26.1% as overweight, 14.5% as obesity class I, 7% as class II, and 5% as class III. Women with elevated BMI had higher rates of chronic hypertension and pre-pregnancy diabetes mellitus. They were also more likely to deliver at an earlier GA. While the stillbirth rate among those at normal weight was 3.86 per 1000 total births, the rate increased with elevated BMI both with and without hypertension. Overall, women who also had chronic hypertension had a higher stillbirth rate in all BMI categories, with the highest rate of perinatal death among underweight women (27.6 per 1000 total births).Women without hypertension saw an increase in the GA-specific risk of stillbirth and perinatal death after 37 weeks of gestation. Regardless of whether hypertension was present, the differences in th","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"81 1","pages":"1-2"},"PeriodicalIF":3.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146010937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2026-01-19DOI: 10.1097/OGX.0000000000001485
Talia Thompson, Samantha Bothwell, Jennifer Janusz, Rebecca Wilson, Susan Howell, Shanlee Davis, Karli Swenson, Sydney Martin, Karen Kowal, Chijioke Ikomi, Maria Despradel, Judith Ross, Nicole Tartaglia
<p><p>The sex chromosome trisomies (SCT), including XXY, XYY, and XXX, are common chromosomal aneuploidies associated with increased risk for early developmental delays and later neurodevelopmental disorders. Precise data on the timing and variability of early milestones in this population remain limited, so despite rising rates of prenatal SCT diagnosis, clinicians and families lack clear, evidence-based expectations for early motor and language development. This study aims to quantify the spectrum of early developmental milestones in infants with SCT and compare their timing with well-established standards for unaffected children to better contextualize early developmental risk. This analysis used data from the eXtraordinarY Babies Natural History Study, a prospective cohort of prenatally identified infants with SCT followed from infancy through early childhood. Between 2 and 36 months of life, parents reported easily observable gross motor and expressive language milestones, and clinicians validated these findings at regularly scheduled study visits as part of a broader assessment of development and health trajectories. A total of 12 milestones were collected for each participant: 8 gross motor skills and 4 expressive communication milestones. To compare these values with a normative reference group, data were retrieved from the Denver II Scales, the WHO Motor Development Study, and the Primitive Reflex Profile. Analyses assessed the median age of acquisition, variance, and differences across SCT karyotypes, as well as the proportion of children who fell outside CDC milestone expectations. Among 298 infants with SCT (174 with XXY, 50 with XYY, and 74 with XXX), results showed a later median age of acquisition for 9 of the 12 milestones evaluated, including rolling front to back, sitting, cruising, walking, running, cooing, babbling, first words, and 2-word phrases. There was also greater variance in milestone timing for the SCT group compared with the reference population, with extended upper percentiles across most skills indicating a wider range of typical achievement. While these delays were statistically significant, there was considerable overlap between the SCT group and the general pediatric population, and only a minority of infants met the CDC criteria for developmental delay. Differences across SCT karyotypes were small and generally not significant, although children with XXY achieved several skills slightly earlier than those with XYY or XXX. These findings provide an evidence-based schedule for early motor and language milestones in infants with SCT to aid early childhood surveillance and counseling. The later median age of acquisition and greater variability observed across all SCT conditions support the need for periodic developmental assessment beyond guidelines for the general population to identify children requiring additional support earlier. Although many infants with SCT will experience developmental trajectories similar
{"title":"Quantifying the Spectrum of Early Motor and Language Milestones in Sex Chromosome Trisomy.","authors":"Talia Thompson, Samantha Bothwell, Jennifer Janusz, Rebecca Wilson, Susan Howell, Shanlee Davis, Karli Swenson, Sydney Martin, Karen Kowal, Chijioke Ikomi, Maria Despradel, Judith Ross, Nicole Tartaglia","doi":"10.1097/OGX.0000000000001485","DOIUrl":"https://doi.org/10.1097/OGX.0000000000001485","url":null,"abstract":"<p><p>The sex chromosome trisomies (SCT), including XXY, XYY, and XXX, are common chromosomal aneuploidies associated with increased risk for early developmental delays and later neurodevelopmental disorders. Precise data on the timing and variability of early milestones in this population remain limited, so despite rising rates of prenatal SCT diagnosis, clinicians and families lack clear, evidence-based expectations for early motor and language development. This study aims to quantify the spectrum of early developmental milestones in infants with SCT and compare their timing with well-established standards for unaffected children to better contextualize early developmental risk. This analysis used data from the eXtraordinarY Babies Natural History Study, a prospective cohort of prenatally identified infants with SCT followed from infancy through early childhood. Between 2 and 36 months of life, parents reported easily observable gross motor and expressive language milestones, and