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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.

Lisa Bayer, MD, MPH, details her presentation at the 2025 ACOG ACSM pain management during IUD placement.

Lisa Bayer, MD, discusses pain management and patient-centered care during IUD placement

Megan Wasson, DO, FACOG, is chair of gynecology at Mayo Clinic in Arizona and a minimally invasive gynecologic surgeon specializing in endometriosis.

Megan Wasson, DO, discusses surgical precision, imaging, and mentorship to improve endometriosis care at the 2025 ACOG Annual Meeting.

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Joshua Fitch is an editor for Contemporary Pediatrics. Previously, he worked at 21 WFMJ as a sports anchor and videographer, as well as a national content writer for Weigel Broadcasting Company. 

Research presented at the 2025 ACOG ACSM highlighted the potential risks tied to personal care product use among African American pregnant patients. 

Use of hair, cosmetic products linked to increased phthalate exposure in pregnancy

In an abstract featured at the 2025 ACOG ACSM, researchers found that after Dobbs, North Carolina saw more out-of-state abortion patients, longer wait times, and increased racial disparities.

Post-Dobbs abortion access in North Carolina shows delays, increased out-of-state travel, and disparities

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What is your diagnosis of this placental lesion in a late second trimester pregnancy?

Clinical

Daily Dx: Placental Lesion

Saying "obstetrician-gynecologist" is a mouthful for most people, and it's probably the most abbreviated specialty in medicine, both spoken and written. However, there doesn't seem to be a consensus on how to pronounce OB-GYN. First, is it the two-syllable "O-B" or the monosyllabic "Ob"? Second, is it "gin" or "gyne" (like "Lyme")? I wonder if you have a preference. I know I do.

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There is a link between taking longer to eat an initial meal after waking up and increased caloric intake later in the day in pregnant women, along with taking longer to sleep after the last meal, according to a recent study published in 

Increasing research has been performed about the link between the timing of food intake and metabolic health, with investigators noting that eating and sleep behaviors should not occur at the same time of the day. This makes the time between awakening and the first meal as an important health factor, with increased health risks reported form skipping this meal.

“It is inferred that the timing of maternal food intake has the potential to influence maternal and fetal circadian rhythms, fetal development during pregnancy, and the subsequent metabolic health of the offspring, though this is still not fully understood,” wrote investigators.

Data has also indicated a link between sleep quality and weight gain distribution during pregnancy. Therefore, investigators conducted the longitudinal study to determine the impact of sleep-eating intervals on eating and sleeping times and food consumption among pregnant women.

Adult patients at the Integrated Care Units of Uberlândia and the Prenatal Service of the Teaching Hospital of Universidade Federal de Uberlândia who agreed to participate were included in the analysis. Exclusion criteria included prior chronic noncommunicable disease, not providing required information, and using illicit substances.

Data was obtained in all 3 trimesters. Initial sociodemographic data, medical history, physical activity, and gestational data were obtained through a questionnaire following the retrieval of consent. Three 24-hour dietary recalls were completed each trimester to assess food intake and meal timing.

Dietary recalls included details about consumed foods and beverages, with common household measures used to determine portion sizes. Anthropometric variables such as pre-pregnancy weight, current weight, and height were also measured.

Participants also reported their habitual sleeping pattern and aske times in a version of the Munich ChronoType Questionnaire. The mean sleep time on free days was used to determine the chronotype. The time between waking and initial eating was calculated to evaluate sleep-eating interactions.

Associations between wake-eating time and sleep behavior

Waking up earlier on work and free days and going to sleep later on free days was reported in pregnant women with a longer waking time to first eating episode vs those with a shorter waking time to first eating episode. A reduced chronotype value was also reported in these individuals.

Six percent, 6%, and 7% of pregnant woman skipped breakfast in the first, second, and third trimesters, respectively. Waking time to first eating episode was negatively correlated with waking time on workdays, with values of β = -0.509, β = -0.503, and β = -0.423 during the first, second, and third trimester, respectively.

For sleep duration on workdays, these values were β = -0.427, β = -0.483, and β = -0.445, respectively, also highlighting a negative association. Finally, a value of β= -0.344 was reported for sleep duration on free days in the first trimester and β= -0.235 for chronotype in the third trimester.

Bedtime and last meal timing correlations

Additional associations included the last eating episode to bedtime interval with sleep duration on workdays, with values of β = -0.391, β = -0.293, and β = -0.288 during the first, second, and third trimesters of pregnancy, respectively, Additionally, a link with sleep duration was noted in the second trimester.

On workdays, positive associations were reported between the last eating episode to bedtime interval and bedtime, at β = 0.394 in the first trimester, β = 0.542 in the second, and β = 0.551in the third. Similar associations were reported on free days.

The waking time to first eating episode interval was also linked to the percentage of calories eaten at dinner in the first and second trimesters, with values of β = 0.266 and β = 0.269, respectively. Links for the percentage of calories in the first meal were reported in the first and third trimesters, at β = 0.404 and β = 0.432, respectively.

Finally, a positive association was reported between the timing of the first meal in the first trimester and the last eating episode to bedtime interval. This showed significant associations in early and mid-pregnancy between delaying the first meal after waking up with both higher calorie intake and shorter sleep duration.

