Am. J. Obstet. Gynecol. [JOURNAL]
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200 papers
Screening for large-for-gestational-age neonates at term: evidence of a labeling effect and increased intervention without neonatal benefit.
Lopian M, Ulusoy CO, Mohamed D … +2 more , Segal E, Khalil A
Am J Obstet Gynecol · 2026 Apr · PMID 41985778 · Publisher ↗
BACKGROUND: Routine third-trimester ultrasound screening for suspected large-for-gestational-age (LGA) and macrosomic fetuses is increasingly used to guide obstetric management and reduce delivery-related morbidity. Howe...
BACKGROUND: Routine third-trimester ultrasound screening for suspected large-for-gestational-age (LGA) and macrosomic fetuses is increasingly used to guide obstetric management and reduce delivery-related morbidity. However, ultrasound estimation of fetal weight at term has limited diagnostic accuracy, and evidence supporting interventions to reduce morbidity in large fetuses remains limited. Together, these uncertainties raise questions regarding the benefit of routine ultrasound screening for fetal largeness at term. OBJECTIVE: To evaluate the diagnostic accuracy of routine third-trimester ultrasound for detecting large-for-gestational-age and macrosomic neonates at term and the impact of inaccurate prenatal diagnosis on obstetric management and perinatal outcomes. STUDY DESIGN: A retrospective cohort study of 21,743 singleton pregnancies undergoing routine 35 to 37 weeks of ultrasound at a tertiary referral center. Pregnancies with major fetal anomalies, genetic abnormalities, or missing outcome data were excluded. Estimated fetal weight ≥90th centile defined screen-positive status; birthweight ≥90th centile and >4000 g defined large-for-gestational-age and macrosomia at birth, respectively. Study outcomes included mode of delivery and composite adverse perinatal outcomes comprising maternal and neonatal outcomes. Composite adverse maternal outcomes included postpartum hemorrhage, high dependency or intensive care unit admission, obstetric anal sphincter injury, and intrapartum cesarean delivery, while composite adverse neonatal outcomes included neonatal intensive care unit admission >48 hours, continuous positive airway pressure support, mechanical ventilation, hypoxic-ischemic encephalopathy, intraventricular hemorrhage, respiratory distress syndrome, seizures, hypoglycemia, transient tachypnea of the newborn, meconium aspiration syndrome, and death. Adjusted relative risks with 95% confidence intervals were estimated using modified Poisson regression, adjusting for maternal and pregnancy characteristics. Diagnostic performance measures, including sensitivity, specificity, positive predictive value, negative predictive value, positive and negative likelihood ratios, and 95% confidence intervals, were calculated. The interval between the index test and reference standard was the time from ultrasound to delivery. Clinicians were aware of ultrasound findings, which informed counseling and management. Results are reported as adjusted relative risks with 95% confidence intervals. RESULTS: Ultrasound screening showed a sensitivity of 34.9% (33.2-36.6) for large-for-gestational-age and 35.6% (33.5-37.9) for macrosomia, with specificity of 97.4% (97.2-97.6) and 95.6% (95.3-95.9), respectively. Screen-positive pregnancies were significantly less likely to attempt labor (adjusted relative risk, 0.87; 95% confidence interval, 0.84-0.90; P<.001) and more likely to undergo intrapartum cesarean delivery (adjusted relative risk, 1.47; 95% confidence interval, 1.30-1.67; P<.001), with higher risks of composite adverse maternal (adjusted relative risk, 1.43; 95% confidence interval, 1.32-1.55; P<.001) and neonatal (adjusted relative risk, 2.37; 95% confidence interval, 1.85-3.05; P<.001) outcomes. Compared to true-positive cases, false-negative cases were associated with significantly lower rates of induction of labor (adjusted relative risk, 0.74; 95% confidence interval, 0.68-0.81; P<.001), intrapartum cesarean delivery (adjusted relative risk, 0.70; 95% confidence interval, 0.59-0.83; P<.001), and composite adverse maternal outcomes (adjusted relative risk, 0.87; 95% confidence interval, 0.77-0.98; P<.032), with no increased risk of adverse neonatal outcomes (adjusted relative risk, 0.77; 95% confidence interval, 0.56-1.06; P=.12). Compared to true-negative cases, false-positive cases experienced higher rates of operative vaginal delivery (adjusted relative risk, 1.29; 95% confidence interval, 1.07-1.57; P<.001), intrapartum cesarean delivery (adjusted relative risk, 1.25; 95% confidence interval, 1.0-1.55; P=.045), and composite adverse maternal outcomes (adjusted relative risk, 1.28; 95% confidence interval, 1.11-1.48; P<.001) with no difference in the risk of adverse neonatal outcomes (adjusted relative risk, 1.35; 95% confidence interval, 0.72-2.53; P=.347) CONCLUSION: Routine third-trimester ultrasound screening for suspected large-for-gestational-age and macrosomia demonstrates limited diagnostic performance and appears to generate a labeling effect, whereby obstetric intervention and some adverse outcomes may be influenced more by suspected large-for-gestational-age status than by fetal size itself. These findings raise questions about the benefit of universal large-for-gestational-age screening at term and support consideration of more individualized, risk-based approaches to late-pregnancy assessment.
