DÉJÀ VU: LPS and Neonatal Sugars (April 2026 AJP)

Yes we have covered antenatal corticosteroids in the late preterm interval on several episodes in the past- it's DEJA VU! However, there is new data in the American Journal of Perinatology (April 2026 ) that is helpful for us as clinicians as we do “shared decision making” with patients in offering betamethasone in the late preterm interval. Listen in for details.1. Zigron R, Rotem R, Erlichman I, Rottenstreich M, Rosenbloom JI, Porat S, Rottenstreich A. Factors associated with the development of neonatal hypoglycemia after antenatal corticosteroid administration: It's all about timing. Int J Gynaecol Obstet. 2022 Aug;158(2):385-389. doi: 10.1002/ijgo.13975. Epub 2021 Oct 30. PMID: 34625970.2. Asirwatham A, Loke R, Rose S, Ho J, Leung K, Leftwich HK. Neonatal Hypoglycemia after Antenatal Late Preterm Steroids. Am J Perinatol. 2026 Apr;43(5):616-620. doi: 10.1055/a-2663-5798. Epub 2025 Aug 4. PMID: 40759170.3. ALPS Trial. NEJM. Published April 7, 2016;374:1311-1320

Iron-deficiency anemia during pregnancy is associated withseveral adverse pregnancy outcomes, including severe maternal morbidity, preeclampsia, placenta previa, and placental abruption. It makes sense that diagnosing and treating anemia and its underlying causes in earlypregnancy may reduce the risk of adverse outcomes, but evidence has been scarce…until now. In this episode, we will review a new retrospective study based on nationwide data that examines this very issue (Green journal, April 2026).Listen for details. 1.  Booman A, Bateman BT, Siadat S, Berube C, Igbinosa I, Leggett C, Lyell DJ, Main EK, Leonard SA. Pregnancy Outcomes Associated With Anemia in the First Trimesterand Anemia Resolution by Late Pregnancy. Obstet Gynecol. 2026 Apr 1;147(4):518-527. doi: 10.1097/AOG.0000000000006183. Epub 2026 Feb 6. PMID:41643193; PMCID: PMC12880618.2.  ACOG OCC 5: Severe Maternal Morbidity: Screening and Review; 2016 and reaffirmed 20253.  ACOG PB 233

Iron-deficiency anemia during pregnancy is associated with several adverse pregnancy outcomes, including severe maternal morbidity, preeclampsia, placenta previa, and placental abruption. It makes sense that diagnosing and treating anemia and its underlying causes in early pregnancy may reduce the risk of adverse outcomes, but evidence has been scarce…until now. In this episode, we will review a new retrospective study based on nationwide data that examines this very issue (Green journal, April 2026). Listen for details. 1. Booman A, Bateman BT, Siadat S, Berube C, Igbinosa I, Leggett C, Lyell DJ, Main EK, Leonard SA. Pregnancy Outcomes Associated With Anemia in the First Trimester and Anemia Resolution by Late Pregnancy. Obstet Gynecol. 2026 Apr 1;147(4):518-527. doi: 10.1097/AOG.0000000000006183. Epub 2026 Feb 6. PMID: 41643193; PMCID: PMC12880618.2. ACOG OCC 5: Severe Maternal Morbidity: Screening and Review; 2016 and reaffirmed 20253. ACOG PB 233

The diagnosis of fetal growth restriction can be made with an isolated abdominal circumference less than the 90th percentile. So is the opposite true? Does a fetal abdominal circumference (isolated) of greater than 90% qualify for “LGA” fetus? In this episode we're going to explain why, although it is logically correct, it is diagnostically incorrect. An isolated abdominal circumference on ultrasound of greater than 90% is however a strong predictive risk factor for one delivery finding. Listen in for details.1. Macrosomia: ACOG Practice Bulletin, Number 216. Obstetrics and Gynecology. 20202. Canavan TP, Hill LM.. Sonographic Biometry in the Early Third Trimester: A Comparison of Parameters to Predict Macrosomia at Birth. Journal of Clinical Ultrasound : JCU. 2015. 3. Culliney KA, Parry GK, Brown J, Crowther CA. Regimens of Fetal Surveillance of Suspected Large-for-Gestational-Age Fetuses for Improving Health Outcomes.The Cochrane Database of Systematic Reviews. 2016.

