Obstetrics and gynecology最新文献

{"title":"Stakeholder Perspectives of New Tailored Prenatal Care Delivery.","authors":"Asavari Rajpurkar,Yannet Daniel,Christopher M Zahn,Mark Turrentine,Lauren Lott,Lamiya Ahmed,Alex F Peahl","doi":"10.1097/aog.0000000000006005","DOIUrl":"https://doi.org/10.1097/aog.0000000000006005","url":null,"abstract":"OBJECTIVETo evaluate obstetric stakeholders' attitudes and implementation considerations regarding the adoption of key components of a newly tailored prenatal care recommendation-PATH (Plan for Appropriate Tailored Healthcare in Pregnancy).METHODSWe conducted a national listening tour that used qualitative focus groups from March 2022 to June 2023. We recruited a national sample of obstetric care clinicians, patients, advocates, policymakers, and payers using maximum variation sampling. We explored core PATH domains, including 1) addressing social needs, 2) telemedicine and remote monitoring, and 3) targeted visit schedules. Participants were queried about their perceived barriers to adopting new recommendations and needed supports. We performed a qualitative content analysis to identify positive attitudes, concerns, and multilevel implementation considerations for each recommendation.RESULTSIn total, 102 obstetric stakeholders participated in nine focus groups from 10 obstetric care organizations, seven patient advocacy and equity organizations, nine policy and public health organizations, and four payer groups. Participants broadly supported the idea of care tailoring and raised important concerns about unintended inequities and negative health outcomes that could arise with inappropriate application of the model. Participants affirmed that addressing social needs is crucial to improving prenatal care access and pregnancy outcomes but identified barriers including insufficient resources and support for interprofessional collaboration. Telemedicine and remote monitoring were widely accepted to improve care access and efficiency, but participants worried that limited access to digital infrastructure could exacerbate existing health disparities. Although participants recognized that targeted visit schedules could enhance visit attendance, care flexibility, and resource equity, some worried about the potential for missed services and worse health outcomes. Across all recommendations, participants identified patient-, clinic-, and policy-level considerations to improve the implementation of new prenatal care models.CONCLUSIONPATH is an acceptable and feasible care model with the potential to improve the quality, equity, and efficacy of prenatal care. Multilevel implementation considerations must be integrated with routine use of PATH to promote sustainability across patient populations and settings.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"153 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144652817","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}

{"title":"Recommendations From the Women's Preventive Services Initiative on Breast Cancer Screening for Women at Average Risk and Patient Navigation Services for Breast and Cervical Cancer Screening.","authors":"Catherine T Witkop,Carla Picardo,Alexis Vosooney,Heidi D Nelson,Amy G Cantor,Sarah Son,Michelle Collins,Susan Hoffstetter,Alayne Markland,Dorianne Mason,Erin Mackay,Mary Rosser,Annamarie Streilein,Amy Weil,Francisco Garcia,Susan M Kendig,Amir Qaseem,Diana Ramos,Alina Salganicoff,Julie K Wood,Nancy O'Reilly,Christopher Zahn,Kimberly D Gregory, ","doi":"10.1097/aog.0000000000006011","DOIUrl":"https://doi.org/10.1097/aog.0000000000006011","url":null,"abstract":"The Women's Preventive Services Initiative (WPSI) expanded its previous breast cancer screening recommendation-initiate annual or biennial mammography screening for women at average risk of breast cancer between the ages of 40 and 50 years-by including additional imaging and pathology evaluation as part of the screening process if needed. Consistent with the previous recommendation, screening should continue through at least age 74 years, and age alone should not be the basis for discontinuing screening. To increase utilization of screening recommendations, the WPSI also issued a new recommendation to provide patient navigation services for breast and cervical cancer screening. To update its 2016 breast cancer screening recommendation, the WPSI found no new evidence of benefits and harms of screening. However, additional studies reported that gaps in insurance coverage contributed to incomplete follow-up after an initial abnormal