Gynecology & Obstetrics (all articles)
Clinical Trial Follow-up: Antenatal corticosteroids not associated with adverse neurodevelopmental outcomes in late preterm births – JAMA
2 May, 2024 | 23:25h | UTCStudy Design and Population:
This research involved a prospective follow-up study of a multicenter randomized clinical trial, specifically focusing on children aged 6 years or older whose birthing parents were enrolled in the Antenatal Late Preterm Steroids (ALPS) trial. The trial initially examined the impact of administering 12 milligrams of intramuscular betamethasone, given twice 24 hours apart, on late preterm infants (34-36 completed weeks). The follow-up study involved 949 children from 13 centers in the Maternal-Fetal Medicine Units (MFMU) Network, assessed for neurodevelopmental outcomes.
Main Findings:
The primary outcome measured was the General Conceptual Ability score less than 85 on the Differential Ability Scales, 2nd Edition (DAS-II). Results showed no statistically significant differences between the betamethasone group (17.1%) and the placebo group (18.5%) in achieving this score. Secondary outcomes related to motor function and social responsiveness also showed no significant differences between the groups. Sensitivity analyses further confirmed these findings, suggesting that the administration of betamethasone did not adversely affect neurodevelopmental outcomes at age 6 or older.
Implications for Practice:
These findings support the continued use of antenatal corticosteroids for improving short-term neonatal respiratory outcomes in late preterm deliveries without concern for long-term neurodevelopmental harm. Clinicians can consider these results reassuring, as the study effectively dispels earlier concerns about potential negative long-term effects related to neurodevelopment from antenatal steroid use in late preterm infants.
Reference (link to abstract – $ for full-text):
USPSTF Guideline: Biennial screening mammography recommended for women aged 40-74 to reduce breast cancer morbidity and mortality
1 May, 2024 | 21:45h | UTCStudy Design and Population:
The US Preventive Services Task Force (USPSTF) performed a systematic review and collaborated on modeling studies to evaluate the effectiveness of various mammography-based breast cancer screening strategies. This assessment included factors such as age of initiation and cessation of screening, screening intervals, modalities, and the use of supplemental imaging. The population studied consisted of cisgender women and all other persons assigned female at birth who are 40 years or older and at average risk of breast cancer.
Main Findings:
The USPSTF concludes with moderate certainty that biennial screening mammography for women aged 40 to 74 years provides a moderate net benefit in reducing the incidence of and progression to advanced breast cancer, as well as in decreasing breast cancer morbidity and mortality. However, the evidence is insufficient to assess the benefits and harms of mammography screening in women aged 75 and older, as well as the use of supplemental screening with ultrasound or MRI in women with dense breasts.
Implications for Practice:
Based on these findings, the USPSTF recommends biennial screening mammography for women aged 40 to 74 years. This recommendation aims to optimize breast cancer outcomes while considering the balance of benefits and harms of screening. There is a need for further research to clarify the benefits and risks associated with mammography in women older than 75 and for those with dense breasts considering supplemental screening.
Commentary on X (thread – click for more)
🧵 Just published: USPSTF recommends all women undergo routine #breastcancer screening every other year beginning at age 40, an update from the 2016 recommendation to start at age 50.
https://t.co/xDPK4qu7JH pic.twitter.com/3zVBMWeuKb— JAMA (@JAMA_current) April 30, 2024
Reference (link to free full-text):
RCT: Radiation therapy alone superior to chemoradiation in low-grade localized endometrial cancer recurrences
1 May, 2024 | 21:41h | UTCThis randomized clinical trial assessed the effectiveness of radiation therapy alone versus concurrent chemoradiation in treating localized recurrences of endometrial cancer. Conducted from February 2008 to August 2020, the study involved 165 patients who were randomized to receive either radiation therapy alone or chemoradiation with weekly cisplatin. Findings indicate that radiation therapy alone resulted in longer progression-free survival (PFS) compared to chemoradiation, with a median PFS not reached for radiation alone versus 73 months for chemoradiation. Additionally, radiation therapy demonstrated lower rates of acute toxicity. The study concluded that for patients with low-grade and primarily vaginal recurrences, radiation therapy alone is the preferable treatment option, offering excellent outcomes without the added toxicity of chemotherapy.
