You can reach her a lcarr@mjhlifesciences.com.

Here’s the latest data, updated on June 27, 2022:

Total pregnant women with COVID-19: 219,451

Pregnant women with COVID-19 by Race/Ethnicity from Jan. 22, 2020 to June 20, 2022:

Multiple or other race, Non-Hispanic: 9,219

Find previous data and the latest COVID-19 updates from Contemporary OB/GYN® 

Data is updated weekly based on data collected by the Centers for Disease Control and Prevention (CDC). The cases reported are only confirmed cases with laboratory evidence of SARS-CoV-2 infection. CDC’s case numbers are validated through a confirmation process with each jurisdiction.

 is a resource with the latest information on COVID-19 testing, vaccines, hospitalizations, deaths, and other vital statistics. Data on COVID-19 during pregnancy comes from the CDC’s 

Articles

Data on COVID-19 during pregnancy, as reported by the CDC, in collaboration with state, local, and territorial health departments and external partners.

COVID-19 pregnancy data in the United States: June 27 update

State of mind is a factor in examining how physicians dispense prescription drugs, according to a 

On June 27, the court ruled in favor of two physicians serving prison sentences after government prosecution for allegedly overprescribing opioids.

 v United States, named for a physician sentenced to 21 years in federal prison “for running a massive pill mill,” according to the U.S. Department of Justice (DOJ). Ruan’s appeal was joined with that 

, who was sentenced to 25 years in prison “for counts including drug distribution resulting in death,” according to DOJ.

Starting in 2017, federal investigators touted the cases as examples of a strong stance against doctors wrongly providing prescriptions, as addiction and deaths spiked due to the continuing 

. The Supreme Court ruling did not address that issue, but examined the legality of the physicians’ convictions from separate jury trials.

Ruan and Khan were “both doctors who actively practiced medicine,” with licenses permitting them to prescribe controlled substances. In court, the doctors argued they acted in good faith prescribing the medications, the Supreme Court ruling said.

“In particular, the question concerns the defendant’s state of mind,” the ruling said. “To prove that a doctor’s dispensation of drugs via prescription falls within the statute’s prohibition and outside the authorization exception, is it sufficient for the government to prove that a prescription was 

 not authorized, or must the government prove that the doctor 

 that the prescription was unauthorized?”

The justices reviewed court precedents and the legal concept of “

,” translated as “guilty mind,” or the consciousness of wrongdoing.

The court ruling answered: “After a defendant produces evidence that he or she was authorized to dispense controlled substances, the government must prove beyond a reasonable doubt that the defendant knew that he or she was acting in an unauthorized manner, or intended to do so.”

The justices voted 9-0 on the decision, with Justice Stephen G. Breyer authoring the opinion for Chief Justice John G. Roberts Jr. and Justices Sonia Sotomayor, Elena Kagan, Neil M. Gorsuch and Brett M. Kavanaugh. Justice Samuel A. Alito Jr. filed a concurring opinion with Justices Clarence Thomas and Amy Coney Barrett joining parts of that.

The court vacated earlier appeals court rulings and returned the cases to them for further proceedings.

The case gained attention for its potential effects on physicians and patients living with chronic pain, according to briefs filed by advocacy groups and published on the Supreme Court’s 

The government has a legitimate interest in deterring misuse of controlled substances, especially in a drug overdose crisis, said the brief filed by the 

“But a standard for criminal liability that overly deters may cause medical professionals to act against their best medical judgment due to fear of oversight, have a chilling effect on their willingness to care for patients in pain, and even encourage them to engage in self-protective practices that risk the safety and endanger the lives of those in their care,” the NPAC brief said. “Each of these predictable negative outcomes is occurring in pain care today.”

Association of American Physicians and Surgeons

“Lengthy incarceration without proving criminal intent is tyrannical,” the AAPS brief said. “A 21-year imprisonment for medicating pain deters all physicians against fully treating patients who suffer.”

 blasted government prosecution that it claimed has made the United States the world leader in incarcerating doctors.

Nearly 99% of convictions “boiled down to … a prosecutor with a hunch hiring an expert using the deep pockets of the government, often not even in the same field as the accused physician, to criminalize behavior of the accused physician,” the organization said in its brief. “While this may be acceptable in the context of medical malpractice litigation, it is not acceptable where the consequences are loss of freedom for the accused physician.”

DOJ announced Ruan’s sentence in May 2017 with that of John Patrick Couch, a physician partner sentenced to 20 years in the alleged scheme that made them some of the nation’s leading prescribers of Subsys and Abstral, two instant-release fentanyl drugs. A judge found Ruan and Couch prescribed illegal opioids equal to 90,000 kilograms of marijuana, that the doctors perjured themselves, and they used “special skills to carry out their criminal enterprise,” in Mobile, Alabama.