Methodological considerations in randomized trial of third trimester ultrasound screening (reply to letter to the editor).
Familiari A, Ferrazzi E, Ghi T
Am J Obstet Gynecol · 2026 Apr · PMID 41967741 · Publisher ↗
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Prolapse phenotypes and 12-month postoperative prolapse recurrence after apical native tissue surgery: a combined analysis using multicenter randomized trials and registry data.
Weston K, Kenne KA, Bradley CS … +2 more , Wendt L, Kowalski JT
Am J Obstet Gynecol · 2026 Apr · PMID 41967740 · Publisher ↗
BACKGROUND: Recurrence after pelvic organ prolapse surgery is not uncommon, and recurrence rates differ based on baseline prolapse characteristics, such as genital hiatus size and prolapse stage. Better understanding the...
BACKGROUND: Recurrence after pelvic organ prolapse surgery is not uncommon, and recurrence rates differ based on baseline prolapse characteristics, such as genital hiatus size and prolapse stage. Better understanding the relationship between anatomic prolapse subgroups and surgical outcomes may allow surgeons to individualize treatment decisions and improve outcomes. Clinically relevant prolapse phenotypes (subgroups) defined using the Pelvic Organ Prolapse Quantification system were previously identified. Therefore, study associations between these phenotypes and surgical outcomes in a large, prospectively collected dataset are sought. OBJECTIVE: The primary aim of this study was to determine the association between a novel system of phenotyping prolapse and prolapse symptom recurrence 12 months postoperatively in women who underwent vaginal native-tissue apical prolapse surgery. Different prolapse phenotypes that would have different risks of prolapse recurrence were hypothesized. The secondary aims of the study were to determine the associations between the phenotypes and anatomic prolapse recurrence and new-onset stress urinary incontinence. STUDY DESIGN: This was a secondary analysis of data combined from 3 multicenter randomized trials and 1 prospective, multicenter patient registry. Participants from these studies who underwent uterosacral ligament suspension or sacrospinous ligament fixation without mesh and had 12-month follow-up data were included and categorized into 1 of 8 phenotypes based on the Pelvic Organ Prolapse Quantification system: (1) no prolapse (n=5, excluded), (2) isolated anterior, (3) isolated posterior, (4) isolated apical, (5) anterior and posterior, (6) anterior-predominant and apical, (7) posterior-predominant and apical, and (8) anterior and posterior and apical. The primary outcome was symptomatic recurrence 12 months after surgery, which was defined as a positive response to the Pelvic Floor Distress Inventory "bulge" question with at least "somewhat" bother. Univariate and multivariate logistic regression analyses (adjusted for prolapse stage [stage II vs stage III/IV] and previous hysterectomy) were developed for each outcome. RESULTS: Of 704 participants, most (473 [67.2%]) had anterior-predominant and apical prolapse (used as the reference group), followed by the anterior and posterior and apical (101 [14.3%]) and isolated apical (45 [6.4%]) phenotypes. Overall, 184 patients (26.1%) had sacrospinous ligament fixation, 520 patients (73.9%) had uterosacral ligament suspension, and 454 patients (64.5%) had midurethral slings. Overall, symptomatic prolapse recurrence occurred in 65 patients (9.2%), ranging from 0.0% to 29.0% across phenotype groups, and was particularly uncommon in the isolated posterior (0.0%) and isolated apical (2.2%: 1 participant) phenotypes. However, the phenotype group was not significantly associated with symptomatic recurrence in univariate or multivariate analysis. Hispanic ethnicity (odds ratio, 2.25 [95% confidence interval, 1.17-4.35]; P=.015), private insurance (odds ratio, 0.58 [95% confidence interval, 0.35-0.98]; P=.042), and vaginal parity (odds ratio, 1.19 [95% confidence interval, 1.02-1.40]; P=.030) were significantly associated with recurrence. Similarly, the phenotype was not significantly associated with anatomic recurrence or new or worsening stress urinary incontinence. CONCLUSION: Prolapse Pelvic Organ Prolapse Quantification phenotypes were not associated with symptomatic recurrence after native tissue repair surgery. Most women who underwent native tissue apical prolapse surgery have anterior-predominant and apical prolapse. Larger studies may be needed to identify differences in outcomes among less common phenotype groups.