clinicians validated these findings at regularly scheduled study visits as part of a broader assessment of development and health trajectories. A total of 12 milestones were collected for each participant: 8 gross motor skills and 4 expressive communication milestones. To compare these values with a normative reference group, data were retrieved from the Denver II Scales, the WHO Motor Development Study, and the Primitive Reflex Profile. Analyses assessed the median age of acquisition, variance, and differences across SCT karyotypes, as well as the proportion of children who fell outside CDC milestone expectations. Among 298 infants with SCT (174 with XXY, 50 with XYY, and 74 with XXX), results showed a later median age of acquisition for 9 of the 12 milestones evaluated, including rolling front to back, sitting, cruising, walking, running, cooing, babbling, first words, and 2-word phrases. There was also greater variance in milestone timing for the SCT group compared with the reference population, with extended upper percentiles across most skills indicating a wider range of typical achievement. While these delays were statistically significant, there was considerable overlap between the SCT group and the general pediatric population, and only a minority of infants met the CDC criteria for developmental delay. Differences across SCT karyotypes were small and generally not significant, although children with XXY achieved several skills slightly earlier than those with XYY or XXX. These findings provide an evidence-based schedule for early motor and language milestones in infants with SCT to aid early childhood surveillance and counseling. The later median age of acquisition and greater variability observed across all SCT conditions support the need for periodic developmental assessment beyond guidelines for the general population to identify children requiring additional support earlier. Although many infants with SCT will experience developmental trajectories similar ","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"81 1","pages":"12-14"},"PeriodicalIF":3.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146011009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2026-01-19DOI: 10.1097/OGX.0000000000001467
Annika Sinha, Brandi Tuttle, Alison Weidner
Importance: Non-neurogenic voiding dysfunction is a common lower urinary tract condition that affects both pediatric and adult patients. Normal bladder physiology requires complex coordination of the brain, spinal cord, bladder, and surrounding pelvic floor musculature. Abnormalities in this cycle can lead to symptoms of voiding dysfunction. The pathophysiology of voiding dysfunction can be multifactorial and influenced by different clinical settings, such as the perioperative or post-obstetric care periods.
Objective: The goal of this review is to review the definitions, pathophysiology, and treatments for pediatric and adult female non-neurogenic voiding dysfunction.
Evidence acquisition: A literature review using PubMed of relevant randomized clinical trials on treatments for voiding dysfunction in adults and children from 2000 to 2024 was completed.
Results: Of the 3397 abstracts initially reviewed, 97 full-text manuscripts were screened, and a total of 31 articles met the criteria for inclusion. These manuscripts were reviewed, and their findings were reported within the manuscript.
Conclusions and relevance: Voiding dysfunction can present as inadequate functioning of the emptying stage of micturition. It can present in children and female adults and has overall similar management strategies in both populations. For clinicians, it is important to understand the definition, relevant physiology, and the current evidence for treatment approaches for voiding dysfunction.
{"title":"Non-neurogenic Voiding Dysfunction in Pediatric Patients and Female Adults: Review of Current Clinical Trials.","authors":"Annika Sinha, Brandi Tuttle, Alison Weidner","doi":"10.1097/OGX.0000000000001467","DOIUrl":"https://doi.org/10.1097/OGX.0000000000001467","url":null,"abstract":"<p><strong>Importance: </strong>Non-neurogenic voiding dysfunction is a common lower urinary tract condition that affects both pediatric and adult patients. Normal bladder physiology requires complex coordination of the brain, spinal cord, bladder, and surrounding pelvic floor musculature. Abnormalities in this cycle can lead to symptoms of voiding dysfunction. The pathophysiology of voiding dysfunction can be multifactorial and influenced by different clinical settings, such as the perioperative or post-obstetric care periods.</p><p><strong>Objective: </strong>The goal of this review is to review the definitions, pathophysiology, and treatments for pediatric and adult female non-neurogenic voiding dysfunction.</p><p><strong>Evidence acquisition: </strong>A literature review using PubMed of relevant randomized clinical trials on treatments for voiding dysfunction in adults and children from 2000 to 2024 was completed.</p><p><strong>Results: </strong>Of the 3397 abstracts initially reviewed, 97 full-text manuscripts were screened, and a total of 31 articles met the criteria for inclusion. These manuscripts were reviewed, and their findings were reported within the manuscript.</p><p><strong>Conclusions and relevance: </strong>Voiding dysfunction can present as inadequate functioning of the emptying stage of micturition. It can present in children and female adults and has overall similar management strategies in both populations. For clinicians, it is important to understand the definition, relevant physiology, and the current evidence for treatment approaches for voiding dysfunction.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"81 1","pages":"29-38"},"PeriodicalIF":3.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146011500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2026-01-19DOI: 10.1097/01.ogx.0001179548.39409.03
