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Natalia Llarena, MD, FACOG, is a Reproductive Endocrinology and Infertility specialist and OB-GYN with HRC Fertility.

New data reveal that over 70% of Gen Z women report age-related fertility concerns, with experts urging education, proactive planning, and supportive language to reduce panic.

Natalia Llarena, MD, discusses rising fertility anxiety in Gen Z

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A recent study found variations in menstrual product use by race, age, socioeconomic status, and menstrual factors.

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Top 5 recent updates in folic acid research

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The US Preventive Services Task Force (USPSTF) has current evidence comparing the benefits and risks of iron supplementation and found that iron deficiency anemia screening is insufficient, publishing a recommendation statement in 

Iron deficiency has been estimated in approximately 18% of pregnant women, with 5% developing iron deficiency anemia.

 However, the USPSTF has highlighted a lack of significant data to determine the influence of screening for these conditions on maternal and infant health outcomes.

“Due to lack of available data, the USPSTF concludes that the current evidence is insufficient, and the balance of benefits and harms of iron supplementation in asymptomatic pregnant persons on maternal and infant health outcomes cannot be determined,” wrote the authors.

While these recommendations apply to asymptomatic patients, the authors noted they do not apply to those with severe malnourishment, iron deficiency or iron deficiency anemia symptoms, specific hematologic conditions, or nutritional deficiencies. Iron is vital for oxygen transportation and metabolic pathway function, making supplementation necessary in some patients.

According to the USPSTF, clinicians should consider the potential preventable burden when deciding whether to screen or supplement for iron deficiency. Current methods of identifying risk, such as questionnaires and risk prediction tools, have limited evidence supporting their use based on 3 studies assessing these strategies.

Potential harms should also be considered, as evidence is also limited about any adverse effects of iron deficiency screening among asymptomatic patients. Iron supplementation has been linked to adverse effects such as constipation, nausea, vomiting, and abdominal pain.

Variations in screening and supplementation practices

The USPSTF noted variations in screening and supplementation practices for iron deficiency, though typical use of these tools was identified. This included a first-trimester hemoglobin screening rate of 53% among Special Supplemental Nutrition Program for Women, Infants, and Children participants.

Racial and ethnic disparities have also been reported in screening rates, with reduced odds of receiving a complete blood cell count reported in Asian, Black, and Hispanic Medicaid recipients vs White recipients. ORs for this association ranged from 0.51 to 0.92.

Iron supplementation within the past 30 days has been reported in 77% of pregnant patients recorded in the National Health and Nutrition Examination Survey. However, food insecurity was linked to a reduction in mean iron intake from supplements.

The USPSTF also highlighted resources for obstetric health care, such as state collaborative tool kits from the CDC and a fact sheet about iron by the National Institutes of Health. A fact sheet about iron deficiency anemia has also been published by the US Department of Health and Human Services.

Recommendations from other organizations were also included in the statement. Screening for anemia during the first prenatal visit is recommended by multiple organizations, including the CDC, American College of Obstetricians and Gynecologists (ACOG), and American Academy of Family Physicians.

ACOG also recommends repeat screening at 24- to 28-weeks’ gestation. Supplementation guidelines were also highlighted, including recommendations from the CDC that all pregnant patients receive universal supplementation with an oral low-dose iron supplement of 30 mg daily.

ACOG also recommends screening pregnant patients for low-dose iron during pregnancy. Once the cause of low-dose iron is identified, treatment with low-dose supplemental iron should be provided. Overall, these recommendations highlight steps for screening and the supplementation of iron deficiency in pregnancy, despite gaps in evidence.

“The USPSTF continues to call for high-quality research, particularly on the critical gap of the association between changes in maternal iron status and improvement in infant and maternal outcomes in pregnant persons,” wrote statement authors.

US Preventive Services Task Force; Nicholson WK, Silverstein M, Wong JB, et al. Screening and supplementation for iron deficiency and iron deficiency anemia during pregnancy: US Preventive Services Task Force Recommendation Statement. 

