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Kenneth M. Johnson, PhD, is a professor of sociology at the University of New Hampshire.

A new analysis shows US births have fallen 22% since 2007, raising concerns about delayed childbearing and shrinking school enrollments.

Kenneth M. Johnson, PhD, highlights record low US fertility rates

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.

Articles

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. 

Mothers with multiple adverse childhood experiences faced double the risk of preterm birth, highlighting intergenerational health effects.

Maternal adverse childhood experiences linked to higher risk of preterm birth

A new study reveals that preconception body mass index outside the normal range is linked to lower fertility and greater miscarriage risk.

Preconception BMI drives fertility struggles and miscarriage risk

A trial found that antenatal betamethasone significantly lowers the risk of respiratory complications in late preterm twin pregnancies.

Antenatal betamethasone reduces neonatal morbidity in twin pregnancies

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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

A large Swedish cohort study found that exposure to prescribed opioid analgesics during pregnancy was not causally associated with an increased risk of autism spectrum disorder (ASD) or attention-deficit/hyperactivity disorder (ADHD) in children after accounting for genetic and environmental confounders. The findings were published September 16, 2025, in 

 by Emma N. Cleary, PhD, of Indiana University Bloomington, and colleagues.

Prescribed opioids are commonly used for pain management during pregnancy, but their safety regarding long-term child neurodevelopmental outcomes has been uncertain. Previous studies suggested a potential link to increased rates of ASD and ADHD, though causality remained unclear.

The retrospective cohort study included 1,267,978 children born in Sweden between 2007 and 2018 for ASD analysis and 918,771 children born between 2007 and 2015 for ADHD analysis. Researchers linked national registers to examine opioid exposure during pregnancy, measured through prescription fills, and compared outcomes in exposed and unexposed children.

Children were followed until 2021 for diagnoses of ASD and ADHD, identified through inpatient or outpatient records or dispensed ADHD medications. Exposure was categorized by dose and duration, using oral morphine equivalents as a standardized measure.

At age 10, 2.0% of unexposed children were diagnosed with ASD, compared with 2.9% of children exposed to low-dose opioids and 3.6% of those exposed to high doses. For ADHD, similar trends appeared, with higher unadjusted risks in exposed groups.

Initial analyses showed associations between cumulative dose or duration of opioid use and higher rates of ASD and ADHD. However, when researchers adjusted for measured covariates, parental health conditions, prescriptions before but not during pregnancy, and sibling comparisons, the increased risks largely disappeared. For example, in sibling comparisons, HRs were near 1.0, indicating no significant difference in risk.

The authors noted that extremely high doses or prolonged opioid use were rare in Sweden and could not be fully evaluated. Nevertheless, the study concluded that typical prescription patterns did not appear to substantially increase risk for neurodevelopmental disorders.

Cleary explained the motivation for the research: “We wanted to conduct this study to help provide more information for pregnant individuals and their physicians who are trying to make complex decisions about how to best manage pain during pregnancy. Pregnant individuals and their physicians must weigh the importance of managing painful conditions with concerns about potential consequences of fetal exposure to prescribed opioid pain medications.”

She added, “While this study is not able to rule out small increased risks with high amounts of exposure, the results suggest that there is not a causal effect of prescribed opioid analgesics on risk for 2 common neurodevelopmental disorders, providing more data to support decision-making.”

Co-author Ayesha C. Sujan, PhD, emphasized the clinical implications: “Our findings suggest that the observed associations between prenatal exposure to opioid analgesics and 2 major neurodevelopmental disorders—autism and ADHD—are largely driven by factors leading up to opioid analgesic use rather than the opioid exposure itself. Our results, therefore, elucidate the critical need to provide pregnant individuals experiencing pain with psychosocial support and evidence-based pain management tools. These can include both pharmaceutical and nonpharmaceutical approaches.”

The results provide reassurance that prescribed opioid use during pregnancy, at levels observed in Sweden, is unlikely to directly increase the risk of ASD or ADHD in children. For clinicians, this evidence may support a more balanced approach to pain management in pregnancy, focusing on individualized assessment and comprehensive counseling.

Still, the authors noted that higher exposures could not be fully studied and recommended continued research in populations with different prescribing practices. For now, the findings highlight the importance of considering confounding factors when evaluating risks of prenatal medication exposure.

Cleary EN, Sujan AC, Rickert ME, et al. Prescribed opioid analgesic use in pregnancy and risk of neurodevelopmental disorders in children: a retrospective study in Sweden. 

. 2025;22(9):e1004721. doi:10.1371/journal.pmed.1004721

PLOS. Prescribed opioid pain medications during pregnancy likely aren’t associated with increased risk of autism, ADHD. EurekAlert. September 16, 2025. Accessed September 19, 2025. https://www.eurekalert.org/news-releases/1097557

A study of 1.2 million children found no causal link between prenatal opioid use and autism or ADHD.

Prenatal opioid use not tied to autism or ADHD risk

Personal care product selection

, Lariah M. Edwards, PhD, associate research scientist at the Columbia University Mailman School of Public Health, discussed how selective product choices can reduce exposure to harmful ingredients commonly found in cosmetics and toiletries.