Thomas F McElrath, Arun Jeyabalan, Arkady Khodursky, Alison B Moe, Manfred Lee, Maneesh Jain, Laura Goetzl, Elizabeth F Sutton, Pamela M Simmons, George R Saade, Antonio Saad, Luis D Pacheco, Esther Park-Hwang, Antonina Frolova, Ebony B Carter, Ai-Ris Y Collier, Daniel G Kiefer, Vincenzo Berghella, Rupsa C Boelig, Michal A Elovitz, Cynthia Gyamfi-Bannerman, Joseph R Biggio, Kara Rood, William A Grobman, Carrie Haverty, Morten Rasmussen
<p><p>Preeclampsia affects ~8% of pregnancies and is a leading cause of maternal and neonatal morbidity and mortality. From 2007 to 2019, rates of hypertensive disorders of pregnancy, including gestational hypertension and preeclampsia, doubled in the United States. This trend coincides with a rise in maternal mortality, which is now the highest among high-income nations. These statistics support the need to develop risk stratification tools that help to prevent and treat preeclampsia. Efforts to develop these risk assessments have not been successful in reproductive medicine, especially for preeclampsia. The US Preventive Services Task Force (USPSTF) has recommended a risk-based approach using clinical and demographic factors and, for individuals at increased risk, treatment with low-dose aspirin prophylaxis (AP) starting at 12 weeks of gestation. The aim of this study was to assess the proportions of a racially and geographically diverse population classified as low, moderate, or high risk for preeclampsia according to USPSTF criteria. This was a prospective cohort study conducted at 11 medical centers across the United States or through direct recruitment via social media. Included were individuals with singleton pregnancies who were 18 years or older and enrolled in the study before 22 weeks' gestation between July 2020 and March 2023. Participants were classified as high risk if they had at least 1 high-risk condition based on the USPSTF criteria. Participants were classified as moderate risk if they had ≥1 moderate risk factors but no high risk factors (moderate +1 risk category); this group was further subdivided into 2 categories: moderate 1 risk (defined as those with only 1 moderate risk factor) and moderate 2+ risk (those with ≥2 moderate risk factors). Those in the low-risk category had no high or moderate risk factors. AP recommendation with or without a prescription was the effect modification. The primary outcome was preeclampsia. A total of 5684 people were included in the analysis. The study population was identified as Asian (4.7%), black (21%), Hispanic (17.4%), white (48.6%), and other (8.3%). About 12% and 11% of participants were diagnosed with preeclampsia and gestational hypertension that progressed to preeclampsia, respectively. There were 18.5% in the high-risk category and 11.2% in the low-risk category. Approximately 70.3% were in the moderate +1 risk category, which was subdivided into the moderate risk 1 category (34.4%) and the moderate risk 2+ category (35.9%). While the incidence of preeclampsia varied by race, limited information was gleaned for sensitivity and specificity. A significantly increased risk of preeclampsia was observed in those with prior preeclampsia [risk ratio (RR), 1.44; 95% CI, 1.25-1.65; P<0.001] or chronic hypertension (RR, 1.26; 95% CI, 1.10-1.44; P=0.001). Much of the statistical significance was lost for moderate risk factors, and none of the racial categories were associated with increase
{"title":"Utility of the US Preventive Services Task Force for Preeclampsia Risk Assessment and Aspirin Prophylaxis.","authors":"Thomas F McElrath, Arun Jeyabalan, Arkady Khodursky, Alison B Moe, Manfred Lee, Maneesh Jain, Laura Goetzl, Elizabeth F Sutton, Pamela M Simmons, George R Saade, Antonio Saad, Luis D Pacheco, Esther Park-Hwang, Antonina Frolova, Ebony B Carter, Ai-Ris Y Collier, Daniel G Kiefer, Vincenzo Berghella, Rupsa C Boelig, Michal A Elovitz, Cynthia Gyamfi-Bannerman, Joseph R Biggio, Kara Rood, William A Grobman, Carrie Haverty, Morten Rasmussen","doi":"10.1097/01.ogx.0001179548.39409.03","DOIUrl":"https://doi.org/10.1097/01.ogx.0001179548.39409.03","url":null,"abstract":"<p><p>Preeclampsia affects ~8% of pregnancies and is a leading cause of maternal and neonatal morbidity and mortality. From 2007 to 2019, rates of hypertensive disorders of pregnancy, including gestational hypertension and preeclampsia, doubled in the United States. This trend coincides with a rise in maternal mortality, which is now the highest among high-income nations. These statistics support the need to develop risk stratification tools that help to prevent and treat preeclampsia. Efforts to develop these risk assessments have not been successful in reproductive medicine, especially for preeclampsia. The US Preventive Services Task Force (USPSTF) has recommended a risk-based approach using clinical and demographic factors and, for individuals at increased risk, treatment with low-dose aspirin prophylaxis (AP) starting at 12 weeks of gestation. The aim of this study was to assess the proportions of a racially and geographically diverse population classified as low, moderate, or high risk for preeclampsia according to USPSTF criteria. This was a prospective cohort study conducted at 11 medical centers across the United States or through direct recruitment via social media. Included were individuals with singleton pregnancies who were 18 years or