Reference (link to abstract – $ for full-text):
RCT: Aspirin fails to improve invasive disease-free survival in breast cancer patients
1 May, 2024 | 21:37h | UTCThis randomized clinical trial assessed the efficacy of daily aspirin (300 mg) as adjuvant therapy in reducing breast cancer recurrence among 3020 participants with high-risk nonmetastatic breast cancer across the United States and Canada. The study, which followed participants for a median of 33.8 months, found no significant benefit of aspirin on invasive disease-free survival or overall survival, with the hazard ratio for disease-free survival being 1.27 (95% CI, 0.99-1.63; P = .06) and for overall survival 1.19 (95% CI, 0.82-1.72). Given these findings, aspirin is not recommended as an adjuvant treatment for breast cancer, challenging earlier observational data that suggested a potential survival benefit in breast cancer survivors. The trial was concluded early due to the lack of observed benefits, with adverse event rates being similar in both the aspirin and placebo groups.
Commentary on X:
Among participants with high-risk nonmetastatic breast cancer, daily aspirin therapy did not improve risk of breast cancer recurrence or survival in early follow-up. https://t.co/uPWTeaqXdJ pic.twitter.com/x6Qb4bRlqF
— JAMA (@JAMA_current) April 29, 2024
Reference (link to abstract – $ for full-text):
Cohort Study: No increased risk of autism, ADHD, or intellectual disability from acetaminophen use in pregnancy
29 Apr, 2024 | 12:34h | UTCThis cohort study investigated the association between acetaminophen use during pregnancy and the risk of autism, ADHD, and intellectual disability in children. The study utilized a population-based sample of nearly 2.5 million Swedish children born between 1995 and 2019, with data analyzed up to 2021. Initial findings without sibling controls suggested a marginal increase in the risks of autism and ADHD. However, sibling control analyses, which help adjust for familial confounding, showed no significant associations (HR for autism and ADHD at 0.98, and intellectual disability at 1.01). These results imply that earlier observed risks might be due to unaccounted familial factors, not acetaminophen exposure.
Reference (link to abstract – $ for full-text):
Observational Study: Synergistic effects of early menopause and vascular risk on cognitive decline in postmenopausal women
27 Apr, 2024 | 18:20h | UTCStudy Design and Population:
This study analyzed data from 8,360 postmenopausal women and an equal number of age-matched male participants from the Canadian Longitudinal Study on Aging. Researchers assessed the independent and combined effects of age at menopause, vascular risk factors, and history of hormone therapy on cognitive outcomes. Participants’ cognitive function was measured using a global cognitive composite at baseline and again at a 3-year follow-up.
Main Findings:
The study found a synergistic interaction between early menopause (ages 35-48) and high vascular risk, significantly associated with lower cognitive scores at follow-up. Specifically, earlier menopause combined with higher vascular risk resulted in greater cognitive decline, compared to their individual effects. Notably, hormone therapy did not modify this association. This pattern was not observed in female participants with average or later menopause ages, nor in the age-matched male cohort.
Implications for Practice:
The findings underscore the importance of considering both endocrine and vascular health as predictive markers in dementia prevention strategies, particularly for women. These results suggest that women with early menopause and vascular risk factors should be closely monitored to mitigate their higher risk of cognitive impairment.
Reference (link to abstract – $ for full-text):
RCT: Free Access to Water vs. Fasting Pre-Cesarean Reduces Vomiting and Increases Maternal Satisfaction
25 Mar, 2024 | 11:17h | UTCStudy Design and Population: This randomized controlled trial was carried out at the Obstetric Unit, Universiti Malaya Medical Center from October 2020 to May 2022. A total of 504 women scheduled for planned cesarean delivery under spinal anesthesia were randomized into two groups: 252 were allowed free access to water up until being called to the operating theater, and 252 were required to fast from midnight before the procedure. The study primarily aimed to evaluate the effects of these preoperative oral intake policies on perioperative vomiting and maternal satisfaction.
