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She joined the MJH Life Sciences team in December 2019. She graduated from Youngstown State University in 2019 with a bachelor's degree in journalism and a minor in political science. Prior to graduating, Morgan worked as the editor-in-chief of her college newspaper. She went on to work as an assignment editor at a broadcast news station in Youngstown, Ohio, before joining 

 You can reach her at mebert@mjhlifesciences.com.

Women in deprived neighborhoods face a 20% higher risk of gestational diabetes, underscoring the need for targeted public health interventions.

Resource-poor neighborhood residence linked to GDM risk

A new study finds higher rates of cyanotic congenital heart disease in states with abortion restrictions following the 2022 Supreme Court ruling.

CCHD rates rise in states with abortion bans after Dobbs decision

A new study reveals significant racial and ethnic differences in maternal and neonatal outcomes among physicians.

Racial disparities in birth outcomes persist among physicians

A new study finds women are significantly less likely to receive curative hepatitis C treatment than men while undergoing opioid use disorder care.

Sex and pregnancy linked to reduced HCV treatment odds in OUD patients

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A Psychedelic to Treat Postpartum Depression?

CMV: In the Know

RSV Roundtable

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Supplement: Closing the Gap in Cervical Cancer Screening

Vaginismus: Managing a Misunderstood and Underdiagnosed Condition

Why vNOTES Make Sense for My Patients

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Angel Foster, MD, is the founder of The Massachusetts Abortion Access Project.

In the wake of tightening abortion laws, telemedicine and advance provision of abortion pills are emerging as essential, safe, and accessible solutions for reproductive health care.

Angel Foster, MD, highlights the importance of telehealth for abortion care

Pharmacologic and psychotherapy treatments are less often given to urban-residing individuals with postpartum depression or anxiety than to rural-residing individuals, according to a recent study published in 

Chronic disease and poverty disproportionately impact rural areas vs urban areas in the United States, with data indicating a higher prevalence of postpartum depression in the former region.

 Despite this, there is little data about mental health treatment in rural areas.

“While perinatal and postpartum depression and anxiety can be treated through both psychotherapy and pharmacologic interventions, there are limited data on treatment rates of these interventions across the United States and how this may differ between urban and rural residing individuals,” wrote investigators.

Study aims to assess treatment differences

The retrospective cohort study was conducted to compare postpartum depression and anxiety treatment between rural- and urban-residing patients. Data were obtained from the IBM MarketScan database with insurance-based claims data from all 50 states.

Female patients aged 13 to 50 years with delivery between 2011 and 2020 determined by 

International Statistical Classification of Diseases, Tenth Revision

 (ICD) codes and with a postpartum depression or anxiety diagnosis within 12 months following delivery were included in the analysis. ICD codes were also used to determine gestational age at delivery.

Exclusion criteria included under 12 months of, predelivery enrollment in MarketScan, receiving depression or anxiety treatment in the 12 months before delivery, and diagnoses for certain psychiatric conditions. Patients’ location of residence was determined by metropolitan statistical area and classified as rural or urban.

Treatment outcomes and participant characteristics

Depression or anxiety treatment within 12 months following delivery was reported as the primary outcome and included pharmacologic, psychotherapy, or both. Type of treatment and time from delivery to first prescription fill were reported as secondary outcomes. National Drug Codes were used to identify prescription fills.

Maternal age at delivery, mode of delivery, gestational age at delivery, depression or anxiety, and region were reported as demographics. ICD codes were used to identify cofounders such as substance use disorder.

There were 181,185 participants included in the final analysis, 88% of whom lived in urban areas. The median maternal age at delivery was 31 years in urban patients vs 28 years in rural patients, and median gestational ages at delivery were 38 weeks and 37 weeks, respectively. Tobacco and illicit substance use were also more common in rural-residing patients.