Health outcomes following oophorectomy during benign hysterectomy in those who are in postmenopausal ages: a population-based study.
Abreu do Valle H, Salmanpour A, Kaur P … +4 more , Dawson L, Wong GC, Kwon JS, Hanley GE
Am J Obstet Gynecol · 2026 Apr · PMID 41967739 · Publisher ↗
BACKGROUND: While postmenopausal bilateral salpingo-oophorectomy during benign hysterectomy may reduce the likelihood of adnexal surgeries and the risk of ovarian cancer, more evidence is needed to evaluate the health im...
BACKGROUND: While postmenopausal bilateral salpingo-oophorectomy during benign hysterectomy may reduce the likelihood of adnexal surgeries and the risk of ovarian cancer, more evidence is needed to evaluate the health impacts of this procedure. Given the role of residual hormone secretion by postmenopausal ovaries, we hypothesize that performing bilateral oophorectomy at the time of benign hysterectomy among postmenopausal people may impact the risk of cardiovascular diseases and accelerated bone loss, both of which can significantly affect the quality of life in aging women. OBJECTIVE: To evaluate cardiovascular and bone health outcomes in people aged 50 to 60 years who did and did not undergo bilateral salpingo-oophorectomy at the time of hysterectomy. STUDY DESIGN: Retrospective population-based study using linked administrative data from British Columbia, Canada between Janaury 1, 1996 and September 30, 2019 with follow-up until December 31st, 2020. Multivariate Cox Proportional hazards models were used, adjusting for age at surgery, year of surgery, systemic menopausal hormone therapy use after surgery, and presence of baseline cardiovascular or bone health conditions up to 5 years before surgery, indication, and route of surgery. Subgroup analyses were conducted by stratifying individuals into early postmenopausal ages (50-55 years) and later postmenopausal ages (56-60 years). Statistical analyses were performed in R software version 4.0.3, STATA 16.1 (StataCorp) and SAS 9.4 (SAS Institute, Cary, NC) software. RESULTS: Of the 18,676 patients who remained in the study after applying exclusion criteria, 46.3% (n=8653) had hysterectomy with bilateral salpingo-oophorectomy. We observed no statistically significant difference in cardiovascular composite event outcomes (congestive heart failure, myocardial infarction, cerebral vascular disease, and ischemic heart disease) and cardiovascular procedure outcomes (percutaneous coronary intervention, coronary artery bypass, or cardiac catheterization) across the groups. Nevertheless, patients who had concurrent oophorectomy were at a higher risk of being diagnosed with conditions that predispose them to cardiovascular diseases, such as diabetes and hypertension (adjusted hazard ratio, 1.16; 95% confidence interval, 1.08-1.25), and were also more likely to be prescribed cardiovascular medications (adjusted hazard ratio, 1.07; 95% confidence interval, 1.00-1.15). No significant differences were observed between the groups in terms of osteoporosis, fractures, or initiating osteoporosis medication after adjustment for covariates. The likelihood of starting menopausal hormone therapy after surgery was significantly higher for those who had hysterectomy with bilateral oophorectomy compared to hysterectomy with ovarian conservation (adjusted hazard ratio, 2.04; 95% confidence interval, 1.92-2.17). Results mostly remained consistent in the subgroup analyses, especially among participants aged 50 to 55 years. CONCLUSION: Our study revealed that although removing postmenopausal ovaries at the time of benign hysterectomy is not associated with an increased risk of adverse cardiovascular or bone health-related outcomes, it might be associated with an increased risk of cardiovascular disease predisposing conditions and the need for prescribing medications for those conditions and hormone therapy. This could indicate a benefit for retaining postmenopausal ovaries at the time of benign hysterectomy among postmenopausal patients. Given the existing variation in practice, pragmatic trials are recommended to inform the decisions on performing oophorectomy in an average-risk population.
