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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.

A study found that insomnia and obstructive sleep apnea during pregnancy are linked to increased risks of ischemic placental disease and severe morbidity.

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OBGYN.net Conference CoverageFrom the American Society of Reproductive Medicine, Montreal, Quebec 2005

The role of surrogacy in infertility treatment

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.

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.

A recent study found that romosozumab significantly outperformed teriparatide and denosumab in improving hip and spine bone strength.

Clinical

Romosozumab outperforms teriparatide and denosumab in bone strength

As we recognize National Folic Acid Awareness Week (September 8-14, 2025), it is vital to discuss innovations, research, and evolving care strategies that influence folic acid management. From its influence on birth defects to increased use in patients with gestational diabetes, groundbreaking folic acid research has emerged throughout 2025.

 highlights some of the most notable folic acid–related developments so far this year, including supplement use before pregnancy and improved child development. These stories show an ongoing effort to highlight the benefits of folic acid supplementation and increase its use in the general population.

Click on each title below for more information on each news item.

Vaginal vault prolapse surgery improves body image

A multicenter randomized clinical trial evaluated the impact of 3 surgical approaches for vaginal vault prolapse repair on body image and sexual function: native tissue repair, sacrocolpopexy, and transvaginal mesh. The study included 335 women, with a mean age of 66 years, most of whom had stage 3 prolapse. 

Using the Body Image in Pelvic Organ Prolapse questionnaire and sexual function measures, investigators found significant improvements in body image and sexual function across all surgical methods over 36 months. No significant differences emerged between approaches, nor between mesh vs nonmesh or vaginal vs abdominal procedures. 

Women who remained or became sexually active post surgery reported greater gains in sexual function, with improvements closely tied to better body image. However, 37% experienced surgical failure by 36 months, which was associated with poorer body image. Overall, findings highlight that prolapse repair enhances body image and sexual health regardless of surgical technique.


 found that two-thirds of US women of reproductive age present with at least one modifiable risk factor for birth defects. Among 5374 nonpregnant, nonlactating women studied from 2007 to 2020, 19.5% had low red blood cell folate levels, 33.8% were obese, 4.8% had diabetes, and nearly 1 in 5 had tobacco exposure. 

Supplement use was low, with only 12.6% meeting recommended folic acid intake, and nearly all participants fell below 400 µg/day without supplements. Over time, obesity, diabetes, prediabetes, and very low food security increased, while active tobacco use and adequate folic acid intake declined. 

Disparities were noted, with non-Hispanic Black and Hispanic women more likely than White women to have risk factors. Investigators emphasized that addressing these preventable factors through improved nutrition, health care access, and preconception counseling could significantly reduce the risk of birth defects and improve pregnancy outcomes.

Survey reveals persistent knowledge gaps about pregnancy health, vaccination safety

A national survey conducted by the Annenberg Public Policy Center in April 2025 revealed persistent gaps in US adults’ knowledge of pregnancy-related health recommendations, despite broad recognition of maternal health’s importance. Among 1653 respondents, 91% acknowledged pregnancy health affects infants, yet their knowledge of specific guidelines was inconsistent and declining in some areas. 

Only 46% correctly identified the recommended weight gain of 25 to 35 pounds during pregnancy, and understanding of folic acid supplementation dropped from 76% in 2023 to 71%. Awareness of iron use, alcohol abstinence prior to conception, and secondhand smoke risks also showed significant gaps, particularly among women of childbearing age. 

Knowledge of vaccine recommendations declined, with just 37% recognizing Tdap as recommended and only 11% aware that MMR is contraindicated in pregnancy. These findings highlight the need for stronger, targeted public health messaging to address misconceptions and support healthier pregnancies, especially among reproductive-aged women and their families.

Higher maternal folic acid intake linked to improved child development

A study presented at the American Academy of Neurology’s 77th Annual Meeting found that higher maternal folic acid intake during the first trimester is linked to improved verbal and behavioral outcomes in children at age 6 years. The analysis included 345 children, most born to women with epilepsy, and compared outcomes based on maternal folic acid doses ranging from none to more than 4 mg per day. 

