The REFEREE: MORE SSRI and PTB Info (Sept 2024)

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.

Back in January 2024, we summarized the SFP's position statement on RH IG use (or rather non-use) under 12 weeks IUP gestations. Then, in February 2024, we released an episode summarizing the more conservative stance from the SMFM. Well now, 7 months after that episode, we have a new Clinical Practice Update from the ACOG on this very issue. That is the focus of this episode...and as we have said better, WORDING matters. We will discuss in this episode.

In our last episode we tackled random questions with specific answers. After that episode went live, one of our nurses asked about the value of antibiotics with a Bakri balloon in place. This conversation happened as we were placing the balloon for PPH in a patient on Mag-Sulfate for Preeclampsia with Severe Features. That's antibiotic question is another random question that needs to be answered! So in this episode we will examine the data on prophylactic antibiotics with Bakri balloon for metritis prevention. Is there data for that? The ACOG has a statement on that very issue from back in 2018. Additional information has come to print since then, and we will review it. PLUS, as our patient was on Mag-Sulfate, we will also throw in this additional question as a FREEBEE: Is Mag-Sulfate an independent risk factor for PPH? The answer may not be what you think. Listen in for details.

Welcome to this episode of "Random Questions: Specific Answers"! In this episode we will (surprise) answer random questions- with specific answers- from our podcast family members: 1. Can administration of IV Calcium at intrapartum CS reduce QBL?, 2. What are the 4 classes of CS performance urgency? and 3. If a normal MVP for amniotic fluid is 2-8cm on ultrasound, does an MVP of >8cm still get "2-points" at mBPP or full BPP? Listen in for details!

on 09/02/2024, we released an episode called, "Do SSRIs Raise PTB Risk?". In that episode, we highlighted a new publication from the AJOG (August 30. 2024) which indicated that SSRIs may raise PTB risk. This is in contrast to a separate cohort study released Feb 2024. This is a classic case of "He Said, She Said". But now we have a REFEREE on the field to settle the score. This new systematic review and metanalysis comes from the September 2024 O&G Open release. Listen in for details.

Tubal sterilization goes back to the 1880s. The first collaborative review of sterilization effectiveness was the CREST study published in 1996 in the AJOG. But that was with prior sterilization techniques. As a way to update the data researchers looked at the national survey for family growth (NSFG) from 2002 to 2015 to determine failure rates after more modern methods of tubal sterilization. This was published in NEJM Evidence on August 27, 2024. The results... Surprising! In this episode, we will review this new data and contrast it to the landmark CRESTstudy. Also, are you aware that the ACOG endorsed a mathematical formula to allow a patient to undergo tubal sterilization, until 1969? It's true! Listen in for details.

Depressive disorders during pregnancy are common, with estimated prevalence ranging from 11% to 16%. Accordingly, antidepressant drugs, most commonly selective serotonin reuptake inhibitors (SSRI), are used by approximately 3–4% of pregnant women worldwide, with a higher prevalence in the United States compared to Europe. As antidepressants cross the placenta and the fetal blood-brain barrier, exposure during pregnancy raises concerns of potential risks of adverse pregnancy outcomes. On August 30, 2024, a new study was released ahead of print in the AJOG. This confirmed the reduction in preterm birth risk with effective mental health counseling approaches; HOWEVER, it also concluded that “use of antidepressants during pregnancy was associated with an increased 31% risk of pre-delivery independent of underlying depression “. Do SSRI meds increase preterm labor risk by 31%?! This is indirect contrast to a separate publication published just six months earlier, in February 2024 in a separate journal. In this episode, we will discuss this very important topic of SSRI use in pregnancy and the preterm birth risk.