Consensus and controversies of international guidelines for the diagnosis, surveillance, and management of fetal growth restriction: an updated comparison.
Di Mascio D, Chauhan SP, Ghi T … +6 more , Khalil A, Martins JG, Sorrenti S, Stampalija T, Zullo F, Figueras F
Am J Obstet Gynecol · 2026 Apr · PMID 41967738 · Publisher ↗
Fetal growth restriction remains a major contributor to perinatal morbidity and mortality, yet its management varies across clinical settings. The aim of this study was to compare areas of consensus and disagreements acr...
Fetal growth restriction remains a major contributor to perinatal morbidity and mortality, yet its management varies across clinical settings. The aim of this study was to compare areas of consensus and disagreements across contemporary international and national guidelines on the diagnosis, surveillance, and management of fetal growth restriction. Electronic searches of Medline from database inception up to March 2026 using Medical Subject Headings terms and keywords related to fetal growth restriction and guidelines. Critical, structured comparison of national or international guidelines on fetal growth restriction published since 2010. Final inclusion required unanimous agreement from all authors. Prespecified extraction across domains: definition, prediction/prevention, surveillance tools and frequency, delivery timing and mode, and labor induction methods. Dual data checking with consensus resolution. We focused mainly on areas of cross-guideline agreement and divergence in (1) definitions (fetal growth restriction vs small for gestational age; early vs late), (2) diagnostic/surveillance tools (biometry, Doppler, cardiotocography [conventional or computerized], biophysical profile, biomarkers), and (3) management (aspirin/low-molecular-weight heparin, steroids, magnesium sulfate, induction methods, delivery timing/mode). Six guidelines, 3 national (Canada, United Kingdom, and France), 1 US society guideline (Society for Maternal-Fetal Medicine), and 2 international societies (International Society of Ultrasound in Obstetrics and Gynecology and International Federation of Gynecology and Obstetrics) published predominantly between 2015 and 2024 were included. Broad agreement exists on the central role of Doppler-especially umbilical artery and, in early-onset cases, ductus venosus (except for Society for Maternal-Fetal Medicine)-for risk stratification and delivery timing. Other consensus points include antenatal corticosteroids, magnesium sulfate for anticipated preterm birth, early aspirin in high-risk pregnancies, and access to genetic counseling/testing in severe or early-onset fetal growth restriction with structural anomalies. Universal third-trimester ultrasound is not recommended in low-risk pregnancies. Controversies remain on the definition of fetal growth restriction vs small for gestational age (Society for Maternal-Fetal Medicine biometric threshold vs Delphi criteria), routine use of angiogenic biomarkers, low-molecular-weight heparin for prevention, choice of growth charts, the role of the biophysical profile, computerized cardiotocography, and induction methods (mechanical generally favored but with limited evidence). Current guidelines converge on Doppler-based surveillance and standard preterm interventions, but substantial heterogeneity persists in definitions and several management domains, reflecting variable evidence and resource contexts. Priorities include harmonizing definitions, validating surveillance algorithms (notably computerized cardiotocography and ductus venosus), clarifying growth-chart selection, and rigorously testing the added value of angiogenic biomarkers and induction strategies to improve fetal growth restriction outcomes.
Questions about the RCT on Evaluation of LAte Iugr Screening study late third-trimester scan trial (letter to the editor).
Thornton J
Am J Obstet Gynecol · 2026 Apr · PMID 41967737 · Publisher ↗
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Uterine surgery before pregnancy is associated with later preterm birth and stillbirth: a population-based record linkage study.
Olive E, Li C, He WQ … +3 more , Davies-Tuck M, Gordon A, Nassar N
Am J Obstet Gynecol · 2026 Apr · PMID 41966510 · Publisher ↗
BACKGROUND: In high-income countries, uterine surgery is performed for the management of failed or unplanned pregnancies, for excision of polyps and fibroids, for correction of congenital anomalies, for investigation of...
