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Brittany L. Ranchoff, PhD, MPH, is a Research Fellow at the Harvard Pilgrim Health Care Institute and Harvard Medical School.

A new study finds under 16% of US counties offer vaginal birth after cesarean services, highlighting regional disparities.

Brittany Ranchoff, PhD, MPH, highlights limited labor after cesarean access

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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: iron deficiency, IBD guidelines, and more

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.

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Structured postnatal monitoring and timely follow-up are vital for managing neonatal outcomes in red cell alloimmunization cases, according to a recent study published in 

Pregnant patients may develop red blood cell (RBC) antibodies that differ from their own, increasing the risk of complications if the fetus inherits incompatible antigens. If maternal antibodies cross the placenta, fetal red blood cells may be targeted, leading to hemolytic disease of the fetus and newborn (HDFN).

Peak systolic velocity in the middle cerebral artery (MCA PSV) monitoring is traditionally used to assess patients with clinically significant antibodies.

 This method has a false positive rate of approximately 12%.

“Although MCA PSV Doppler surveillance is widely used in managing red cell alloimmunized pregnancies, limited data exist on neonatal outcomes when the threshold for intrauterine transfusion (MCA PSV ≥1.5 MoM) is not persistently reached,” wrote investigators.

A retrospective cohort study was conducted to evaluate the outcomes of these pregnancies. Data between January 2018 and December 2023 were obtained from a single center of level 4 maternity and neonatal care units.

Pregnancies needing MCA PSV Doppler monitoring for red cell alloimmunization with an at-risk fetus or neonate not requiring intrauterine transfusion (IUT) were included in the analysis. Those with no antenatal or postnatal testing, needing IUT, or with multiple gestations were excluded.

Maternal and neonatal medical records were assessed for relevant data, including maternal demographics, obstetric history, red cell alloimmunization profiles, MCA PSV Doppler assessment characteristics, antenatal interventions, delivery characteristics, and neonatal outcomes. HDFN risk was determined based on antigen testing.

Antibody profiles and pregnancy characteristics

There were 40 pregnancies and 39 neonates with increased risk of HDFN included in the final analysis, 50% of whom had antenatal testing and 50% had neonatal testing. Anti-D was the most common antibody, observed in 52.5% of pregnancies. This was followed by anti-E in 17.5% and anti-c in 15%. Multiple antibodies were reported in 21.1% of cases.

Mothers were aged a median of 31 years and had a median gravidity of 3 and parity of 1. Red cell alloimmunization in previous pregnancy was identified in 60.6% of patients with documented alloimmunization history, but no prior IUT cases were found.

Neonatal intensive care unit (NICU) admission was necessary for 46.2% of neonates, while 56.4% required phototherapy to treat hyperbilirubinemia, 2.6% required transfusion, and 12.8% required intravenous immunoglobulin (IVIG). Only needing phototherapy was reported in 33.3% of neonates, and none received IVIG or transfusion as isolated therapy.

RBC transfusions were given to 28.2% of neonates to treat anemia, with only 5.1% receiving RBC transfusions as isolated therapy. Postnatal therapy for hyperbilirubinemia was required for 61.5% of at-risk neonates, while 38.5% did not need treatment. Those not needing treatment were born to younger mothers vs those requiring treatment.

A reduction in birth weight was reported in the treatment group vs the no-treatment group, at 2859 vs 3420 g, respectively. NICU admission rates were 66.7% vs. 13.3%, respectively, and median NICU durations were 7 vs 0 days, respectively. However, gestational age at delivery did not differ between groups.

These results highlighted neonatal outcomes in red cell alloimmunized pregnancies without IUT monitored with MCA PSV Doppler. Investigators concluded there is a need for tailored prenatal counseling and structured postnatal monitoring.

“Future research should focus on risk stratification tools and standardized follow-up protocols to better identify and manage at-risk infants in this understudied population,” wrote investigators.

Arkerson BJ, Aghajani F, Modrall KE, et al. Neonatal outcomes among pregnancies with red cell alloimmunization requiring doppler monitoring without intrauterine transfusion: a retrospective cohort study. 

HDFN hemolytic disease of the fetus and newborn/alloimmunization. Fetal Health Foundation. Accessed August 29, 2025. https://www.fetalhealthfoundation.org/fetal-syndromes/hemolytic-disease-of-the-fetus-and-alloimmunization/

A study shows the need for structured postnatal care in pregnancies affected by red cell alloimmunization.

