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A study found that pregnancy malaria and preterm delivery increase early-life susceptibility to malaria in children.

Maternal malaria and preterm birth linked to higher infant malaria risk

Bat-Sheva Maslow, MD, is a reproductive endocrinologist at IVI RMA North America. 

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.

Ob-gyns play a crucial role in identifying fertility issues and facilitating referrals to reproductive endocrinologists for seamless patient care.

When to refer to a reproductive endocrinologist and how to ensure a seamless handoff

A study found that insomnia and obstructive sleep apnea during pregnancy are linked to increased risks of ischemic placental disease and severe morbidity.

Pregnancy insomnia and sleep apnea linked to complications

A study found that recommended treatment significantly increases survival rates in women aged 65 years and older with early-stage cervical cancer.

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Why vNOTES Make Sense for My Patients

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A recent clinical study presented by Koji Ishikawa, MD, PhD, orthopedic spine surgeon at Duke University, and Tony M. Keaveny, PhD, Founder and Chief Science Officer of O.N. Diagnostics, compared the effects of romosozumab, teriparatide, and denosumab on bone strength in patients with osteoporosis. 

The analysis focused on the hip and spine, where fracture risk is particularly great. Results showed that romosozumab provided substantially greater improvements in bone strength after 1 year of treatment compared to the other 2 drugs. At the spine, for example, romosozumab increased bone density by approximately 25% but boosted bone strength by about 40%, highlighting that strength gains are not fully reflected by bone density measurements from standard DXA scans.

The findings are significant because fracture prevention depends more on improved breaking strength than on density alone. Data from real-world clinical care also suggest even greater percentage gains than those seen in earlier phase-2 and phase-3 trials. 

Notably, romosozumab demonstrated the unique ability to transform highly osteoporotic vertebrae into bones at much lower risk of biomechanical failure, as shown through virtual stress testing models. According to the researchers, romosozumab stands out as the most effective treatment for strengthening both hip and spine bones, offering a compelling advantage over teriparatide and denosumab.

Please provide an overview of your presentation about bone strength from romosozumab vs teriparatide or denosumab.

This study compared the breaking strength of the hip and spine bones for different osteoporosis drug treatments and showed that the strength benefits after 1 year of treatment were substantially greater for romosozumab compared to both teriparatide and denosumab.

Spinal instrumentation remains challenging in patients with bone fragility. The concept behind this project is to provide additional support for achieving favorable surgical outcomes, beyond surgical techniques. Based on simulation-based biomechanical analysis, we found that romosozumab offered multiple advantages over denosumab and teriparatide in terms of biomechanical parameters relevant to spinal surgery.

What is the significance of these findings?

Changes in bone density as measured by clinical-standard DXA testing are difficult to interpret because what matters most in terms of fracture reduction is how much the 

 changes. This study is significant because it demonstrates the substantial benefits for breaking strength – more than for bone density. For example, at the spine, romosozumab increased bone density by about 25% but bone strength by about 40%. So, the benefits of the treatment are underestimated when measured by bone density. And of course, those benefits were greater for romosozumab than either of the other 2 treatments.

Evaluating mechanical parameters such as screw fixation strength or bone-breaking force in clinical practice for assessing drugs effects is impractical and often difficult with traditional biomechanical methods. To address this, we developed a simulation approach using patient CT data. Our findings provide a new perspective on their effectiveness in the context of implant surgery.

What were the main takeaways of your presentation?

As we have seen in other clinical trials, romosozumab is the better treatment in terms of its bone-strengthening benefits, both at the hip and spine. Here we have data from actual clinical care.

After 1 year of treatment, romosozumab showed greater improvements than denosumab and teriparatide in surgical instrumentation-related biomechanical analyses.

What other research about the impact of romosozumab on bone strength would you like to highlight?

These results suggest even greater gains, percentage-wise at least, for these highly osteoporotic and treatment-naïve patients from clinical care than what we observed in a prior phase-2 BCT study in women with low bone mass (Keaveny JBMR 2017) and also in a phase-3 imaging substudy of osteoporotic women with prior bisphosphonate therapy (Langdahl Lancet 2017).

