The Mask of Pregnancy

Our regular podcast family members know that we have been following the antenatal corticosteroid story (especially in the late pre-term/early term interval) for several years now. A variety of countries have now pulled back from recommending corticosteroids in the late pre-term/early term interval due to concerns of adverse child neurodevelopment, especially when the children deliver at term. But today, April 24, 2024, a new publication from JAMA has provided some reassuring information. Is this data truly reassuring? Or is there more to the story? In this episode, we will dive into this brand new publication, released today, which provides follow-up from the original ALPS Study. This issue of steroids in the late pre-term/early term interval is hot hot hot 🔥🔥🔥. Listen in to get the latest information!

Breast cancer is the second most common cancer among women in the United States (with skin cancer are the most common). About 9% of all new cases of breast cancer in the United States are found in women younger than 45 years of age. Unfortunately, breast cancer is being diagnosed in women under 40 at an increased rate. This was recently published in a Jan 2024 JAMA population-based, cross-sectional study using data from Surveillance, Epidemiology, and End Results database. Every year, more than 1,000 women under age 40 die from breast cancer. Nearly 80% of young women diagnosed with breast cancer find their breast abnormality themselves. Breast cancer is the most common form of cancer in women who are pregnant or have recently given birth. According to US statistics, Breast cancer occurs about once in every 3,000 pregnancies, with some reports stating it may be as high as 1 in 1,000. For those under the age of 40, most are diagnosed between the ages 32 to 38 years. Because many women are choosing to delay having children, it is likely that the number of new cases of breast cancer during pregnancy will increase. In this episode, we’re going to look at breast cancer in reproductive age women with a focus on gestational breast cancer. Is MMG contraindicated in pregnancy? Can chemotherapy be used during pregnancy? What about radiation therapy? And is it better to have a complete mastectomy or breast conservation, during pregnancy? Listen in for details.

Historically, colostrum was expressed by women mid- to late-pregnancy with the intent to avoid engorgement and breast trauma in the postnatal period, but it was not stored for use after birth. But storing colostrum antepartum for newborn feeding has gained attention in social media channels. Is antenatal milk expression, also called colostrum harvesting, evidence-based? Are there benefits to this? Does this run the risk of initiating labor? Are there published studies? In this episode, we will “milk” the data- including a RCT from 2023 – and present some key points to consider about what it is and what it isn’t.

From 2012 to 2021, congenital syphilis cases in the United States increased by 755%. According to the CDC, 88% of congenital syphilis cases in 2022 could have been prevented with timely screening and treatment. Despite repetitive messaging about the need to identify syphilis early in pregnancy, with appropriate treatment, gaps remain. A new publication in the Green Journal (4/17/24) provides shocking information about gaps in diagnosis and treatment. In this episode, we will review that original research as well as summarize the new ACOG Practice Advisory (April 2024) regarding screening for syphilis in pregnancy.

There is a STRONG debate within the medical community as to whether testosterone should be prescribed to women during menopause and the time before and after it. Social media influencers and other media personalities are touting testosterone as a cure-all for mood, sex drive, cognitive changes, fatigue, reduced muscle strength, and other symptoms associated with menopause. In fact, the number of testosterone prescriptions for women has risen within the last five years in the United States and internationally. But is that evidence-based? The answer is both YES and NO. In this episode, we will focus on testosterone replacement for female low sexual interest. We will highlight the position statements from a large international coalition in 2019, a separate 2021 position statement, and the opinion of the ACOG. We have LOTS to cover here, so go lather up with your testosterone cream (JK) and listen in!

While the importance of optimizing a woman's hemoglobin level during the peripartum period has been emphasized in recent guidelines by the Society for Obstetric Anesthesia and Perinatology, the ACOG, and the Enhanced Recovery After Surgery Society, postpartum anemia remains a real issue in both the developed and developing world. Postpartum anemia has been associated with depression, fatigue, impaired lactation, and impaired cognition. This may lead to impaired maternal-child bonding. Additionally, severe anemia during the antepartum interval is an important predictive factor of PPH! This relationship was shown in a published meta-analysis in 2021. Postpartum, IV Fe has been proven to be of value for asymptomatic anemia. Packed RBC transfusion may be recommended for women with postpartum hemoglobin levels

Amnioinfusion was first described in 1976 using a rhesus monkey model. In that landmark study, the authors reported that variable decelerations occurred when amniotic fluid was removed from the uterine cavity and resolved when it was replaced. Although this experiment established that variable decelerations related to oligohydramnios and cord compression could be corrected by amnioinfusion, the technique did not achieve clinical application until 1983, when a novel approach to the relief of variable or prolonged decelerations was described. Amnioinfusion is mainly utilized in the rescue of recurrent fetal variable decelerations intrapartum. But what if the patient has suspected IAI? Is that a relative contraindication for amnioinfusion? Is that safe? In this episode we will examine the data and provide some clinical insights.

In 2014, a publication out of JAMA Pediatrics raised questions regarding the safety of acetaminophen in pregnancy describing a possible “association” with later neurodevelopmental and cognitive delays in children. What followed was a string of controversial publications (observational) with mounds of conflicting data. This led to a controversial international consensus opinion in 2021 calling for “caution for use” regarding acetaminophen in pregnancy. The ACOG had a strong rebuttal to that statement at that time. But now, as of April 9, 2024, we have new data on acetaminophen/paracetamol use in pregnancy and possible neurodevelopmental affects in children. This new study was published out of JAMA network and followed 2.4 million children with sibling pairs out of Sweden. This is making a lot of news within the last 24 hours and it is hot off the press 🔥🔥🔥. Listen in, and find out more.

It has been stated that “Trauma is in the eye of the beholder”. Healthcare providers must be aware that a woman makes experience a birth as traumatic, even if she and her infant are healthy. The ACOG has highlighted perinatal PTSD in several publications, which we will review in this episode. Perinatal PTSD has definitely been in the OB/GYN and psychology literature with an increased frequency just over the last 3 months. In this episode, we will review the very real and devastating condition of perinatal PTSD, its diagnosis, and discuss interventions to reduce its development. We will also review new data on “service dogs“ detecting PTSD in people with trauma histories? NOTE: We will also highlight a real world account of a traumatic birth event from one of our podcast listeners (Deidentified, and shared with permission).

In July 2023 and again in November 2023, we discussed the “Rule of 55“ and its role in the management of hypertensive disorders of pregnancy. The Rule of 55 has been mainly applied in the selection of appropriate antipretensive medications when urgent/emergent hypertension is present. Does the Rule of 55 also work for antihypertensive management of gestational hypertension or preeclampsia without severe features? A new publication (April 1, 2024) from the AJOG MFM gives us that answer! In this episode, we will cover the newly released PYTT study from Italy.