Pub Date : 2026-02-01Epub Date: 2026-02-02DOI: 10.1016/j.ajogmf.2025.101848
Saule Issenova DMS, Dilfuza Sultanmuratova PhD
{"title":"Response to Letter to the Editor regarding Sequential use of Foley catheter and misoprostol vs misoprostol alone for induction of labor: a multicenter randomized controlled trial","authors":"Saule Issenova DMS, Dilfuza Sultanmuratova PhD","doi":"10.1016/j.ajogmf.2025.101848","DOIUrl":"10.1016/j.ajogmf.2025.101848","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"8 2","pages":"Article 101848"},"PeriodicalIF":3.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146120680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2026-02-02DOI: 10.1016/j.ajogmf.2025.101849
Laurie Beth Griffin MD, PhD , Marie Anderson MD , Christina Raker MS , Phinnara Has MS , Cindy-Lee Dennis PhD , Adam K. Lewkowitz MD, MPHS
{"title":"A pilot randomized control trial assessing the acceptability and effect of in-hospital antenatal video breastfeeding education among nulliparous pregnant people","authors":"Laurie Beth Griffin MD, PhD , Marie Anderson MD , Christina Raker MS , Phinnara Has MS , Cindy-Lee Dennis PhD , Adam K. Lewkowitz MD, MPHS","doi":"10.1016/j.ajogmf.2025.101849","DOIUrl":"10.1016/j.ajogmf.2025.101849","url":null,"abstract":"","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"8 2","pages":"Article 101849"},"PeriodicalIF":3.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146120588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-07DOI: 10.1016/j.ajogmf.2025.101865
Karley Dutra MD , Jonathan M. Fenkel MD, FACP, FAASLD
Hepatitis C virus (HCV) infection has become a public health crisis in the last few decades, with a significant impact on individuals of reproductive age. Direct-acting antivirals (DAAs) were introduced in 2011 and are highly effective at eradicating HCV infection through 8- to 12-week treatment courses, making them the mainstay of treatment for nonpregnant adults. Obstetric guidelines have not recommended treatment of HCV infection during pregnancy due to more limited data on DAA use during pregnancy. The risk of perinatal transmission of HCV is up to 9%, with at least one-third of transmissions occurring antenatally. Infant follow-up after perinatal exposure to HCV infection has been poor due to loss to care and a long latency to recommended testing. In recent years, there has been a growing body of evidence that DAAs are safe and effective in pregnancy, with similar cure rates as nonpregnant adults. Pregnancy represents a time when individuals are continuously engaged in care, providing an optimal window for treatment of HCV infection. Obstetrician/gynecologists should employ shared decision-making surrounding treatment of HCV infection during pregnancy, acknowledging the benefits and efficacy of treatment versus the available data on DAA exposure in pregnancy. Therapy should be initiated during the second or third trimesters, with limited but reassuring data on DAA exposure through breastmilk. Ledipasvir/sofosbuvir and sofosbuvir/velpatasvir currently have the most data available in pregnancy and should be included in conversations regarding HCV treatment in pregnancy. Multidisciplinary care between maternal-fetal medicine, infectious disease, and hepatology can help promote access to HCV treatment in pregnancy.
{"title":"Hepatitis C treatment during pregnancy: time for a practice change","authors":"Karley Dutra MD , Jonathan M. Fenkel MD, FACP, FAASLD","doi":"10.1016/j.ajogmf.2025.101865","DOIUrl":"10.1016/j.ajogmf.2025.101865","url":null,"abstract":"<div><div>Hepatitis C virus (HCV) infection has become a public health crisis in the last few decades, with a significant impact on individuals of reproductive age. Direct-acting antivirals (DAAs) were introduced in 2011 and are highly effective at eradicating HCV infection through 8- to 12-week treatment courses, making them the mainstay of treatment for nonpregnant adults. Obstetric guidelines have not recommended treatment of HCV infection during pregnancy due to more limited data on DAA use during pregnancy. The risk of perinatal transmission of HCV is up to 9%, with at least one-third of transmissions occurring antenatally. Infant follow-up after perinatal exposure to HCV infection has been poor due to loss to care and a long latency to recommended testing. In recent years, there has been a growing body of evidence that DAAs are safe and effective in pregnancy, with similar cure rates as nonpregnant adults. Pregnancy represents a time when individuals are continuously engaged in care, providing an optimal window for treatment of HCV infection. Obstetrician/gynecologists should employ shared decision-making surrounding treatment of HCV infection during pregnancy, acknowledging the benefits and efficacy of treatment versus the available data on DAA exposure in pregnancy. Therapy should be initiated during the second or third trimesters, with limited but reassuring data on DAA exposure through breastmilk. Ledipasvir/sofosbuvir and sofosbuvir/velpatasvir currently have the most data available in pregnancy and should be included in conversations regarding HCV treatment in pregnancy. Multidisciplinary care between maternal-fetal medicine, infectious disease, and hepatology can help promote access to HCV treatment in pregnancy.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"8 2","pages":"Article 101865"},"PeriodicalIF":3.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145716014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To identify and synthesize key characteristics of prenatal counseling process and content, and support provided to parents carrying a fetus with a congenital anomaly.
