Bed Rest for FGR? Surprising 2024 Data

The ACOG defines Fetal Growth Restriction (FGR) as fetuses with an estimated fetal weight or abdominal circumference that is less than the 10th percentile for gestational age. Currently, the ACOG, SMFM, FIGO, and the ISUOG do not recommend maternal bed rest for this condition. However, a recent publication from the AJOG (May 2024) concluded that strict maternal bed rest could in fact reverse FGR in a short two-week interval! Is this possible? In this episode, we will dissect this controversial, retrospective study and give it proper perspective with real world clinical implications.

In the ACOG practice bulletin 203, the ACOG states that, “Traditionally, the diagnosis of hypertension (HTN) in pregnancy has been 140/90, on 2 occasions at least 4 hrs apart“. The keyword there is… “Traditionally”. In 2017, the ACC/AHA redefined hypertension with Stage I HTN being 130/80. Do some societies recommend the use of this lowered blood pressure criteria in pregnancy? It’s a complicated answer. Does aspirin help prevent preeclampsia in women with Stage I (130/80) hypertension? The answer may surprise you! In this episode, we will do a deep dive into ACOG PB 203, the ACOG practice advisory from 2022 in response to the CHAP trial, and discuss the CLIP 2021 published data. This is a story of CHIP, CHAP, and CLIP… And we will give clear clinical implications of each in this episode!

Dysphoric Milk Ejection Reflex (D-MER) is an abrupt emotional "drop" that occurs in some women just before milk release and continues for not more than a few minutes. Although research is still evolving, one study Published in 2019 (Breastfeeding Medicine) states that up to 9% of breastfeeding women may experience dysphoric milk ejection, although the true incidence is still unknown. The brief negative feelings range in severity from wistfulness to self-loathing. In Arch Gynecol Obstet, in July 2024, authors published, “Dysphoric milk ejection reflex – a call for future trials”. This is gaining interest in the published literature. The etiology of this is unclear but a new (soon-to-be-released) publication in the AJOG provides some interesting insights into this. This was just accepted for publication on September 18, 2024 and the official release is pending. Haven’t heard about D-MER? Due to a lack of awareness, this phenomenon is easily misdiagnosed as postpartum depression and aversion by many healthcare professionals. A July 2024 Harvard Review in Psychiatry publication called D-MER, “A Novel Neuroendocrine Condition with Psychiatric Manifestations”. This condition is a physiologic tale of oxytocin, milk- let down, dopamine and prolactin, and the fight and flight response. Listen in for details.

Podcast Family, every once in a while we need a little reminder that we are all wired for community. Despite differences in geographic locations, cultures, and family history, we really do have a lot in common. In this episode, I'll share with you 3 examples which prove that we really do live in a very small world. I hope this brings a smile to your face and encourages you! PLUS, of course, we will provide one main clinical pearl regarding CS-Hysterotomy closure while keeping with our "small world" theme. Listen in for details!

The LNG-IUS has been on the U.S. market since 2001. Since 2005, there have been several studies examining the association (if any) of LNG-IUS users and the diagnosis of breast cancers. This is a controversial and conflicting story. In this episode, we will highlight a soon to be released publication (OCT 2024) from the AJOG looking into this relationship. PLUS, we will very quickly walk down history’s timeline starting in 2005 and ending in October 2024 looking at the cumulative data on the subject. Does the ACOG has a statement on it? Listen in for details!

We all what to win in life, right? That’s why we have life hacks…to beat the system. Sometimes those tricks are tremendously successful while some other random hack can be- well, just WACK. Such is the case for LABOR HACKS! We all want our inductions and augmentations of labor to be successful, and there have been some labor hacks promoted throughout the years. But is there evidence of their effectiveness? Is a Pitocin break effective at kickstarting the uterus back up? We will cover that in this episode. PLUS, we will highlight two new publications, both from AJOG MFM which have just been released (September 2024; October 2024): Can “pretreatment” with calcium help with labor? What about the use of propranolol? Listen in for details.

On May 22, 2024, we summarized a then soon-to-be-released ACOG CPU on Screening for GDM in Pregnancy and Postpartum. That CPU was officially released July 2024. That update endorsed the possibility of immediate postpartum GTT testing with a 75-gram OGTT. Now, on September 19, 2024, authors from UT Houston have published a systematic review/meta-analysis on this subject. In this episode, we will review what this data is and what it isn't. Listen in for details.

Magnesium Sulfate for preeclampisa can be traced back to the work of Horn in 1906! Yet, despite such a long history of use, there are still questions about mag sulfate use that we just don’t have good answers for, and that’s indicative of the all the continued articles and commentaries on the subject that are still being released. For example, there are still sparse data regarding the ideal dosage of magnesium sulfate for preeclampsia with severe features. Even the therapeutic range of 4–8 mEq/L quoted in the literature is questionable. What to know where that statement comes from? That’s in the ACOG PB 222 from 2020! So is the case for mag duration…you know, the 24-hour infusion tradition. The ACOG states in that same PB, “For women requiring cesarean delivery (before onset of labor), the infusion should ideally begin before surgery and continue during surgery, as well as for 24 hours afterwards. For women who deliver vaginally, the infusion should continue for 24 hours after delivery.” But this 24-hour mark, while TOTALLY OK, is more traditional than hard data driven. YES…its true, MOST if not ALL of would give mag for 24 hrs. in cases of eclampsia, and that is SUPER fitting and reasonable since they are the highest to have a recurrent seizure, but what about preeclampsia with severe features, without eclampsia or neurological symptoms. That’s where the 24-hour use can get into a greyer zone; can mag be used for less than 24hrs? Can we use diuresis as a clinical marker to stop mag? Two systematic reviews and meta-analyses looking at PP Mag duration were just published in July 2024 and in September 2024. We will summarize these findings- and more- in this episode.

Filet Mignon, Pork Loin, Rib-Eye….all delicious (unless you are vegetarian)! If you are a meat- eater, be aware of AGS. Alpha-gal syndrome (AGS), also known as Red Meat Allergy, is a potentially life-threatening allergic reaction that can occur after a tick bite from a Lone Star tick or other tick species. While clustering within the US, Alpha-gal syndrome is found on every continent except Antarctica. With the tick bite, the tick transfers alpha-gal, a sugar molecule found in most mammals, into the person's bloodstream. The body then produces antibodies to fight the alpha-gal, which can trigger an allergic reaction when the person eats meat from a mammal or is exposed to other products containing alpha-gal. It's named for a molecule, galactose-α-1,3-galactose, that's found in most mammals but not in humans. According to the CDC, the overall prevalence is increasing. In this episode, we will review this allergic condition, the animal-based foods that may trigger it, and what the implications are during pregnancy.

Today, 9/12/24, the FDA released a SAFETY COMMUNICATION regarding Veozah. As you may recall, we have been following this novel medication since March 2023. This episode is NOT our regularly planned episode- that topic will come out as scheduled tomorrow AM 9/13/24! This is a SPECIAL REPORT episode in response to the FDA's communication released today. Listen in for important information regarding fezolinetnet.