In a previous study, we were the first to demonstrate the potential benefits of short-term romosozumab treatment (3 months) in reducing postoperative complications after spinal surgery (Ishikawa K, JOR Spine 2024). Taken together with the present findings, our research further supports the role of romosozumab for surgical support.

These results are particularly compelling at the spine for romosozumab because the drug benefit is so large — it takes a highly osteoporotic bone and transforms it into one at much lower risk of biomechanical failure. This is seen visually with the virtual stress testing. Here, virtual forces are placed on the bone that would normally fracture and crush an osteoporotic bone. After treatment with romosozumab, that same level of force produces almost no damage in the bone. Romosozumab appears to be the only drug treatment that can transform the osteoporotic vertebra in this way.

Even the best surgeons face complications when patients have osteoporosis. Yet perioperative bone health care is often overlooked. Our studies underscore the importance of assessing and managing bone health in perioperative settings to improve surgical outcomes.

A recent study found that romosozumab significantly outperformed teriparatide and denosumab in improving hip and spine bone strength.

Clinical

Romosozumab outperforms teriparatide and denosumab in bone strength

Investigators of a study published in the 

American Journal of Obstetrics & Gynecology 

have found a slightly increased surgical retreatment risk in patients receiving a hysteropexy for prolapse vs receiving a hysterectomy during native-tissue prolapse surgery.

Nearly 3% of US women experience pelvic organ prolapse, which is traditionally treated through hysterectomy. Hysteropexy has been considered as an alternative treatment method, with some studies highlighting potential decreases in surgical morbidity, operative time, and other outcomes.

“Current evidence remains mixed, and there is a lack of long-term data,” wrote investigators. “Existing retrospective studies are limited to less than 3 years of follow-up. Population database studies are limited to cohorts prior to 2012 or did not specifically include prolapse surgeries with apical suspension.”

Assessing pelvic organ prolapse treatment

The retrospective cohort study was conducted to evaluate surgical retreatment rates between hysterectomy and uterine preservation for pelvic organ prolapse following native-tissue apical prolapse surgery. Data from 2011 to 2021 were obtained from the Medicare 5% Limited Data Set.

Participants included women aged at least 65 years receiving native-tissue pelvic organ prolapse surgery with apical suspension based on 

) codes 57,282, 57,283, and 58,410. Exclusion criteria included concurrent mesh placement, obliterative procedures, and laparoscopic supracervical or open hysterectomy.

 International Classification of Diseases, Ninth 

 codes, with concurrent hysterectomy based on 

 codes. Participants were classified as having a concurrent hysterectomy during native-tissue pelvic organ prolapse surgery or as having uterine preservation through hysteropexy.

Surgical retreatment for pelvic organ prolapse based on 

 codes was reported as the primary outcome, while secondary outcomes included any additional surgical treatment. Follow-up occurred until outcomes of interest, loss to follow-up, or death.

There were 2341 participants included in the final analysis, 584 of whom underwent hysteropexy and 1757 underwent hysterectomy. Mean ages in these groups were 73.4 vs 71.8 years, respectively, and hypertension rates were 74.1% vs 68.8%, respectively.

A higher disease burden was reported in hysteropexy patients with a mean Charlson comorbidity index score of 1.6 vs 1.3 in patients with hysterectomy. Follow-up occurred for a mean of 1445 and 1600 days, respectively.

During a 5-year follow-up period, repeat prolapse surgery was reported in 2.9% of the hysteropexy group and 2.3% of the hysterectomy group, indicating no significant difference. Unadjusted prolapse retreatment rates were 9.1% and 6.7%, respectively.

The risk of surgical retreatment significantly increased among patients receiving hysteropexy vs hysterectomy when adjusting for covariates, with an adjusted HR of 1.52. However, mortality risks did not significantly differ between groups.

Subsequent procedures and composite outcomes

Subsequent hysterectomy within 5 years of the index surgery was reported in 3.4% of patients receiving hysteropexy. Uterine or cervical-related procedures during this period occurred in 0.5% of the overall study population.

The hysteropexy group had a composite rate of surgical retreatment of 9.7% vs 7% in the hysterectomy group. Overall, these results indicated significantly reduced future prolapse repair risk from hysterectomy over hysteropexy in Medicare patients.