mammogram for many women. For its new patient navigation recommendation, the WPSI evaluated 42 randomized controlled trials of patient navigation services for breast and cervical cancer screening and follow-up that showed increased rates compared with usual care. Patient navigation services involve person-to-person contact and are individualized to the patient's specific needs. Services include but are not limited to person-centered assessment and planning, health care access and health system navigation, referrals to support services, and patient education. The new recommendations are intended to expand breast cancer screening follow-up and to improve access and equity for cancer screening. Beginning in 2026, under the Affordable Care Act, these services will be covered without copay or deductible charges for most eligible women.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"52 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144652862","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}

{"title":"Success of Methotrexate for the Management of Recurrent Compared With Primary Ectopic Pregnancy: A Systematic Review and Meta-analysis.","authors":"Shreya Bhat,Sameer Bhat,Sikhar Sircar","doi":"10.1097/aog.0000000000006013","DOIUrl":"https://doi.org/10.1097/aog.0000000000006013","url":null,"abstract":"OBJECTIVETo compare the efficacy of intramuscular (IM) methotrexate in patients with recurrent compared with primary ectopic pregnancy.DATA SOURCESSystematic searches of the MEDLINE, EMBASE, and Scopus databases were conducted in February 2025.METHODS OF STUDY SELECTIONThis meta-analysis was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. All English-language, full-text studies in which adult patients (18 years of age or older) were treated with IM methotrexate and stratified by their history of a previous ectopic pregnancy were included. Patients with at least one prior ectopic pregnancy, regardless of which fallopian tube was affected and how it was managed, were defined as having recurrent ectopic pregnancy. We excluded studies that did not report patients requiring further treatment, those in which medical management through alternative routes (other than IM) or therapies were studied, and those investigating nontubal ectopic pregnancy or heterotopic pregnancies.TABULATION, INTEGRATION, AND RESULTSTwo investigators independently identified studies using the eligibility criteria. The primary outcome was treatment success, characterized by the complete resolution of ectopic pregnancy without the need for further treatment. The efficacy of single-dose and multidose (comprising both two doses and fixed multidose, ie, two or more doses) IM methotrexate regimens was evaluated. Outcomes were reported as relative risk (RR) and 95% CI. From 6,349 search results, 15 observational studies comprising 3,944 patients (502 recurrent, 3,442 primary ectopic pregnancy) were included. Administration of a single dose of IM methotrexate was significantly less successful in patients with recurrent compared with those with primary ectopic pregnancy (RR 0.79, 95% CI, 0.63-1.00, P=.050). However, there was no statistical difference in success for patients receiving multidose treatment (RR 1.14, 95% CI, 0.71-1.84, P=.590).CONCLUSIONCurrent observational data suggest that patients with recurrent ectopic pregnancy should be considered for multidose IM methotrexate to achieve similar rates of success compared with primary ectopic pregnancy.SYSTEMATIC REVIEW REGISTRATIONPROSPERO, CRD42025642895.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"679 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144652938","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}

{"title":"Association of Intimate Partner Violence Around the Time of Pregnancy With Postpartum Visits.","authors":"Denise V D'Angelo,Lauren B Zapata,Jesse L Coe,Yanet Ruvalcaba,Ceiara M Hyde,Kara Tsukerman,Letitia Williams,Sarah Huber-Krum","doi":"10.1097/aog.0000000000006002","DOIUrl":"https://doi.org/10.1097/aog.0000000000006002","url":null,"abstract":"OBJECTIVETo examine the association between experiencing emotional or physical intimate partner violence (IPV) around the time of pregnancy and having a postpartum visit.METHODSWe conducted a secondary analysis of data from 2016 to 2021 from PRAMS (Pregnancy Risk Assessment Monitoring System), a population-based surveillance system that collects self-reported information about experiences before, during, and after pregnancy among women with a recent live birth. We used multivariable logistic