Children whose mothers took folic acid scored higher in verbal skills (mean 108 vs 96) and behavior (102 vs 82) than those whose mothers took none. Among folic acid users, verbal scores averaged 110 for high-dose vs 108 for low-dose groups, with behavioral scores similar at 103. 

These findings suggest that folic acid intake, regardless of dose, benefits neurodevelopment, while higher doses appear safe. Investigators emphasized the importance of early supplementation for children's brain health, particularly in women at higher risk, such as those with epilepsy.


Deep learning model enhances gestational diabetes prediction accuracy

 suggests that a multilayer perceptron (MLP) deep learning model may improve the prediction of gestational diabetes mellitus (GDM) compared with traditional logistic regression approaches. GDM affects 5% to 30% of pregnancies worldwide, varies by region and ethnicity, and poses serious risks for both mothers and infants. 

Investigators conducted a retrospective cohort study of pregnant women who delivered between 2008 and 2018, analyzing 32 prenatal variables, including age, prepregnancy body mass index (BMI), folic acid supplementation, family history, and laboratory biomarkers. Women with GDM were more likely to be older, have higher BMI, lower education, earlier menarche, and distinct hematological, renal, and liver profiles. 

The MLP model, structured with 3 neural network layers, demonstrated superior predictive performance with an area under the receiver operating characteristic curve of 0.943, average precision of 0.855, and F1 score of 0.879, compared with weaker results from logistic regression models. Investigators noted that incorporating genetic data could further refine prediction and support personalized prevention and treatment strategies for GDM.

Find out the top 5 latest updates and headlines in folic acid research in honor of National Folic Acid Awareness Week (September 8-14, 2025).

Top 5 recent updates in folic acid research

Ovarian cancer

Jesus Gonzalez Bosquet, MD, PhD, associate professor of obstetrics and gynecology at The University of Iowa, highlighted the efficacy of a machine learning model using blood-based biomarkers to identify ovarian cancer.

Ovarian cancer remains one of the most difficult gynecologic cancers to detect early, and this significantly impacts patient survival outcomes. According to Gonzalez Bosquet, the primary challenge is the lack of effective early screening or detection methods. Current tools, such as ultrasound and tumor markers, have been tested in multiple studies in the United States and abroad, but none have demonstrated consistent accuracy. 

As a result, most patients are diagnosed at advanced stages, when treatment options are limited and survival rates drop significantly. Gonzalez Bosquet noted that 5-year survival rates for early-stage ovarian cancer reach approximately 95%, but this falls between 40% and 50% for patients diagnosed at later stages, underscoring the need for earlier detection strategies.

To address this gap, Gonzalez Bosquet and his team have explored the use of machine learning models to identify ovarian cancer through blood-based biomarkers. Their work focuses on detecting methylated DNA fragments shed by tumors into the bloodstream. Starting with a platform that examined more than 850,000 methylation probes, the researchers used machine learning to narrow the list down to 9 probes that showed strong potential for accurately identifying ovarian cancer. While promising, these findings are still in the pilot phase and require further validation before they can be used in clinical settings.

According to Gonzalez Bosquet, the next step in this research is to confirm whether these methylated probes can be reliably detected in blood samples, not just in surgical tissue specimens. He that his team, in collaboration with Mayo Clinic, has submitted a project aimed at this validation step. If successful, the model will need to be tested in large-scale screening studies involving both patients with and without ovarian cancer to determine its true diagnostic accuracy and clinical value.

Looking ahead, Gonzalez Bosquet envisions practical applications of these artificial intelligence (AI) models that would make them accessible to clinicians worldwide. Once fully developed, the models could be hosted on web-based platforms, allowing physicians to upload data such as imaging scans or blood test results. The system would then provide a risk assessment, ranging from low to high probability of ovarian cancer. This streamlined, user-friendly approach could integrate seamlessly into clinical workflows, offering physicians a powerful tool for earlier and more accurate cancer detection.