Data sources
A scoping review was conducted searching 2 electronic databases (PubMed and Embase) on January 23rd, 2025.
Study eligibility criteria
We included original studies on prenatal counseling for fetal anomalies. Eligible populations included parents receiving a fetal anomaly diagnosis, individuals with a congenital anomaly, healthcare professionals involved in prenatal counseling, and patient representatives. Publications had to be in English, Dutch, or German. Reviews without original data were excluded.
Study appraisal and synthesis methods
No quality assessment was performed. Extracted data were categorized into counseling process and content, and thematically analyzed.
Results
Of the 9028 articles screened, 43 articles met predefined eligibility criteria. The included articles, published between 1995 and 2024, encompassed a range of perspectives, including those of parents, individuals with a congenital anomaly, healthcare professionals, and representatives from patient advocacy groups. Findings were organized into 2 main categories: prenatal counseling process and content. Process themes included: (1) Communication, (2) Multidisciplinary counseling, (3) Shared decision-making, (4) Continuity, (5) Accessibility, (6) Psychosocial support, and (7) Counseling prerequisites. Content themes were: (1) Informational content, and (2) Delivery of information.
Conclusion
Results underscore the necessity of a holistic approach to prenatal counseling for parents after fetal diagnosis, and highlight the importance of integrating psychological care alongside information delivery.
{"title":"Advancing prenatal counseling and support for parents carrying a fetus with a congenital anomaly: a scoping review of key characteristics and practices","authors":"Neeltje M.T.H. Crombag , Bente Teeuwen , Sigrid Teuben , Nadine A. Kasparian , Erica Sood , Bauke M.E. Adriaanse , Mireille N. Bekker","doi":"10.1016/j.ajogmf.2025.101874","DOIUrl":"10.1016/j.ajogmf.2025.101874","url":null,"abstract":"<div><h3>Objective</h3><div>To identify and synthesize key characteristics of prenatal counseling process and content, and support provided to parents carrying a fetus with a congenital anomaly.</div></div><div><h3>Data sources</h3><div>A scoping review was conducted searching 2 electronic databases (PubMed and Embase) on January 23rd, 2025.</div></div><div><h3>Study eligibility criteria</h3><div>We included original studies on prenatal counseling for fetal anomalies. Eligible populations included parents receiving a fetal anomaly diagnosis, individuals with a congenital anomaly, healthcare professionals involved in prenatal counseling, and patient representatives. Publications had to be in English, Dutch, or German. Reviews without original data were excluded.</div></div><div><h3>Study appraisal and synthesis methods</h3><div>No quality assessment was performed. Extracted data were categorized into counseling process and content, and thematically analyzed.</div></div><div><h3>Results</h3><div>Of the 9028 articles screened, 43 articles met predefined eligibility criteria. The included articles, published between 1995 and 2024, encompassed a range of perspectives, including those of parents, individuals with a congenital anomaly, healthcare professionals, and representatives from patient advocacy groups. Findings were organized into 2 main categories: prenatal counseling process and content. Process themes included: (1) Communication, (2) Multidisciplinary counseling, (3) Shared decision-making, (4) Continuity, (5) Accessibility, (6) Psychosocial support, and (7) Counseling prerequisites. Content themes were: (1) Informational content, and (2) Delivery of information.</div></div><div><h3>Conclusion</h3><div>Results underscore the necessity of a holistic approach to prenatal counseling for parents after fetal diagnosis, and highlight the importance of integrating psychological care alongside information delivery.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"8 2","pages":"Article 101874"},"PeriodicalIF":3.