regression to estimate the prevalence of experiencing emotional or physical IPV around the time of pregnancy and associations with having a postpartum visit.RESULTSIn seven jurisdictions with information on emotional IPV (n=30,333), 3.3% (95% CI, 3.0-3.6) of women with a recent live birth reported experiencing any emotional violence 12 months before pregnancy, during pregnancy, or after pregnancy; for these women, the prevalence of having a postpartum visit was 91.4% (95% CI, 90.9-91.9). Any emotional IPV was associated with lower odds of having a postpartum visit (adjusted odds ratio [aOR] 0.74; 95% CI, 0.55-0.99). In 48 jurisdictions with information on physical IPV (n=224,957), 3.3% (95% CI, 3.2-3.5) of women with a recent live birth reported physical violence 12 months before pregnancy or during pregnancy; for these women, the prevalence of having a postpartum visit was 90.2% (95% CI, 90.0-90.4). Any physical IPV was associated with lower odds of having a postpartum visit (aOR 0.63; 95% CI, 0.57-0.69). Among women who had a postpartum visit, 34.2% (95% CI, 29.0-39.0) of those who experienced emotional IPV and 35.1% (95% CI, 33.2-37.1) of those who experienced physical IPV were not asked about IPV by a health care professional during the visit.CONCLUSIONExperiencing emotional or physical IPV around the time of pregnancy was associated with lower odds of having a postpartum visit. Conducting screenings at various encounters such as telehealth, pediatric visits, or home health visits and ensuring availability of standard protocols and trainings for IPV screening and referrals may increase support for and identification of women experiencing IPV.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"14 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144652806","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}

{"title":"Etiology, Natural History, and Management of Recent Advances in Molar Pregnancy.","authors":"Antonio Braga,Ross Berkowitz,Neil Horowitz","doi":"10.1097/aog.0000000000005998","DOIUrl":"https://doi.org/10.1097/aog.0000000000005998","url":null,"abstract":"Molar pregnancy is a rare reproductive anomaly that globally affects 1:1,000-1,500 pregnancies. It is caused by aberrant fertilization and can be associated with medical complications or progress to postmolar gestational trophoblastic neoplasia. Molar pregnancy presents with two distinct entities, complete and partial hydatidiform mole, which differ in their clinical, genetic, and prognostic aspects. Maternal age and history of molar pregnancy are the main risk factors for the occurrence of molar pregnancy. Early diagnosis of molar pregnancy by ultrasonography is associated with a decrease in medical complications but not decreased postmolar gestational trophoblastic neoplasia. After the diagnosis of a presumed molar pregnancy, patients should be referred to an expert with experience taking care of molar pregnancy or to a reference center for uterine evacuation and postmolar follow-up, which facilitates early diagnosis of gestational trophoblastic neoplasia. Weekly human chorionic gonadotropin measurement is essential to confirm remission and to identify cases of gestational trophoblastic neoplasia that will require further treatment. To maintain the reliability of this tumor marker, hormonal contraception is indicated during postmolar follow-up. The postmolar follow-up should extend for 1 month and from 3 to 6 months after remission in cases of partial and complete hydatidiform mole, respectively. The reproductive outcomes after molar pregnancy are comparable with those of the general population, except for the higher occurrence of recurrent molar pregnancy, affecting 1.0-2.0% of subsequent pregnancies. The considerable psychosocial repercussions of molar pregnancy require a multidisciplinary approach to minimize the repercussions of this disease on mental health.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"22 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144603851","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}