BACKGROUND: In high-income countries, uterine surgery is performed for the management of failed or unplanned pregnancies, for excision of polyps and fibroids, for correction of congenital anomalies, for investigation of subfertility, and to facilitate the use of an intrauterine contraceptive device. Many women undergo at least 1 procedure before their first birth. OBJECTIVE: The study hypothesis was that any uterine surgery requiring dilation of the cervix could weaken the cervix and lead to a higher risk of preterm birth in a later pregnancy, that uterine surgery could leave endometrial scarring which might lead to later impaired placentation and increased risk of stillbirth, and that the strength of association would increase for individuals undergoing repeated surgical procedures. STUDY DESIGN: This was a population-linked data study of all first births in New South Wales, Australia, between 2007 and 2019. Linkage between the New South Wales Admitted Patient Data Collection and the Perinatal Data Collection allowed the assessment of uterine surgery exposure and subsequent obstetrical outcomes for individuals. Logistic regression was used to assess the effect of surgery and the known relevant covariates. RESULTS: There were 520,050 women who had a first birth in New South Wales between 2007 and 2019 and 99,659 uterine surgical procedures performed between 2001 and 2019. Uterine surgery occurred in 14.7% of the population. Uterine surgery before a first birth is associated with both later preterm birth (adjusted odds ratio, 1.51 [95% confidence interval, 1.47-1.55]) and stillbirth (adjusted odds ratio, 1.39 [95% confidence interval, 1.26-1.53]). The associations strengthened with repeated procedures and were most substantial at the earliest gestational age. CONCLUSION: This hypothesis-generating study suggests that uterine surgery before pregnancy should be carefully considered with reference to evidence of benefit and any available medical alternative treatment strategies. Further research is needed to understand potential confounding by indication, as the reason for surgery may independently increase pregnancy risks. Antenatal surveillance for the risk of preterm birth may be considered when surgery is unavoidable.
Associations between psychological and trauma-related factors and urinary incontinence severity and treatment response among women veterans.
Scharp D, Goldstein KM, Kelly UA … +4 more , Burgio KL, Vaughan CP, Intrator O, Markland AD
Am J Obstet Gynecol · 2026 Apr · PMID 41966509 · Full text
BACKGROUND: Psychological and trauma-related factors (ie, stress, anxiety, post-traumatic stress disorder, and military sexual trauma) may induce physiological responses that contribute to urinary incontinence. Women vet...
BACKGROUND: Psychological and trauma-related factors (ie, stress, anxiety, post-traumatic stress disorder, and military sexual trauma) may induce physiological responses that contribute to urinary incontinence. Women veterans are disproportionately affected by psychological and trauma-related factors, which may influence urinary incontinence severity and response to behavioral urinary incontinence treatment. OBJECTIVE: We aimed to examine associations between psychological and trauma-related factors and both urinary incontinence severity and response to behavioral urinary incontinence treatment among women veterans. STUDY DESIGN: We conducted a secondary analysis of data from a randomized controlled trial that evaluated the effectiveness of 2 remote urinary incontinence behavioral treatment modalities in 3 southeastern Veterans Healthcare Administration systems from April 2020 to September 2023. Urinary incontinence severity was measured with International Consultation on Incontinence-Urinary Incontinence Short Form scores to reflect urinary incontinence frequency and amount leaked. Treatment response was defined as a 2.52-point reduction in International Consultation on Incontinence-Urinary Incontinence Short Form scores and modeled as a binary outcome. Stress was assessed with the Perceived Stress Scale-10. Military sexual trauma was determined based on 2 validated Veterans Health Administration screening items. Post-traumatic stress disorder and anxiety were assessed with self-reported items indicating whether participants were ever diagnosed with these conditions. We performed bivariate analyses to examine differences in sample characteristics by treatment response status. We used linear regression models to examine associations between each psychological and trauma-related factor and urinary incontinence severity at baseline and reported β coefficients. We used logistic regression models to estimate the odds of treatment response by each psychological and trauma-related factor. RESULTS: Among 200 women veterans (mean age=54 years, standard deviation=11), the most commonly reported psychological and trauma-related factors were anxiety (138/200, 69%), military sexual trauma (120/200, 60%), and post-traumatic stress disorder (101/200, 51%), and their mean perceived stress score was 17.9 (standard deviation=8.6) indicating moderate stress. Higher levels of perceived stress (β=0.18, 95% confidence interval [0.08, 0.27], P<.001), diagnosed anxiety (β=3.35, 95% confidence interval [1.73, 4.97], P<.001), post-traumatic stress disorder (β=1.96, 95% confidence interval [0.40, 3.51], P=.02), and reported military sexual trauma (β=1.80, 95% confidence interval [0.18, 3.41], P=.03) were significantly associated with greater urinary incontinence severity after adjusting for age, race, ethnicity, education level, body mass index, vaginal parity, menopausal status, medication for urinary incontinence, hysterectomy status, and randomization group. In total, 55% (109/200) of women veterans were classified as treatment responders. Higher levels of perceived stress were associated with lower odds of response to behavioral urinary incontinence treatment in the adjusted model (adjusted odds ratio=0.98, 95% confidence interval [0.97, 0.99], P=.01). CONCLUSION: Findings highlight the importance of understanding what psychological and trauma-related factors are associated with urinary incontinence among women and underscore the need for trauma-informed, interdisciplinary approaches to urinary incontinence care to improve health outcomes.