Main Findings: The results demonstrated significant benefits for the group with free access to water. Specifically, perioperative vomiting was observed in 3.6% of women with water access compared to 9.5% of those fasting, indicating a relative risk reduction. Maternal satisfaction scores were notably higher in the water access group, with median scores of 9 versus 5 for the fasting group. Additional findings included lower reports of thirst, fewer instances of preoperative intravenous hydration, reduced ketone presence in urine, and a lower average number of vasopressor doses needed. Significantly, 95.2% of participants in the water access group would recommend their regimen to a friend, compared to only 39.7% in the fasting group.
Implications for Practice: Allowing free access to water up until the time of surgery for women scheduled for cesarean delivery under spinal anesthesia significantly reduces the risk of perioperative vomiting and improves maternal satisfaction, without adversely affecting post-cesarean recovery or neonatal outcomes. These findings support revising current preoperative fasting guidelines to improve patient experience and potentially enhance clinical outcomes.
Cohort Study: Elevated autism spectrum disorder risk in children exposed to valproate during pregnancy
21 Mar, 2024 | 13:16h | UTCStudy Design and Population: This cohort study utilized two health care utilization databases in the United States, covering the period from 2000 to 2020, to investigate the association between prenatal exposure to antiseizure medications and the risk of autism spectrum disorder (ASD) in children. The study compared children exposed to topiramate, valproate, or lamotrigine during the second half of pregnancy to those unexposed to any antiseizure medication, specifically focusing on a population-based cohort of pregnant women and their offspring.
Main Findings: The cumulative incidence of ASD at 8 years of age was found to be higher in children exposed to these medications compared to the general population. Notably, the incidence was 6.2% for children exposed to topiramate, 10.5% for valproate, and 4.1% for lamotrigine among children born to mothers with epilepsy. However, after adjusting for potential confounders, the increased risk of ASD remained significant only for valproate exposure, with a hazard ratio of 2.67, indicating a substantial risk compared to unexposed children. Topiramate and lamotrigine showed no significant increase in risk after adjustment.
Implications for Practice: The findings underscore the importance of carefully considering the risks and benefits of using antiseizure medications during pregnancy. Specifically, valproate should be used with caution, if at all, given its significant association with an increased risk of ASD in offspring. This study supports the need for targeted counseling and monitoring of pregnant women with epilepsy and highlights the necessity for further research to fully understand the neurodevelopmental impact of prenatal exposure to antiseizure medications.
Reference: Sonia Hernández-Díaz et al. (2024). Cohort Study: Assessing Autism Spectrum Disorder Risk in Children Exposed to Antiseizure Medications During Pregnancy. N Engl J Med, 390(13), 1069-1079. DOI: 10.1056/NEJMoa2309359. Access the study here: [Link]
Caring for two in the ICU: pharmacologic management of pregnancy-related complications
7 Aug, 2023 | 14:31h | UTCCaring for two in the ICU: Pharmacologic management of pregnancy-related complications – Pharmacotherapy (free for a limited period)
USPSTF | Reaffirming the importance of folic acid to all women planning to or who could become pregnant to prevent neural tube defects
4 Aug, 2023 | 12:15h | UTCEvidence Report: Folic Acid Supplementation to Prevent Neural Tube Defects: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force – JAMA
Patient Page: Folic Acid to Prevent Neural Tube Defects – JAMA
Commentary on Twitter
2023 Recommendation Statement from the USPSTF: all persons planning to or who could become pregnant should take a daily supplement containing 0.4 to 0.8 mg (400 to 800 μg) of folic acid (A recommendation). https://t.co/gdavbWyZZ7 pic.twitter.com/2PAjb0OCBO
— JAMA (@JAMA_current) August 1, 2023
RCT | Mammography screening with AI reduces workload by 44.3% without loss in detection efficacy