“However, the absolute risk difference is small,” wrote investigators. “The decision to remove or retain the uterus at the time of prolapse surgery is complex with considerations of future risk of prolapse retreatment, potential development of uterine or cervical pathologies, and patients' values.”

Chang OH, Ford C, Wu JM, Cadish LA, Jelovsek JE. Surgical retreatment after native-tissue apical prolapse surgery with hysterectomy vs hysteropexy. 

 2025;233(3):176.e1-176.e6. doi:10.1016/j.ajog.2025.03.003

Detollenaere RJ, den Boon J, Stekelenburg J, et al. Sacrospinous hysteropexy versus vaginal hysterectomy with suspension of the uterosacral ligaments in women with uterine prolapse stage 2 or higher: multicentre randomised non-inferiority trial. 

A study found that hysteropexy patients faced a greater long-term risk of surgical retreatment compared with hysterectomy.

Hysteropexy tied to greater retreatment risk than hysterectomy for POP

All surgical approaches for vaginal vault prolapse repair improve body image, leading to greater sexual function among sexually active women, according to a recent study published in the 

American Journal of Obstetrics & Gynecology.

Components of personal body image include positive and negative perceptions, thoughts, behaviors, and attitudes. Increased odds of depression, reduced self-confidence, and poor sexual health have been reported in individuals with poor body image, adversely impacting multiple facets of life.

“The improvement of body image and sexual function with treatment of POP [pelvic organ prolapse] has previously been demonstrated,” wrote investigators.

 “However, there are limited data available regarding whether a particular method of treatment is superior to another with respect to improvement of body image and sexual health.”

Surgical approaches and assessing body image

Investigators conducted a multicenter randomized clinical trial to evaluate the safety and efficacy of 3 apical repair methods for vaginal vault prolapse. These methods included transvaginal native tissue repair (NTR), mesh placed abdominally through sacrocolpopexy (SC), and mesh placed transvaginally (TVM).

Participants completed the Body Image in Pelvic Organ Prolapse (BIPOP) questionnaire at baseline and at 6, 12, 18, 24, 30, and 36 months. Responses were used to determine the impact of POP on body image. The questionnaire included 10 questions, with responses ranging from strongly disagree to strongly agree.

Subscales of the BIPOP questionnaire included the attractiveness subscale and partner subscale. Each score ranged from 1 to 5, with higher values indicating worse prolapse-related body image. Strongly agree and agree responses indicated poor body image, while other responses indicated not poor body image.

During each visit, patients reported sexual activity status as a binary yes or no variable. The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire was used to measure sexual function.

There were 335 women included in the final analysis, 123 of whom received NTR, 107 SC, and 105 TVM. The study population was aged a mean 66.1 plus or minus 8.5 years, and 72% had stage 3 POP. Being White was reported in 84%, living with a partner in 69%, and being sexually active in 44%. Baseline BIPOC scores did not significantly differ between groups.

While all groups reported significantly improved total and subscale BIPOC scores across the 36 months following surgery, no significant differences in improvement were reported based on surgical method. When assessing individual BIPOC items, rates of poor body image were reduced in all 10 items compared to baseline.

These results were mirrored by models repeated for mesh vs no mesh and vaginal vs abdominal comparisons. Additionally, being sexually active at all visits was reported by 30% of women. However, 39% reported not being sexually active at all visits.

Being nonsexually active at first but becoming sexually active at least once following surgery was reported by 17% of participants. The remaining participants changed their sexual activity status throughout the study.

Participants with sexual activity in all groups reported improved sexual function following surgery. However, no differences were reported based on treatment method, nor in mesh vs no mesh and vaginal vs abdominal comparisons.

Positive correlations were found between improved body image and improved sexual function at each visit, with sexual function scores significantly altered by reversed BIPOC scores. Additionally, 37% of women met the criteria for surgical failure by 36 months.

Poorer body image was reported in these patients based on significantly increased BIPOC scores at 36 months. Overall, the data highlighted improved body image and sexual function following repair of vaginal vault prolapse, regardless of the surgical method used.

“Improvements in body image and sexual function are positively correlated among sexually active women,” wrote investigators.

. Body image and sexual function improve following prolapse repair. 