Vaginal antisepsis should not be routinely performed prior to cesarean delivery in developed countries (reply to letter to the editor).
McKinney JA, Sanchez-Ramos L, Duncan J
Am J Obstet Gynecol · 2026 Apr · PMID 41962815 · Publisher ↗
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Uterine fibroids in Latinas: findings from the Environment, Leiomyomas, Latinas, and Adiposity Study.
Marsh EE, Jean DA, Jiang C … +6 more , Valbuena F, Harlow SD, Neff L, Carnethon M, Wegienka G, Baird DD
Am J Obstet Gynecol · 2026 Apr · PMID 41956310 · Publisher ↗
BACKGROUND: Latinos are among the fastest growing populations in the United States. While previous work indicates racial/ethnic differences in fibroid prevalence, little is known about the prevalence of this condition am...
BACKGROUND: Latinos are among the fastest growing populations in the United States. While previous work indicates racial/ethnic differences in fibroid prevalence, little is known about the prevalence of this condition among Latina females in the United States. OBJECTIVE: To determine the prevalence of fibroids among reproductive-aged Latina females and identify associated factors in this population. STUDY DESIGN: Environment, Leiomyomas, Latinas, and Adiposity Study is a prospective cohort study of Latina females, based in Southeast Michigan, and conducted using Community Based Participatory Research (CBPR) principles. Data were collected between October 2017 and October 2022, a community health clinic in Detroit, MI and at the University of Michigan's Center for Reproductive Medicine in Ann Arbor, MI. Eligible participants self-identified as Hispanic or Latina; were assigned female sex at birth; were aged 21 to 50 years at enrollment; could speak, read, and write in either English or Spanish; were not currently pregnant; and did not have an implantable electrical device, history of malignancy, or other conditions requiring chemotherapy or radiation. Fibroid symptoms were not a requirement of participation. Fibroid prevalence was rigorously established via self-reported medical history and expert administration of transvaginal ultrasounds. Participant features-including demographics, health, acculturation level, and other factors of interest-were established via surveys, interviews, and in-person measurement. RESULTS: Among Environment, Leiomyomas, Latinas, and Adiposity Study participants who completed a vaginal ultrasound (N=609 of 621 eligible), the mean age was 37.3±7.0 years and 68 (11.2%; confidence interval, 8.6%-13.8%) presented with fibroids. The majority had a single fibroid (75.0%), while 25.0% had 2 or more. The mean size of the largest fibroid-most often intramural (80.9%)-was 2.9±1.2 cm in diameter. Fibroid prevalence was found to be higher in older age groups, rising from 3.5% (confidence interval, 1.4%-10.0%) among participants aged 21 to 30 years, to 8.3% (confidence interval, 4.9%-11.7%) in those aged 31 to 40 years, and 18.7% (confidence interval, 13.3%-24.1%) in those aged between 41 and 50 years (P<.001). Logistic regression models indicated that fibroid presence was associated with younger age at menarche (adjusted odds ratio, 0.84; 95% confidence interval, 0.72-0.99) and increasing gravidity (adjusted odds ratio, 0.80; confidence interval, 0.66-0.97). Findings indicated no significant association with parity (adjusted odds ratio, 0.85; confidence interval, 0.68-1.07). CONCLUSION: Environment, Leiomyomas, Latinas, and Adiposity Study is among the first prospective studies of its size to use an ultrasound confirmation approach to establish fibroid prevalence among Latina females in the United States. Our findings suggest the prevalence of fibroids among Latina females is much lower than previously reported in the literature and markedly lower than that in Black and White women. More research is needed to understand why burden may be lower in this population and how such findings can be used to benefit all women.