older and enrolled in the study before 22 weeks' gestation between July 2020 and March 2023. Participants were classified as high risk if they had at least 1 high-risk condition based on the USPSTF criteria. Participants were classified as moderate risk if they had ≥1 moderate risk factors but no high risk factors (moderate +1 risk category); this group was further subdivided into 2 categories: moderate 1 risk (defined as those with only 1 moderate risk factor) and moderate 2+ risk (those with ≥2 moderate risk factors). Those in the low-risk category had no high or moderate risk factors. AP recommendation with or without a prescription was the effect modification. The primary outcome was preeclampsia. A total of 5684 people were included in the analysis. The study population was identified as Asian (4.7%), black (21%), Hispanic (17.4%), white (48.6%), and other (8.3%). About 12% and 11% of participants were diagnosed with preeclampsia and gestational hypertension that progressed to preeclampsia, respectively. There were 18.5% in the high-risk category and 11.2% in the low-risk category. Approximately 70.3% were in the moderate +1 risk category, which was subdivided into the moderate risk 1 category (34.4%) and the moderate risk 2+ category (35.9%). While the incidence of preeclampsia varied by race, limited information was gleaned for sensitivity and specificity. A significantly increased risk of preeclampsia was observed in those with prior preeclampsia [risk ratio (RR), 1.44; 95% CI, 1.25-1.65; P<0.001] or chronic hypertension (RR, 1.26; 95% CI, 1.10-1.44; P=0.001). Much of the statistical significance was lost for moderate risk factors, and none of the racial categories were associated with increase","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"81 1","pages":"5-7"},"PeriodicalIF":3.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146011243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2026-01-19DOI: 10.1097/01.ogx.0001179580.14616.46
Gudny A Arnadottir, Hakon Johnsson, Tanja Schlaikjær Hartwig, Jennifer R Gruhn, Peter Loof Møller, Arnaldur Gylfason, David Westergaard, Andrew Chi-Ho Chan, Asmundur Oddsson, Lilja Stefansdottir, Louise le Roux, Steinthorsdottir, Kristjan H Swerford Moore, Sigurgeir Olafsson, Pall I Olason, Hannes P Eggertsson, Gisli H Halldórsson, G Bragi Walters, Hreinn Stefansson, Sigurjon A Gudjonsson, Gunnar Palsson, Brynjar O Jensson, Run Fridriksdottir, Jesper Friis Petersen, Agnar Helgason, Gudmundur L Norddahl, Palle Duun Gohde, Jona Saemundsdottir, Olafur Th Magnusson, Bjarni V Halldorsson, Sofie Bliddal, Karina Banasik, Daniel F Gudbjartsson, Mette Nyegaard, Patrick Sulem, Unnur Thorsteinsdottir, Eva R Hoffmann, Henriette S Nielsen, Kari Stefansson
<p><p>Germline mutations are heritable; they occur before the formation of a fertilized egg and are found in all cells. They can be detected through somatic tissue sampling, and de novo mutations (DNMs) are well-studied. The majority of known DNMs originate in paternal cells, but some include maternal contributions as well. Certain kinds of DNMs prevent a fertilized egg from developing to term, and these are much less well-characterized. Some also lack sequence variants in certain genes and some are never observed in a homozygous form; these are also not well studied. Recombination failure can cause aneuploidies (trisomies or monosomies), and an estimated half of pregnancy losses are explained by this phenomenon. Early pregnancy loss is understudied, and there are few therapeutic interventions. This study, the Copenhagen Pregnancy Loss (COPL) study, was designed to contribute to the understanding of pregnancy loss through trios of patients (mother, father, and fetus) with clinically diagnosed pregnancy loss, attempting to document sequence diversity and interplay between meiotic recombination and point mutations. This study included 664 cases of early pregnancy loss with 1439 fetal samples (multiple were collected from each loss, where possible). In 467 of the 664 cases, there was at least 1 fetal sample and 1 sample from both parents. A total of 59 losses indicated a higher-than-expected kinship with the mother, and 11 indicated a higher kinship with the father. Whole-genome sequencing (WGS) was used to assess aneuploidies, and detected them in 206 cases. Of these, monosomy X and trisomy 16 were the most common. In addition, 19 large de novo copy number variants (CNVs) were detected in 14 loss cases, none of which were near a common fragile site. Of these 14 cases, 11 were euploid losses and 6 contained aneuploidies. Failure at meiosis I results in the presence of both homologous chromosomes from the same parent. An estimated 27.2% of paternal and 32.3% of maternal triploidies occur at recombination hotspots, supporting the idea of meiosis failure. A total of 15,086 DNMs were pinpointed as paternal and 5967 as maternal, consistent with previous literature supporting a high paternal contribution to DNMs. Consistent with this, paternal triploidies showed a proportionally higher paternal fraction of phased mutations. DNMs shown in maternal triploidies indicated a lower paternal fraction than euploid fetuses. In addition, there was no correlation between sister/homologous state differences for high-AB DNMs in paternal triploidies. When searching for pathogenic single-site variants (SSVs) in the DNMs, 26 genotypes were found that were pathogenic or likely pathogenic; a total of 23 were DNMs and 3 were biallelic predicted loss-of-function variants (pLoF). The frequency of pathogenic SSVs in early pregnancy loss was higher compared with controls [odds ratio (OR) 2.98, P=5.7×10-6), and this effect remained after correction for parental age. These result