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145776098","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Preeclampsia (PE) and fetal growth restriction (FGR) are major causes of maternal and perinatal morbidity. The retina, an accessible and non-invasive window to the systemic microcirculation, offers quantitative biomarkers of maternal endothelial dysfunction that are central to development of PE and FGR. Advances in optical coherence tomography and Optical Coherence Tomography Angiography (OCTA) enable rapid, contrast-free measurement of vessel density, foveal avascular zone geometry and layer-specific thickness with high reproducibility. Emerging studies report reduced superficial capillary plexus density and hypertensive retinopathy signs in hypertensive disorders of pregnancy, with larger effects in early-onset PE. However, evidence remains mostly cross-sectional, heterogeneous and limited by small sample size. We describe potential clinical applications including targeted screening of high-risk women, enhancement of existing risk prediction models, longitudinal disease monitoring and assessment of treatment response. A staged research agenda is proposed, as following: (1) harmonized acquisition and quality standards; (2) prospective, trimester-specific cohorts linking retinal metrics to maternal and perinatal outcomes; (3) conducting mechanistic substudies to relate retinal signatures to systemic hemodynamics; 4) performing implementation trials to evaluate feasibility, equity and the impact on maternal and perinatal outcomes.
{"title":"The eye as a window to placental health: retinal imaging as a novel biomarker for preeclampsia and fetal growth restriction","authors":"Gabriele Saccone MD, PhD , Francesco Matarazzo MD , Mariarosaria Motta MD , Michele Rinaldi MD , Maurizio Guida MD , Ciro Costagliola MD","doi":"10.1016/j.ajogmf.2025.101855","DOIUrl":"10.1016/j.ajogmf.2025.101855","url":null,"abstract":"<div><div>Preeclampsia (PE) and fetal growth restriction (FGR) are major causes of maternal and perinatal morbidity. The retina, an accessible and non-invasive window to the systemic microcirculation, offers quantitative biomarkers of maternal endothelial dysfunction that are central to development of PE and FGR. Advances in optical coherence tomography and Optical Coherence Tomography Angiography (OCTA) enable rapid, contrast-free measurement of vessel density, foveal avascular zone geometry and layer-specific thickness with high reproducibility. Emerging studies report reduced superficial capillary plexus density and hypertensive retinopathy signs in hypertensive disorders of pregnancy, with larger effects in early-onset PE. However, evidence remains mostly cross-sectional, heterogeneous and limited by small sample size. We describe potential clinical applications including targeted screening of high-risk women, enhancement of existing risk prediction models, longitudinal disease monitoring and assessment of treatment response. A staged research agenda is proposed, as following: (1) harmonized acquisition and quality standards; (2) prospective, trimester-specific cohorts linking retinal metrics to maternal and perinatal outcomes; (3) conducting mechanistic substudies to relate retinal signatures to systemic hemodynamics; 4) performing implementation trials to evaluate feasibility, equity and the impact on maternal and perinatal outcomes.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"8 2","pages":"Article 101855"},"PeriodicalIF":3.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145589177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-11-13DOI: 10.1016/j.ajogmf.2025.101840
Rupsa C. Boelig MD, MS , Eshika Agarwal MD , Jenani Jayakumaran MD , Vincenzo Berghella MD , Julio Mateus MD, PhD , Joanne Quiñones-Rivera MD, MSCE , Jennifer Tymon MD , José Bareño-Silva MD , Mónica Rincón MD, MCR , Richard Burwick MD , Luisa López-Torres MD , Catalina Valencia MD , Jorge E. Tolosa MD, MSCE , IC-CLEAR Collaborative (Supplement)
