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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.

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Jesus Gonzalez Bosquet, MD, PhD is the associate professor of obstetrics and gynecology at The University of Iowa.

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Continuous glucose monitoring lowers HbA1c and LGA risk in pregnancy

The updated guidelines emphasize shared decision-making, early counseling, and Pregnancy Heart Teams to improve outcomes.

ESC 2025 guidelines prioritize women’s autonomy in high-risk pregnancies

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A Psychedelic to Treat Postpartum Depression?

CMV: In the Know

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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

1rem

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Posterior Urethral Valve Syndrome

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.

Clinical

New guidelines set for managing IBD in pregnancy

Women in high-income countries are increasingly delaying childbirth, with new research warning that this trend is associated with rising maternal health risks and persistent inequities. An international review, published in the 

 and led by researchers at Flinders University in Australia, examined pregnancy and birth outcomes in Australia, the United States (US), and the United Kingdom (UK) over the past 2 decades.

“One of the most noticeable shifts is that women are having babies later in life,” said lead author Anya Arthurs, PhD, research fellow at Flinders University. “The average age of first-time mothers has steadily increased, with many now starting their families aged 35 years or over, reflecting broader societal changes including career priorities, financial pressures, and improved access to contraception.”

The review found that older mothers are more likely to access prenatal care but also experience higher rates of complications. “We’re seeing increased rates of gestational diabetes, high blood pressure, and cesarean sections among older mothers, which raises important questions about how maternity care systems are adapting,” Arthurs explained. Data show that in Australia, the average age of mothers increased from 28.9 years in 1998 to 31.1 years in 2021, while in the UK it rose to 30.9 years in 2022. In the US, the average age of first-time mothers reached 27.5 years in 2023.

Across all 3 countries, fertility rates have declined to below replacement levels. In 2022, the total fertility rate was 1.63 in Australia, 1.67 in the US, and 1.49 in the UK. Despite this decline, the number of births to Indigenous and minority women is increasing. The authors highlighted the significance of these demographic shifts for future health care planning.

Maternal mortality remains a key concern, particularly in the US, where the maternal mortality rate (MMR) was 32.9 per 100,000 live births in 2021, markedly higher than Australia (5.8) and the UK (13.4). Racial and ethnic disparities are prominent. “Maternal mortality remains a serious concern, especially in the US, where Black, Indigenous, and Hispanic women are far more likely to die during pregnancy or childbirth due to limited access to quality health care and systemic inequalities,” said Arthurs.

Indigenous women in Australia and migrant women in the UK also face worse outcomes. In Australia, First Nations women have an MMR 3 times that of non-Indigenous women. In the UK, Black women are nearly 4 times more likely to die during or after pregnancy than White women.

The COVID-19 pandemic further strained maternity care. In the UK, COVID-19 became a leading cause of maternal death between 2019 and 2021. The review also noted a rise in cesarean deliveries, particularly among older mothers and those delivering in private hospitals. While cesarean deliveries can be lifesaving, the authors cautioned that rates exceeding 10% to 15% may reflect systemic rather than clinical drivers.

Some positive trends were observed. Smoking during pregnancy has declined across all 3 countries, and breastfeeding rates are improving, particularly in Australia and the UK. However, disparities persist. “But younger mothers are still more likely to smoke, and the USA continues to lag in breastfeeding rates, partly due to the absence of a national paid maternity leave policy,” Arthurs said.

Senior author professor Claire Roberts emphasized the need for policy reforms. “We’re calling for governments and health systems to take action by focusing on maternity care that is equitable, culturally safe and responsive to changing needs,” she said. Recommendations include adopting midwifery-led continuity of care, improving postpartum follow-up for women with gestational diabetes or hypertensive disorders, expanding culturally safe perinatal programs, and introducing universal paid parental leave in the US.

The authors also called for governments to address social determinants of health, including housing, income, and food security, and to establish an international maternal health equity task force to coordinate global efforts.

Flinders University. Global study reveals alarming gaps in maternal health across Australia, USA, and UK. News release. EurekAlert. August 26, 2025. Accessed September 2, 2025. https://www.eurekalert.org/news-releases/1096054

Arthurs AL, Harrison JK, Williamson JM, Roberts CT. Pregnancy and birth trends across Australia, the United States of America and the United Kingdom. 