Livi by LiviWell is an FDA-cleared, single-use, soft polyurethane foam device designed to immediately absorb post-intercourse fluids (semen) to support vaginal health. Inserted like a tampon within 15 minutes post-coitus, it works in roughly 60 seconds to restore natural pH, helping to manage odor, dripping, and discomfort. Is this evidence-based? Listen in for details.1. https://www.biospace.com/press-releases/liviwell-secures-fda-clearance-for-livi-introducing-a-new-category-in-post-intercourse-vaginal-care#:~:text=Advertise-,LiviWell%20Secures%20FDA%20Clearance%20for%20Livi%2C%20Introducing%20a%20New%20Category,and%20other%20post%2Dintercourse%20fluids.2. Mngomezulu K, Mzobe GF, Mtshali A, et al. Recent Semen Exposure Impacts the Cytokine Response and Bacterial Vaginosis in Women. Frontiers in Immunology. 2021. 3. Abstract: ISSWSH/ISSM Joint Meeting 2025. Abstract citation ID: qdaf068.138 (155) SEMEN IS NOTTHEVAGINA’SFRIEND:ANOVEL POST-SEX TAMPON IMPROVES VAGINAL HEALTH PARAMETERS

Modern medicine has come a long way in its fight against diabetes. We now have continuous glucose monitors (CGM) and automated insulin delivery (AIDs) systems. These have revolutionized patient care. The FDA has approved devices for use in pregnancy as “nonadjunctive use” (meaning they may be used alone), although capillary finger stick assessments are currently still considered the Gold Standard. While the most robust data in support of CGMs is for preexisting Type 1 DM (Class B or beyond) and Type 2, there is recent growing support for CGM use in GDM patients, although some limitations still apply. Listen in for details.1. Feig DS, et al; CONCEPTT Collaborative Group. Continuous glucose monitoring in pregnant women with type 1 diabetes (CONCEPTT): a multicentre international randomised controlled trial. Lancet. 2017 Nov 25;390(10110):2347-2359. doi: 10.1016/S0140-6736(17)32400-5. Epub 2017 Sep 15. Erratum in: Lancet. 2017 Nov 25;390(10110):2346. 2. Benhalima K, Durnwald C, Sweeting A et al.Application of continuous glucose monitoring and automated insulin delivery technologies for pregnant women with type 1, type 2, or gestational diabetes: an international consensus statementThe Lancet Diabetes & Endocrinology, 2025; 14, 157-1773. Salmen BM, Reurean-Pintilei D, Salmen T, Bohîlțea RE. Exploring Continuous Glucose Monitoring in Gestational Diabetes: A Systematic Review. Life (Basel). 2025 Aug 28;15(9):1369. doi: 10.3390/life15091369. PMID: 41010309; PMCID: PMC12470761.4. Wyckoff JA, Lapolla A, Asias-Dinh BD, et al.Preexisting Diabetes and Pregnancy: An Endocrine Society and European Society of Endocrinology Joint Clinical Practice Guideline. The Journal of Clinical Endocrinology and Metabolism. 20255. American Diabetes Association Professional Practice Committee for Diabetes*; 15. Management of Diabetes in Pregnancy: Standards of Care in Diabetes—2026. Diabetes Care 1 January 2026; 49 (Supplement_1): S321–S338. https://doi.org/10.2337/dc26-S0156. Burk J, Ross GP, Hernandez TL, Colagiuri S, Sweeting A. Evidence for improved glucose metrics and perinatal outcomes with continuous glucose monitoring compared to self-monitoring in diabetes during pregnancy. Am J Obstet Gynecol. 2025 Sep;233(3):162-175. doi: 10.1016/j.ajog.2025.04.010. Epub 2025 Apr 10. PMID: 40216177.7. Linder T, et al; GRACE study collaborative group. Glycaemic control and pregnancy outcomes with real-time continuous glucose monitoring in gestational diabetes (GRACE): an open-label, multicentre, multinational, randomised controlled trial. Lancet Diabetes Endocrinol. 2026 Jan;14(1):50-61. doi: 10.1016/S2213-8587(25)00288-8. Epub 2025 Nov 24. PMID: 41308662.8. Valent AM, et al. Real-Time Continuous Glucose Monitoring in Pregnancies With Gestational Diabetes Mellitus: A Randomized Controlled Trial. Diabetes Care. 2025 Sep 1;48(9):1581-1588. doi: 10.2337/dc25-0115. PMID: 40730104; PMCID: PMC12368369.9. Kusinski LC, et al. Continuous Glucose Monitoring Metrics and Pregnancy Outcomes in Women With Gestational Diabetes Mellitus: A Secondary Analysis of the DiGest Trial. Diabetes Care. 2025 Aug 19:dc250452. doi: 10.2337/dc25-0452. Epub ahead of print. PMID: 40828742; PMCID: PMC7618813.10. García-Moreno RM, et al. Efficacy of continuous glucose monitoring on maternal and neonatal outcomes in gestational diabetes mellitus: a systematic review and meta-analysis of randomized clinical trials. Diabet Med. 2022 Jan;39(1):e14703. doi: 10.1111/dme.14703. Epub 2021 Oct 13. PMID: 34564868.11. Amylidi-Mohr Set,.et al (DipGluMo): an open-label, single-centre, randomised, controlled trial. Lancet Diabetes Endocrinol. 2025 Jul;13(7):591-599. doi: 10.1016/S2213-8587(25)00063-4. Epub 2025 May 26. Erratum in: Lancet Diabetes Endocrinol. 2026 Mar;14(3):e6. doi: 10.1016/S2213-8587(25)00403-6. PMID: 40441173.