. 2024;332(11):906–913. doi:10.1001/jama.2024.15196

Mei Z﻿, Cogswell ME﻿, Looker AC﻿, et al. Assessment of iron status in US pregnant women from the National Health and Nutrition Examination Survey (NHANES), 1999-2006.﻿ 

2011;93(6):1312-1320. doi:10.3945/ajcn.110.007195

The USPSTF cites a lack of strong data to support routine screening or supplementation for iron deficiency in asymptomatic pregnant individuals.

Clinical

USPSTF reports gaps in evidence for iron deficiency screening in pregnancy

Researchers from Flinders University have found a severe emotional and physical burden among pregnant women with extreme morning sickness, publishing their findings in 

The data also indicated significant rates of considering pregnancy termination, alongside 9 in 10 pregnant women with extreme morning sickness considering not having more children. This highlights the debilitating nature of the condition and the inconsistent efficacy of common treatment methods.

“Women are often prescribed multiple medications in an attempt to manage their symptoms, but the reality is that many of these treatments come with their own burdens,” said Luke Grzeskowiak, PhD, associate professor at Flinders University.

The cross-sectional online survey study was conducted to evaluate treatment usage and experiences among women with severe nausea and vomiting of pregnancy (NVP) or hyperemesis gravidarum (HG).

 Participants included women residing in Australia with prior or current NVP or HG experience.

There were 4 parts to the study survey, which were completed online between July and September 2020. These parts included respondent characteristics, awareness, and perceived safety of treatments, characteristics of HG, and quality of life impact, and personal experiences.

Quality-of-life impacts were reported on a 5-point Likert scale, with higher scores indicating a greater impact. Additional questions gauged considerations for pregnancy termination, depression and anxiety experiences, and requests for induction or elective cesarean delivery.

Treatment experiences included treatment methods used, week of pregnancy beginning or stopping treatment, treatment duration, adverse effects, reasons for termination, and perceived efficacy of treatment on a 5-point Likert scale. Two consumer representatives and 2 clinical experts assessed the survey’s face validity.

There were 289 participants aged a mean of 33 years included in the final analysis. Of these, 38% were currently pregnant, 94% were Caucasian, 95% were married, and 87% had completed secondary education. One or more prior births were reported in 88% and not smoking in the current or prior pregnancy was reported in 96%.

NVP onset occurred at a median of 6 weeks’ gestation, with all cases beginning during the first trimester. Weight loss during pregnancy was reported by 75% of participants, ranging from 1 to 40 kg, and with a median of 7 kg. Moderate NVP was reported in 41% of participants and severe NVP in 59%.

A formal HG diagnosis was given to 76% of respondents, while 72% were admitted to the hospital for IV fluids during pregnancy. Difficulty eating or drinking as normal was reported by 98% and feelings of anxiety or depression because of HG symptoms by 62%. Thirty-seven percent requested labor induction because of their symptoms.

Considering pregnancy termination was reported by 54% of respondents and not having more children by 90%. Over half of respondents experienced significant impacts of HG on aspects of life, including social life, work, sleep, ability to undertake daily chores, ability to eat or drink, and taking care of pre-existing children.

The use of at least one antiemetic during pregnancy was reported by all participants. A mean of 4.2 antiemetics were used, with a range of 1 to 9. Ondansetron was the most common antiemetic used by 91% of participants, followed by pyridoxine in 70%, doxylamine in 70%, metoclopramide in 69%, and ginger in 53%.

Only 7% of respondents used a single antiemetic in pregnancy. Ginger, metoclopramide, ondansetron, and pyridoxine were initiated earlier than other treatments, at a median 6 weeks’ gestation for each antiemetic. The latest median time of initiation at 12 weeks’ gestation was reported for corticosteroids.

The shortest durations of use were reported for ginger, metoclopramide, and prochlorperazine, at 2 to 4 weeks, while doxylamine and ondansetron had the longest median durations of 16 and 20 weeks, respectively.

Adverse effects were reported in 78% of women taking doxylamine, 73% ondansetron, and 72% promethazine. Thirty-one percent taking metoclopramide ceased treatment because of ad

verse effects, vs 24% for ginger and 23% for prochlorperazine. Common adverse effects included constipation, sedation, and mood disorders.

Over half of respondents taking corticosteroids, ondansetron, and doxylamine reported the medication to be effective. However, less than 10% reported efficacy for pyridoxine or ginger. This highlighted a complex landscape of medication use for severe NVP and HG.