. 2025;14(16):5841. doi:10.3390/jcm14165841

An international review found rising maternal age, increasing complications, and ongoing disparities in maternity care across 3 nations.

Pregnancy trends show later maternal age and persistent inequities

Saying "obstetrician-gynecologist" is a mouthful for most people, and it's probably the most abbreviated specialty in medicine, both spoken and written. However, there doesn't seem to be a consensus on how to pronounce OB-GYN. First, is it the two-syllable "O-B" or the monosyllabic "Ob"? Second, is it "gin" or "gyne" (like "Lyme")? I wonder if you have a preference. I know I do.

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

Is It Ob-Gin or Ob-Gyne?

Racial and ethnic differences in sexually transmitted infection (STI) testing persist in pediatric care, but a new multicenter study indicates that a standardized, universally offered clinical decision support (CDS) tool can mitigate these disparities. The findings, published in 

, suggest that integrating universal prompts into the electronic health record (EHR) increases equity in testing for chlamydia (CT) and gonorrhea (GC) among adolescents presenting to the emergency department (ED).

Adolescents from minoritized racial and ethnic groups undergo CT and GC testing at higher rates than non-Hispanic White peers, raising concerns about clinician bias. Previous studies have shown testing differences, with one reporting that “differential testing for CT between Black (66% tested) and White (24% tested) adolescents has been demonstrated in the pediatric primary care setting.”

 Similarly, emergency department data reveal that non-White adolescents are more likely to be tested for STIs than White adolescents.

This secondary analysis drew on a prospective pragmatic trial conducted at 6 pediatric EDs between January 2021 and September 2022. Patients aged 15 to 21 years completed a tablet-based sexual health screen. Two testing approaches were compared:

 CDS was triggered by risk identified on the sexual health screen.

 Patients were offered testing directly, and their request for CT/GC testing generated a CDS order prompt.

Demographics, including race and ethnicity, were abstracted from the EHR. The primary outcome was whether CT/GC testing occurred.

Across the study, 94,743 adolescents were evaluated: 18,256 in the baseline phase, 40,185 in the targeted phase, and 36,302 in the universally offered phase. The majority were female (57.9%) and non-Hispanic White (34.6%).

At baseline, testing disparities were evident. Non-Hispanic Black adolescents had more than twice the odds of CT/GC testing compared with non-Hispanic White patients (adjusted OR [aOR], 2.10; 95% CI, 1.83–2.41). During the targeted phase, CDS did not alter disparities: “the racial and ethnic differences in CT/GC testing persisted and were not mitigated by the CDS alert” (

In contrast, when universally offered testing was implemented, disparities disappeared. The authors reported that “CDS did mitigate racial and ethnic differences in the universally offered phase, meaning all racial and ethnic groups had CT/GC testing at a similar proportion” (

The study demonstrates that clinician decision-making influenced by patient-reported risk may perpetuate inequities, whereas universally offered testing reduces opportunities for bias. The authors noted that “universally offered CT/GC testing is adolescent-driven and based on patient desire, requiring the clinician to merely order a test, remaining unaware of the patient’s STI risk.”

However, the researchers also observed inequities in which adolescents were offered tablets to complete the health screen. Hispanic adolescents were more likely to receive a tablet than others, raising concerns that bias may still enter at the point of screening access.

Limitations included reliance on EHR-documented rather than self-reported race and ethnicity, potential site-level differences in implementation, and exclusion of one site due to missing data. Additionally, universal testing may increase detection across all groups but does not directly address infection burden or broader social determinants of health.

The findings provide evidence that universally offered, EHR-integrated CDS can eliminate racial and ethnic differences in CT/GC testing among adolescents in pediatric EDs. The authors concluded that “larger systemic change, including targeted interventions to diversify the medical workforce, bias and microaggression/microaffirmation training for medical professionals, and policy change, are all needed to improve equity in health and care.”

This article was originally published by our sister publication 

Pickett ML, Cafferty R, Palmer C, et al. Mitigation of racial and ethnic differences in chlamydia and gonorrhea testing. 

. 2025;1(3):1-9. doi:10.1542/pedsos.2025-000513

Wood S, Min J, Tam V, Pickel J, Petsis D, Campbell K. Inequities in 

 screening between Black and White adolescents in a large pediatric primary care network, 2015–2019. 