{"title":"Sequence Diversity Lost in Early Pregnancy.","authors":"Gudny A Arnadottir, Hakon Johnsson, Tanja Schlaikjær Hartwig, Jennifer R Gruhn, Peter Loof Møller, Arnaldur Gylfason, David Westergaard, Andrew Chi-Ho Chan, Asmundur Oddsson, Lilja Stefansdottir, Louise le Roux, Steinthorsdottir, Kristjan H Swerford Moore, Sigurgeir Olafsson, Pall I Olason, Hannes P Eggertsson, Gisli H Halldórsson, G Bragi Walters, Hreinn Stefansson, Sigurjon A Gudjonsson, Gunnar Palsson, Brynjar O Jensson, Run Fridriksdottir, Jesper Friis Petersen, Agnar Helgason, Gudmundur L Norddahl, Palle Duun Gohde, Jona Saemundsdottir, Olafur Th Magnusson, Bjarni V Halldorsson, Sofie Bliddal, Karina Banasik, Daniel F Gudbjartsson, Mette Nyegaard, Patrick Sulem, Unnur Thorsteinsdottir, Eva R Hoffmann, Henriette S Nielsen, Kari Stefansson","doi":"10.1097/01.ogx.0001179580.14616.46","DOIUrl":"https://doi.org/10.1097/01.ogx.0001179580.14616.46","url":null,"abstract":"<p><p>Germline mutations are heritable; they occur before the formation of a fertilized egg and are found in all cells. They can be detected through somatic tissue sampling, and de novo mutations (DNMs) are well-studied. The majority of known DNMs originate in paternal cells, but some include maternal contributions as well. Certain kinds of DNMs prevent a fertilized egg from developing to term, and these are much less well-characterized. Some also lack sequence variants in certain genes and some are never observed in a homozygous form; these are also not well studied. Recombination failure can cause aneuploidies (trisomies or monosomies), and an estimated half of pregnancy losses are explained by this phenomenon. Early pregnancy loss is understudied, and there are few therapeutic interventions. This study, the Copenhagen Pregnancy Loss (COPL) study, was designed to contribute to the understanding of pregnancy loss through trios of patients (mother, father, and fetus) with clinically diagnosed pregnancy loss, attempting to document sequence diversity and interplay between meiotic recombination and point mutations. This study included 664 cases of early pregnancy loss with 1439 fetal samples (multiple were collected from each loss, where possible). In 467 of the 664 cases, there was at least 1 fetal sample and 1 sample from both parents. A total of 59 losses indicated a higher-than-expected kinship with the mother, and 11 indicated a higher kinship with the father. Whole-genome sequencing (WGS) was used to assess aneuploidies, and detected them in 206 cases. Of these, monosomy X and trisomy 16 were the most common. In addition, 19 large de novo copy number variants (CNVs) were detected in 14 loss cases, none of which were near a common fragile site. Of these 14 cases, 11 were euploid losses and 6 contained aneuploidies. Failure at meiosis I results in the presence of both homologous chromosomes from the same parent. An estimated 27.2% of paternal and 32.3% of maternal triploidies occur at recombination hotspots, supporting the idea of meiosis failure. A total of 15,086 DNMs were pinpointed as paternal and 5967 as maternal, consistent with previous literature supporting a high paternal contribution to DNMs. Consistent with this, paternal triploidies showed a proportionally higher paternal fraction of phased mutations. DNMs shown in maternal triploidies indicated a lower paternal fraction than euploid fetuses. In addition, there was no correlation between sister/homologous state differences for high-AB DNMs in paternal triploidies. When searching for pathogenic single-site variants (SSVs) in the DNMs, 26 genotypes were found that were pathogenic or likely pathogenic; a total of 23 were DNMs and 3 were biallelic predicted loss-of-function variants (pLoF). The frequency of pathogenic SSVs in early pregnancy loss was higher compared with controls [odds ratio (OR) 2.98, P=5.7×10-6), and this effect remained after correction for parental age. These result","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"81 1","pages":"26-27"},"PeriodicalIF":3.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146011268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2026-01-19DOI: 10.1097/OGX.0000000000001487
Marie Couldwell, Anna Jane Tidwell, Ann E Taylor
<p><p>About 2 decades ago, researchers discovered that glucagon-peptide 1 (GLP-1) stimulates insulin secretion and can treat type 2 diabetes. Some of the physiological effects of this drug class that allow for glycemic control include delayed gastric emptying, enhanced satiety, and anti-inflammatory effects. Since their discovery, the scope of GLPs has expanded into treatment for obesity, sleep apnea, osteoarthritis of the knees, renal failure, and heart failure across a wide range of drug variations. The aim of this study is to review and evaluate the currently available data on GLP-1 agonist use for the treatment of obesity-associated reproductive dysfunction. This narrative review used targeted searches of terms including "GLP1," "GLP1 receptor agonist," and "GLP1 receptor" in combination with "female," "male," "reproduction," "fertility," "polycystic ovary syndrome," "PCOS," "oral contraceptives," "gastric emptying," "drug interactions," "major congenital anomalies," and "pregnancy" through March 1, 2025. Prescribing information from FDA drug labels was also reviewed. Obesity is strongly associated with reproductive dysfunction in both men and women, with well-documented hormonal, structural, and gamete cell effects. In men, obesity can cause problems like reduced luteinizing hormone, testosterone, semen volume, and sperm count. These can cause