<div><h3>BACKGROUND</h3><div>There was a randomized trial that suggested a benefit with indomethacin and antibiotics in the setting of an examination-indicated cerclage. However, there is little evidence to guide the use of perioperative indomethacin and/or antibiotics in the setting of an ultrasound-indicated cerclage.</div></div><div><h3>OBJECTIVE</h3><div>This study aimed to determine whether perioperative antibiotics and/or indomethacin at the time of ultrasound-indicated cerclage placement reduces the rate of spontaneous preterm birth at <37 weeks of gestation.</div></div><div><h3>STUDY DESIGN</h3><div>This was a multicenter retrospective cohort study of women with singleton pregnancies who received a transvaginal cervical cerclage from June 2016 to July 2021. This study aimed to evaluate whether perioperative antibiotics and/or indomethacin at the time of cerclage was superior to no antibiotics/indomethacin in the prevention of spontaneous preterm birth. Of note, 10 sites were involved, 8 in the United States and 2 in Colombia. Because this was an observational cohort, a few propensity score–based analyses were performed to adjust for potential confounding or assignment bias. First, the propensity score for each treatment group comparison (indomethacin vs none, perioperative antibiotics vs none, and indomethacin and perioperative antibiotics vs neither) was determined using multivariate logistic regression taking into consideration study country (United States or Colombia), previous preterm birth history (yes or no), body mass index, cervical length before placement, cervical dilation, gestational age at placement, use of postoperative progestogen (yes vs no), and use of other perioperative interventions (indomethacin or perioperative antibiotics). This propensity score was used for a weighted analysis (1/propensity score). The primary outcome was spontaneous preterm birth at <37 weeks of gestation. The secondary outcomes include rates of spontaneous preterm birth at <34 weeks of gestation and <28 weeks of gestation and latency (weeks) from randomization to delivery for the outcome of spontaneous preterm birth at <37 weeks. Data were weighted using the propensity score for the primary and secondary outcomes, with the respective predictors being indomethacin vs none, perioperative antibiotics vs none, or perioperative indomethacin and antibiotics vs neither in bivariate regression analysis. A 2-sided alpha level of 0.05 was considered statistically significant for all analyses.</div></div><div><h3>RESULTS</h3><div>The database included cerclages placed in women with singleton pregnancies from March 2016 to July 2021. Overall, 340 cases of ultrasound-indicated cerclage were included in this study. Of note, 29.4% of cases had documented cervical dilation at the time of surgery, 28.5% of cases did not have documented cervical dilation at the time of surgery, and 42.1% of cases did not have examination findings recorded. There wer
{"title":"Evaluation of perioperative antibiotics and indomethacin with cerclage for short cervix: a retrospective cohort study with the International Collaborative for Cerclage Longitudinal Evaluation and Research","authors":"Rupsa C. Boelig MD, MS , Eshika Agarwal MD , Jenani Jayakumaran MD , Vincenzo Berghella MD , Julio Mateus MD, PhD , Joanne Quiñones-Rivera MD, MSCE , Jennifer Tymon MD , José Bareño-Silva MD , Mónica Rincón MD, MCR , Richard Burwick MD , Luisa López-Torres MD , Catalina Valencia MD , Jorge E. Tolosa MD, MSCE , IC-CLEAR Collaborative (Supplement)","doi":"10.1016/j.ajogmf.2025.101840","DOIUrl":"10.1016/j.ajogmf.2025.101840","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>There was a randomized trial that suggested a benefit with indomethacin and antibiotics in the setting of an examination-indicated cerclage. However, there is little evidence to guide the use of perioperative indomethacin and/or antibiotics in the setting of an ultrasound-indicated cerclage.</div></div><div><h3>OBJECTIVE</h3><div>This study aimed to determine whether perioperative antibiotics and/or indomethacin at the time of ultrasound-indicated cerclage placement reduces the rate of spontaneous preterm birth at <37 weeks of gestation.