Ultimately, Gonzalez Bosquet emphasized that while the technology is still under development, AI-driven models hold great promise in transforming ovarian cancer diagnosis, potentially improving survival rates by identifying the disease before it reaches advanced stages.

Gonzalez Bosquet J, Wagner VM, Russo D, et al. Identifying ovarian cancer with machine learning DNA methylation pattern analysis. 

2025;15(1):20910. doi:10.1038/s41598-025-05460-9

Jesus Gonzalez Bosquet, MD, PhD, discusses how machine learning could improve early ovarian cancer diagnosis by identifying methylated DNA in blood.

Jesus Gonzalez Bosquet, MD, PhD, highlights test for earlier ovarian cancer detection

Intending to take folic acid supplements before pregnancy is more common among women with a food and nutrition major in college, awareness of neural tube defects (NTDs), and access to folic acid–related information, according to a recent study published in 

Cell growth is significantly influenced by folic acid. Additionally, folic acid supplement use before pregnancy has been linked to reduced odds of developing NTDs, defined as congenital malformations that occur when the neural tube is unable to properly close. This has led folic acid supplementation to be recommended during pregnancy for more than 20 years.

“However, awareness of the recommendation to take folic acid to prevent NTDs remains insufficient, particularly among women who have never been pregnant,” wrote investigators.

Investigators conducted a trial to evaluate factors linked to the intent to take folic acid supplementation in reproductive-aged women prior to pregnancy. A questionnaire was developed by reviewing available literature about folic acid intake during pregnancy. The study authors discussed variables aligned with the purposes of the trial.

Following this process, a research team utilized professional judgement to review and cross-evaluate questionnaire items and terminology. Finally, 10 experts assessed the clarity and content validity of the draft questionnaire.

Graduates from the Department of Life Culture at Wakayama Shin-Ai Women’s Junior College between March 2006 and March 2023 were recruited for the analysis. Folic acid supplement use prior to pregnancy was reported in these patients as the primary outcome.

Major, pregnancy experience, NTD awareness, awareness of the role of folic acid in reducing NTD risk, access to folic acid information, recollection of learning about folic acid during junior college, and sharing information about the necessity of folic acid intake before pregnancy were considered potential predictors of intending to take folic acid before pregnancy.

Findings on folic acid supplementation intent

There were 47 respondents included in the final analysis, 51% of whom intended to take folic acid supplements before pregnancy, while 49% did not. A significant association was reported between graduating with a food and nutrition major and being more likely to intend to take folic acid supplementation before pregnancy, with an OR of 17.69.

Pregnancy experience was linked to an OR of 3.33 for this outcome, indicating a weak or nonsignificant association. ORs of 3.81 and 7.20 were reported for folic acid supplementation before pregnancy in patients with awareness of NTDs and access to folic acid information, respectively, highlighting significant associations.

Additionally, the odds of taking folic acid supplements were increased by learning about folic acid during junior college, with an OR of 6.50. However, investigators noted high uncertainty about the effect of providing others with information about the need to take folic acid supplements before pregnancy.

These results indicated positive associations for a major in food and nutrition, NTD awareness, educational experiences in junior college, and access to folic acid information with an intention to take folic acid supplements before pregnancy. However, investigators noted the data were limited by a low response rate.

“Further prospective cohort studies with larger sample sizes are necessary to confirm these associations,” wrote investigators.

Morioka M, Kataoka Y, Taito S. Folic acid supplement intake before pregnancy with and without educational intervention: a cross-sectional study in Japan. 

2025;17(7):e87959. doi:10.7759/cureus.87959

Notice on the promotion of appropriate information provision regarding folic acid intake for women of childbearing age to reduce the risk of neural tube defects. Article in Japanese. Accessed May 25, 2025. https://www.mhlw.go.jp/www1/houdou/1212/h1228-1_18.html

A study found that women with a nutrition major in college and access to folic acid information were more likely to plan folic acid supplementation prior to pregnancy.

Folic acid awareness influences supplement use before pregnancy

 levels are reduced by continuous glucose monitoring (CGM) vs self-monitoring of blood glucose, alongside a potential reduction in large for gestational age (LGA) risk, according to a recent study published in the 

American Journal of Obstetrics & Gynecology.