Clinical

Postnatal monitoring key in red cell alloimmunization cases

Prostaglandin use to induce labor or treat postpartum hemorrhage (PPH) is safe in patients with sickle cell disease, according to a cohort study published in 

Complications of sickle cell disease include acute chest syndrome, vaso-occlusive crises, venous or arterial thromboembolisms, and chronic kidney, heart, and chest syndrome. These complications are exacerbated by pregnancy, indicating a need for close monitoring of pregnant patients with the condition.

“Prostaglandins…are commonly used to induce labor,” wrote investigators.

 “However, there is concern that prostaglandins may increase the risk of vaso-occlusive crisis.”

The retrospective cohort study was conducted to assess the risk of vaso-occlusive crisis in pregnant patients with sickle cell disease taking prostaglandins. Pregnancies with sickle cell disease between January 1, 2009, and June 30, 2020, in the databases of 10 French centers were included in the analysis.

In the first of 3 analyses, populations exposed to any prostaglandin were compared to those unexposed. In the second analysis, those exposed to labor induction were compared to those unexposed. Finally, those exposed to PPH treatment were compared to controls.

A recorded acute complication was reported as the primary outcome of the analysis, while secondary outcomes included needing intravenous morphine for vaso-occlusive crises and crises leading to intensive care unit admission. Maternal, pregnancy, delivery, and neonatal characteristics were collected alongside sickle cell disease variables.

Prostaglandins used and patient demographics

PGE2 analog dinoprostone and PGE1 analog misoprostol were common prostaglandins used for the induction of labor. For PPH, the PGE2 analog intravenous sulprostone is recommended by French guidelines.

There were 411 pregnancies included in the final analysis, 61.1% of which were complicated by S/S gene sickle cell disease, 27% by S/C gene, and 11.7% by S/ß-thalassemia. Severe disease was reported in more than 50% of cases, and at least one vaso-occlusive crisis in 55.5%.

Morphine was required in 39.4% of cases, transfusion in 60.7%, and hospitalization in intensive care in 11.9%. While no maternal death cases were reported, there were 12 cases of fetal demise and 1 case of neonatal death.

Older age and increased nulliparity prevalence were reported in patients receiving prostaglandins vs those unexposed. However, the odds of prior cesarean delivery, having a thromboembolic event before or during pregnancy, receiving low-dose aspirin, and having preeclampsia were reduced in this population.

No difference in outcomes from prostaglandins

Vaso-occlusive crisis rates did not significantly differ between patients exposed vs unexposed to prostaglandins, at 12.2% vs 11.6%, respectively. Rates of intensive care unit admission and intravenous morphine use also did not significantly differ between groups.

Vaginal deliveries were more common in the exposed group vs the unexposed group, with rates of 56.1% and 31.4%, respectively. Additionally, failed induction was more often the indication for cesarean delivery in these patients, at 20.1% vs 5.4% in unexposed patients. Mean gestational ages at delivery were 37.7 vs 36.7 weeks, respectively.

Sickle-cell disease was the indication for induction of labor in 44.5% of patients. Prostaglandins were used in 57.9% of inductions, but vaso-occlusive crisis rates were similar between exposed and unexposed individuals, at 11.6% vs 7.2%, respectively. Secondary and obstetrical outcomes were also similar between groups.

PPH was reported in 14.6% of patients, and severe PPH in 5.8%. Sulprostone was provided to 18.3% patients with PPH, and rates of the primary and most secondary outcomes did not differ between those exposed vs unexposed. However, blood transfusions were more common in women receiving sulprostone.

Overall, the results indicated no association between prostaglandin use in pregnancy and severe complications of sickle cell disease. Investigators concluded prostaglandins are safe for use in pregnant women with sickle cell disease.

“Further large-scale prospective multicentric studies are necessary to explore the impact of specific prostaglandin drugs, particularly misoprostol,” wrote investigators.

. Safety of prostaglandins in the peripartum period in case of sickle-cell disease: a multicenter cohort study. 