 2025;233(3):182.e1-182.e12. doi:10.1016/j.ajog.2025.01.042

Jelovsek JE, Barber MD. Women seeking treatment for advanced pelvic organ prolapse have decreased body image and quality of life. 

 2006;194(5):1455-1461. doi:10.1016/j.ajog.2006.01.060

A trial shows all surgical approaches for vaginal vault prolapse enhance body image and sexual health in women.

Vaginal vault prolapse surgery improves body image

As we recognize National Folic Acid Awareness Week (September 8-14, 2025), it is vital to discuss innovations, research, and evolving care strategies that influence folic acid management. From its influence on birth defects to increased use in patients with gestational diabetes, groundbreaking folic acid research has emerged throughout 2025.

 highlights some of the most notable folic acid–related developments so far this year, including supplement use before pregnancy and improved child development. These stories show an ongoing effort to highlight the benefits of folic acid supplementation and increase its use in the general population.

Click on each title below for more information on each news item.

A multicenter randomized clinical trial evaluated the impact of 3 surgical approaches for vaginal vault prolapse repair on body image and sexual function: native tissue repair, sacrocolpopexy, and transvaginal mesh. The study included 335 women, with a mean age of 66 years, most of whom had stage 3 prolapse. 

Using the Body Image in Pelvic Organ Prolapse questionnaire and sexual function measures, investigators found significant improvements in body image and sexual function across all surgical methods over 36 months. No significant differences emerged between approaches, nor between mesh vs nonmesh or vaginal vs abdominal procedures. 

Women who remained or became sexually active post surgery reported greater gains in sexual function, with improvements closely tied to better body image. However, 37% experienced surgical failure by 36 months, which was associated with poorer body image. Overall, findings highlight that prolapse repair enhances body image and sexual health regardless of surgical technique.


 found that two-thirds of US women of reproductive age present with at least one modifiable risk factor for birth defects. Among 5374 nonpregnant, nonlactating women studied from 2007 to 2020, 19.5% had low red blood cell folate levels, 33.8% were obese, 4.8% had diabetes, and nearly 1 in 5 had tobacco exposure. 

Supplement use was low, with only 12.6% meeting recommended folic acid intake, and nearly all participants fell below 400 µg/day without supplements. Over time, obesity, diabetes, prediabetes, and very low food security increased, while active tobacco use and adequate folic acid intake declined. 

Disparities were noted, with non-Hispanic Black and Hispanic women more likely than White women to have risk factors. Investigators emphasized that addressing these preventable factors through improved nutrition, health care access, and preconception counseling could significantly reduce the risk of birth defects and improve pregnancy outcomes.

Survey reveals persistent knowledge gaps about pregnancy health, vaccination safety

A national survey conducted by the Annenberg Public Policy Center in April 2025 revealed persistent gaps in US adults’ knowledge of pregnancy-related health recommendations, despite broad recognition of maternal health’s importance. Among 1653 respondents, 91% acknowledged pregnancy health affects infants, yet their knowledge of specific guidelines was inconsistent and declining in some areas. 

Only 46% correctly identified the recommended weight gain of 25 to 35 pounds during pregnancy, and understanding of folic acid supplementation dropped from 76% in 2023 to 71%. Awareness of iron use, alcohol abstinence prior to conception, and secondhand smoke risks also showed significant gaps, particularly among women of childbearing age. 

Knowledge of vaccine recommendations declined, with just 37% recognizing Tdap as recommended and only 11% aware that MMR is contraindicated in pregnancy. These findings highlight the need for stronger, targeted public health messaging to address misconceptions and support healthier pregnancies, especially among reproductive-aged women and their families.

Higher maternal folic acid intake linked to improved child development

A study presented at the American Academy of Neurology’s 77th Annual Meeting found that higher maternal folic acid intake during the first trimester is linked to improved verbal and behavioral outcomes in children at age 6 years. The analysis included 345 children, most born to women with epilepsy, and compared outcomes based on maternal folic acid doses ranging from none to more than 4 mg per day. 

Children whose mothers took folic acid scored higher in verbal skills (mean 108 vs 96) and behavior (102 vs 82) than those whose mothers took none. Among folic acid users, verbal scores averaged 110 for high-dose vs 108 for low-dose groups, with behavioral scores similar at 103. 