. 2022;112(1):135-143. doi:10.2105/ajph.2021.306498

Universal EHR-based decision support eliminated racial disparities in adolescent chlamydia and gonorrhea testing in pediatric EDs.

Standardized approach improves equity in chlamydia and gonorrhea testing

Investigators have identified the presence of at least one modifiable risk factor for birth defects in two-thirds of reproductive-aged women, publishing their findings in the 

These findings included low red blood cell (RBC) folate concentrations in 1 in 5 women, diabetes in nearly 5%, obesity in 1 in 3, and tobacco exposure in nearly 1 in 5. Investigators stated that this data can be used to identify and challenge modifiable risk factors to reduce the risk of birth defects.

“The most significant finding—that two-thirds of women of reproductive age had at least one modifiable risk factor—highlights how common these changeable risk factors are. The good news is that they can be lowered,” said Arick Wang, PhD, epidemiologist at the CDC.

Data from a US sample was obtained through household interviews and in-person health examinations.

 Investigators also conducted 2 dietary-intake 24-hour recall interviews for each participant to complete. The collected data was categorized into 5 cycles of 2 years and 1 prepandemic cycle of 3.2 years, all from 2007 to March 2020.

Women of reproductive age (WRA) status was determined through self-reported sex and age, with reproductive age defined as 12 to 49 years. Patients with a positive pregnancy test or self-reporting pregnancy or lactation were excluded from the analysis.

There were 5374 nonpregnant, nonlactating WRA included in the final analysis, 66.4% of whom presented with at least one known risk factor of birth defects and 10.4% with 3 or more based on the all-risks profile. When assessing risks with the nonfolate risk profile, these rates were 59.1% and 6.3%, respectively.

Nutritional supplement use and folate intake

Of WRA, 6.7% had very low food security, while consumption of FA-containing supplements was reported in approximately 28% and both FA- and B12-containing supplements in 27.2%. Consumption of supplements with at least 400 µg/day of FA was reported in only 12.6%.

When excluding supplement use, 98.7% of patients had FA intakes under 400 µg/day. RBC folate concentrations under 748 nmol/L were reported in 19.5%, obesity in 33.8%, diabetes in 4.8%, and prediabetes in 28.9%.

An increasing trend of women with at least one known risk factor was observed over time, from 65.3% between 2007 and 2010 to 69.5% between 2015 and 2020. Rates of women with at least one nonfolate risk also rose from 55.3% to 64%, while the prevalence of RBC folate concentrations 748 nmol/L declined from 23.4% to 17.9%.

Rates of very low food security, total FA intake under 400 µg/day, obesity, diabetes, and prediabetes increased over time, while rates of active tobacco use and daily FA intake over 400 µg/day decreased. A correlation was reported between age and presenting with at least one risk factor.

Non-Hispanic Black and Hispanic patients were significantly more likely to present with at least one risk factor vs White patients, with rates of 80.4%, 70%, and 62.2%, respectively. For the nonfolate risk profile, these rates were 70.3%, 62.8%, and 56.2%, respectively.

These results indicated a high prevalence of modifiable risk factors for birth defects among US women. Investigators concluded women should visit their physician before pregnancy to prevent adverse outcomes.

“Every growing family hopes for a healthy pregnancy and healthy baby. Understanding modifiable risk factors for birth defects helps families, health care providers, and public health professionals make data-informed decisions that can lead to healthier pregnancies and babies,” said Wang.

Elsevier. Two thirds of reproductive-aged women have at least one modifiable risk factor for birth defects, study reveals. News release. EurekAlert. August 26, 2025. Accessed September 3, 2025. https://www.eurekalert.org/news-releases/1095031

Wang A, Zauche LH, Crider KS, et al. Trends and prevalence of modifiable risk factors for birth defects among US women of reproductive age: National Health and Nutrition Examination Survey 2007 to March 2020. 

 Published online August 19, 2025. doi:10.1016/j.amepre.2025.107947

A study highlights common, preventable risk factors such as obesity and diabetes that could impact outcomes.

Modifiable birth defect risk factors found in 2 in 3 US women

These are 3D ultrasound images of a 14-week fetus. What is your diagnosis?

occipital meningocele and umbilical hernia

Tricia Jacobsen, MD

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