 2025;1(5):e70014. doi:10.1002/pmf2.70014

Society for Maternal-Fetal Medicine; Sinkey RG, Ogunsile FJ, et al. Society for Maternal-Fetal Medicine Consult Series #68: sickle cell disease in pregnancy. 

2024;230(2):B17-B40. doi:10.1016/j.ajog.2023.10.031

A study found no increased risk of vaso-occlusive crises or severe complications from prostaglandin use in pregnancy.

Prostaglandins safe in pregnant patients with sickle cell disease

highlighted that patients with a positive family history of diabetes and personal history of gestational diabetes mellitus (GDM) have the highest polygenic risk scores (PRSs).

One in 10 US pregnancies is impacted by GDM, which has been linked to a greater than 7-fold increase in type 2 DM (T2DM) risk. Being born to a mother with GDM has also been linked to increased T2DM and obesity risks.

 PRS may be used to predict diabetes risk, but few studies have used PRS scores with clinical characteristics.

“By integrating additional predictive characteristics, such as sociodemographics, behavioral, and biochemical factors, this could improve accuracy for a GDM risk prediction model, and help stratify individuals who may benefit from knowing their PRS to determine optimal intervention strategies,” wrote investigators.

The secondary analysis was conducted to evaluate clinical characteristics in PRS quartiles. Patients were recruited from the Hoosier Mom's Cohort, which prioritized patients with a higher GDM risk. Eligibility criteria included being aged at least 18 years with a single gestation of less than 20 weeks.

Patients with any pregestational diabetes, a first-trimester hemoglobin A

 screening of 6.5% or higher, planned pregnancy termination, chronic systemic steroid use, or major fetal anomalies were excluded from the analysis. Two visits occurred during the prenatal period and at delivery, with survey data and biospecimens collected during these visits.

A QIAsymphony instrument was used to complete DNA extraction, while genotyping was performed using the Infinium Global Diversity Array-8 v1.0. Genetic data were used to validate loci linked to diabetes and assess the performance of reported diabetes PRS. Investigators excluded patients with missing phenotype information.

There were 391 patients aged a mean 29.7 years and with a mean body mass index of 27.8 included in the final analysis. Of the patients, 16.6% were Hispanic, 71.4% White, and 15.9% Black. A family history of diabetes was reported in 54% and prior GDM in 4.3%. A similar ancestry-adjusted PRS was reported in the cohort vs a large, nulliparous population.

Patients were categorized into 4 quartiles, with quartile 1 indicating the lowest genetic risk and quartile 4 the highest. Maternal characteristics did not significantly differ between PRS quartiles, but quartile 4 had higher rates of family diabetes history and prior GDM, at 61.9% and 8.2%, respectively.

In comparison, a family history of diabetes was reported in 46.4% of quartile 1. Additionally, when comparing quartiles 1 and 2 with quartiles 3 and 4, the higher risk group had increased GDM rates, at 12.8% vs 7.1% in the lower risk group.

Racial and ethnic differences across quartiles

Significant differences in race and ethnicity status were also noted between PRS quartiles. Self-reported racial minority status was reported in 68.1% of quartile 4 vs 3% of quartile 1, and Hispanic ethnicity rates were 29.2% and 9%, respectively.

Lower educational attainment and reduced gestational age at delivery were also reported in quartile 4 vs quartile 1, at 38.1 plus or minus 2.5 weeks vs. 38.7 plus or minus 2.1 weeks, respectively. Additionally, birth weights were 3067.7 vs. 3344.9 g, respectively, and cholesterol levels were 187.9 plus or minus 36.5 vs. 201.7 plus or minus 43.3, respectively.

These results indicated higher GDM rates among patients in higher risk quartiles of GDM. Investigators concluded that this data may be used to inform the development of GDM prevention strategies.

“Using ancestry-adjusted PRS calculations was able to account for differences in baseline demographic characteristics such as race and ethnicity, and thus are likely preferred to isolate the PRS effects on outcomes,” wrote investigators.

Ellis A, Bhamidipaty-Pelosi S, Aamir M, Kotarski A, Guerrero RF, Haas DM. Diabetes polygenic risk scores and maternal characteristics in Hoosier Moms Cohort participants. 

ACOG Practice Bulletin No. 190: Gestational Diabetes Mellitus. 

 2018;131(2):e49-e64. doi:10.1097/AOG.0000000000002501

A study found that women with a family history of diabetes and prior gestational diabetes have the highest polygenic risk scores.

