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A study found that women exposed to computed tomography imaging before conception faced increased odds of pregnancy loss and congenital anomalies.

Preconception CT linked to miscarriage and birth defect risks

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: fertility anxiety, folic acid awareness, and more

A study found women with Medicaid are over twice as likely to experience delays in starting cervical cancer treatment.

Cervical cancer treatment delayed in Medicaid patients

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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CMV: In the Know

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Vaginismus: Managing a Misunderstood and Underdiagnosed Condition

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In this video, a clinician discusses new data on how surgeons are doing tissue extraction for uterine fibroids.

Are surgeons still morcellating fibroids?

This week at Contemporary OB/GYN®, we covered topics ranging from gaps in iron deficiency screening to racial gaps in endometriosis care. Click the links below to read anything you might have missed from Monday, September 1, to Friday, September 5, 2025.

USPSTF reports gaps in evidence for iron deficiency screening in pregnancy

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

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.

New guidelines set for managing IBD in pregnancy

On August 28, 2025, the Helmsley PIANO Expert Global Consensus was published in 6 international journals to provide 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.

Racial gaps in diagnosis and care for endometriosis reported

A cross-sectional qualitative review published in 

 highlights the need for culturally responsive, patient-centered care in Black women with endometriosis.

The first theme identified was physical symptoms, which included vomiting, pelvic pain, headaches, pain during sex, heavy bleeding, rectal pain, constipation, and blood clots. Many patients experienced these symptoms as teenagers and later linked them to endometriosis. Additionally, symptoms were often intense and radiated to areas of the body beyond the uterus.

Psychosocial impacts were discussed as a second theme. Following a diagnosis, many patients were frustrated about the duration between symptom onset and diagnosis, alongside the severe health concerns that may have been prevented with an earlier diagnosis.

Hormonal contraception linked to emotional regulation

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 HC 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.”

Severe burden and treatment gaps reported for hyperemesis gravidarum

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.

Clinical

Contemporary OB/GYN week in review: Iron deficiency, IBD guidelines, and more

The risk of stroke is greater in women with hysterectomy or bilateral oophorectomy vs no surgery, according to a recent study published in 

These data support the link between estrogen and stroke risk, indicated by an increased risk among postmenopausal women vs reproductive-aged women. Hysterectomy with bilateral oophorectomy was linked to an 18% increase in risk vs 5% for hysterectomy alone.

“The results of this study demonstrate increased stroke risk related to hysterectomy and/or bilateral oophorectomy, highlighting that these common procedures carry longer-term risks,” said Stephanie Faubion, MD, MBA, medical director for The Menopause Society. “They also call attention to an opportunity for more careful assessment of cardiovascular risk.”

Data were obtained from the National Health and Nutrition Examination Survey, a prospective CDC study with health, diet, personal, social, and economic information.

 A retrospective cohort from 1999 to 2018 was developed using this data.

Reproductive health questions were used to collect hysterectomy and bilateral oophorectomy data. This included questions about whether patients had a hysterectomy, age at hysterectomy, whether an ovary was removed, and how many ovaries were removed.

This information was linked to the National Death Index for death certificate records. Stroke was based on 

 codes, with follow-up occurring until the end of the interview period, participant death, or December 31, 2019. Covariates included demographics, traditional risk factors, and female-specific factors.

There were 21,240 US women aged 20 to 85 years included in the final analysis, representing approximately 85.9 million patients. Among this cohort, 193 stroke-related deaths were reported.

A significant link was reported between hysterectomy and stroke, with an HR of 2.34. However, when adjusting for demographics and traditional risk factors, the HR decreased to 1.16, no longer showing significance. Similarly, an HR of 1.28 was reported when further adjusting for female-specific factors.

There were also no significant associations found across subgroups based on age. However, hysterectomy with bilateral oophorectomy led to a significant increase in stroke risk of 51%, with an HR of 1.55. In comparison, nonsignificant HRs of 0.92 and 1.32 were reported for hysterectomy alone and hysterectomy with unilateral ovariectomy.

Hysterectomy with bilateral oophorectomy also had an HR of 1.62 for stroke vs hysterectomy alone, highlighting a significant increase in risk. There was also no significant association between hysterectomy and stroke risk in a sensitivity analysis of only patients without a history of stroke.

In a meta-analysis of 15 articles published between 2009 and 2023, increased odds of stroke were reported in patients with hysterectomy, with an HR of 1.09. However, this was only pronounced in benign indications during subanalysis. The HR for these indications was 1.10 vs 1.05 for benign and malignant indications.

Ovarian conservation and bilateral oophorectomy had HRs of 1.05 and 1.18, respectively, for stroke, both indicating increased risk. Overall, the data indicated increased stroke risk among women with hysterectomy with or without bilateral oophorectomy vs no surgery, though the data was limited by being self-reported and potentially including unilateral cases in the reference group.

“Future prospective studies with a large sample size and longer follow-up period are needed to address the disparities of type of stroke, age at surgery, surgical techniques, and menopause status on the association between stroke risk and hysterectomy and/or bilateral oophorectomy,” wrote investigators.

The Menopause Society. Hysterectomy with bilateral oophorectomy may increase risk of stroke. News release. EurekAlert. September 3, 2025. Accessed September 4, 2025. https://www.eurekalert.org/news-releases/1096712

Shao C, Xu C, Zou D, et al. Stroke risk in women with or without hysterectomy and/or bilateral oophorectomy: evidence from the NHANES 1999-2018 and meta-analysis. 

A study found that women receiving hysterectomy, especially with bilateral oophorectomy, face a significant increase in stroke risk.