{"title":"Prediction of Treatment Failure After Excisional Treatment of Cervical Precancer: A Systematic Review and Meta-analysis.","authors":"Leandro Bomans,Arianis Tatiana Ramirez,Peter Hillemanns,Murat Gultekin,Marc Arbyn","doi":"10.1097/aog.0000000000005997","DOIUrl":"https://doi.org/10.1097/aog.0000000000005997","url":null,"abstract":"OBJECTIVETo evaluate the diagnostic accuracy and clinical utility of posttreatment tests to predict treatment failure after excisional treatment of cervical intraepithelial neoplasia grade 2 or worse (CIN 2+).DATA SOURCESElectronic databases (EMBASE, PubMed MEDLINE) were searched for studies published from January 1975 to August 2024 assessing the occurrence of treatment failure in women who underwent excisional treatment for histologically confirmed CIN 2+ lesion.METHODS OF STUDY SELECTIONPreviously published meta-analyses were extended and updated. A total of 1,802 studies were reviewed. Studies that assessed the diagnostic accuracy of the margin status, cytologic testing, combination of cytology and high-risk human papillomavirus (HPV), or combination of margin status and high-risk HPV compared with high-risk HPV testing were included. The primary outcome was treatment failure (residual or recurrent CIN 2+) and the absolute and relative diagnostic accuracy to predict this outcome. Studies with at least 18 months of follow-up were included.TABULATION, INTEGRATION, AND RESULTSForty-six studies and 20,385 women were included in the analysis. Treatment failure occurred in 6.6% of patients. The pooled sensitivity and specificity of high-risk HPV testing were 86.8% and 80.5%, respectively. Cytology had a sensitivity of 70.8% and a specificity of 85.7%, pooled from 34 studies. Compared with high-risk HPV testing in the same studies, cytology was 6.5% more specific (95% CI, 1.024-1.108) but 21.3% less sensitive (95% CI, 0.702-0.882). Assessment of the margin status was 39.9% less sensitive (95% CI, 0.532-0.678) but similarly specific (95% CI, 0.970-1.069) to high-risk HPV testing in 29 studies, with a pooled sensitivity and specificity of 48.9% and 82.5%, respectively. Co-testing with cytology and high-risk HPV was similarly sensitive (95% CI, 0.992-1.061) but 10.5% less specific (95% CI, 0.850-0.944) compared with high-risk HPV testing in 16 studies, with a pooled sensitivity and specificity of 94.7% and 69.9%, respectively. The pooled sensitivity and specificity of co-testing with margin status and high-risk HPV were 96.9% and 55.7%, respectively, 6.6% more sensitive (95% CI, 1.021-1.114) but 26.7% less specific (95% CI, 0.637-0.844) than high-risk HPV testing in eight studies. Involved resection margins, abnormal cytology, and a positive high-risk HPV test result were associated with a failure risk of 16.1%, 29.0%, and 26.1%, respectively. Women with negative margins, normal cytology, and a negative high-risk HPV test result had a failure risk of 3.6%, 2.3%, and 0.9%, respectively. The risk of treatment failure was highest for women with involved margins and a positive high-risk HPV test result (45.3%) and lowest for women with negative margins and a negative high-risk HPV test result (0.3%). Abnormal cytology and a positive high-risk HPV test result increased the risk of treatment failure to 42%, whereas normal cytology and a negative high-risk HP","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"101 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144603807","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}

{"title":"Relationship Between Third-Trimester Low Maternal Blood Pressure and Small-for-Gestational-Age Birth Weight in Pregnant Individuals With Mild Chronic Hypertension.","authors":"Kim Boggess,Justin Leach,Lorraine Dugoff,Baha Sibai,Brenna L Hughes,Joseph Bell,Kjersti Aagaard,Rodney Edwards,Kelly Gibson,David M Haas,Lauren Plante,Torri Metz,Brian Casey,Sherri Longo,Matthew K Hoffman,George R Saade,Kara K Hoppe,Janelle Foroutan,Michelle Owens,Hyagriv N Simhan,Heather Frey,Todd Rosen,Anna Palatnik,Susan Baker,Wendy Kinzler,Emily Su,Iris Krishna,Mary E Norton,Daniel Skupski,Yasser Y El-Sayed,Ronald Librizzi,Leonardo Pereira,Mounira Habli,Shauna Williams,Gabriella Pridijan,David S McKenna,Eugene Chang,Sarah Osmundson,Zorina Galis,Lorie Harper,Namasivavam Ambalavanan,Jeff Szychowski,Alan Tita","doi":"10.1097/aog.0000000000006008","DOIUrl":"https://doi.org/10.1097/aog.0000000000006008","url":null,"abstract":"OBJECTIVETo estimate the association between third-trimester maternal low blood pressure (BP) and delivery of a neonate with small-for-gestational-age (SGA) birth weight in patients treated for mild chronic hypertension.METHODSThis is a secondary analysis of the CHAP (Chronic Hypertension and Pregnancy) study, which randomized pregnant participants with mild chronic hypertension to treatment to achieve goal BP below 140/90 mm Hg compared with usual care. We calculated mean systolic and diastolic BPs between 28 and 34 weeks of gestation and excluded those with systolic BP of 140 mm Hg or higher or diastolic BP of 90 mm Hg or