They were ordered to repay more than $11.61 million to Medicare and insurance companies, according to DOJ. “Following their convictions, the defendants agreed to forfeit to the United States several houses, beach condos, and bank accounts, as well as 23 luxury cars, including multiple Bentleys, Lamborghinis, Mercedes, and Ferraris,” and each agreed to an additional $5 million judgment, according to DOJ.

Khan, based in Casper, Wyoming, “purported to be a pain management physician,” but “targeted vulnerable addicts as customers” that paid as much as $4,000 a month for their prescription opioids, according to the DOJ announcement of August 2019.

“The patients who received the medications often had no visible source of income that would allow them to afford the prescriptions – other than what they were earning re-selling the drugs on the street,” the DOJ announcement said. “Tragically, at least one patient, Jessica Burch, died as a result of an overdose of medications received from Shakeel Kahn’s practice.”

This article originally appeared on Medical Economics®. 

Ruling comes in cases of physicians serving in prison for convictions over prescription drugs.

Supreme Court issues ruling on opioid prescriptions

The virtual event will feature interactive discussions and lively presentations across a variety of specialties—from uterine fibroid care to endometriosis diagnoses and chronic diseases in pregnancy.

This year’s International Congress on the Future of Women’s Health is packed with a variety of engaging certified obstetrics, gynecology, and women’s health continuing medical education (CME) courses. Attendees will have the opportunity to learn about the newest diagnostic approaches and treatments in the field and hear from experts across the country.

Supported by educational grants from Astellas and CooperSurgical, the event was curated by co-chairs Elizabeth Stewart, MD, professor of obstetrics and gynecology, consultant for the Division of Reproductive Endocrinology and Infertility at Mayo Clinic in Rochester, Minnesota; and Hugh Taylor, MD, professor and chair of the Department of Obstetrics, Gynecology, and Reproductive Sciences at Yale University School of Medicine, chief of obstetrics and gynecology for Yale-New Haven Hospital in New Haven, Connecticut.

 and learn more about CME credit designation.

Physicians’ Education Resources (PER) is hosting its 3rd annual International Congress on the Future of Women’s Health Saturday, July 23, 2022, from 9 a.m. to 5 p.m. EST. 

PER to host its 3rd Annual International Congress on the Future of Women’s Health

, outlines women’s reproductive rights and details the various reproductive health care services still available and protected by law.

The website provides helpful information about access to and coverage of various reproductive health care resources and services, including abortion care, birth control, emergency contraception, and family planning counseling.

the most comprehensive directory of trusted and verified abortion service providers in the country—where women can find verified abortion providers, resources for financial assistance, and a state-by-state guide on the current abortion laws.

The Department of Health and Human Services (HHS) launched a website Friday which offers women a comprehensive list of reproductive health care resources, services, and information.  

HHS launches reproductive health care website

Period poverty isn’t just an issue in third-world countries or among low-income women. Across the United States, women of all ages still struggle to afford menstrual products—which are too-often viewed by commercial markets and governments as a luxury item rather than a basic necessity for personal hygiene.

For teens and young women, a lack of access to menstrual supplies can have far-reaching effects, even detracting from things like time in the classroom.

Menstrual equity movements have gained traction in recent years, but the COVID-19 pandemic highlighted the fact that there is still much work to be done.

a survey commissioned by Thinx and PERIOD

, nearly a quarter of all school-aged students struggle to afford period products, and 16% have had to make the choice between purchasing menstrual products of food and clothing. While this is a problem that is faced across the spectrum of socioeconomic groups, the report indicates that Latinx, low-come, rural, and college-age students are most impacted.1

Schools have long been a resource for many students who struggle to get access to menstruation products, but the COVID-19 pandemic made that more difficult. Nearly a third of students in the survey reported that going back to school after COVID-19 lockdowns was a relief in terms of menstrual support, but 3 in 5 students say free hygiene products are still rarely available in their school bathrooms.1

It isn’t just anxiety and shame that can develop from period poverty, though. Roughly half of the students surveyed reported wearing menstrual products for longer than recommended due to lack of resources, and 1 in 10 students globally are believed to miss school during their periods because of a lack of access to hygiene items.2

There are a lot of issues that contribute to the problem of period poverty, but about three-quarters of the students surveyed want more education and advocacy when it comes to menstrual health and access to hygiene products. This is where pediatricians can help.