diminished fertility through increased inflammation and oxidative stress, and reduced connection between the hypothalamic-pituitary-gonadal axis. Early evidence suggests that GLP-1 improves these pathways, with preclinical research showing action on gonadotropin-releasing hormone and Kiss neurons, remodeling testicular architecture, reduced oxidative stress, and improved testosterone and gonadotropin levels. Clinical studies of men have shown increased luteinizing hormone and follicle-stimulating hormone, improved sexual function, and greater sperm quality. Women have GLP-1 receptors in their ovarian and uterine tissue, and animal models of PCOS show improvements in ovarian follicle development, steroidogenesis, estrous cyclicity, and inflammatory markers. In clinical studies of women with PCOS, GLP-1 agonists improve androgen profiles, increase SHBG, reduce ovarian volume, regulate menstrual cycles, enhance ovulation, and improve both spontaneous and assisted pregnancy rates. Observational data also suggest lower rates of gestational diabetes, hypertensive disorders, preterm birth, and cesarean delivery among women who used GLP-1 agonists before pregnancy, even when matched for BMI, implying additional benefits beyond weight loss. At the same time, preclinical toxicology demonstrates fetal harm, and weight loss during pregnancy is associated with adverse fetal outcomes, underscoring the need for careful preconception management. Current recommendations emphasize counseling on improved fertility potential, possible reduced oral contraceptive efficacy due to altered gastric emptying, and the need for re
{"title":"Effect of GLP1 Agonists on Reproduction.","authors":"Marie Couldwell, Anna Jane Tidwell, Ann E Taylor","doi":"10.1097/OGX.0000000000001487","DOIUrl":"https://doi.org/10.1097/OGX.0000000000001487","url":null,"abstract":"<p><p>About 2 decades ago, researchers discovered that glucagon-peptide 1 (GLP-1) stimulates insulin secretion and can treat type 2 diabetes. Some of the physiological effects of this drug class that allow for glycemic control include delayed gastric emptying, enhanced satiety, and anti-inflammatory effects. Since their discovery, the scope of GLPs has expanded into treatment for obesity, sleep apnea, osteoarthritis of the knees, renal failure, and heart failure across a wide range of drug variations. The aim of this study is to review and evaluate the currently available data on GLP-1 agonist use for the treatment of obesity-associated reproductive dysfunction. This narrative review used targeted searches of terms including \"GLP1,\" \"GLP1 receptor agonist,\" and \"GLP1 receptor\" in combination with \"female,\" \"male,\" \"reproduction,\" \"fertility,\" \"polycystic ovary syndrome,\" \"PCOS,\" \"oral contraceptives,\" \"gastric emptying,\" \"drug interactions,\" \"major congenital anomalies,\" and \"pregnancy\" through March 1, 2025. Prescribing information from FDA drug labels was also reviewed. Obesity is strongly associated with reproductive dysfunction in both men and women, with well-documented hormonal, structural, and gamete cell effects. In men, obesity can cause problems like reduced luteinizing hormone, testosterone, semen volume, and sperm count. These can cause diminished fertility through increased inflammation and oxidative stress, and reduced connection between the hypothalamic-pituitary-gonadal axis. Early evidence suggests that GLP-1 improves these pathways, with preclinical research showing action on gonadotropin-releasing hormone and Kiss neurons, remodeling testicular architecture, reduced oxidative stress, and improved testosterone and gonadotropin levels. Clinical studies of men have shown increased luteinizing hormone and follicle-stimulating hormone, improved sexual function, and greater sperm quality. Women have GLP-1 receptors in their ovarian and uterine tissue, and animal models of PCOS show improvements in ovarian follicle development, steroidogenesis, estrous cyclicity, and inflammatory markers. In clinical studies of women with PCOS, GLP-1 agonists improve androgen profiles, increase SHBG, reduce ovarian volume, regulate menstrual cycles, enhance ovulation, and improve both spontaneous and assisted pregnancy rates. Observational data also suggest lower rates of gestational diabetes, hypertensive disorders, preterm birth, and cesarean delivery among women who used GLP-1 agonists before pregnancy, even when matched for BMI, implying additional benefits beyond weight loss. At the same time, preclinical toxicology demonstrates fetal harm, and weight loss during pregnancy is associated with adverse fetal outcomes, underscoring the need for careful preconception management. Current recommendations emphasize counseling on improved fertility potential, possible reduced oral contraceptive efficacy due to altered gastric emptying, and the need for re","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"81 1","pages":"2-4"},"PeriodicalIF":3.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146011470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2026-01-19DOI: 10.1097/OGX.0000000000001469
Elisabeth N Adkins, Carla W Brady, Jeffrey A Kuller, Luke A Gatta
Importance: Physiological changes in pregnancy pose unique challenges for cirrhosis and portal hypertension, particularly during the third trimester and intrapartum setting. Pregnancy may increase the risk of worsening of esophageal varices and life-threatening variceal hemorrhage. Therefore, it is important that clinicians recognize risk factors for appropriate referral and management for delivery planning to mitigate risks associated with acute variceal bleeding in pregnancy.