higher. We defined low BP as mean systolic BP below 110 and mean diastolic BP below 70 mm Hg or mean arterial pressure below 80 mm Hg and compared those individuals with participants with mean systolic BP of 110-139 mm Hg or mean diastolic BP of 71-89 mm Hg or both or mean arterial pressure of 80 mm Hg or higher. Our primary outcome was delivery of a neonate with SGA birth weight (birth weight below the 5th percentile). Logistic regression estimated the association between low BP and SGA birth weight, and adjusted odds ratios (aORs) and 95% CIs were reported.RESULTSOf 2,408 CHAP participants, 1,205 (50.0%) met analysis criteria. Of those 1,205, 31 (2.6%) had low BP and 1,174 (97.4%) had mean BP 110/70-139/89 mm Hg; 33 (2.7%) had mean arterial pressure below 80 mm Hg, and 1,172 (97.3%) had mean arterial pressure of 80 mm Hg or higher. Having a neonate with SGA birth weight below the 5th percentile occurred in 62 participants (5.1%): 1 of the 31 (3.2%) with BP below 110/70 mm Hg and 1 of the 33 (3.0%) with mean arterial pressure below 80 mm Hg. There was no significant association between delivery of a neonate with SGA birth weight less than the 5th percentile and low BP by either mean systolic BP and mean diastolic BP (aOR 0.46, 95% CI, 0.06-3.58) or mean arterial pressure (aOR 0.53, 95% CI, 0.07-4.01). We found a nonlinear relationship between mean arterial pressure and delivery of a neonate with SGA birth weight less than the 5th percentile, and, as mean arterial pressure decreased, there was lower probability of having a neonate with SGA birth weight (P=.02).CONCLUSIONPharmacologic treatment of mild chronic hypertension infrequently results in low BP and does not appear to be associated with delivery of a neonate with SGA birth weight less than the 5th percentile for birth weight.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"35 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144603808","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}

{"title":"Longitudinal Epigenetic Aging in Pregnancy and Associations With Adverse Outcomes.","authors":"Danielle M Panelli,Nicole Gladish,Nicola C Perlman,Stephanie A Leonard,Jane Chueh,Ian H Gotlib,Andres Cardenas,Katherine Bianco","doi":"10.1097/aog.0000000000006000","DOIUrl":"https://doi.org/10.1097/aog.0000000000006000","url":null,"abstract":"OBJECTIVETo understand the relationship between pregnancy and epigenetic aging estimated by DNA methylation \"clocks,\" which offers a molecular measure of biologic aging.METHODSThis was a prospective cohort study of nulliparous women (age 18-50 years) seeking obstetric (pregnant 10-14 weeks) or gynecologic (nonpregnant) care in 2020-2021. Blood was collected at enrollment (time 1) and postpartum day 1 (pregnant, time 2) or 7 months later (nonpregnant, time 2). Epigenetic age was measured with 11 established clocks from Illumina EPIC 2 arrays. Within-person changes in epigenetic age were compared with mixed-effects linear regression models adjusted for confounders and interval duration (days). Results were scaled per 200-day interval. P values were corrected for multiple testing. Multivariable logistic regression explored associations between first-trimester epigenetic age and a composite of potentially immune-mediated complications (hypertensive disorders, gestational diabetes mellitus, preterm birth before 37 weeks of gestation, and small-for-gestational-age birth weight) adjusted for age and body mass index (BMI) higher than 30 at time 1.RESULTSIn total, 75 women enrolled; 45 (60.0%) were pregnant, and 61 (81.3%) completed the study. Pregnant women exhibited significant within-person epigenetic age acceleration compared with nonpregnant women in six clocks (Hannum, PhenoAge, GrimAge, GrimAge2, Stem Cell Division, DunedinPACE). Additional epigenetic age acceleration per 200 days in the pregnant cohort ranged from 1.58 years (Hannum, 95% CI, 0.45-2.72, P=.01) to 5.28 years (PhenoAge, 95% CI, 2.97-7.61, P<.01). Each additional year of first-trimester GrimAge2 increased odds of the composite of pregnancy complications by 36% (adjusted odds ratio [aOR] 1.36, 95% CI, 1.01-1.84), while chronologic age (in continuous years) showed no association (aOR 1.00, 95% CI, 0.83-1.21).CONCLUSIONPregnancy accelerated within-person epigenetic aging by up to 5.3 years. Older first-trimester GrimAge2, but not chronologic age, was associated with a composite of pregnancy complications. These findings suggest that gestation may influence biologic aging and support further investigation into epigenetic age as a potential marker of pregnancy health.","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":"27 1","pages":""},"PeriodicalIF":7.2,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144603853","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}