More than 17% of live births annually are impacted by diabetes in pregnancy (DIP), with increased risks of stillbirth, congenital malformations, LGA, and other complications. Glucose management is often accomplished through self-monitoring of blood glucose (SMBG), but data have indicated improved outcomes when adding CGM.

“Despite increasing interest in the use of CGM in [type 2 diabetes (T2D)] and [gestational diabetes mellitus (GDM)], it is uncertain whether similar benefits in pregnancy outcomes are seen,” wrote investigators.

A systematic review and meta-analysis were conducted to compare the outcomes of CGM vs SMBG for managing DIP. Articles published from January 2003 to August 2024 were obtained through systematic searches of the Embase, Medline, CINAHL, CENTRAL, and Scopus databases.

Studies with participants using CGM for type 1 diabetes (T1D), T2D, or GDM with an SMBG comparator group were included in the analysis. Reporting maternal glycemia or perinatal outcomes was also required for inclusion. Exclusion criteria included nonpregnant patients, the absence of a comparator SMBG group, and the study conducted in an inpatient setting.

Two independent study authors extracted study and participant characteristics, consulting a third author to resolve discrepancies. Cohort characteristics, participant characteristics, CGM data, and outcomes were extracted for assessment, along with links between CGM metrics and perinatal outcomes.

There were 18 studies included in the final analysis, 14 of which were randomized controlled trials (RCTs) and 4 were quasi-experimental. Three CGM methods were reported across these studies, including real-time CGM in 6, intermittently scanned CGM in 5, and retrospective CGM in 6. A mix of real-time CGM and intermittently scanned CGM was used in 1 study.

was reported for DIP following CGM vs SMBG in a meta-analysis of 7 RCTs, with a mean difference (MD) of -0.22%. An improvement from CGM was also reported in quasi-experimental data, but the evidence had low certainty.

Another RCT highlighted reduced third-trimester HbA

 from CGM vs SMBG in patients with T1D, with an MD of -0.18% Quasi-experimental data indicated an MD of -0.30%, supporting this association. However, no differences between CGM and SMBG were reported across 2 studies assessing third-trimester HbA

For mixed DIP, the MD in third-trimester HbA

 for CGM vs SMBG across 4 RCTs was -0.60%, highlighting a reduction. A decline in third-trimester HbA

 was also reported for GDM across 7 RCTs, with an MD of -0.18%.

Associations were reported for CGM glucose metrics and LGA. Specifically, reduced LGA was reported in patients with first-trimester CGM use and lower mean sensor glucose (SG), with an OR of 1.04. A single trial showed benefits toward LGA when using CGM for pregnancy duration, reporting an OR of 0.54.

A decline in neonatal hypoglycemia based on an OR of 0.56 was also reported for CGM vs SMBG across 2 RCTs. Small for gestational age odds were not influenced by the glucose monitoring method used. Overall, the results highlighted reduced third-trimester HbA

 and mean SG from CGM use in T1D and GDM, leading to a decrease in LGA.

“Ongoing studies including RCTs of CGM use in T2D and GDM…as well as observational studies…alongside health economic analyses, will provide important insights into the role of CGM use in the management of both T2D and GDM, and in the prediction of GDM and perinatal complications more broadly,” wrote investigators.

Burk J, Ross GP, Hernandez TL, Colagiuri S, Sweeting A. Evidence for improved glucose metrics and perinatal outcomes with continuous glucose monitoring compared to self-monitoring in diabetes during pregnancy. 

2025;233(3):162-175. doi:10.1016/j.ajog.2025.04.010

. Continuous glucose monitoring in pregnant women with type 1 diabetes (CONCEPTT): a multicentre international randomised controlled trial. 

. 2017;390(10110):2347-2359. doi:10.1016/S0140-6736(17)32400-5

A study found continuous glucose monitoring improves glycemic control vs self-monitoring in diabetes during pregnancy.

Sharon LaMothe

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