High genetic risk tied to gestational diabetes and family history

This week at Contemporary OB/GYN®, we covered topics ranging from the link between neighborhood deprivation and gestational diabetes to the safety of IV iron. Click the links below to read anything you might have missed from Monday, August 25, to Friday, August 29, 2025.

Melissa Furlong, PhD, links neighborhood deprivation to gestational diabetes risk

 Melissa Furlong, PhD, assistant professor in the Department of Environmental Health Sciences at the University of Arizona Mel and Enid Zuckerman College of Public Health, highlighted her study assessing the relationship between neighborhood deprivation and the risk of gestational diabetes mellitus (GDM).

The trial used Arizona birth certificate data spanning nearly a decade. By linking residential addresses reported on birth certificates to the Neighborhood Deprivation Index, a validated measure of neighborhood socioeconomic conditions, a clear association was identified between women living in more deprived neighborhoods and increased odds of developing GDM.

Neighborhood deprivation

PCOS patients report feeling dismissed by health care providers

Patients with polycystic ovary syndrome (PCOS) often feel dismissed, misunderstood, and underserved by the health care system, according to a study published in 

Feelings of being dismissed or ignored were reported by patients in all focus groups when discussing their symptoms. These experiences often occurred during adolescence, with many patients not receiving a diagnosis for years. During this period, they would often feel frustrated, isolated, and blamed for their condition.

“Patients told us their concerns, such as missed periods, acne or hair loss, were frequently minimized. They often felt that their voices were not heard, and that led to a delay in both diagnosis and effective treatment,” said Noy Phimphasone-Brady, PhD, senior study author and assistant professor at the University of Colorado Anschutz Medical Campus.

Prostaglandin use to induce labor or treat postpartum hemorrhage is safe in patients with sickle cell disease, according to a cohort study published in 

IV iron therapy safe and effective for pregnant patients

Intravenous (IV) iron therapy can be safely administered without significant maternal or fetal safety concerns in obstetrical clinics, according to a recent study published in 

Hgb significantly increased between diagnosis and delivery, from 9.7 g/dL to 11.2 g/dL. In patients receiving 2 or fewer IV iron infusions, the mean Hgb rose from 10.1 g/dL to 11.5 g/dL. In those with 3 or more doses, the mean Hgb rose from 9.3 to 10.9. These changes were 1.4 and 1.6 g/dL, respectively, indicating similar improvements from 3 vs 2 doses.

However, a significantly greater improvement was observed from doses of 600 mg or more vs those under 600 mg, with increases in mean Hgb of 1.50 and 0.94 g/dL, respectively. Adverse effects were reported in 11.5% of patients, though only 0.5% of cases were terminated early because of adverse events.

Experts warn menopause hormone tests often unnecessary

Experts have warned that menopause care is being adversely impacted by unnecessary services that do not improve care, publishing their findings in 

The authors highlighted a rise in the use of commercial services among menopausal women, especially for routine hormone panel testing to evaluate hormone levels. According to investigators, these tests cost hundreds of dollars despite being of limited clinical use, as there is no clear therapeutic window for hormonal therapy in menopause.

“The principle of evidence-based practice is that a test should only be done if the result will directly guide patient care,” wrote investigators. “For perimenopause and menopause, hormone testing offers no reliable way to determine who will benefit from treatment.”

Contemporary OB/GYN week in review: gestational diabetes, PCOS dismissal, and more

 Umair Khanm, graduate student at the University of California (UCSF), San Francisco, and Marina Sirota, PhD, Acting Director at the Bakar Computational Health Sciences Institute at UCSF, discussed current challenges and research advancements in endometriosis screening, diagnosis, and understanding. 

The researchers highlighted the primary limitation in diagnosing endometriosis: the significant delay between the onset of symptoms and formal diagnosis, often spanning 5 to 7 years. This delay is largely because of the heterogeneity of symptoms. Some patients may be asymptomatic, while others suffer from severe, debilitating pain. The inconsistent presentation makes it difficult for clinicians to identify the condition early.