Objective: Review preconception counseling, antepartum surveillance, and intrapartum management of patients with esophageal varices, while emphasizing professional societal guidelines.
Evidence acquisition: A literature review identified relevant research, review articles, databases, and societal guidelines.
Results: Optimal management of esophageal varices in pregnancy requires an individualized, multidisciplinary team. Preconception counseling should include a screening endoscopy within 1 year of conception; with pregnancy, a second-trimester upper endoscopy should be considered. Small varices may be managed with a beta-blocker and surveillance. Medium and large varices should be managed with therapeutic endoscopy. Counseling regarding the mode of delivery is individualized, and attempting vaginal birth is acceptable in patients at low risk of variceal bleeding and with an anticipated short duration of the second stage of labor. Cesarean deliveries may be considered for patients with intensive care coordination needs and a high risk for variceal bleeding. Postpartum follow-up should include appropriate follow-up with Hepatology, contraception counseling, and follow-up for other comorbidities.
Conclusions and relevance: Optimal management for patients with esophageal varices due to cirrhosis and portal hypertension requires highly individualized care. Clinical advancements, as well as a steady increase in rates of cirrhosis in reproductive-aged women, has led to a higher prevalence of clinicians caring for these patients.
{"title":"Perinatal Management of Esophageal Varices.","authors":"Elisabeth N Adkins, Carla W Brady, Jeffrey A Kuller, Luke A Gatta","doi":"10.1097/OGX.0000000000001469","DOIUrl":"https://doi.org/10.1097/OGX.0000000000001469","url":null,"abstract":"<p><strong>Importance: </strong>Physiological changes in pregnancy pose unique challenges for cirrhosis and portal hypertension, particularly during the third trimester and intrapartum setting. Pregnancy may increase the risk of worsening of esophageal varices and life-threatening variceal hemorrhage. Therefore, it is important that clinicians recognize risk factors for appropriate referral and management for delivery planning to mitigate risks associated with acute variceal bleeding in pregnancy.</p><p><strong>Objective: </strong>Review preconception counseling, antepartum surveillance, and intrapartum management of patients with esophageal varices, while emphasizing professional societal guidelines.</p><p><strong>Evidence acquisition: </strong>A literature review identified relevant research, review articles, databases, and societal guidelines.</p><p><strong>Results: </strong>Optimal management of esophageal varices in pregnancy requires an individualized, multidisciplinary team. Preconception counseling should include a screening endoscopy within 1 year of conception; with pregnancy, a second-trimester upper endoscopy should be considered. Small varices may be managed with a beta-blocker and surveillance. Medium and large varices should be managed with therapeutic endoscopy. Counseling regarding the mode of delivery is individualized, and attempting vaginal birth is acceptable in patients at low risk of variceal bleeding and with an anticipated short duration of the second stage of labor. Cesarean deliveries may be considered for patients with intensive care coordination needs and a high risk for variceal bleeding. Postpartum follow-up should include appropriate follow-up with Hepatology, contraception counseling, and follow-up for other comorbidities.</p><p><strong>Conclusions and relevance: </strong>Optimal management for patients with esophageal varices due to cirrhosis and portal hypertension requires highly individualized care. Clinical advancements, as well as a steady increase in rates of cirrhosis in reproductive-aged women, has led to a higher prevalence of clinicians caring for these patients.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"81 1","pages":"39-44"},"PeriodicalIF":3.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146011474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-01Epub Date: 2026-01-19DOI: 10.1097/OGX.0000000000001482
Johanna Gandelsman-Ginis, Stephanie Bentley, Fareesa Khan, Cynthia Brincat, Michele O'Shea
<p><p>The prevalence of symptomatic pelvic organ prolapse (POP) in the United States is estimated at 3%, with around 300,000 patients undergoing surgical correction of POP annually. Surgical correction of POP often includes hysterectomy, and a potential risk of this procedure is unexpected pathology. Previous literature has shown the risk of premalignancy or malignancy in patients having procedures for benign indications to be 0.22% to 2.6%; understanding this risk is important when counseling patients as well as when considering preservation of the uterus. There is limited evidence, however, surrounding the rate of abnormal pathology at POP repair for racially and ethnically diverse populations. Preliminary evidence has suggested that rates may be higher in racial or ethnic subgroups, and this study was designed to assess this possibility. The purpose of this study was to provide a rate for abnormal uterine, cervical, fallopian tube, and ovarian pathology in a diverse population of nononcologic patients undergoing surgery for symptomatic POP. This was a retrospective study using data from an urban