Hysterectomy, oophorectomy linked to raised stroke risk

Updated international guidelines for the management of inflammatory bowel disease (IBD) during pregnancy have been developed to unify recommendations for clinicians and improve patient care worldwide. According to Uma Mahadevan, MD, director of the University of California, San Francisco Colitis and Crohn's Disease Center, these guidelines are significant because past recommendations varied by country and medical society, leading to confusion for both providers and patients. A single universal guideline now offers clear, evidence-based direction for gastroenterologists and obstetricians.

IBD affects an estimated 3 million to 5 million people in the United States, with rates increasing globally. Mahadevan explained that while genetic predisposition is the primary risk factor, environmental influences such as in-utero antibiotic exposure, alterations in the gut microbiome, and immune system function also play a role in disease development.

One of the major updates emphasizes preconception counseling. Women with IBD should aim for remission before pregnancy, optimize nutritional status, and be classified as high-risk obstetric patients. In the United States, this typically involves referral to maternal-fetal medicine specialists, though in resource-limited settings, enhanced monitoring may suffice.

The guidelines also provide updated recommendations on medication use. Mahadevan highlighted that mesalamines and biologic therapies—including anti-tumor necrosis factor agents, IL-23 inhibitors, and anti-integrins—should be continued throughout pregnancy, a change from prior practices that often paused biologics late in gestation. Conversely, small molecule therapies such as S1P modulators and Janus kinase inhibitors should be avoided during conception and pregnancy unless no alternatives exist.

Cesarean delivery is recommended only for women with active perianal disease or rectovaginal fistula; otherwise, the mode of delivery can be determined by the obstetrician. Women with IBD face increased risks of spontaneous abortion, preterm birth, venous thromboembolism, and labor complications, further underscoring the need for high-risk management.

Postpartum care and infant health are also addressed. Breastfeeding is considered safe for women using mesalamine, thiopurines, and biologics, but not small molecule therapies. Importantly, new data support the safe administration of the live rotavirus vaccine to infants, regardless of maternal medication. Additionally, women are advised to start low-dose aspirin between 12 and 16 weeks of pregnancy to reduce the risk of preeclampsia.

Mahadevan emphasized that clinicians can begin applying these guidelines by prioritizing preconception counseling, monitoring disease remission, ensuring appropriate medication use, and maintaining close follow-up. Comprehensive resources—including published recommendations, educational slide decks, and multilingual patient videos—are available at pianostudy.org to support implementation.

Disclosures: Takeda Pharmaceuticals USA, Inc

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. 

 Published online August 6, 2025. doi:10.1016/j.cgh.2025.04.005

Uma Mahadevan, MD, explains updated international recommendations for inflammatory bowel disease in pregnancy.

Uma Mahadevan, MD, highlights new guidelines for managing IBD

Labor access

A recent study led by Brittany L. Ranchoff, PhD, MPH, Research Fellow at the Harvard Pilgrim Health Care Institute and Harvard Medical School, investigated access to labor after cesarean (LAC) across US counties using birth certificate data from 2016 to 2021. 

The study defined access as the presence of at least one hospital in a county offering vaginal birth after cesarean (VBAC) services. Findings revealed that only 15.9% of US counties had LAC access during the study period, with availability stable over time. Metropolitan counties were more likely to provide these services than nonmetro areas. 

Regionally, Northeast and Western counties had higher proportions of hospitals offering VBAC than those in the South and Midwest. In a subgroup analysis focusing on counties with hospitals offering obstetric services, only 30.9% provided LAC access, again showing no significant change across years.

Ranchoff emphasized the significance of these findings: Despite modest increases in national VBAC rates between 2011 and 2021, access has not expanded geographically. Instead, LAC appears concentrated in a smaller group of hospitals and providers. This confirms reported challenges that many birthing people face in securing VBAC opportunities. With fewer than 1 in 6 counties offering access, the majority of individuals with prior cesareans lack meaningful choice in delivery method for subsequent pregnancies.

Expanding LAC is crucial for improving maternal health outcomes and patient autonomy. The United States maintains a persistently high cesarean delivery rate, which increases risks for complications in future pregnancies, including placenta previa accreta, maternal morbidity, and mortality. By broadening VBAC access, health care systems can help reduce repeat cesarean rates, improve safety, and preserve pregnant individuals’ ability to choose their mode of delivery.

For clinicians, Ranchoff advised advocating for hospital policy changes that encourage VBAC. She acknowledged that many hospitals and providers avoid offering LAC because of liability concerns, outdated clinical practices, and the convenience of scheduling repeat cesareans. However, the American College of Obstetricians and Gynecologists has long recognized VBAC as a reasonable option for most patients with a prior cesarean. 

Ranchoff suggested clinicians engage in dialogue with hospitals about updating policies, emphasizing that VBAC can provide better outcomes for many patients. Overall, the study highlights the limited and uneven access to VBAC services across the United States and underscores the need for systemic changes to expand options, improve equity, and enhance obstetric care.

University of Massachusetts Amherst. Access to vaginal labor after C-section is limited to some 16% of U.S. counties. News release. EurekAlert.  August 26, 2025. Accessed September 2, 2025. https://www.eurekalert.org/news-releases/1095975

Ranchoff BL, Geissler KH, Goff SL, Bertone-Johnson ER, Paterno MT, Attanasio LB. Trends in labor after cesarean delivery access in the US. 

 2025;8(8):e2526224. doi:10.1001/jamanetworkopen.2025.26224

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

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

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.

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.

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.

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

Renita Kim, MD

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