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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.

Articles

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

Jayant S. Vaidya, PhD, is a professor of surgery and oncology at the University College London.

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

Reassessing hormone therapy after breast cancer

Lopa Pandya, MD, MS, FACOG, is a urogynecologist and reconstructive surgeon at UI Health.

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

Elevated maternal sFlt-1 and sFlt-1/PlGF ratios are linked to placental abruption, highlighting potential early risk assessment in singleton pregnancies.

Maternal placental growth factor ratios linked to placental abruption

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Supplement: Closing the Gap in Cervical Cancer Screening

Vaginismus: Managing a Misunderstood and Underdiagnosed Condition

Why vNOTES Make Sense for My Patients

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Sarah Glynne, MBBS, BSC, is a GP menopause specialist at The Portland Hospital.

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

Mothers who experienced adverse childhood experiences (ACEs) are at increased risk of giving birth prematurely, according to new research presented at the American Academy of Pediatrics (AAP) 2025 National Conference & Exhibition in Denver, Colorado.

The study, The Association of Maternal Adverse Childhood Experiences with Preterm Birth of Their Infants, found that mothers with 2 or more ACEs were nearly twice as likely to deliver preterm as those with fewer or no ACEs.

“These findings provide further evidence that the effects of adverse childhood experiences may be passed from generation to generation and support action through public health and policy initiatives and clinical care to prevent and mitigate childhood trauma,” said research author Molly Easterlin, MD, MS, FAAP, neonatologist at Children’s Hospital Los Angeles and assistant professor of clinical pediatrics at the Keck School of Medicine of the University of Southern California.

Researchers conducted a secondary retrospective analysis using data from the Panel Study of Income Dynamics, a nationally representative household survey that links maternal and child health outcomes.

The study population included 823 women who gave birth to 1285 children between 2011 and 2021. Maternal ACEs included experiences of abuse, neglect, or household dysfunction such as parental separation, mental illness, incarceration, domestic violence, or substance use.

Mothers were categorized into 2 groups: those with 0–1 ACEs and those with 2 or more ACEs. Multivariable logistic regression analyses examined associations between maternal ACEs and preterm birth (<37 weeks’ gestation), adjusting for socioeconomic, behavioral, and clinical factors. Researchers also analyzed the impact of individual ACEs.

Results showed significant associations between maternal ACEs and birth outcomes:

 12.6% of mothers with 2 or more ACEs delivered preterm, compared with 6.7% of mothers with 0–1 ACEs.

 Maternal exposure to 2 or more ACEs was associated with more than twice the odds of preterm birth (OR 2.10; 95% CI, 1.24–3.57).

 Physical abuse, emotional abuse, and parental interpersonal violence were each significantly associated with preterm birth.

 Experiences such as parental separation, parental mental illness, and substance abuse did not demonstrate significant associations when analyzed individually.

Adverse childhood experiences, as defined by the Centers for Disease Control and Prevention, include potentially traumatic events such as abuse, neglect, or household instability. Importantly, children do not have to be direct victims to be affected; witnessing these events can be equally damaging.

The study underscores the potential intergenerational impact of ACEs. “As intensive care doctors who care for critically ill infants in the neonatal intensive care unit, it is important to understand the changing landscape of where, when, and how pregnant people are delivering their babies and the associated impact on infant health outcomes,” Easterlin said.

Researchers recommend that obstetric practices consider incorporating ACE screening into prenatal care. Identifying women with histories of childhood trauma may help clinicians provide additional social support, anticipate risks, and improve monitoring for preterm birth.

The findings highlight how maternal experiences beginning in childhood may shape health outcomes in the next generation. Addressing ACEs through screening, support services, and trauma-informed care may reduce preterm birth risk and improve maternal and infant health.

The authors received financial support for this research from the Keck School of Medicine of the University of Southern California Dean’s Pilot Funding Program.

This article was published by our sister publication, 

Maternal exposure to adverse childhood experiences are associated with an increased risk of preterm birth. News release. American Academy of Pediatrics. September 26, 2025. Accessed September 26, 2025. https://www.eurekalert.org/news-releases/1098757

Easterlin M. The Association of Maternal Adverse Childhood Experiences with Preterm Birth of their Infants. Presented at: American Academy of Pediatrics 2025 National Conference & Exhibition; September 26-30, 2025; Denver, Colorado.

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

Preconception body mass index (BMI) outside of the normal category in men and women is associated with time to pregnancy and miscarriage, according to a recent study published in 

Obesity during pregnancy has been associated with multiple adverse birth outcomes, including increased risks of miscarriage and pregnancy loss.

 However, investigators have hypothesized that a BMI beyond the extremes of obesity, alongside BMI in both women and men, may impact fertility outcomes and miscarriage risk.

“A better understanding of the separate and combined associations of BMI in women and men with fertility and miscarriage outcomes is needed to develop novel targeted population strategies to optimize BMI from the preconception period onward,” wrote investigators.