“We need to move away from a one-size-fits-all approach and toward personalized care that recognizes the full impact of HG,” said Caitlin Kay-Smith, study co-author and founder of Hyperemesis Australia.

Flinders University. Emotional and medical toll of extreme pregnancy nausea, with many women considering ending pregnancies. News release. EurekAlert. September 3, 2025. Accessed September 4, 2025. https://www.eurekalert.org/news-releases/1096797

Wills L, Hsiao HF, Thomas A, Kay-Smith C, Henry A, Grzeskowiak LE. Assessing the burden of severe nausea and vomiting of pregnancy or hyperemesis gravidarum and the associated use and experiences of medication treatments: an Australian consumer survey. 

A new study finds extreme pregnancy nausea often leads to emotional distress and highlights a need for better care.

Severe burden and treatment gaps reported for hyperemesis gravidarum

Alongside preventing pregnancy, hormonal contraceptives (HCs) may be effective for managing endometriosis, polycystic ovary syndrome, and irregular cycles, according to a recent study published in 

These contraceptive methods have also been linked to mood changes, weight fluctuations, and emotional ups and downs. Overall, stronger emotional responses were found in women using HCs vs those without contraception, which may help this population move past negative emotional experiences.

“For women, the findings highlight what many have long suspected: Birth control can affect more than reproductive health,” said Beatriz Brandao, lead study author and graduate student at Rice University. “Hormonal birth control does more than prevent pregnancy—it also influences brain areas involved in emotions and memory.”

Experimental conditions and contraceptive use

The analysis included 179 participants aged 18 to 35 years, 87 of whom were in the HC group and 92 in the natural cycle (NC) group.

 Eligibility criteria for the HC group included at least 3 months of active HC use before study participation, while the NC group included patients with no HC use for at least 3 months before participation.

Patients with current pregnancy, pregnancy within the past year, hysterectomy or menopause history, and breastfeeding were excluded from the analysis. Participants were randomly assigned to 1 of 3 experimental conditions.

These included no emotional regulation for controls, distancing toward negative images and immersion toward positive images (D/I), and reinterpretation toward negative images and immersion toward positive images (R/I). HC and NC participants were balanced across these conditions.

Reproductive status, demographics, and medical history data were obtained using a demographics form and a medical screening form. Questionnaires were also distributed to determine emotion regulation abilities, tendencies, and mental health.

A reproductive health questionnaire was distributed to evaluate participants’ HC use, reproductive health history, menstrual cycle characteristics, and medication use. Current HC use was reported by 49% of participants, with 86.2% indicating they used HCs for reproductive purposes and 13.8% reporting use for noncontraceptive reasons.

Distancing from negative images was defined as developing an impartial viewpoint of negative stimulus, while reinterpretation was defined as changing the meaning of an image by stating something to feel less negative. Immersion in positive images was defined as approaching them with an engaged mindset, picturing them close to oneself.

Demographic and questionnaire results did not significantly differ between HC users vs nonusers. When assessing emotional reactivity, investigators found a significant main effect of HC status. Emotional reactivity was significantly greater among participants using HCs vs those not using HCs (F(1,173) = 5.30, 

Increased emotional reactivity was also observed for negative relative to positive images (F(1,173) = 52.19, 

 < .001). Emotion significantly correlated with the experimental group, with a greater difference reported in those utilizing R/I vs D/I. The control group presented with the greatest difference in emotional reactivity.

Investigators also highlighted a significant main effect of emotion in the D/I group (F(1, 57) = 12.28, 

 < .001). These patients had increased emotion regulation success toward positive images vs negative images, and this effect was also observed in HC users vs nonusers.

Applying immersion toward positive images was linked to increased emotion regulation success vs either reinterpretation or distancing toward negative images. HC status did not significantly impact this correlation.

These results indicated an impact of HC on emotional activity and emotional regulation success. Investigators concluded that psychological and cognitive components are both effective for use in women’s health care.

“These results are novel and shed light on how hormonal contraceptives may influence emotion and memory processes in important ways,” said Bryan Denny, PhD, MA, BA, study coauthor and associate professor of psychological sciences at Rice University.