Depression and anxiety rates before delivery did not significantly differ between groups. However, medication or psychotherapy treatment for postpartum depression or anxiety was less common in urban patients vs rural patients, with rates of 55.1% and 59.4%, respectively.

For medication alone, rates were 31.8% and 39.6%, respectively, while rates for psychotherapy alone were 44.8% and 46%, respectively. The adjusted hazard ratio (aHR) for receiving any treatment among urban patients vs rural patients was 0.90, highlighting reduced odds.

This difference was mainly driven by a significant reduction in the chance of receiving medication, with an aHR of 0.79. In comparison, the aHR for receiving psychotherapy was 0.99, which was not statistically significant.

Urban patients also reported a longer time from delivery to first fill vs rural patients, with means of 134 and 128 days, respectively. Similarly, the mean times from diagnosis to first fill were 46 and 41 days, respectively. However, these differences were not statistically significant.

These results highlighted differences in treatment for postpartum depression and anxiety between rural and urban residents. However, investigators noted the results are likely underestimated, as under 50% of individuals with postpartum depression seek treatment.

“Promotion of follow-up for treatment and efforts to understand differences in treatment between urban and rural individuals during the postpartum period are warranted,” concluded investigators.

Gimbel LA, Bruno AM, Horns J, Paudel N, Smid MC, Silver RM. Differences in rural and urban treatment of postpartum depression and anxiety in the United States. 

 2025;1(4):e70053. doi:10.1002/pmf2.70053

Mollard E, Hudson DB, Ford A, Pullen C. An integrative review of postpartum depression in rural US communities

. 2016;30(3):418-424. doi:10.1016/j.apnu.2015.12.003

A nationwide analysis reveals rural mothers are more likely to receive medication or therapy for postpartum depression and anxiety compared with their urban counterparts.

Clinical

Urban mothers less likely to receive postpartum depression treatment

This week at Contemporary OB/GYN®, we covered topics ranging from a record low US fertility rate to racial differences in pelvic floor anatomy. Click the links below to read anything you might have missed from Monday, July 28 to Friday, August 1, 2025.

Jessica Shepherd, MD, clarifies cervical cancer screening guidelines

 Jessica Shepherd, MD, MBA, chief medical officer at Hers, discussed current guidelines and emerging strategies for cervical cancer screening.

She emphasized that confusion often arises around when to begin screening, how frequently it should be done, and which method to use. According to the latest recommendations, women should start cervical cancer screening with a Pap test every 3 years beginning at age 21 years and continue through age 29. From the age of 30 years onward, co-testing—which combines the Pap test with HPV testing—is recommended every 5 years. These guidelines aim to maximize the early detection of cervical cancer and precancerous cells, which is crucial for timely intervention.

Cervical cancer

Record low US fertility rate reported in 2024

The fertility rate has dropped below 1.6 births per woman in the United States, hitting an all-time low, according to the Centers for Disease Control and Prevention.

Factors such as concerns over health care, childcare, affordability, and paid leave have led individuals to delay or forgo parenthood. The decline was observed despite an increase in US births registered, from 3,628,934 births to 3,596,017.

 While this indicated an increase of 1%, the general fertility rate (GFR) dropped by 1%.

In 2023, the GFR among female patients aged 15 to 44 years was 54.5 births per 1000 individuals vs 53.8 per 1000 in 2024. In teenagers aged 15 to 19 years, a decline of 4% was reported vs a 3% decline in those aged 20 to 24 years, and a 2% decline in those aged 25 to 29 years.

Study finds preconception hypoglycemia tied to adverse pregnancy outcomes

Women with low blood glucose levels prior to pregnancy may face a higher risk of adverse pregnancy outcomes, according to findings from a large retrospective study published July 29 in 

Researchers analyzed data from nearly 4.9 million Chinese women and found that preconception hypoglycemia was associated with an increased risk of preterm birth, low birth weight, small for gestational age, and birth defects—even in women without preexisting diabetes.