To address this, Khan and Sirota conducted a large-scale study leveraging electronic health records (EHRs) from multiple medical centers. Their research aimed to comprehensively examine comorbidities associated with endometriosis. Previous studies had been limited in size or scope, but this broader approach allowed them to identify hundreds of health conditions linked to the disease. These include reproductive, autoimmune, gastrointestinal, neurological, and respiratory disorders. Notably, many of these associated conditions were present even before a formal diagnosis, suggesting a window of opportunity for earlier detection.

The researchers hope their findings will contribute to a better understanding of the various subtypes of endometriosis and inform future diagnostic strategies. One promising avenue is the potential use of artificial intelligence and machine learning to analyze EHR data and predict which patients are at higher risk of developing endometriosis. This could significantly shorten the current diagnostic journey and help clinicians recognize symptom patterns that might otherwise be overlooked.

Sirota and Khan also discussed the potential for integrating richer data sources, such as lab results, medication histories, and even information extracted from clinical notes using advanced language models. The ultimate goal is to develop predictive models that assess an individual’s likelihood of having endometriosis based on their comprehensive clinical profile.

Finally, the researchers emphasized the importance of validating their findings across different health care systems and geographical regions. They also expressed interest in combining clinical data with molecular data, such as biopsy results, to bridge the gap between real-world patient records and deeper biological insights. This integrative approach could pave the way for more personalized and effective care strategies for endometriosis patients in the future.

Khan U, Oskotsky TT, Yilmaz BD, et al. Comorbidity analysis and clustering of endometriosis patients using electronic health records. 

By analyzing electronic health records, researchers such as Marina Sirota, PhD, and Umair Khan have uncovered hundreds of conditions linked to endometriosis.

New research aims to transform endometriosis diagnosis

More than 1 in 3 pregnant patients worldwide experience iron deficiency anemia (IDA), leading to more than half of antepartum anemia cases and severe adverse maternal and neonatal outcomes. Antenatal oral iron supplementation is often used to reduce the risk of IDA. However, while oral administration is cost-effective, it is often limited by poor absorption.

“Despite…advantages, IV iron administration is often limited due to outdated beliefs regarding potential [adverse] effects, such as anaphylaxis,” wrote investigators. “This practice necessitates the use of specialized infusion centers or hospital settings, primarily due to elevated costs and the requirement for resource utilization.”

The retrospective chart review study was conducted to assess maternal and fetal outcomes following IV iron therapy administration in an outpatient obstetric clinic. Data were obtained from electronic medical records between January 2017 and June 2024.

Participants included pregnant patients receiving antenatal IV iron infusions at the antenatal testing center. This regimen was given to patients with poor response to oral iron, hemoglobin (Hgb) under 10 g/dL at 34 weeks’ gestation or later, or anticipated delivery before adequate oral iron repletion.

Iron sucrose and ferric carboxymaltose regimens were available, with the former including 2 doses of 300 mg IV 1 week apart or 3 doses of 200 mg IV 1 week apart. The latter regimen included 2 doses of 750 mg IV 1 week apart. Investigators collected patient vital signs at arrival, halfway through infusion, and at completion.

Infusion cessation for at least 15 minutes was employed to manage mild adverse reactions, while moderate reactions were managed through IV saline bolus and possible corticosteroids to infusion cessation and monitoring. These methods were also used to manage severe reactions, alongside transfer to the hospital if needed.

RedCap software was used to collect and abstract data, including demographic and medical history characteristics. The safety and feasibility of IV iron infusion in an obstetric clinic setting were reported as the primary outcome. Change in Hgb levels, timing of last IV iron infusion before delivery, maternal outcomes, and neonatal outcomes were also reported.

There were 417 participants included in the final analysis, 29.5% of whom were White, 14.9% Black, 10.5% Asian, 39.2% other race or ethnicity, and 5.1% not reported. Private insurance was reported in 53.4%, Medicaid in 43.5%, and being uninsured in 3.1%. Iron sucrose was provided to 87.3% and ferric carboxymaltose to 12.7%.

Participants had a mean gestational age of 31.7 plus or minus 4.6 weeks at the first infusion, 32.3 plus or minus 4.4 weeks at the second, and 33.0 plus or minus 4.7 weeks at the third. At baseline, the study population had a mean ferritin of 13.9 plus or minus 26.4 ng/mL.

New research shows that intravenous iron infusions can be safely administered in outpatient obstetric clinics.

Brittany L. Ranchoff, PhD, MPH

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