</div></div><div><h3>STUDY DESIGN</h3><div>This was a multicenter retrospective cohort study of women with singleton pregnancies who received a transvaginal cervical cerclage from June 2016 to July 2021. This study aimed to evaluate whether perioperative antibiotics and/or indomethacin at the time of cerclage was superior to no antibiotics/indomethacin in the prevention of spontaneous preterm birth. Of note, 10 sites were involved, 8 in the United States and 2 in Colombia. Because this was an observational cohort, a few propensity score–based analyses were performed to adjust for potential confounding or assignment bias. First, the propensity score for each treatment group comparison (indomethacin vs none, perioperative antibiotics vs none, and indomethacin and perioperative antibiotics vs neither) was determined using multivariate logistic regression taking into consideration study country (United States or Colombia), previous preterm birth history (yes or no), body mass index, cervical length before placement, cervical dilation, gestational age at placement, use of postoperative progestogen (yes vs no), and use of other perioperative interventions (indomethacin or perioperative antibiotics). This propensity score was used for a weighted analysis (1/propensity score). The primary outcome was spontaneous preterm birth at <37 weeks of gestation. The secondary outcomes include rates of spontaneous preterm birth at <34 weeks of gestation and <28 weeks of gestation and latency (weeks) from randomization to delivery for the outcome of spontaneous preterm birth at <37 weeks. Data were weighted using the propensity score for the primary and secondary outcomes, with the respective predictors being indomethacin vs none, perioperative antibiotics vs none, or perioperative indomethacin and antibiotics vs neither in bivariate regression analysis. A 2-sided alpha level of 0.05 was considered statistically significant for all analyses.</div></div><div><h3>RESULTS</h3><div>The database included cerclages placed in women with singleton pregnancies from March 2016 to July 2021. Overall, 340 cases of ultrasound-indicated cerclage were included in this study. Of note, 29.4% of cases had documented cervical dilation at the time of surgery, 28.5% of cases did not have documented cervical dilation at the time of surgery, and 42.1% of cases did not have examination findings recorded. There wer","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"8 2","pages":"Article 101840"},"PeriodicalIF":3.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145530993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-17DOI: 10.1016/j.ajogmf.2025.101878
Nicole Ehrhardt MD , Stephanie J. Fonda PhD , Patali Mandava MBBS , Ghada Abdalla MBBCH , Emily Fay MD
Background
Gestational diabetes mellitus (GDM) - a risk factor for adverse pregnancy outcomes - is on the rise. Real-time continuous glucose monitoring (RT-CGM) may enhance glucose control during GDM and thereby improve outcomes; however, more data are needed.
Objective
This study aimed to determine if RT-CGM improved glycemic indices in GDM.
Study Design
An open-label, randomized controlled trial was conducted with GDM patients diagnosed between 14 and 30 weeks estimated gestational age (EGA), assigning them either to RT-CGM or blinded CGM in addition to self-monitoring of blood glucose (SMBG). This analysis compares CGM metrics for the study groups at EGA of 32 and 36 weeks (± 10 days). The primary outcome was percentage of time in range 63 to 140 mg/dL (TIR) over 24 hours. Secondary outcomes included mean glucose over 10 days and additional CGM indices, HbA1c, diabetes medication usage, satisfaction with CGM, and maternal and fetal outcomes.
Results
105 participants with GDM were enrolled (RT-CGM [n=53] or blinded CGM [n=52]) Thirty-one of 52 SMBG participants withdrew, with 30 citing desiring RT-CGM. In participants who completed the study, average EGA was 29.8 weeks (SD=2.5) on their first day of CGM wear with average duration of wear of 64.4 days (SD=19.4). TIR 63-140 mg/dL (TIR) was 93.0 (SD=6.7) and 93.7 (SD=6.8) (p=.86) while mean glucose was 106.7 mg/dL (SD=9.0) and 98.1 mg/dL (SD=13.8) for the RT-CGM and SMBG groups (p=.02), respectively. At study completion, mean glucose and TIR were similar. Insulin and/or metformin use was 66.7% in the RT-CGM group and 33.4% in the SMBG group (p=.02). There were no significant differences in maternal or fetal outcomes. The RT-CGM group’s satisfaction with CGM was high.
Conclusions
In this study in which CGM was initiated at about 30 weeks EGA, TIR and mean glucose were similar. However, more participants in the CGM group initiated insulin. Selection and attrition bias could have affected the results. Glycemic changes were minor, but interest in CGM was high. Further research is needed to assess if earlier implementation and use in higher risk populations may provide benefit.