A growing body of evidence highlights personal care products as a significant source of chemical exposure, particularly for women and women of color, who tend to use these products more frequently than other groups. Edwards emphasized that many personal care products contain chemicals such as phthalates, parabens, and benzophenone-3 (BP-3), which are linked to hormone-disrupting effects. Research in both animals and humans has demonstrated associations between these substances and a range of adverse health outcomes. 

For example, phthalates—often used to preserve fragrance and flexibility in products—are well-established hormone-altering agents connected to obesity, diabetes, and reproductive health concerns. Parabens, widely used as preservatives to prevent microbial growth in shampoos, lotions, and other products, have been implicated in metabolic disruption and potential carcinogenic effects. While these chemicals serve functional purposes, their long-term health risks are concerning.

Edwards explained that although regulatory protections are still insufficient, individual consumers can take steps to lower their personal exposures. Choosing products labeled “fragrance-free” or specifically marketed as free from phthalates, parabens, and related compounds can make a measurable difference. In fact, her team’s research found that women who intentionally avoided these ingredients showed lower levels of the chemicals in their bodies, providing clear evidence that consumer choices can reduce internal exposure.

Reducing contact with these chemicals may, in turn, improve health and well-being by lowering risks associated with endocrine disruption, metabolic disease, and reproductive complications. Edwards stressed, however, that while informed shopping can help, responsibility should not fall entirely on consumers. Access to safe, affordable, and effective products should be guaranteed across all price points, and stronger regulations are needed to prevent harmful chemicals from being included in personal care products in the first place.

Until such policies are enacted, Edwards encourages consumers to shop selectively when possible, as avoiding specific ingredients can reduce toxic burden and support long-term health. Her key takeaway is 2-fold: making mindful choices can have immediate benefits, but broader systemic changes are necessary to ensure equitable access to safe personal care products for everyone.

This video is part 1 of a 2-part series. Click 

Choosing safer personal care products can help lower exposures to risky chemicals. Columbia University’s Mailman School of Public Health. September 17, 2025. Accessed September 22, 2025. https://www.eurekalert.org/news-releases/1098745.

Edwards L, Connolly CL, Dodson RE, et al. Examining the role of self-reported product selection strategies in shifting chemical exposures among Black women and Latinas: Lessons from the Taking Stock Study. 

Lariah M. Edwards, PhD, explains how avoiding risky ingredients in care products may lower health risks while highlighting the need for stronger safety regulations.

How safer personal care product selection can reduce chemical exposure

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.

Almost nobody says "obstetrician-gynecologist" when speaking about these specialist physicians. But what's the "correct" way to pronounce OB/GYN?

Is It Ob-Gin or Ob-Gyne?

Neonatal acidemia, indicated by umbilical cord arterial pH (UApH) under 7.05 at birth, is associated with a higher risk of death, cerebral palsy (CP), and epilepsy in long-term follow-up, according to a recent Swedish cohort study published in the 

American Journal of Obstetrics & Gynecology

Umbilical cord blood pH has long been used as a marker of neonatal acid-base status and a diagnostic tool for neonatal acidemia.

 However, large-scale evidence linking specific pH thresholds to long-term neurodevelopmental outcomes has been limited.

“Cord arterial pH [less than] 7.05 is linked to a higher likelihood of death, [CP] and epilepsy, but no other mental or organ system diseases. A marked increase in risk for CP, epilepsy, and intellectual disability was noted at cord arterial pH [less than] 6.95,” wrote investigators.

Researchers conducted a retrospective cohort study using birth data from January 1, 1997, to May 8, 2012, at Skåne University Hospital in Malmö, Sweden. After applying validation criteria for arterial pH and excluding incomplete records, 35,931 singleton infants were included. Of these, 912 were classified as acidemic based on a UApH under 7.05, while 35,019 were nonacidemic based on a UApH of 7.05 or greater.

Umbilical cord blood samples were drawn immediately after birth, and pH values were analyzed within 15 minutes. Researchers linked maternal and neonatal data to national health care registers, allowing follow-up for up to 20 years. Outcomes included mortality, organ system diseases, and neurodevelopmental disorders, coded according to the 

Mortality up to age 20 years was higher in the acidemic group at 4.1 per 1000 vs nonacidemic infants at 1.4 per 1000. No differences were found in causes of death between groups. Analyses across all organ systems revealed no significant differences in disease incidence between acidemic and nonacidemic infants.

Subanalyses revealed a higher risk of CP (1.0% vs 0.2%; adjusted HR, 4.35; 95% CI, 2.17-8.73) and epilepsy (1.6% vs 0.9%; adjusted HR, 1.71; 95% CI, 1.02-2.88) among acidemic infants. Intellectual disability incidence was higher in acidemic infants (1.4% vs 0.9%), but did not reach statistical significance (adjusted HR, 1.74; 95% CI, 0.99-3.04).

Dose-response analysis showed the risk of CP increased with declining UApH, becoming statistically significant at under 6.95. At this threshold, cumulative risk at 20 years was nearly 5% for CP, 12% for epilepsy, and 6% for intellectual disability, compared with less than 1% for nonacidemic infants.