Pediatricians often ask families and patients about access to all sorts of basic needs like housing and food, but period products might not often make the cut.1

Elise Joy, executive director and co-founder of the New Jersey-based non-profit Girls Helping Girls Period, says pediatricians should keep in mind that several forms of poverty often go hand-in-hand. Joy and her daughters formed Girls Helping Girls Period after volunteering at a local food bank and realizing that nutrition wasn’t the only thing visitors to the resource center were lacking.

“Where there is period poverty there is, most likely, food insecurity. I recommend anyone who is struggling begin visiting a food pantry. While they are not created equal, more and more are seeing the need to supply menstrual products,” Joy says. “They can be in short supply at food pantries, too, but in many states, like our state of NJ, the state food banks have started to make period products available.”

Organizations like Girls Helping Girls Period raise funds and awareness to help secure hygiene products for food banks so that they can be distributed to those in need. Joy says the need has been there a long time, but increased reliance on food banks during the COVID-19 pandemic really highlighted the problem.

Pediatricians should direct patients and families who report or are suspected to have food or housing insecurity to additional resources that can help them with all their needs, including period products.

Advocacy is another important area where pediatricians can have a strong voice about period poverty. There are numerous state and federal laws either recently passed or in consideration that aim to reduce period poverty and biased pricing on gender-based hygiene products. Some states have repealed or banned so-called “pink taxes” or “tampon taxes” that add a luxury tax to basic period products, but 

“Slowly states are realizing that providing basic period products is part of their responsibility in publicly educating students,” Joy says. “There has been a huge groundswell of advocacy across the nation from students and families demanding that pads and tampons be offered, free of charge, to students for use in school.”

Pediatricians shouldn’t limit their advocacy efforts to the legislature, either. Check your state laws and make sure that they are being enforced in your local schools, she says.

“There are many places that have these mandates on the books but they have not been implemented well. If your state law says there should be free products in school and your child does not find them, help make a change. Write a letter to the principal. Make a presentation to the school board. Get other parents involved, too,” Joy says. “Can you imagine having to make this much of a fuss to get toilet paper in bathrooms? Of course not. Students tell us not having pads or tampons in bathrooms sends a strong message that they are not a priority, and that their education is not as important to educators as that of their peers who do not menstruate.”

Pediatricians can also help parents and their children have open discussions about menstruation, period products, and other personal hygiene methods to help reduce the stigma and fears around these topics.

“It doesn't have to be dinner table discussion, but there is no way we will normalize periods if we all don't help break the taboos. It is primarily because we don't talk about them openly that this problem of period poverty exists,” Joy adds. “Until we all play a role in making change, we can expect things to stay the same. Students today are fantastic about talking about tough subjects—they need to teach their parents to do the same. I think pediatricians can really help in normalizing the conversation simply in their approach to talking to patients and families. If they are open and matter-of-fact in the doctor's office, it will go a long way toward letting a patient and their family know it's ok to talk about it, ask for help, ask questions about their own bodies.”

The national non-profit Alliance for Period Products also offers national support for menstrual supplies in partnership with the National Diaper Bank Network. The Alliance for Period Products works with a network of 120 community-based organizations that can be found 

Program Director Jennifer Gaines offers the follow advice to pediatricians whose have patients facing period poverty.

Take a basic needs-informed approach with the patient and ask direct questions:

Do you know how to use menstrual products?

Do you have access to the period supplies you need to manage your period?

Do you and/or your family struggle to afford the period supplies you need to manage your period?

Do you know resources in your area that can help supply free period products?

Organize or identify educational workshops for both parents and children about periods and using products.

Consider keeping period supplies in stock in the office and providing the patient with enough products to manage a full cycle.

Identify and build community partnerships with local basic needs organizations.

To find out if an agency in your area provides period supplies to individuals in need, please contact the local service directory in your area by calling 2-1-1 or going online to 

Ask about or search for period supplies or basic needs.

Also check the listings under women, girls, families, or transgender individuals.

If you still can’t find a resource, try local faith-based organizations and food pantries.

State of the period: The widespread impact of period poverty on U.S. students.

2013/4 Education for All Global Monitoring Report.

State of the period 2021: The widespread impact of period poverty on U.S. students.

This article was originally published by our sister publication Contemporary Pediatrics.

Period poverty isn’t just an issue in third-world countries or among low-income women. Across the United States, women of all ages still struggle to afford menstrual products.

What clinicians can do to help with period poverty

Not just abortion: How the demise of Roe v Wade may impact fertility care

As we were going to press with the July issue, the United States Supreme Court overturned Roe v Wade, eliminating the constitutional right to an abortion, and leaving the question of abortion rights to the states.