Rice University. Millions of women rely on contraceptives, but new Rice study shows they may do more than just prevent pregnancy. News release. EurekAlert. August 29, 2025. Accessed September 3, 2025. https://www.eurekalert.org/news-releases/1096501

Brandao BM, Castro M, Buergler JB, Clark KR, Denny BT, Leal SL. Emotion regulation strategies differentially impact memory in hormonal contraceptive users. 

 Published online August 14, 2025. doi:10.1016/j.yhbeh.2025.105805

A new study reveals that hormonal contraceptives not only regulate reproductive health but also influence emotional reactivity.

Hormonal contraception linked to emotional regulation

The American Urological Association (AUA), in collaboration with the Canadian Urological Association and the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU), has released the 2025 amendment to its guideline on recurrent uncomplicated urinary tract infections (rUTIs) in women. The updated document provides 20 recommendations designed to guide clinicians in diagnosing, treating, and managing rUTIs, with new emphasis on patient-centered care, antimicrobial stewardship, and recognition of the urinary microbiome.

“Recurrent urinary tract infections are a source of great suffering among our patients, and SUFU was thrilled to partner with the AUA on the new rUTI Guideline Amendment,” said Anne Pelletier Cameron, MD, FRCSC, URPS, president of SUFU and professor and vice chair of Academic Affairs in the Department of Urology at the University of Michigan. “Clear guidance on diagnosis and management of this condition will be used by urology providers and the greater medical community, and this updated document incorporates the most recent scientific evidence in a clear and actionable manner.”

The guideline focuses on otherwise healthy adult women with rUTIs, excluding those who are pregnant, immunocompromised, or have anatomic or functional urinary tract abnormalities. It emphasizes the accurate diagnosis, appropriate use of antibiotics, and consideration of nonantibiotic preventive strategies.

The amendment reflects growing awareness of antimicrobial resistance and the limitations of traditional diagnostic methods. “In updating the 2025 Guideline Update for Recurrent Uncomplicated Urinary Tract Infections (rUTI) in Women, we hope to take a more patient-centered, risk-based and microbiome-aware approach to rUTI management,” said A. Lenore Ackerman, MD, PhD, director of Research for the Division of Urogynecology and Reconstructive Pelvic Surgery at the University of California, Los Angeles, and chair of the guideline amendment.

Ackerman added, “The updated Guideline tries to balance diagnostic accuracy with clinical judgment, redefining treatment success as symptom resolution rather than microbial eradication and placing a premium on antimicrobial stewardship and patient-centered care. These changes reflect a maturing understanding of the urinary microbiome, the limitations of existing diagnostics, and a public health imperative to reduce unnecessary antibiotic exposure.”

The 2025 amendment builds upon earlier versions with several new elements:

: Emphasis on accurate documentation of symptomatic episodes, including urine cultures, while minimizing unnecessary cystoscopy or upper tract imaging.

: Clinicians are advised to prescribe first-line therapies such as nitrofurantoin, trimethoprim-sulfamethoxazole, or fosfomycin, with the shortest reasonable duration, generally no longer than 7 days. Prophylactic antibiotics may be offered after discussion of risks and benefits.

: The amendment includes new recommendations for nonantibiotic strategies. Cranberry products may be offered for prevention, though variability in formulations is acknowledged. Other interventions, such as D-mannose, lactobacillus, and methenamine, were noted as having insufficient evidence to support routine use.

: Vaginal estrogen therapy is recommended for peri- and postmenopausal women with rUTIs, provided there are no contraindications.

: Routine test-of-cure urine cultures in asymptomatic patients are discouraged, and treatment success is defined by resolution of symptoms rather than eradication of bacteria.

The guideline also highlights emerging diagnostic and therapeutic tools, including molecular technologies, vaccines for urinary pathogens, and host-directed therapies. 

According to the authors, the amendment underscores the need for individualized care, balancing antimicrobial stewardship with effective management of a condition that affects millions of women worldwide. With the new updates, the guideline aims to provide clinicians with evidence-based strategies that align with evolving scientific understanding and patient-centered priorities.

Ackerman AL, Bradley M, D'Anci KE, Hickling D, Kim SK, and Kirkby E. Updates to Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline (2025). 

