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Ethan Lowder, BA, is an MD student Harvard Medical School.

Ethan Lowder, BA, and Alexander Nagrebetsky, MD, MSc, reported that nearly 80% of children fast longer than recommended before surgery.

Experts say most children fast too long before surgery

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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 with prior cesarean delivery are more likely to experience severe pain, sleep disturbances, and daily activity disruption postpartum.

Cesarean birth linked to greater risk of pain and sleep disorders

The Menopause Society’s 2025 meeting heads to Orlando with sessions on longevity, hormones, cognition, and care innovation at midlife and beyond.

The Menopause Society prepares to convene in Orlando for 2025 Annual Meeting

Women who undergo cesarean delivery during advanced labor face a greater risk of scarring that may increase preterm birth risk in future pregnancies.

Advanced labor cesarean birth raises future preterm birth risk

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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.

Below, Keaveny shares further details on their presentation 

”(SUN-416) Greater increase in bone strength with romosozumab vs teriparatide or denosumab in women with postmenopausal osteoporosis in real-world clinical setting

 and Ishikawa provides an overview of the presentation 

“(SUN-564) Greater increases in bone strength estimates of virtual bone-implant constructs for spinal surgery with romosozumab vs teriparatide or denosumab in women with postmenopausal osteoporosis”. 

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.

Recent work presented at the 2025 annual meeting of American Society of Bone & Mineral Research found that romosozumab significantly outperformed teriparatide and denosumab in improving hip and spine bone strength. 

Clinical

Romosozumab outperforms teriparatide and denosumab in bone strength

Breast cancer

, Jayant S. Vaidya, MD, FRCS, PhD, professor of surgery and oncology at the University College London in England, and Sarah Glynne, MBBS, BSc, a general practitioner menopause specialist at The Portland Hospital in London, discussed current evidence and evolving perspectives on the use of hormone replacement therapy (HRT) after breast cancer.

Their discussion centered on a newly published paper in 

 that reexamines long-held assumptions about the risks and benefits of HRT in breast cancer survivors. Historically, the use of HRT after breast cancer has been contraindicated because of the well-established link between estrogen and tumor growth. 

As Vaidya explained, breast cancer often involves estrogen receptors that stimulate cancer cell proliferation. Treatments such as tamoxifen work by blocking these receptors, reducing recurrence and improving survival. Consequently, introducing estrogen through HRT has long been viewed as potentially dangerous, increasing the likelihood of relapse.

However, as Glynne noted, this creates a difficult dilemma for many survivors. Treatments that suppress estrogen can trigger severe menopausal symptoms, including hot flashes, mood changes, brain fog, joint pain, and sexual dysfunction. For some women, these symptoms are debilitating, impairing daily function and quality of life. While HRT is the most effective therapy for menopause-related symptoms, its use remains largely prohibited for women with a history of breast cancer, particularly for those with estrogen receptor (ER)–positive disease.

Glynne emphasized that breast cancer is not a uniform condition. Women with ER-negative tumors or carcinoma in situ face different risks from those with ER-positive cancers. Even among ER-positive cases, relapse risk varies widely. The researchers argue that treatment recommendations should be individualized rather than guided by a blanket prohibition.

Vaidya also revisited the 2 landmark randomized controlled trials—the HABITS and Stockholm studies—that established the foundation for current clinical guidance. These studies, halted early because of higher relapse rates among women receiving HRT, showed a 6% absolute increase in recurrence risk. Yet, closer examination revealed that most of this increase involved local or contralateral breast recurrences, which are typically treatable, while the rise in life-threatening distant metastases was only approximately 0.4%.

Given advances in cancer therapies and newer forms of HRT, Vaidya and colleagues are launching the MENO-ABC trial to reevaluate HRT safety in contemporary settings. The study aims to better stratify risk and guide personalized decision-making through data-driven tools. Ultimately, the researchers advocate for shared, informed decisions between patients and clinicians, balancing symptom relief with individualized cancer risk.

This video is part 1 of a 2-part series. Check back tomorrow for part 2.

Experts call for change of heart on hormone replacement therapy after breast cancer. News release. University College London. September 30, 2025. Accessed October 1, 2025. https://www.eurekalert.org/news-releases/1100355

Glynne S, Simon J, Branson A, et al. Menopausal hormone therapy for breast cancer patients: what is the current evidence? 

 Published online September 30, 2025. doi:10.1097/GME.0000000000002627

Jayant S. Vaidya, MD, FRCS, PhD, and Sarah Glynne, MBBS, BSc, discuss new evidence challenging the blanket ban on HRT use after breast cancer.

Experts reassess hormone therapy after breast cancer

Up to 1 in 7 pregnancies may be impacted by negative 

, even in patients without heart disease, according to a recent study published in 

the flagship journal of the American Heart Association.

There were more than 56,000 pregnancies included in the analysis, 15% of which were impacted by cardiovascular conditions, including stroke, heart attack, blood clots, heart failure, hypertensive disorders, and maternal death. According to researchers, this highlights a need for patients to engage with health care providers before, during, and after pregnancy.