Podcast family, we have to be careful what we ask for…Because we might just get it! We have been asking for new ways to predict preeclampsia for close to two decades. Well now we have new biomarker serum tests that are even offered direct- to-consumer. The problem is, what do we dowith a positive test?! In a past episode we covered an FDA cleared serum test by Thermo Fisher for use in patients already diagnosed with preeclampsia. Now there is a new blood test which uses cell free RNA, drawn between 18 and 22 weeks of gestation, which can also predict preterm preeclampsia. Does this work? And what do we do when the result shows “high risk” It's a complicated issue. Wehave to be careful what we ask for. Listen in for details!1.     https://publications.smfm.org/publications/554-acog-clinical-practice-update-biomarker-prediction-of-preeclampsia/2.     ACOG Clinical Practice Update: BiomarkerPrediction of Preeclampsia With Severe Features June 20243.    https://www.healthywomen.org/tech-talk-hp/tools-to-predict-preeclampsia4.     Elovitz, M.A., Gee, E.P.S., Delaney-Busch, N. etal. Molecular subtyping of hypertensive disorders of pregnancy. Nat Commun 16,2948 (2025). https://doi.org/10.1038/s41467-025-58157-y5.     https://www.businesswire.com/news/home/20250717476669/en/New-Study-in-JAMA-Network-Open-Shows-Current-Approaches-to-Assessing-Preeclampsia-Risk-Are-Failing-the-Majority-of-Pregnant-Moms

Words matter, and equally as important, our actions matter. Sometimes the words opportunistic salpingectomy (OPS or OS) are used interchangeably with risk-reducing salpingectomy (RRS). However, these are two completely different items. In fact, there are 4 very important differences between the two. In the April 2026 AJOG, there's a new Clinical Opinion on this very topic. Listen in for details.1. Kindelberger DW, Lee Y, Miron A, Hirsch MS, Feltmate C, Medeiros F, Callahan MJ, Garner EO, Gordon RW, Birch C, Berkowitz RS, Muto MG, Crum CP. Intraepithelial carcinoma of the fimbria and pelvic serous carcinoma: Evidence for a causal relationship. Am J Surg Pathol. 2007 Feb;31(2):161-9. 2. ACOG CO 774; 20193. NCCN, Ovarian Cancer Including Fallopian Tube Cancer and Primary Peritoneal Cancer. Updated 2026-03-12.4. ACOG Practice Bulletin No. 147: Lynch Syndrome.Obstetrics and Gynecology. 20145. Falconer H, Yin L, Grönberg H, Altman D. Ovarian cancer risk after salpingectomy: a nationwide population-based study. J Natl Cancer Inst. 2015 Jan 27;107(2):dju410. doi: 10.1093/jnci/dju410. PMID: 25628372.6. Rice MS, Hankinson SE, Tworoger SS. Tubal ligation, hysterectomy, unilateral oophorectomy, and risk of ovarian cancer in the Nurses' Health Studies. Fertil Steril. 2014 Jul;102(1):192-198.e3. doi: 10.1016/j.fertnstert.2014.03.041. Epub 2014 May 10. PMID: 24825424; PMCID: PMC4074555.7. Wilke RN, Pennington KP, Gootzen TA, Steenbeek MP, de Hullu JA, Long KC, Blank SV, Swisher EM, Lu KH, Norquist B. Salpingectomy in individuals at high risk for tubo-ovarian cancer: consensus and precaution. Am J Obstet Gynecol. 2025 Nov 1:S0002-9378(25)00820-8. doi: 10.1016/j.ajog.2025.10.044. Epub ahead of print. PMID: 41183726.