. Published online September 4, 2025. doi:10.1097/JU.0000000000004723

American Urological Association. American Urological Association release Recurrent Uncomplicated Urinary Tract Infections in Women Guideline Amendment. News release. Globe Newswire. September 4, 2025. Accessed September 4, 2025.  https://www.globenewswire.com/news-release/2025/09/04/3144698/0/en/American-Urological-Association-Release-Recurrent-Uncomplicated-Urinary-Tract-Infections-in-Women-Guideline-Amendment.html

The 2025 amendment updates diagnostic, treatment, and prevention strategies for recurrent urinary tract infections in women.

New guidance released for managing recurrent urinary tract infections in women

On August 28, 2025, the Helmsley PIANO Expert Global Consensus was published in 6 international journals, providing standardized guidelines for providing care to women with inflammatory bowel disease (IBD).

The guidelines were developed based on data from the Pregnancy Inflammatory Bowel Disease and Neonatal Outcomes study, assessing the safety of IBD medications in pregnancy alongside short- and long-term offspring outcomes. These new findings include continuing all biologics throughout pregnancy and universal preconception counseling.

“Some of the findings were expected, but others were novel,” said Uma Mahadevan, MD, director of the Colitis and Crohn’s Disease Center at the University of California, San Francisco. “The goal of our study and consortium has been to provide hope, comfort, and the same high-level care to current and future mothers with IBD."

Family history was highlighted as a vital risk factor for IBD.

 This is supported by a Danish study indicating an HR of 4.6 for maternal ulcerative colitis (UC) among offspring of women with IBD vs those without IBD. Additionally, maternal Crohn disease (CD) was linked to an HR of 7.7 for IBD development in offspring.

Investigators also noted current research about a potential link between IBD and the placenta. They noted IBD likely does not negatively impact placental development because of the organ’s vital role in normal pregnancy and pregnancy complications.

Smoking during pregnancy has also been linked to IBD, though no significant association with IBD subtypes has been observed. In a meta-analysis including 9 studies, the OR for IBD in offspring of mothers who smoked during pregnancy was 1.5. This link was also found in a population-based cohort study.

An OR of 1.75 for IBD has also been reported in offspring of mothers with prenatal antibiotic use, highlighting a significant association. Intrauterine antibiotic exposure was linked to very-early-onset IBD in a population-based study, with an adjusted HR of 1.93. CD was found to increase this risk, but no link was found for UC.

Investigators noted increased odds of offspring IBD when mothers present with the condition vs fathers. Therefore, they hypothesized that early environmental triggers, such as maternal diet during pregnancy, may impact IBD development. In a longitudinal birth cohort, increased food additive (FA) was reported in IBD mothers vs non-IBD mothers.

The data also highlighted significant increases in fecal calprotectin levels in the guts of infants born to mothers with greater FA intake, regardless of IBD status. This data supports the hypothesis that prenatal diet may impact offspring conditions among mothers with IBD.

Currently, only one human study provides data with a significant quality of evidence linking the maternal microbiome to IBD risk in offspring. Mothers with prenatal IBD maintained abnormal gut microbiota composition during pregnancy, altering offspring’s bacterial diversity and abundance of bacterial species.

This has led to research about preventing intestinal inflammation in offspring by targeting the maternal microbiome. The Modulating Early Life Microbiome through Dietary Intervention in Pregnancy trial is assessing the outcomes of this intervention in pregnant women with CD, but investigators noted long-term follow-up is necessary to validate the findings.

Highlighting all this data, investigators stressed the importance of preconception counseling. This should be conducted by an IBD care provider at least 6 months before attempting conception, beginning at IBD diagnosis among reproductive-aged women.

“We hope that this consensus statement will provide a blueprint for evidence-based [treatment] of women with IBD, from preconception to post delivery,” said Millie D. Long, MD, MPH, cochair of the Global Consensus Conference at the University of North Carolina.

University of California San Francisco Medical Center. First global guidelines for pregnancy and inflammatory bowel disease developed. News release. EurekAlert. August 28, 2025. Accessed September 2, 2025. https://www.eurekalert.org/news-releases/1096189

Global Consensus Group for Pregnancy and IBD

. Global consensus statement on the management of pregnancy in inflammatory bowel disease. 

The global consensus offers evidence-based guidance for treating inflammatory bowel disease in pregnant women.

Natalia Llarena, MD

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