{"title":"Association of Health-Related Social Needs With Adverse Pregnancy Outcomes Among Black and Latina Individuals.","authors":"Lauren Belak, Kaitlyn James, Marya Rana, Victoria Viscosi, Imuetiyan Eweka, Jaiden Busso, Amy Sarma, Camille Powe, Katherine Economy, Michael C Honigberg","doi":"10.1097/AOG.0000000000005999","DOIUrl":"10.1097/AOG.0000000000005999","url":null,"abstract":"<p><p>Rates of adverse pregnancy outcomes (APOs) are increasing among Black and Latina Americans. Whether health-related social needs (HRSNs) are prospectively associated with APOs among racial and ethnic minoritized groups is unclear. Black and Latina pregnant individuals completed a Centers for Medicare & Medicaid Services-endorsed screening tool encompassing 13 domains of HRSNs. We tested the association of cumulative HRSN scores with APOs, adjusted for age, prior APO history, and parity. Among 320 participants, 119 (37.2%) had at least one APO. Each 1-point increase in a composite HRSN score was associated with 11.0% higher odds of developing an APO. An HRSN score of 7 or higher, compared with 0-4, was associated with 2.34-fold odds of APOs (95% CI, 1.26-4.34, P=.007). Pregnancy may provide an opportunity to identify and address HRSNs that place Black and Latina Americans at risk for APOs.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12233133/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National Trends in Prepregnancy Cardiometabolic Risk and Counseling: An Analysis of the Pregnancy Risk Assessment Monitoring System, 2016-2022.","authors":"Megan M McLaughlin, Catherine Lee, Neda Ghaffari, Juan M Gonzalez Velez, Alexis L Beatty","doi":"10.1097/AOG.0000000000005990","DOIUrl":"https://doi.org/10.1097/AOG.0000000000005990","url":null,"abstract":"<p><strong>Objective: </strong>To assess national U.S. trends in self-reported prepregnancy cardiometabolic risk factors and counseling about improving cardiometabolic health.</p><p><strong>Methods: </strong>We analyzed data from the Centers for Disease Control and Prevention's PRAMS (Pregnancy Risk Assessment Monitoring System), a nationally representative population-based survey of postpartum individuals who had live births from 2016 to 2022. We identified prepregnancy cardiometabolic risk factors (obesity, overweight, hypertension, diabetes mellitus, smoking cigarettes or electronic cigarettes). We then tested for age-standardized trends in both cardiometabolic risk factors and prepregnancy counseling using logistic regression with survey year as a continuous variable. We examined whether patient sociodemographic factors were associated with self-reported prepregnancy counseling about cardiometabolic health, adjusting for clinical characteristics.</p><p><strong>Results: </strong>Among 225,431 participants (weighted n=11,052,761), the majority (61.6%) reported having at least one prepregnancy cardiometabolic risk factor and 14.8% reported having two or more risk factors. Only 38.4% of individuals had optimal prepregnancy cardiometabolic health (no risk factors). The age-standardized prevalence of having a cardiometabolic risk factor increased from 59.1% in 2016 to 62.8% in 2022 (P<.001) and was driven by an increase in the prevalence of obesity from 22.4% to 28.4% (P<.001). Only 58.3% reported receiving any type of prepregnancy counseling about cardiometabolic risk, with screening for smoking most common (54.4%), followed by counseling about maintaining a healthy weight (26.9%), counseling about improving health before pregnancy (21.4%), and counseling about controlling medical conditions such as diabetes or high blood pressure (10.4%). Lower income, lower education, rural residence, and no health insurance were associated with lower odds of being counseled about cardiometabolic health.</p><p><strong>Conclusion: </strong>Prepregnancy cardiometabolic risk factors were common among U.S. birthing people and have increased over time. Self-reported prepregnancy counseling about cardiometabolic health remains suboptimal, and there were disparities by income, education, geography, and insurance status.</p>","PeriodicalId":19483,"journal":{"name":"Obstetrics and gynecology","volume":" ","pages":""},"PeriodicalIF":5.7,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560696","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}