The findings suggest that adverse neurodevelopmental outcomes may occur at higher UApH values than previously assumed. Additionally, they may inform clinical guidelines on monitoring and intervention for neonates with acidemia. They underscore the need for careful assessment of infants with UApH under 7.05 and particularly under 6.95, for timely detection and management of potential neurodevelopmental disorders. 

Investigators recommended further studies to refine risk thresholds and explore combined use of cord pH with other clinical markers to improve prediction of long-term outcomes. The importance of extended follow-up was also highlighted.

“At an age of 20 years the incidence of CP was doubled compared with at 5 years of age. Similarly, the incidence of both epilepsy and intellectual disability quadrupled at 20 years as compared to 5 years when UApH was [less than] 6.95," wrote investigators.

Zaigham M, Källén K, Sundberg TM, Olofsson P. Long-term outcomes after neonatal acidemia. 

l. 2025;233(3):195.e1-195.e11. doi:10.1016/j.ajog.2025.02.028

Malin GL, Morris RK, Khan KS. Strength of association between umbilical cord pH and perinatal and long term outcomes: systematic review and meta-analysis. 

New data show umbilical cord arterial pH under 7.05 at birth is associated with a higher risk of cerebral palsy, epilepsy, and death.

Umbilical cord acidemia linked to long-term neurodevelopmental risks

Data presented at the European Association for the Study of Diabetes Annual Meeting from September 15 to September 19, 2025, has indicated increased cardiovascular risk in patients taking oral hormone replacement therapy (HRT).

Prior data has indicated no significant impact of HRT on blood clot or stroke risk in women with type 2 diabetes (T2D). However, this research has unveiled a 2-fold increase in pulmonary embolism (PE) risk among patients with T2D taking oral HRT vs transdermal HRT, alongside a 21% increased risk of heart disease.

“Our study suggests that up to 5 years of regulator-approved doses of transdermal HRT appears safe in a large cohort of women in midlife with T2D and that the use of HRT skin patches is not associated with an excess increased risk of cardiovascular complications,” said Matthew Anson, BSc, researcher at the University of Liverpool.

“However, given increased risks with oral HRT, we propose that women with T2D should not be prescribed oral estrogen therapy,” added Anson.

The data was gathered from 3 analyses evaluating the impact of oral and transdermal HRT and cardiovascular, gynecological, and estrogen-related cancer risks in women with T2D. The TriNetX global database, including 140 health care organizations from the United States and Europe, was evaluated for electronic health records.

Of the participants, 75% were White, 17% Black, and 2% Asian. The study population was aged a mean 59 years, and the mean follow-up duration was 5 years. Participants were classified as either initiating HRT and statin, or controls initiating statin alone.

Relevant outcomes included PE, deep vein thrombosis (DVT), ischemic stroke, ischemic heart disease, and ovarian, breast, and endometrial cancer. In the first analysis, these outcomes were compared between women taking transdermal estrogen HRT with T2D vs without T2D, matched 1:1 based on age and ethnicity.

A 90% increase in DVT risk, 77% increase in heart disease risk, and 89%increase in stroke risk were observed in women with T2D vs those without T2D. No increases in PE or breast cancer risks were observed.

According to authors, these increased risks are largely because of the impacts of T2D on cardiovascular health. This leads women with T2D to experience increased risks vs those without T2D before considering additional factors.

In the second analysis, transdermal HRT use was compared with no HRT use in women with T1D matched 1:1 based on age, ethnicity, body mass index, blood glucose, and hypertension history. The risk of heart disease was reduced 25% in those taking HRT, but no other risks were significantly impacted.

Finally, investigators compared risks based on oral vs transdermal HRT use. Patients were matched 1:1 using the same characteristics as the second analysis. While no significant impacts on stroke, DVT, heart disease, or cancer risks were reported, the results highlighted the 2-fold increase in PE risk and a 21% increase in heart disease risk from oral vs transdermal HRT.

Menopausal women often experience symptoms such as hot flashes and night sweats. Additionally, data has indicated HRT may reduce the need for antidepressants in these patients.

 Therefore, HRT may be prescribed as a form of symptom relief.

“The decision to use HRT, even for a short period of time, is very difficult for many women," said Anson. "We hope our data will provide the increasing number of postmenopausal women living with T2D and their physicians with more evidence to consider when weighing the risks vs benefits of the most appropriate HRT formulation."

Researchers sound warning about women with type 2 diabetes taking oral HRT. News release. European Association for the Study of Diabetes. September 14, 2025. Accessed September 16, 2025. https://www.eurekalert.org/news-releases/1098060

Krewson C. HRT may reduce antidepressant need in menopausal women. Contemporary OB/GYN. March 1, 2025. Accessed September 16, 2025. https://www.contemporaryobgyn.net/view/hrt-may-reduce-antidepressant-need-in-menopausal-women

New research shows oral HRT increases cardiovascular risks in women with type 2 diabetes, while transdermal HRT appears to be safer.

Kenneth M. Johnson, PhD

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