The study was conducted to evaluate the impact of BMI in women and men with fertility and birth outcomes. Participants included women and their partners aged at least 18 years, living in Rotterdam in the Netherlands, who were pregnant or trying to conceive between August 9, 2017, and July 1, 2021.

Patients underwent height and weight measurements without wearing shoes or heavy clothing. In men, these assessments were performed during a first-trimester visit. In women who were pregnant, a questionnaire was used to obtain prepregnancy weight, with prepregnancy BMI measured by substituting prepregnancy weight with measurements at first-trimester visits.

Underweight BMI was defined as under 18.5, normal weight as 18.5 to 24.9, overweight as 25 to 29.9, and obesity as 30 or greater. Questionnaires in preconception and early pregnancy were administered to evaluate time to pregnancy and mode of conception. Assisted reproductive technology use, including in vitro fertilization, was also reported.

Assessing fertility and pregnancy outcomes

The start date of seeking conception to the last date of study participation was used to determine the duration of actively pursuing pregnancy in patients unable to conceive. Fecundability, defined as the odds of conception within 28 days, was also reported.

Categories of time to pregnancy included 12 months or less and over 12 months, defined as fertile and subfertile, respectively. Pregnancy loss before 22-weeks’ gestation was defined as miscarriage. Covariates included age, ethnicity, and greatest education level.

There were 3033 pregnancy or preconception episodes across women aged a median 31.6 years and with a median BMI of 23.5 included in the analysis. In men, the median age and BMI were 33.4 years and 24.9, respectively. Of episodes among women, 17.8% were subfertile and 11.3% led to miscarriage. Overall, the median time to pregnancy was 3.7 months.

Negative association for BMI and fecundability

A decrease in fecundability was identified for every unit increase in BMI among both women and men, with a fecundability ratio (FR) of 0.98 for the former and 0.99 for the latter. Additionally, an FR of 0.88 was reported for overweight vs normal weight status, alongside 0.72 for obesity vs normal weight.

In men, overweight and obesity also decreased fecundability, with an FR of 0.89. Women and men also reported FRs of 1.04 and 1.03, respectively, for subfertility with increased BMI. The FRS for subfertility among women with underweight, overweight, and obesity vs normal weight were 1.88, 1.35, and 1.67, respectively.

An increased probability of miscarriage per week was also reported in normal weight vs overweight women, with an HR of 1.43. However, no other associations between BMI in women and men and miscarriage odds were reported.

Odds ratios for miscarriage were 1.49 in overweight women and 1.44 in women with obesity. Overall, the results highlighted associations of BMI outside the normal range in women and men with reduced fecundability, subfertility, and increased miscarriage odds.

“Optimizing BMI from the preconception period onward in women and men might be an important strategy to improve fertility and pregnancy outcomes,” wrote investigators.

Boxem AJ, Blaauwendraad SM, Mulders AGMGJ, et al. Preconception and early-pregnancy body mass index in women and men, time to pregnancy, and risk of miscarriage. 

. 2024;7(9):e2436157. doi:10.1001/jamanetworkopen.2024.36157

Magnus MC, Hockey RL, Håberg SE, Mishra GD. Pre-pregnancy lifestyle characteristics and risk of miscarriage: the Australian Longitudinal Study on Women's Health. 

. 2022;22(1):169. doi:10.1186/s12884-022-04482-9

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

Pregnancy vaccine confidence

, Kathleen Hall Jamieson, PhD, Annenberg Public Policy Center director, highlighted the potential long-term public health consequences of declining support for vaccination during pregnancy. 

While scientific evidence strongly supports the safety and benefits of maternal immunization for both mothers and infants, new data suggest that the broader public, including individuals of childbearing age, remains uncertain or hesitant about recommending vaccines in pregnancy. Jamieson emphasized that this hesitancy may stem not from opposition but from a lack of knowledge about vaccine safety and the diseases these immunizations prevent. Increasing public understanding of the protective role of vaccines during pregnancy, she noted, is essential for improving both maternal and infant outcomes.

Exploring the roots of vaccine skepticism, Jamieson described how the cautionary culture surrounding pregnancy contributes to uncertainty. Pregnant individuals are advised to avoid numerous potential risks to protect both their own health and that of their baby. Within this precautionary environment, new medical interventions such as vaccines can trigger additional concern about safety. This natural caution, Jamieson explained, becomes amplified when misinformation circulates, particularly around newer vaccines such as those for COVID-19. 

Conflicting messages, such as the Centers for Disease Control and Prevention (CDC) withdrawing its formal recommendation for the COVID-19 vaccine in pregnancy, add another layer of confusion. Even though the CDC continues to endorse other maternal vaccines, such as those for influenza, Tdap, and RSV, the absence of clear COVID-19 guidance can easily be interpreted by patients as a sign of risk, further reinforcing hesitancy.

