Contemporary OB/GYN week in review: Cervical screening, US fertility, and more

This week at Contemporary OB/GYN®, we covered topics ranging from a record low US fertility rate to racial differences in pelvic floor anatomy. Click the links below to read anything you might have missed from Monday, July 28 to Friday, August 1, 2025.

Jessica Shepherd, MD, clarifies cervical cancer screening guidelines

In a recent interview with Contemporary OB/GYN, Jessica Shepherd, MD, MBA, chief medical officer at Hers, discussed current guidelines and emerging strategies for cervical cancer screening.

She emphasized that confusion often arises around when to begin screening, how frequently it should be done, and which method to use. According to the latest recommendations, women should start cervical cancer screening with a Pap test every 3 years beginning at age 21 years and continue through age 29. From the age of 30 years onward, co-testing—which combines the Pap test with HPV testing—is recommended every 5 years. These guidelines aim to maximize the early detection of cervical cancer and precancerous cells, which is crucial for timely intervention.

Record low US fertility rate reported in 2024

The fertility rate has dropped below 1.6 births per woman in the United States, hitting an all-time low, according to the Centers for Disease Control and Prevention.¹

Factors such as concerns over health care, childcare, affordability, and paid leave have led individuals to delay or forgo parenthood. The decline was observed despite an increase in US births registered, from 3,628,934 births to 3,596,017.² While this indicated an increase of 1%, the general fertility rate (GFR) dropped by 1%.

In 2023, the GFR among female patients aged 15 to 44 years was 54.5 births per 1000 individuals vs 53.8 per 1000 in 2024. In teenagers aged 15 to 19 years, a decline of 4% was reported vs a 3% decline in those aged 20 to 24 years, and a 2% decline in those aged 25 to 29 years.

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Study finds preconception hypoglycemia tied to adverse pregnancy outcomes

Women with low blood glucose levels prior to pregnancy may face a higher risk of adverse pregnancy outcomes, according to findings from a large retrospective study published July 29 in PLOS Medicine.

Researchers analyzed data from nearly 4.9 million Chinese women and found that preconception hypoglycemia was associated with an increased risk of preterm birth, low birth weight, small for gestational age, and birth defects—even in women without preexisting diabetes.

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Racial differences found in pelvic floor anatomy may impact prolapse risk

Black patients have larger levator hiatal (LH) dimensions and a more ovular, narrower, U-shaped levator hiatus compared with White patients, according to a study published in the American Journal of Obstetrics & Gynecology.

All regions of levator ani muscle (LAM) thickness were similar between Black and White patients, except for the right middle LAM, which was thicker in Black patients. In comparison, transverse diameter was the only LH dimension similar between groups. Black patients had an increased LH area, perimeter, and anteroposterior (AP) diameter vs White patients.

The White cohort had significant associations between parity with a larger LH area, perimeter, AP diameter, and transverse diameter. However, no associations of parity with LAM or LH dimensions were reported in the Black cohort. Parity-related correlations were not significantly impacted when adjusting for age and BMI.

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History-based screening accurately identifies eligibility for medication abortion

History-based screening protocols have high efficacy for ensuring medication abortion is rarely provided to ineligible patients, according to a recent study published in the American Journal of Obstetrics & Gynecology.

When using the full set of eligibility criteria, an accuracy of 0.65 was reported based on survey responses. The sensitivity was 92.2% and the specificity was 37.8%. An increase in accuracy to 0.71 was reported when removing unexplained pain as an ineligibility criteria, with a sensitivity of 89.5% and specificity of 53%.

In sensitivity analyses including patients responding “Not sure” on survey questions, the accuracy was 0.67, with a sensitivity of 89.5% and specificity 45.3%. Overall, the results highlighted few instances of incorrect self-screening for medication abortion, supporting these models.

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