Racial differences found in pelvic floor anatomy may impact prolapse risk

Black patients have larger levator hiatal (LH) dimensions and a more ovular, narrower, U-shaped levator hiatus compared with White patients, according to a study published in the 

American Journal of Obstetrics & Gynecology.

All regions of levator ani muscle (LAM) thickness were similar between Black and White patients, except for the right middle LAM, which was thicker in Black patients. In comparison, transverse diameter was the only LH dimension similar between groups. Black patients had an increased LH area, perimeter, and anteroposterior (AP) diameter vs White patients.

The White cohort had significant associations between parity with a larger LH area, perimeter, AP diameter, and transverse diameter. However, no associations of parity with LAM or LH dimensions were reported in the Black cohort. Parity-related correlations were not significantly impacted when adjusting for age and BMI.

History-based screening accurately identifies eligibility for medication abortion

History-based screening protocols have high efficacy for ensuring medication abortion is rarely provided to ineligible patients, according to a recent study published in the 

When using the full set of eligibility criteria, an accuracy of 0.65 was reported based on survey responses. The sensitivity was 92.2% and the specificity was 37.8%. An increase in accuracy to 0.71 was reported when removing unexplained pain as an ineligibility criteria, with a sensitivity of 89.5% and specificity of 53%.

In sensitivity analyses including patients responding “Not sure” on survey questions, the accuracy was 0.67, with a sensitivity of 89.5% and specificity 45.3%. Overall, the results highlighted few instances of incorrect self-screening for medication abortion, supporting these models.

Review some of the top stories from the Contemporary OB/GYN website over the past week and catch up on anything you may have missed.

Contemporary OB/GYN week in review: Cervical screening, US fertility, and more

Illness representations and coping strategies influence the link between pelvic pain severity and health-related quality of life (HRQOL) in patients with endometriosis, according to a recent study published in the 

Chronic pelvic pain, defined as pain lasting at least 3 to 6 months, is a common symptom in women with endometriosis, significantly impacting their HRQOL. This often leads to decreased work productivity, impaired relationships, and additional adverse outcomes.

“The relationship between endometriosis and pain is complex and remains not yet fully understood,” wrote investigators.

 “In most cases, the severity and presence of symptoms do not correlate with the extent of the lesions, and symptoms often recur after treatment, even in the absence of lesions, further complicating our understanding of the disease.”

Using the common-sense model to examine coping and HRQOL

The common-sense model of illness self-regulation (CSM) hypothesizes a dynamic interplay of psychosocial factors influencing an individual’s adjustment to illness. Therefore, investigators conducted a cross-sectional study to assess the link between pelvic pain severity and HRQOL through a CSM lens.

Participants included women aged at least 18 years diagnosed with endometriosis. These patients self-reported information through an online questionnaire. Those with pregnancy or lacking an endometriosis diagnosis by a health care professional were excluded from the analysis.

Relevant data included age, education level, marital status, nationality, parity, weight, height, hormonal therapy, and medication-induced amenorrhea. Endometriosis information, such as type of endometriosis, diagnostic delay, and prior surgeries, was also obtained.

A numerical rating scale was used to evaluate pelvic pain intensity on a 10 mm numerical line. The scale measured pain in the past 3 months, with one side representing no pain and the other representing the worst pain imaginable. The 8-item Brief Illness Perception Questionnaire assessed illness perceptions.

Questionnaire responses were rated on an 11-point Likert scale, with a higher score indicating greater agreement. The sum of all responses was calculated to determine the total score.

The Chronic Pain Coping Inventory and Pain Catastrophizing Scale were used to measure coping strategies, while the Endometriosis Health Profile was used to determine HRQOL. The latter scale included 5 domains: pain, control, emotions, social support, and self-image.

Diagnostic delay, pain severity, and coping

There were 273 women aged a mean 35.3 years included in the final analysis, 97.1% of whom were White and 61.2% were employed. Ovarian endometriosis was reported in 36%, deep infiltrated endometriosis in 44.6%, and both in 19.3%.