Platelet-rich plasma (PRP) injections do not have formal FDA approval for specific clinical indications. PRP is regulated as an autologous blood product and is used "off-label" in clinical practice. However, there is substantial clinical evidence supporting its use for certain dental surgeries and musculoskeletal conditions, particularly lateral epicondylitis, knee osteoarthritis, and plantar fasciitis. The American Medical Society for Sports Medicine notes that PRP is primarily used to treat tendinopathies and osteoarthritis, though clinical efficacy results remain mixed due to variability in PRP formulations and preparation methods. As of now, there are no FDA approved uses for PRP for gynecologic use, although there has been some evidence of possible benefit in vulvar dermatoses and possiblt ovarian function enhancement. But what about its use in the vagina for sexual pleasure? Injecting into the anterior vaginal wall (around the famed G-Spot location) is nothing new. Over a decade ago, a TV show introduced the masses to the “G-Spot amplication” shot which injected collagen to that area. But there was no data for this. Well, we are back to this idea in a new RCT in the Green Journal. Can PRP light up the vaginal fires of pleasure? Listen in for details. 1. Clarke, Bayley MD; Gaddam, Neha MD; Garcia, Bobby MD; Iglesia, Cheryl B. MD; Podolsky, Robert PhD; Dieter, Alexis A. MD. Vaginal Injection of Platelet-Rich Plasma for Sexual Function: A Randomized Controlled Trial. Obstetrics & Gynecology ():10.1097/AOG.0000000000006256, March 19, 2026. | DOI: 10.1097/AOG.00000000000062562. Finnoff JT, Awan TM, Borg-Stein J, et a American Medical Society for Sports Medicine Position Statement: Principles for the Responsible Use of Regenerative Medicine in Sports Medicine. Clinical Journal of Sport Medicine : Official Journal of the Canadian Academy of Sport Medicine. 2021. 3. Alsousou J, Ali A, Willett K, Harrison P. The Role of Platelet-Rich Plasma in Tissue Regeneration.Platelets. 2012.

Podcast family, welcome to Quickie #4. This one will be fun: A. Medicine changes, and changes fast. I trained with and learned the Grannum grading placental system (grades 0-III based on ultrasound appearance). Is that still a thing? We recently found a “grade III placenta at 34 weeks” as an incidental finding. Is there specific management considerations for this? Listen in for details. B. What do we do when a patient has “two GBS results” in one pregnancy hat are discordant. Listen in for that as well!1. Jaiman S, Romero R, Pacora P, et al. Disorders of Placental Villous Maturation Are Present in One-Third of Cases With Spontaneous Preterm Labor. Journal of Perinatal Medicine. 2021. 2. European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2017. Sentilhes L, Sénat MV, Ancel PY, et al. Prevention of Spontaneous Preterm Birth: Guidelines for Clinical Practice From the French College of Gynaecologists and Obstetricians (CNGOF).3. Brink LT, Roberts DJ, Wright CA, et al. Placental Pathology in Spontaneous and Iatrogenic Preterm Birth: Different Entities With Unique Pathologic Features. Placenta. 2022. 4. Chitlange SM, Hazari KT, Joshi JV, Shah RK, Mehta AC. Ultrasonographically Observed Preterm Grade III Placenta and Perinatal Outcome.International Journal of Gynaecology and Obstetrics: The Official Organ of the International Federation of Gynaecology and Obstetrics. 1990. 5. Mirza FG, Ghulmiyyah LM, Tamim H, et al. To Ignore or Not to Ignore Placental Calcifications on Prenatal Ultrasound: A Systematic Review and Meta-Analysis. The Journal of Maternal-Fetal & Neonatal Medicine : The Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians. 2018. 6. Quinlan RW, Cruz AC, Buhi WC, Martin M. Changes in Placental Ultrasonic Appearance. II. Pathologic Significance of Grade III Placental Changes. American Journal of Obstetrics and Gynecology. 1982. 7. Karen M. Puopolo Group B Streptococcal Disease. https://orcid.org/0000-0002-5581-8825; Published February 25, 2026 N Engl J Med 2026;394:896-905ACOG 797