“Additional studies are needed for a more comprehensive understanding of this subject,” wrote investigators.

Pereira CS, Balieiro LCT, Teixeira GP, et al. Association between eating-fasting and sleep-wake cycles with eating times and food consumption throughout the day: Longitudinal study with pregnant women. 

 2024;18(1):e44-e55. doi:10.1055/s-0044-1787276

Ma X, Chen Q, Pu Y. Skipping breakfast is associated with overweight and obesity: A systematic review and meta-analysis. 

. 2020;14(1):1-8. doi:10.1016/j.orcp.2019.12.002

A new study found that prolonged time between waking and eating in pregnancy is associated with increased calorie consumption and disrupted sleep patterns.

Length of time to meal after waking linked to caloric intake in pregnant women

The Stanford Obstetric Recovery Checklist (STORK) is effective for measuring outpatient postpartum recovery, according to a recent study published in 

Screening in large populations is often performed through patient-reported outcomes measures (PROMs), making them the standard method for measuring recovery after childbirth. However, experts have noted difficulties in measuring postpartum recovery because of its unique and complex characteristics.

“A PROM designed and validated for use at the 6-week obstetric outpatient follow-up clinic visit could be useful for clinicians to facilitate discussion and counseling,” wrote investigators.

The Delphi method may be used to reach consensus among experts about a certain topic, leading to the development of new condition-specific PROMs. Therefore, investigators conducted a study to create a global outpatient postpartum recovery PROM using Delphi consensus across multidisciplinary stakeholders and patient representatives.

The STORK was developed across 3 phases, the first being identification of existing questions relevant to postpartum recovery. This was accomplished through a systematic review, in which items were selected from a list of 16 PROMs.

Afterward, STORK items were chosen using the Delphi method between January 11 and April 12, 2021. Sixteen stakeholders were included on the panel, from fields including obstetrics, maternal-fetal medicine, postpartum recovery, pain, epidemiology, psychiatry, sleep, nursing and midwifery, and PROM development.

Finally, feedback on STORK items was obtained through cognitive debriefing interviews with 10 postpartum patients. The STORK was then tested in English-speaking women aged over 18 years, with all modes of delivery and anesthesia modes included. Recruitment occurred 12 to 36 hours after delivery.

Postpartum recovery quality was assessed at baseline, as well as weeks 2, 6, and 12 postpartum. Demographic, medical, obstetric, and anesthetic data were collected at baseline, while PROMs were completed at each follow-up time point using REDCap software (Research Electronic Data Capture, version 14.1.4; Vanderbilt University).

PROMs completed included the 47-item STORK PROM using a 5-point Likert scale and the validated EuroQoL Five-Dimensions Three-Levels (EQ-5D-3L). Psychometric STORK properties at 6 weeks postpartum were reported as the primary outcome. This outcome was assessed through validity, reliability, responsiveness, and feasibility.

There were 500 items in the first round of the Delphi process, 165 in the second, and 47 in the third. Participants were aged a mean 33.3 years, with 1% being American Indian, 14% Asian, 7% Black, 14% Hispanic, 0.4% Pacific Islander, 63% White, and 3% other races and ethnicities. Sixty-two percent of patients responded after 6 weeks.

Structural validity and score correlations

Structural validity was reported for STORK when defining dimensions with a 4-factor model including dimensionality, model fit, item and scale properties, and differential item functioning for key groups. Differences in performance at baseline vs week 6 were found for interest in sexual activity and aches and pains-related items.

A correlation between STORK scores and EQ-5D-3L scores of ρ = −0.67 was reported. Additionally, STORK successfully differentiated between patients with good vs poor recovery, with a median STORK score of 151 indicating good recover and 129 indicating poor recovery.

Consistency was also found for individuals in the lowest and highest postpartum recovery percentiles. Additionally, reliability was found for STORK, with a Cronbach of α = 0.92, interitem correlation of r = 0.20, and split-half reliability of ρ = 0.98.

STORK scores increased across 12 weeks, indicating responsiveness. Increases between baseline and week 12 were 19% after spontaneous vaginal delivery, 31% after operative vaginal delivery, 27% after scheduled cesarean delivery, and 20% after nonscheduled cesarean delivery.

These results indicated STORK as a valid, reliable, and responsive PROM for measuring global postpartum recovery. The clinical utility of this tool may be determined through future research.

“Future studies are needed to evaluate the clinical utility of STORK by comparing it with standard care for evaluation of outpatient postpartum recovery and to evaluate its performance in different patient groups, languages, and health care settings,” wrote investigators.

Sultan P, Pandal P, Murthy A, et al. Development and validation of the Stanford Obstetric Recovery Checklist (STORK): A Delphi consensus and multicenter clinical validation study. 

. 2025;8(4):e255713. doi:10.1001/jamanetworkopen.2025.5713

Ciechanowicz S﻿, Setty T﻿, Robson E﻿, et al. Development and evaluation of an obstetric quality-of-recovery score (ObsQoR-11) after elective caesarean delivery.﻿ 

. 2019;122(1):69-78. doi:10.1016/j.bja.2018.06.011

A new study shows the Stanford Obstetric Recovery Checklist is a valid, reliable, and responsive tool for assessing outpatient postpartum recovery at multiple stages.

Erin Keyser, MD, FACOG

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