A mean duration of 11.4 years was reported between symptom onset and diagnosis. Surgery for endometriosis was reported in 61.2% of patients and the use of hormonal medication in 71.4%. Diagnostic delay was significantly linked to body mass index (BMI) and HRQOL, while a significant inverse association was reported between severity of pelvic pain and BMI.

Associations were reported for pelvic pain severity with illness representations and HRQOL, with β values of 0.44 and 0.21, respectively. Additional associations were reported for negative illness perceptions with pain catastrophizing and illness-focused coping, with β values of 0.63 and 0.36, respectively.

HRQOL was also impacted by pain catastrophizing, illness-focused strategies, and illness representations. These links were consistent with the CSM, highlighting a significant role of illness representations and cognitive coping strategies in the link between pelvic pain severity in HRQOL.

“Accordingly, future research should explore experimental interventions aimed at modifying illness representations or coping strategies and evaluate their impact on health outcomes in women with endometriosis,” wrote investigators.

Spinoni M, Capano AU, Porpora MG, Grano C. Understanding the psychological factors linking pelvic pain and health-related quality of life in endometriosis: the influence of illness representations and coping strategies. 

 2025;233(1):54.e1-54.e10. doi:10.1016/j.ajog.2024.12.027

Quinlivan J, Lambregtse-van den Berg M. Managing the stigma and women's physical and emotional cost of endometriosis. 

. 2021;42(1):1-2. doi:10.1080/0167482X.2021.1883218

A new study found that the severity of pelvic pain in patients with endometriosis affects health-related quality of life through the influence of coping mechanisms.

Coping strategies found to impact quality of life in endometriosis

The efficacy of immediate release (IR) nifedipine is similar to that of intravenous (IV) labetalol and IV hydralazine for managing severe hypertension in pregnancy, according to a recent review published in 

Up to 8% of pregnancies worldwide are impacted by hypertensive disorders, significantly contributing to maternal mortalities.

 This includes preeclampsia, with an increased prevalence of 25% in the past 2 decades. Preeclampsia and associated hypertension are often transient, but delayed treatment increases the risks of adverse outcomes.

“Thus, blood pressure (BP) control remains a key component of the management of preeclampsia.,” wrote investigators.

Current guidelines recommend severe hypertension, defined by systolic BP of at least 160 mmHg or diastolic BP at least 110 mmHg, be managed within 30 to 60 minutes. IV labetalol and IV hydralazine are commonly used for management, alongside oral IR nifedipine. However, the former 2 methods remain recommended as first-line therapy unless unavailable.

A clinical trial reported increases in IV labetalol, IV hydralazine, and IR nifedipine rates between 2006 and 2015 of 60.9%, 21.3%, and 54.7%, respectively. This highlighted a preference for labetalol use over hydralazine or nifedipine use.

Since nifedipine is not recommended for front-line therapy, investigators conducted a review to determine its efficacy in pregnant patients. Literature comparing this method to IV labetalol was included in the analysis.

Clinical data highlights comparable outcomes

One of the articles assessed was a systematic review including 363 patients across 7 trials, 4 of which were conducted in low-resource countries. In the pooled analysis, a risk ratio of 0.42 was reported for persistent hypertension in patients receiving IR nifedipine vs IV labetalol, highlighting a reduction in risk.

A similar safety profile was also found between the 2 treatments, indicating IR nifedipine is equally safe and efficacious as IV labetalol. In another trial with 147 participants, the time to achieve a target BP of under 150 or 100 mmHg did not significantly differ between IR nifedipine or IV labetalol, at 35 vs 42 minutes, respectively.

The review also assessed clinical trials evaluating all 3 acute anti-hypertensive medications. In one trial, patients were randomly assigned 1:1:1 to each method, with BP and mean arterial pressure (MAP) measured 5 hours postintervention.