These findings suggest that folic acid intake, regardless of dose, benefits neurodevelopment, while higher doses appear safe. Investigators emphasized the importance of early supplementation for children's brain health, particularly in women at higher risk, such as those with epilepsy.


Deep learning model enhances gestational diabetes prediction accuracy

 suggests that a multilayer perceptron (MLP) deep learning model may improve the prediction of gestational diabetes mellitus (GDM) compared with traditional logistic regression approaches. GDM affects 5% to 30% of pregnancies worldwide, varies by region and ethnicity, and poses serious risks for both mothers and infants. 

Investigators conducted a retrospective cohort study of pregnant women who delivered between 2008 and 2018, analyzing 32 prenatal variables, including age, prepregnancy body mass index (BMI), folic acid supplementation, family history, and laboratory biomarkers. Women with GDM were more likely to be older, have higher BMI, lower education, earlier menarche, and distinct hematological, renal, and liver profiles. 

The MLP model, structured with 3 neural network layers, demonstrated superior predictive performance with an area under the receiver operating characteristic curve of 0.943, average precision of 0.855, and F1 score of 0.879, compared with weaker results from logistic regression models. Investigators noted that incorporating genetic data could further refine prediction and support personalized prevention and treatment strategies for GDM.

Find out the top 5 latest updates and headlines in folic acid research in honor of National Folic Acid Awareness Week (September 8-14, 2025).

Top 5 recent updates in folic acid research

Ovarian cancer

Jesus Gonzalez Bosquet, MD, PhD, associate professor of obstetrics and gynecology at The University of Iowa, highlighted the efficacy of a machine learning model using blood-based biomarkers to identify ovarian cancer.

Ovarian cancer remains one of the most difficult gynecologic cancers to detect early, and this significantly impacts patient survival outcomes. According to Gonzalez Bosquet, the primary challenge is the lack of effective early screening or detection methods. Current tools, such as ultrasound and tumor markers, have been tested in multiple studies in the United States and abroad, but none have demonstrated consistent accuracy. 

As a result, most patients are diagnosed at advanced stages, when treatment options are limited and survival rates drop significantly. Gonzalez Bosquet noted that 5-year survival rates for early-stage ovarian cancer reach approximately 95%, but this falls between 40% and 50% for patients diagnosed at later stages, underscoring the need for earlier detection strategies.

To address this gap, Gonzalez Bosquet and his team have explored the use of machine learning models to identify ovarian cancer through blood-based biomarkers. Their work focuses on detecting methylated DNA fragments shed by tumors into the bloodstream. Starting with a platform that examined more than 850,000 methylation probes, the researchers used machine learning to narrow the list down to 9 probes that showed strong potential for accurately identifying ovarian cancer. While promising, these findings are still in the pilot phase and require further validation before they can be used in clinical settings.

According to Gonzalez Bosquet, the next step in this research is to confirm whether these methylated probes can be reliably detected in blood samples, not just in surgical tissue specimens. He that his team, in collaboration with Mayo Clinic, has submitted a project aimed at this validation step. If successful, the model will need to be tested in large-scale screening studies involving both patients with and without ovarian cancer to determine its true diagnostic accuracy and clinical value.

Looking ahead, Gonzalez Bosquet envisions practical applications of these artificial intelligence (AI) models that would make them accessible to clinicians worldwide. Once fully developed, the models could be hosted on web-based platforms, allowing physicians to upload data such as imaging scans or blood test results. The system would then provide a risk assessment, ranging from low to high probability of ovarian cancer. This streamlined, user-friendly approach could integrate seamlessly into clinical workflows, offering physicians a powerful tool for earlier and more accurate cancer detection.

Ultimately, Gonzalez Bosquet emphasized that while the technology is still under development, AI-driven models hold great promise in transforming ovarian cancer diagnosis, potentially improving survival rates by identifying the disease before it reaches advanced stages.

Jesus Gonzalez Bosquet, MD, PhD, discusses how machine learning could improve early ovarian cancer diagnosis by identifying methylated DNA in blood.

Bat-Sheva Maslow, MD

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