academic medical center. Inclusion criteria were patients above the age of 18 undergoing hysterectomy for POP between January 2018 and June 2023. Exclusion criteria were a primary indication for hysterectomy that did not include POP, patients who did not have a hysterectomy, patients who only received care from a benign gynecologist, and patients who had a known premalignant or malignant gynecologic lesion. The final analysis included 229 patients without a known premalignancy or malignancy before hysterectomy for POP. This cohort included 36% Hispanic individuals, 17% non-Hispanic Black individuals, and 38% non-Hispanic White individuals. A total of 75% of patients were postmenopausal, and ~23% had experienced abnormal bleeding. Incidence of unexpected pathology was 1.7%. Patients with abnormal findings included 2 patients with endometrial carcinoma (1 non-Hispanic black, 1 non-Hispanic White) and 2 patients with cervical dysplasia (1 non-Hispanic White, 1 Hispanic). These results indicate that the rate of unexpected malignancy was 1.7% in this cohort, much higher than the expected rate of 0.9%. This risk estimate may be useful in counseling patients who desire uterine preservation when undergoing surgical reconstruction for POP. Previous recommendations have indicated that in asymptomatic individuals, endometrial biopsy or evaluation is not necessary due to the low risk of unexpected malignancy, but if there is suspicion, such as abnormal uterine bleeding, greater age, menopausal status, hypertension, anemia, or weight loss, then endometrial assessment should be considered. This study's estimated risk of unexpected malignancy does not necessarily impact these recommendations, but does emphasize that care should be taken to assess all symptoms and counsel patients accordingly. Future research should focus on characterizing risks and benefits of uterin
{"title":"Unexpected Pathology During Pelvic Organ Prolapse Repair in an Urban Population.","authors":"Johanna Gandelsman-Ginis, Stephanie Bentley, Fareesa Khan, Cynthia Brincat, Michele O'Shea","doi":"10.1097/OGX.0000000000001482","DOIUrl":"https://doi.org/10.1097/OGX.0000000000001482","url":null,"abstract":"<p><p>The prevalence of symptomatic pelvic organ prolapse (POP) in the United States is estimated at 3%, with around 300,000 patients undergoing surgical correction of POP annually. Surgical correction of POP often includes hysterectomy, and a potential risk of this procedure is unexpected pathology. Previous literature has shown the risk of premalignancy or malignancy in patients having procedures for benign indications to be 0.22% to 2.6%; understanding this risk is important when counseling patients as well as when considering preservation of the uterus. There is limited evidence, however, surrounding the rate of abnormal pathology at POP repair for racially and ethnically diverse populations. Preliminary evidence has suggested that rates may be higher in racial or ethnic subgroups, and this study was designed to assess this possibility. The purpose of this study was to provide a rate for abnormal uterine, cervical, fallopian tube, and ovarian pathology in a diverse population of nononcologic patients undergoing surgery for symptomatic POP. This was a retrospective study using data from an urban academic medical center. Inclusion criteria were patients above the age of 18 undergoing hysterectomy for POP between January 2018 and June 2023. Exclusion criteria were a primary indication for hysterectomy that did not include POP, patients who did not have a hysterectomy, patients who only received care from a benign gynecologist, and patients who had a known premalignant or malignant gynecologic lesion. The final analysis included 229 patients without a known premalignancy or malignancy before hysterectomy for POP. This cohort included 36% Hispanic individuals, 17% non-Hispanic Black individuals, and 38% non-Hispanic White individuals. A total of 75% of patients were postmenopausal, and ~23% had experienced abnormal bleeding. Incidence of unexpected pathology was 1.7%. Patients with abnormal findings included 2 patients with endometrial carcinoma (1 non-Hispanic black, 1 non-Hispanic White) and 2 patients with cervical dysplasia (1 non-Hispanic White, 1 Hispanic). These results indicate that the rate of unexpected malignancy was 1.7% in this cohort, much higher than the expected rate of 0.9%. This risk estimate may be useful in counseling patients who desire uterine preservation when undergoing surgical reconstruction for POP. Previous recommendations have indicated that in asymptomatic individuals, endometrial biopsy or evaluation is not necessary due to the low risk of unexpected malignancy, but if there is suspicion, such as abnormal uterine bleeding, greater age, menopausal status, hypertension, anemia, or weight loss, then endometrial assessment should be considered. This study's estimated risk of unexpected malignancy does not necessarily impact these recommendations, but does emphasize that care should be taken to assess all symptoms and counsel patients accordingly. Future research should focus on characterizing risks and benefits of uterin","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"81 1","pages":"18-19"},"PeriodicalIF":3.6,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146011241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号