“Most of these health risk factors can be prevented through lifestyle changes or medication. Yet, many of my patients aren’t even aware they have these conditions or that they’re at risk,” said

, volunteer president of the American Heart Association.

The study was conducted to evaluate trends in cardiometabolic comorbidities during pregnancy.

 Data was obtained from Mass General Brigham (MGB), a health care network including 11 tertiary care and community hospitals. Pregnant patients visiting MGB from 2011 to 2019 were included in the analysis.

Exclusion criteria included being aged under 18 years or at least 60 years, induced abortion, spontaneous abortion, missing gestational age, pregnancy under 20 weeks’ gestation, and ectopic pregnancy. Pregnancy encounters were independently verified by 2 physicians.

Unstructured clinical notes were assessed to determine gravidity, parity, and estimated gestational age. 

 were defined as the time between the last estimated menstrual period and the date of delivery.

Cardiovascular complications during pregnancy included the composite of major adverse cardiovascular events (MACEs), maternal death, and hypertensive disorders of pregnancy (HDP). Baseline clinical variables included vital signs, demographic data, smoking status, prevalent comorbidities and disease, and alcohol use.

There were 56,833 pregnancies among 38,996 patients aged a mean 32 plus or minus 5 years at the start of pregnancy included in the analysis. Of pregnancies, 92% were live birth, 0.1% mixed birth, 1% stillbirth, and 7% unclassified. The mean gravidity and parity were 2.5 plus or minus 1.7 and 1.2 plus or minus 1.1 pregnancies, respectively.

Preexisting obesity was reported in 12% of pregnancies, preexisting diabetes in 3%, preexisting hypertension in 8%, and preexisting hyperlipidemia in 10%. A mean maternal body mass index of 26.2 plus or minus 5.9 kg/m2 was reported.

, with venous thromboembolism in 2%, transient ischemic attacks in 0.5%, and heart failure in 1%. Additionally, 0.7% of pregnancies were impacted by prevalent arrhythmias and 0.1% by myocardial infarction.

An incident cardiovascular event was reported in 15% of pregnancies, 12% of which occurred intrapartum and 2% occurred postpartum. Four percent of pregnancies were impacted by MACEs, the most common of which was venous thromboembolism in 2%.

An increase in pregnancy-related cardiovascular complications was reported over time, from 11% in 2001 to 13% in 2019. Increasing incident HDP rates were also reported, though no significant trend in incident MACEs was identified.

 of cardiovascular complications in pregnancy, with a significant increase over the past 2 decades. Investigators concluded that the pregnancy period is a crucial time to implement primary prevention strategies.

“Starting before pregnancy and continuing after birth, there are valuable opportunities to make heart-healthy choices that can help prevent cardiovascular disease and support long-term wellness,” said Rosen.

Risk factors for cardiovascular disease negatively impact health during, after pregnancy. News release. American Heart Association. October 6, 2025. Accessed October 8, 2025. https://www.eurekalert.org/news-releases/1100836

Lau ES, D’Souza V, Zhao Y, et al. Contemporary burden of cardiovascular disease in pregnancy: insights from a real-world pregnancy electronic health record cohort. 

2025;152(15):1044-1055. doi:10.1161/CIRCULATIONAHA.125.074692

A study highlights rising rates of cardiovascular complications during pregnancy and underscores the need for preventive care before, during, and after birth.

Cardiovascular conditions reported in 1 in 7 pregnancies

Society for Maternal-Fetal Medicine (SMFM)

 has released new recommendations addressing the diagnosis and management of right and left heart failure during pregnancy and the postpartum period. The guidance, 

, emphasizes early counseling, multidisciplinary care coordination, and referral to specialized centers to optimize maternal and newborn outcomes.

Heart disease remains a leading cause of pregnancy-related deaths in the United States, with a disproportionate burden among non-Hispanic Black individuals. Heart failure—a syndrome in which the heart cannot pump blood effectively—is a major contributor to maternal morbidity and mortality and is associated with adverse perinatal outcomes such as low birthweight, lower Apgar scores, prematurity, and increased risk of death.

“Heart disease is a leading cause of maternal deaths, and it’s a growing problem,” said Arthur Jason Vaught, MD, a maternal-fetal medicine subspecialist and critical care physician at Johns Hopkins Medicine, and a member of the SMFM Publications Committee. “This new guidance focuses attention on heart failure in pregnancy so that we can improve both short- and long-term quality of life for our patients. Getting accurately diagnosed and treated for heart disease, either before pregnancy or early in pregnancy, is both life-prolonging and life-changing if caught early.”

SMFM recommends that patients with known heart failure receive preconception or early pregnancy consultation to assess individual risk and identify maternal and perinatal health concerns. The guideline underscores that pregnancy is a state of hemodynamic stress, which can exacerbate existing cardiac disease and mimic symptoms of heart failure, such as shortness of breath and fatigue.

Patients with severe pulmonary arterial hypertension or a left ventricular ejection fraction less than 30% should be counseled on the substantial risks of morbidity and mortality. Abortion care should be available to all patients with heart failure, regardless of severity, as part of individualized counseling and risk communication.