{"title":"A randomized controlled trial of real-time continuous glucose monitoring (RT-CGM) for self-management of gestational diabetes","authors":"Nicole Ehrhardt MD , Stephanie J. Fonda PhD , Patali Mandava MBBS , Ghada Abdalla MBBCH , Emily Fay MD","doi":"10.1016/j.ajogmf.2025.101878","DOIUrl":"10.1016/j.ajogmf.2025.101878","url":null,"abstract":"<div><h3>Background</h3><div>Gestational diabetes mellitus (GDM) - a risk factor for adverse pregnancy outcomes - is on the rise. Real-time continuous glucose monitoring (RT-CGM) may enhance glucose control during GDM and thereby improve outcomes; however, more data are needed.</div></div><div><h3>Objective</h3><div>This study aimed to determine if RT-CGM improved glycemic indices in GDM.</div></div><div><h3>Study Design</h3><div>An open-label, randomized controlled trial was conducted with GDM patients diagnosed between 14 and 30 weeks estimated gestational age (EGA), assigning them either to RT-CGM or blinded CGM in addition to self-monitoring of blood glucose (SMBG). This analysis compares CGM metrics for the study groups at EGA of 32 and 36 weeks (± 10 days). The primary outcome was percentage of time in range 63 to 140 mg/dL (TIR) over 24 hours. Secondary outcomes included mean glucose over 10 days and additional CGM indices, HbA1c, diabetes medication usage, satisfaction with CGM, and maternal and fetal outcomes.</div></div><div><h3>Results</h3><div>105 participants with GDM were enrolled (RT-CGM [n=53] or blinded CGM [n=52]) Thirty-one of 52 SMBG participants withdrew, with 30 citing desiring RT-CGM. In participants who completed the study, average EGA was 29.8 weeks (SD=2.5) on their first day of CGM wear with average duration of wear of 64.4 days (SD=19.4). TIR 63-140 mg/dL (TIR) was 93.0 (SD=6.7) and 93.7 (SD=6.8) (<em>p</em>=.86) while mean glucose was 106.7 mg/dL (SD=9.0) and 98.1 mg/dL (SD=13.8) for the RT-CGM and SMBG groups (<em>p</em>=.02), respectively. At study completion, mean glucose and TIR were similar. Insulin and/or metformin use was 66.7% in the RT-CGM group and 33.4% in the SMBG group (<em>p</em>=.02). There were no significant differences in maternal or fetal outcomes. The RT-CGM group’s satisfaction with CGM was high.</div></div><div><h3>Conclusions</h3><div>In this study in which CGM was initiated at about 30 weeks EGA, TIR and mean glucose were similar. However, more participants in the CGM group initiated insulin. Selection and attrition bias could have affected the results. Glycemic changes were minor, but interest in CGM was high. Further research is needed to assess if earlier implementation and use in higher risk populations may provide benefit.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"8 2","pages":"Article 101878"},"PeriodicalIF":3.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145795019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-12-03DOI: 10.1016/j.ajogmf.2025.101869
Johanna Quist-Nelson MD , Marie-Louise Meng MD , Janet Rich-Edwards ScD , Matthew Fuller MS , Chuan Hong PhD , Michael Pencina PhD , Kim Boggess MD , Ricardo Henao PhD , Jennifer Stuart ScD
BACKGROUND
There are limited data defining the rate of progression of the development of adverse pregnancy outcomes and short-term cardiovascular risk factors in a contemporary cohort.
OBJECTIVE
This study aimed to examine the association between adverse pregnancy outcomes and short-term cardiovascular disease risk factors in a contemporary population.
STUDY DESIGN
This was a hospital-based electronic health record retrospective cohort study from 2 healthcare systems in North Carolina. Patients who gave birth between 2016 and 2020, were free of cardiovascular disease risk factors or events at delivery, and had >1 prenatal care appointment during pregnancy and 1 postnatal care appointment ≤3 months after delivery were included in the study. However, only the first pregnancy in the study period was included. Adverse pregnancy outcomes were defined using the International Classification of Diseases, 10th Revision, codes for preeclampsia, gestational hypertension, gestational diabetes mellitus, preterm birth, and small-for-gestational-age infant. The development of a short-term cardiovascular disease risk factor was defined as a new diagnosis of chronic hypertension, hyperlipidemia, diabetes mellitus, or prediabetes mellitus by December 31, 2021. Cox proportional hazards regression was used to model associations between adverse pregnancy outcomes and cardiovascular disease risk factors.