IR nifedipine successfully reduced MAP by 20% within 20 minutes of a single dose in 57.5% of patients, vs 42.1% from IV labetalol and 40.9% from IV hydralazine. After 3 doses, failure to reach this target was reported in 15%, 5%, and 35%, respectively. This indicated nifedipine as the most rapid in its effect, while hydralazine was more effective overall.

Meta-analysis confirms high efficacy for IR nifedipine

Similarly, a systematic review and meta-analysis evaluated the relative efficacy of antihypertensives in pregnancy. The cohort included 8324 participants across 74 trials. Based on the results, IR nifedipine and sublingual nifedipine most often helped patients reach the target BP, with IR nifedipine being the most effective when sub-grouping for preeclampsia.

Data has also indicated high safety for IR nifedipine. However, rare cardiovascular risk factors highlight the need for risk-benefit consideration on an individual level. Overall, the review highlighted a growing body of evidence indicating at least equal efficacy to IV labetalol and IV hydralazine from IR nifedipine in managing severe hypertension in pregnancy.

“Furthermore, we believe there is adequate evidence to support a change to preferential utilization of IR nifedipine for severe hypertension in pregnancy except in the case of imminent operative cesarean delivery or when oral intake is otherwise contraindicated,” wrote investigators.

Sarker MR, Wen T, Teal EN, Emeruwa UN. Immediate release oral nifedipine for severe hypertension in pregnancy—time for re-prioritization as a management option. 

 Committee on Obstetric Practice. Committee opinion no. 692: emergent therapy for acute-onset, severe hypertension during pregnancy and the postpartum period. 

2017;129:e90-e95. https://ilpqc.org/wp-content/docs/htn/ACOG%20Committee%20Opinion%20692.pdf

A new review finds immediate release nifedipine offers comparable safety and efficacy to IV labetalol and hydralazine in managing severe hypertension during pregnancy.

IR nifedipine as effective as IV labetalol for severe hypertension in pregnancy

Black patients have larger levator hiatal (LH) dimensions and a more ovular, narrower, U-shaped levator hiatus than White patients, according to a study published in the 

Pelvic organ prolapse (POP) and urinary incontinence (UI) have been indicated as risk factors of pelvic floor dysfunction (PFD), and a 20% lifetime risk of undergoing surgery for these conditions has been reported in vagina-bearing women. Race has also been reported as a risk factor, with the highest POP and UI rates reported in White women.

“Studies have shown that the LH area, the region enclosed by the inferior pubic rami and levator ani muscle (LAM), is predictive of POP and pertinent to POP etiology and pathogenicity. However, those study populations are not representative of parous or asymptomatic individuals of reproductive age,” wrote investigators.

The retrospective study was conducted to compare normal LAM thickness, LH morphology, and their association with risk factors for PFD between asymptomatic Black and White individuals. Participants included women aged 18 to 50 years with normal pelvic anatomy.

Pelvic MRIs from 2005 to 2023 were obtained from 2 sites for a retrospective chart review. These MRIs were obtained from patients in the supine position using 1.5-T and 3-T scanners.

Noninfected urethral diverticuli under 3 cm, uterine fibroids 3 cm or under, simple or paratubal ovarian cysts 3 cm or under, thrombosed pelvic vein, thickened endometrial stripe, hydrosalpinx, and intrauterine device were considered permissible anatomical-related abnormalities. Other abnormalities were excluded from the analysis.

A 3D pelvic coordinate system was used to register MRIs. To generate a 3D spine curve, investigators placed fiducial points along the ventral surface of the LAM. This was followed by placing a fiducial point on the inferior pubic point (IPP). The plane of minimal hiatal dimensions was calculated as the distance between the IPP and levator plate.

A new study reveals Black women have larger, more U-shaped levator hiatus dimensions than White women, highlighting potential implications for pelvic floor disorder.

Angel Foster, MD

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