For those with a history of peripartum cardiomyopathy, decisions about future pregnancies should be individualized. Patients whose ventricular function has fully recovered should be informed about recurrence risk and severity if heart failure returns.

SMFM advises clinicians to review medication compatibility before conception and during pregnancy. The following agents should be discontinued or avoided because of teratogenic or safety concerns:

Sodium-glucose cotransporter inhibitors (SGLT2i)

Angiotensin-converting enzyme (ACE) inhibitors

Angiotensin receptor–neprilysin inhibitors (ARNi)

These medications should be replaced with alternatives such as hydralazine or isosorbide dinitrate for afterload reduction and furosemide for diuresis in acute left ventricular heart failure. β-blockers, including metoprolol, carvedilol, and bisoprolol, are recommended to continue when clinically appropriate.

During pregnancy, inotropic blockade with β-blockers is not advised in acute decompensated heart failure, and prophylactic anticoagulation is recommended for hospitalized pregnant patients with acute left ventricular dysfunction. Postpartum, ACE inhibitors, ARBs, or ARNi may be used for afterload reduction unless contraindicated.

Delivery planning should begin early and involve a multidisciplinary team—typically obstetrics, maternal-fetal medicine, cardiology, anesthesiology, and nursing. The guidance recommends planned vaginal delivery at term for most stable patients, with cesarean delivery reserved for obstetric indications. Neuraxial anesthesia is advised to manage pain and limit hemodynamic stress during labor.

Postpartum, patients remain at elevated risk because of sudden cardiovascular volume changes. The guideline stresses close inpatient monitoring after delivery, individualized discharge planning, and early follow-up to mitigate the high risk of postpartum cardiac complications.

Routine counseling on infant feeding should be provided, and all medications should be reviewed for compatibility with breastfeeding. ACE inhibitors are considered compatible, while caution is advised with ARBs, aldosterone antagonists, and SGLT2 inhibitors due to limited neonatal safety data.

Brite mom study

SMFM issues new guidance on diagnosing and managing heart failure during pregnancy and postpartum. News release. Society for Maternal-Fetal Medicine. October 3, 2025. Accessed October 7, 2025. https://www.eurekalert.org/news-releases/1100779

; Hameed AB, Licon E, Vaught AJ, Shree R; 

. Society for Maternal‐Fetal Medicine Consult Series #73: diagnosis and management of right and left heart failure during pregnancy and postpartum. 

. 2025;1(5):e70059. doi:10.1002/pmf2.70059

New SMFM guidance outlines key recommendations for diagnosing, counseling, and managing heart failure in pregnancy and postpartum.

SMFM issues new guidance on diagnosis and management of heart failure during pregnancy, postpartum

Hysterectomy

According to Lopa Pandya, MD, MS, FACOG, a urogynecologist and reconstructive surgeon at UI Health and medical adviser at Aeroflow Urology, recent research indicates a complex relationship between hysterectomy and urinary incontinence, with outcomes varying by type and time since surgery.

Hysterectomy, the second most common surgical procedure among women in the United States, is performed more than 600,000 times annually and can be conducted through various approaches, including vaginal, open, laparoscopic, or robotic. Urinary incontinence encompasses several types, including stress incontinence, overactive bladder, and mixed incontinence, which combines features of both. 

Pandya referenced a recent study examining the long-term risk of pelvic floor disorders following hysterectomy. Findings showed that within 10 years of the procedure, rates of stress and mixed incontinence tend to increase. For an overactive bladder, risk also rises within the first decade. However, data beyond 10 years do not consistently show a continued elevation in risk. Importantly, there is limited research comparing urinary incontinence outcomes across different surgical approaches, making it difficult to determine whether certain hysterectomy types pose higher risks than others.

Pandya emphasized the importance of preoperative counseling and managing patient expectations. Since women undergo hysterectomy for varied reasons, such as fibroids, abnormal bleeding, prolapse, or preexisting incontinence, individual risk factors differ widely. Therefore, providers should clearly communicate that urinary incontinence is a possible long-term adverse effect, even if the exact likelihood varies.

Regarding prevention and management, Pandya noted that while strong evidence is lacking that pelvic floor exercises can prevent posthysterectomy incontinence, such exercises—especially Kegels or physical therapy-guided pelvic floor training—are low-risk and can improve muscle strength and bladder control. For patients requiring incontinence products, physicians typically must document the diagnosis, note the number of pads or briefs used, and coordinate with support teams to obtain insurance coverage.

Finally, Pandya explained that the exact mechanism behind incontinence after hysterectomy remains uncertain but likely involves structural changes to the pelvic anatomy and nerve disruption during surgery. Understanding and addressing these potential outcomes through counseling, physical therapy, and supportive care remain key aspects of comprehensive postoperative management.

New research highlights an increased risk of urinary incontinence following hysterectomy, underscoring the need for long-term management strategies.

Lopa Pandya, MD, discusses link between hysterectomy and urinary incontinence

Discover effective strategies and insights to navigate menopause, enhancing well-being and embracing this transformative life stage.

Ethan Lowder, BA

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