RESULTS
A total of 32,623 patients were included in this study. More than a quarter of the patients (8965 [27.5%]) experienced at least 1 adverse pregnancy outcome, with more patients with an adverse pregnancy outcome developing a cardiovascular disease risk factor during follow-up than those without an adverse pregnancy outcome (9.5% vs 3.2%, respectively). Patients with any adverse pregnancy outcomes were 3 times more likely to be diagnosed with a cardiovascular disease risk factor (hazard ratio, 3.11 [95% confidence interval, 2.87–3.38]) and had a median time to event of 1.98 years (interquartile range, 0.82–3.34). The highest risks were observed in patients with gestational diabetes mellitus developing type 2 diabetes mellitus (hazard ratio, 21.29 [95% confidence interval, 16.49–27.47]) and in those with preeclampsia developing chronic hypertension (hazard ratio, 6.35 [95% confidence interval, 5.51–7.32]).
CONCLUSION
A pregnancy complicated by an adverse pregnancy outcome is associated with a 3-fold increased risk of developing cardiovascular disease risk factors as early as 2 years after delivery. These findings highlight the importance of screening for cardiovascular disease risk factors in the early years after delivery for patients who experienced an adverse pregnancy outcome.
{"title":"Adverse pregnancy outcomes and development of short-term cardiovascular disease risk factors","authors":"Johanna Quist-Nelson MD , Marie-Louise Meng MD , Janet Rich-Edwards ScD , Matthew Fuller MS , Chuan Hong PhD , Michael Pencina PhD , Kim Boggess MD , Ricardo Henao PhD , Jennifer Stuart ScD","doi":"10.1016/j.ajogmf.2025.101869","DOIUrl":"10.1016/j.ajogmf.2025.101869","url":null,"abstract":"<div><h3>BACKGROUND</h3><div>There are limited data defining the rate of progression of the development of adverse pregnancy outcomes and short-term cardiovascular risk factors in a contemporary cohort.</div></div><div><h3>OBJECTIVE</h3><div>This study aimed to examine the association between adverse pregnancy outcomes and short-term cardiovascular disease risk factors in a contemporary population.</div></div><div><h3>STUDY DESIGN</h3><div>This was a hospital-based electronic health record retrospective cohort study from 2 healthcare systems in North Carolina. Patients who gave birth between 2016 and 2020, were free of cardiovascular disease risk factors or events at delivery, and had >1 prenatal care appointment during pregnancy and 1 postnatal care appointment ≤3 months after delivery were included in the study. However, only the first pregnancy in the study period was included. Adverse pregnancy outcomes were defined using the International Classification of Diseases, 10th Revision, codes for preeclampsia, gestational hypertension, gestational diabetes mellitus, preterm birth, and small-for-gestational-age infant. The development of a short-term cardiovascular disease risk factor was defined as a new diagnosis of chronic hypertension, hyperlipidemia, diabetes mellitus, or prediabetes mellitus by December 31, 2021. Cox proportional hazards regression was used to model associations between adverse pregnancy outcomes and cardiovascular disease risk factors.</div></div><div><h3>RESULTS</h3><div>A total of 32,623 patients were included in this study. More than a quarter of the patients (8965 [27.5%]) experienced at least 1 adverse pregnancy outcome, with more patients with an adverse pregnancy outcome developing a cardiovascular disease risk factor during follow-up than those without an adverse pregnancy outcome (9.5% vs 3.2%, respectively). Patients with any adverse pregnancy outcomes were 3 times more likely to be diagnosed with a cardiovascular disease risk factor (hazard ratio, 3.11 [95% confidence interval, 2.87–3.38]) and had a median time to event of 1.98 years (interquartile range, 0.82–3.34). The highest risks were observed in patients with gestational diabetes mellitus developing type 2 diabetes mellitus (hazard ratio, 21.29 [95% confidence interval, 16.49–27.47]) and in those with preeclampsia developing chronic hypertension (hazard ratio, 6.35 [95% confidence interval, 5.51–7.32]).</div></div><div><h3>CONCLUSION</h3><div>A pregnancy complicated by an adverse pregnancy outcome is associated with a 3-fold increased risk of developing cardiovascular disease risk factors as early as 2 years after delivery. These findings highlight the importance of screening for cardiovascular disease risk factors in the early years after delivery for patients who experienced an adverse pregnancy outcome.</div></div>","PeriodicalId":36186,"journal":{"name":"American Journal of Obstetrics & Gynecology Mfm","volume":"8 2","pages":"Article 101869"},"PeriodicalIF":3.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145688301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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