Jamieson stressed that health care providers remain the most trusted source of information for pregnant patients, far surpassing public agencies or media. Research on public trust consistently shows that when clinicians recommend vaccination and take time to address patients’ specific concerns, acceptance rates rise significantly. She underscored that clinicians’ willingness to engage empathetically and communicate the scientific evidence about vaccine safety and benefits can directly influence maternal and infant health outcomes.

Ultimately, Jamieson concluded, clinicians play a critical role in reversing declining vaccination trends. By making informed, compassionate recommendations, they can counter misinformation, strengthen public confidence, and help prevent serious and sometimes fatal infections in mothers and their newborns.

Under half in US would recommend some routine vaccinations during pregnancy. Annenberg Public Policy Center of the University of Pennsylvania. September 30, 2025. Accessed October 2, 2025. https://www.eurekalert.org/news-releases/1100243.

As public uncertainty about vaccination during pregnancy grows, experts highlight the vital role of trusted health care providers in addressing hesitancy.

Kathleen Hall Jamieson, PhD, highlights clinician role in pregnancy vaccine confidence

have indicated a significant reduction in neonatal respiratory morbidity among women with twin pregnancies at risk of late preterm delivery receiving antenatal betamethasone.

Twin pregnancies, which are at an increased risk of neonatal morbidity and mortality, have become more prevalent over time in the United States.

 As antenatal corticosteroid administration has been linked to improved outcomes in singleton pregnancies, this regimen has also been recommended for use in twin pregnancies at risk of preterm birth.

“Guidelines pertaining to late preterm twin gestation are lacking,” wrote investigators. “Higher neonatal morbidity in late preterm neonates compared with full-term neonates…may support the use of antenatal corticosteroid in late preterm twin neonates.”

The multicenter double-blind randomized clinical trial was conducted to evaluate the impact of antenatal betamethasone administration in twin pregnancies with late preterm births. Participants included twin pregnant women between 34 weeks’ and 36 weeks, 5 days’ gestation at great risk of late preterm delivery.

These patients were randomly assigned 1:1 to undergo either antenatal corticosteroid administration as 2 intramuscular injections of 12 mg/3 mL betamethasone or placebo administration as 2 intramuscular injections of 3 mL normal saline. All participants injected the doses 24 hours apart.

Baseline characteristics, pregnancy outcomes, and neonatal outcomes were obtained from the medical records of participants and neonates, collected by trained medical staff blinded to the randomization assignment. Additionally, neonatal outcomes were reevaluated 28 days after birth.

Patient characteristics and adverse events

Perinatal death or severe respiratory morbidity within 72 hours after birth were reported as primary outcomes. Morbidity outcomes included continuous positive airway pressure (CPAP) or high-flow nasal cannula use, supplementary oxygen administration, mechanical ventilation, and extracorporeal membrane oxygenation.

There were 812 participants included in the final analysis, 410 of whom were randomly assigned to the study group and 402 to the placebo group. Median maternal ages were 35 years in both groups, and nulliparity status was reported in 78.1%. Assisted reproduction was provided to 77.2%, and rates of monochorionic twins and congenital malformation were 18.7% and 5.5%, respectively.

The completion of both doses was reported by 68.5% of participants in the betamethasone group and 66.4% in the placebo group. Receiving only one dose was reported by 31% and 33.1%, respectively. No significant differences in adverse event rates were reported between groups, and events were mild, such as nausea and pain at the injection site.

A significantly reduced risk of neonatal morbidity and mortality was reported in patients receiving antenatal corticosteroids vs placebo, with rates of 4.8% and 7.5%, respectively. This indicated a relative risk (RR) of 0.64.

For 12 or more hours of CPAP use, the RR was 0.50, with rates of 2.3% and 4.7%, respectively. Based on this data, investigators stated 23 twin pregnancies would need antenatal corticosteroid injection to prevent a primary outcome in at least 1 neonate per twin pair.

The betamethasone group also had reduced risks of CPAP for 2 hours or more and transient tachypnea of the newborn, with RRs of 0.58 and 0.47, respectively. Neonatal hypoglycemia was reported in 15.6% of the betamethasone group and 11.7% of the placebo group, while 1% and 2.7%, respectively, reported feeding difficulty.

No significant differences in chorioamnionitis or postpartum endometritis risks were reported between groups. Overall, the data highlighted reduced neonatal respiratory morbidity in twin-pregnant patients at risk of late preterm delivery receiving antenatal betamethasone.

“Antenatal corticosteroid injection should be recommended in this population,” wrote investigators.

Lee SM, Park HS, Choi SR, et al. Antenatal corticosteroid in twin-pregnant women at risk of late preterm delivery: a randomized clinical trial. 

 Published online September 22, 2025. doi:10.1001/jamapediatrics.2025.3284

Osterman MJK﻿, Hamilton BE﻿, Martin JA﻿, Driscoll AK﻿, Valenzuela CP﻿. Births: final data for 2022. ﻿

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

Elinzanetant

In the 52-week OASIS-3 trial, elinzanetant significantly reduced the frequency and severity of hot flashes and night sweats.

Sarah Glynne, MBBS, BSc

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