Pharmacies limiting Plan B purchases after Roe v. Wade reversal

The American Medical Association is urging the FDA to approve OTC access to oral contraceptives.

HHS secretary details department’s efforts to protect reproductive health care

“The impact was visible and real,” said Xavier Becerra, secretary of the US Department for Health and Human Services during a press conference Tuesday.

The Society of Ob/Gyn Hospitalists released a statement on the Supreme Court Decision overturning Roe v Wade.

In case you missed it: June 27 to July 1

Regular health screenings are essential to maintaining overall health and critical for detecting when something is not right with your body. As every obstetrician and gynecologist knows, for women, early cancer detection through annual breast and gynecologic screenings is key for optimal treatment and management.

At times, however, events like the COVID-19 pandemic can intervene and cause patients to miss or skip yearly screenings, thus losing an opportunity to detect an abnormality early. In fact, a recent survey published in 

 found that between 2018 and 2020, breast and cervical cancer screenings decreased by 6% and 11%, respectively.¹ The authors discovered that “early in the pandemic when routine procedures were paused, [breast cancer] screening volumes decreased more sharply among Hispanic, Asian, and American Indian and Alaska Native[s].”

According to Ahmedin Jemal, DVM, PhD, senior study author, and senior vice president of the American Cancer Society, the “COVID-19 pandemic had an immediate impact in March and April of 2020, as screenings initially dropped by close to 80%,” and although “many people caught up on screenings later in 2020 . . . overall, the . . . pandemic kept screenings down over the course of the entire year. As we move forward, it’s crucial to get people back into their doctor’s offices to get screened.”

Aside from delayed detection, misdiagnosis can also alter treatment. In this month's issue, you’ll find our 

 column, written by Jim M. Shwayder, MD, JD; and Hindi Stohl, MD, JD, which discusses how clinicians can prevent, and navigate, a breast cancer misdiagnosis.

Remember that, as Jemal pointed out, it is imperative for you and your
patients that annual screenings be conducted on time to that ensure irregularities are caught as early as possible. 

1. Fedewa SA, Star J, Bandi P, et al. Changes in cancer screening in the US during the COVID-19 pandemic. 

. 2022;5(6):e2215490. doi:10.1001/jamanetworkopen.2022.15490

It is imperative for you and your patients that annual screenings be conducted on time to that ensure irregularities are caught as early as possible.

A missed opportunity: annual screenings are essential

Despite a global decrease in the incidence and morality of neonatal preterm birth from 1990 to 2019, in Southern Sub-Saharan Africa there remains an increasing trend in the overall age-standardized incidence rate (ASIR) in high sociodemographic index (SDI) regions and in the age-standardized mortality rate (ASMR), according to a study in 

The authors sought to answer the question: What is the burden of neonatal preterm birth at the global, regional and national levels?

The cross-sectional study used data from the 2019 Global Burden of Disease (GBD) study.

Data from 204 countries and territories were divided into five SDI regions and 21 GBD regions, according to geographical contiguity.

Data on sociodemographic status, including SDI and the universal health coverage index (UHCI), from 204 countries and territories were also collected from the Global Health Data Exchange query tool.

Among infants born alive before 37 completed weeks of gestation between 1990 and 2019, the global incident cases of neonatal preterm birth decreased by 5.26%: from 16.06 million in 1990 to 15.22 million in 2019.

More dramatically, deaths decreased by 47.71%: from 1.27 million in 1990 to 0.66 million in 2019.

The overall ASIR of neonatal preterm birth decreased in the same period (estimated annual percentage changes [EAPCs] = −0.19): from 244.19 per 100 000 in 1990 to 234.96 per 100 000 in 2019. 

The ASMR of neonatal preterm birth also decreased, by a mean of 2.09% per year in the same period: from 19.34 per 100,000 in 1990 to 10.24 per 100,000 in 2019.

In high SDI regions, the incident cases of neonatal preterm birth decreased by 5% from 1990 to 2019. But the ASIR of neonatal preterm birth in these high-SDI regions increased in the same period (EAPC = 0.25): from 171.30 per 100,000 in 1990 to 183.62 per 100,000 in 2019.

On the other hand, the ASIR of neonatal preterm birth decreased in low, low-middle, middle and middle-high SDI regions.

The number of deaths of neonatal preterm birth decreased by more than 50% in low-middle, middle, middle-high and high SDI regions, yet increased by 4.62% in low-SDI regions from 1990 to 2019.

In low SDI regions, the growing number of deaths of neonatal preterm birth was in nearly neonates aged 0 to 6 days.

Overall, the ASIR of neonatal preterm birth increased by a mean of 0.25% in high SDI regions from 1990 to 2019.