4 Aug, 2023 | 12:13h | UTCArtificial intelligence-supported screen reading versus standard double reading in the Mammography Screening with Artificial Intelligence trial (MASAI): a clinical safety analysis of a randomised, controlled, non-inferiority, single-blinded, screening accuracy study – The Lancet Oncology (link to abstract – $ for full-text)
News Release: First randomized trial finds AI-supported mammography screening is safe and almost halves radiologist workload – Lancet
Commentaries:
Large Mammography Study Shows Significant Benefits with AI-Aided Screening – Diagnostic Imaging
M-A | Antenatal corticosteroid exposure linked to negative outcomes in term-born infants
4 Aug, 2023 | 11:59h | UTCRelated Study: Association between antenatal corticosteroids and risk of serious infection in children: nationwide cohort study – The BMJ
Editorial: Antenatal corticosteroids and longer term outcomes – The BMJ
News Releases:
New studies shed more light on potential risks of antenatal steroids – BMJ Newsroom
Cohort Study | Antenatal corticosteroid exposure associated with increased incidence of pediatric serious infection
4 Aug, 2023 | 11:57h | UTCEditorial: Antenatal corticosteroids and longer term outcomes – The BMJ
M-A | Exploring perinatal interventions and their impact on severe intraventricular hemorrhage in preterm neonates
4 Aug, 2023 | 11:56h | UTC
Commentary on Twitter
A meta-analysis by @DrAbdulRazak_MD & colleagues on perinatal interventions are associated with a reduction or increase of IVH and PVL #EBNEOalerts #neoEBM #neotwitter https://t.co/SPzNHwy3HD pic.twitter.com/KDQBSYZjdq
— Evidence-Based Neo (@EBNEO) April 26, 2023
Review | Atypical hyperplasia of the breast: Clinical cases and management strategies
3 Aug, 2023 | 13:07h | UTC
BSH guideline for anticoagulant management of pregnant individuals with mechanical heart valves
2 Aug, 2023 | 14:01h | UTC
RCT | Maternal egg intake in early neonatal period does not impact infant egg allergy risk
2 Aug, 2023 | 13:47h | UTCSee also: Visual Abstract
RCT | Early vs. delayed intrauterine balloon tamponade: no difference in severe postpartum hemorrhage
2 Aug, 2023 | 13:42h | UTCEfficacy of early intrauterine balloon tamponade for immediate postpartum hemorrhage after vaginal delivery: a randomized clinical trial – The American Journal of Obstetrics and Gynecology (link to abstract – $ for full-text)
Cohort Study | History of pregnancy loss linked to higher MI and stroke risk in women, but not in male partners
1 Aug, 2023 | 14:13h | UTCCommentary: Pregnancy Loss Linked to Increased Risk of Heart Attack in Women, But Not Male Partners – HCP Live
RCT | Cervical pessary fails to prevent preterm birth in short cervix singleton pregnancies
27 Jul, 2023 | 13:06h | UTCCervical Pessary for Prevention of Preterm Birth in Individuals With a Short Cervix: The TOPS Randomized Clinical Trial – JAMA (free for a limited period)
Editorial: The Vexing Problem of Preterm Birth Prevention – JAMA (free for a limited period)
See also: Visual Abstract
News Release: Cervical pessary no more effective than usual care in preventing preterm birth risk – NIH News Releases
RCT | Zuranolone, a potential rapid-acting oral treatment for severe postpartum depression
27 Jul, 2023 | 13:00h | UTCZuranolone for the Treatment of Postpartum Depression – American Journal of Psychiatry (link to abstract – $ for full-text)
Commentary: Postpartum Depression Pill Zuralonone Shows Promise in Women With Severe Symptoms – Psychiatric News Alert
Related: RCT | Zuranolone outperforms placebo in major depressive disorder treatment
Consensus Paper | Urinary tract infections in pregnant individuals
25 Jul, 2023 | 13:53h | UTCUrinary Tract Infections in Pregnant Individuals – Obstetrics & Gynecology
Key factors associated with quality of postnatal care: a pooled analysis of 23 countries
25 Jul, 2023 | 13:50h | UTC
Cohort Study | The role of antiphospholipid syndrome and specific antibodies in predicting SLE pregnancy complications
25 Jul, 2023 | 13:44h | UTCPregnancy outcomes in 1869 pregnancies in a large cohort from the Spanish Society of Rheumatology Lupus Register (RELESSER) – Seminars in Arthritis and Rheumatism (link to abstract – $ for full-text)
Commentary: SLE and Pregnancy Outcomes – RheumNow
Systematic Review | Post-mastectomy RT likely lowers recurrence and improves survival in early breast cancer with 1-3 positive nodes
25 Jul, 2023 | 13:34h | UTC