The ASMR of neonatal preterm birth also increased by a mean of 2.09% in Southern Sub-Saharan Africa in the same time period.

Furthermore, the study found a positive correlation between EAPC of ASIR and SDI or the UHCI in 2019; conversely, there was a negative link between EAPC in ASMR and SDI or UHCI in 2019 at national levels.

Preterm birth remains a crucial issue in children worldwide,” wrote the authors. “Efforts to reduce both the incidence and mortality of preterm births are essential.”

Cao G, Liu J, Liu M. Global, regional, and national incidence and mortality of neonatal preterm birth, 1990-2019. 

Published online May 31, 2022. doi:10.1001/jamapediatrics.2022.1622

GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019.

The authors of a study in JAMA Pediatrics sought to answer the question: What is the burden of neonatal preterm birth at the global, regional and national levels?

Incidence and mortality of neonatal preterm birth

In women with bacterial vaginosis (BV), probiotics reduce the levels of interleukin 1 beta (IL-1

) and interleukin 6 (IL-6), and lower the overall Nugent score and Amsel’s criteria for restitution of a balanced vaginal microbiota, according to a systematic review in the 

Probiotics can also reduce the vaginal colonization of Group B streptococci among pregnant women.

“Pre/probiotic regimens, when used for BV treatment, are usually safe and can exhibit long-term and short-term benefits,” wrote the authors.

The review searched Medline, Scopus, Embase and Google Scholar for randomized controlled trials published in English from 2010 to 2020 to determine the efficacy of pre/probiotics on the treatment of BV in pregnant and nonpregnant women. There were 24 eligible clinical trials, representing 8,242 women participants.

Of the 24 studies, 10 examined the effect of probiotics in combination with antibiotics, 12 assessed the effect of probiotics and 2 evaluated the effect of prebiotics without antibiotics on the BV treatment.

A total of 16 different probiotic species were given 1, 2, or 3 times daily, at doses of 1 × 104 to 6 × 109 colony forming units (CFUs). The average dose of probiotics was 1.35 × 109 CFU.

The most common probiotic administered was 

A cocktail of different probiotic species was more effective than probiotic monotherapies.

Half of the trials found that pre/probiotics combined with metronidazole are more efficient in reducing BV recurrence rate compared to metronidazole alone.

Furthermore, both the intravaginal and oral administration of pre/probiotics are linked to significant improvements in the cure rate of BV.

Although the intravaginal route appears to be the preferred route, the ideal route of delivery for pre/probiotics remains controversial, according to the authors, who noted that some studies indicate that orally applied 

 may positively influence vaginal health.

For the oral route, it is essential to consider the viability of the probiotic strains under high concentrations of gastric acid and bile salts, as well as the time the strains take to reach and colonize the vagina, which varies from person to person.

It is unclear whether the initial pathogenic event is the overgrowth of anaerobes or the primary diminution of 

Overall, 14 of the 24 trials concluded that BV patients who receive probiotics alone have significantly higher cure rates than those receiving placebo.

Probiotics also improve the microbial pattern in vaginal dysbiosis by producing lactic acid and maintaining a normal vaginal pH, degrading the epithelium glycogen and inhibiting the growth of pathogens, and producing bacteriocins, biosurfactants and hydrogen peroxide (H2O2) and competing with pathogens for adhesion sites.

Some studies confirmed that certain strains of vaginal lactobacilli can create H2O2, which inhibits adherence of 

 to the epithelial cells and produces an immunomodulatory effect.

However, there were significant variations among the pre/probiotics interventions—including variation in dosage, administration routes, therapy duration, prebiotics type, and probiotics strain and species – thus making comparisons across different trials challenging.

Commercially available probiotics products can also have variations in their ingredients.

Because probiotics are not systemically absorbed, they are generally considered safe for healthy people. None of the studies reported significant adverse effects.

“In order to prove the benefits of pre/probiotics in BV treatment, additional high-quality research is required,” wrote the authors.

Afifirad R, Emamie AD, Zadeh RG, et al. Effects of pro/prebiotics alone over pro/prebiotics combined with conventional antibiotic therapy to treat bacterial vaginosis: a systematic review. 

. Published online April 21, 2022. doi:10.1155/2022/4774783

A cocktail of different probiotic species may be more effective than probiotic monotherapies, according to a recent literature review.

Probiotics may increase cure rates for bacterial vaginosis

Videos

Allison August, MD, Kathleen Muldoon, PhD, Stanley Plotkin, MD, and Patricia Purcell, MD, MPH, share recommendations for messaging that healthcare providers should be sharing regarding CMV.