Vaginal antisepsis should not be routinely performed prior to cesarean delivery in developed countries (letter to the editor).
Wiesenfeld HC
Am J Obstet Gynecol · 2026 Apr · PMID 41956309 · Publisher ↗
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Flash glucose monitoring addition to self-monitoring of blood glucose and perinatal outcomes in gestational diabetes: a randomized controlled trial.
Zorko K, Munda A, Janež A … +1 more , Pongrac Barlovič D
Am J Obstet Gynecol · 2026 Apr · PMID 41935728 · Publisher ↗
BACKGROUND: Self-monitoring of blood glucose represents the standard for glycemic monitoring in gestational diabetes mellitus, while the role of continuous glucose monitoring remains uncertain. OBJECTIVE: To assess wheth...
BACKGROUND: Self-monitoring of blood glucose represents the standard for glycemic monitoring in gestational diabetes mellitus, while the role of continuous glucose monitoring remains uncertain. OBJECTIVE: To assess whether adjunctive flash glucose monitoring improves achievement of established self-monitored glucose targets compared with self-monitoring alone and to examine maternal and neonatal outcomes. STUDY DESIGN: We conducted an open-label, single-center, randomized controlled trial comparing adjunctive flash glucose monitoring plus self-monitoring of blood glucose with self-monitoring of blood glucose alone. The prespecified primary outcome was the percentage of self-monitored glucose measurements within the established target range. Secondary outcomes included maternal and neonatal outcomes. Analyses followed the intention-to-treat principle. RESULTS: A total of 205 women (median age, 32 years; median prepregnancy body mass index, 23.5 kg/m; median gestational age, 27 weeks) were randomized (102 to adjunctive flash glucose monitoring and 103 to self-monitoring alone). The percentage of self-monitored glucose measurements within target range was lower in the adjunctive flash monitoring group (89.5% vs 92.6%, P=.04). Median fasting and 1-hour postprandial self-monitored glucose concentrations were comparable between groups and within recommended targets. The incidence of large-for-gestational-age infants was lower in the flash monitoring group (3% vs 11%; P=.05; odds ratio, 0.27; 95% confidence interval, 0.07-0.99). CONCLUSION: Adjunctive flash glucose monitoring did not improve glycemic outcome in this low-risk gestational diabetes population. However, it was associated with fewer large-for-gestational-age neonates, a secondary outcome that should be interpreted cautiously given the sample size and number of events.
New biomarkers for the detection of fetal death derived from large-scale proteomic analysis of maternal plasma.
Romero R, Bhatti G, Chaiworapongsa T … +11 more , Gomez-Lopez N, Meyyazhagan A, Chaemsaithong P, Jung E, Awonuga AO, Kim YM, Gudicha DW, Kim CJ, Bryant DR, Hassan SS, Tarca AL
Am J Obstet Gynecol · 2026 Apr · PMID 41935727 · Full text
BACKGROUND: Normal pregnancy involves the modulation of thousands of maternal plasma proteins, and protein values not within the normal range may indicate the development of adverse pregnancy outcomes. A decrease in plac...
BACKGROUND: Normal pregnancy involves the modulation of thousands of maternal plasma proteins, and protein values not within the normal range may indicate the development of adverse pregnancy outcomes. A decrease in placental growth factor and an increase in soluble fms-like tyrosine kinase 1 in maternal plasma were shown to be associated with fetal death at the time of diagnosis and to predict this devastating pregnancy outcome at 24 to 28 weeks of gestation. However, these proteomic dysregulations are also present in other obstetrical syndromes, and more specific and sensitive biomarkers are needed to implement preventive strategies. OBJECTIVE: This study aimed to identify candidate protein biomarkers that can improve the prediction of fetal death relative to placental growth factor and soluble fms-like tyrosine kinase 1. STUDY DESIGN: This retrospective case-control study included 38 patients who experienced fetal death (cases) and 23 patients with uncomplicated pregnancies (controls). Plasma samples were collected at the time of diagnosis (20-41 weeks of gestation) from cases and during routine care from gestational age-matched controls. An aptamer-based multiplex assay was used to measure the abundance of >7000 protein analytes. Differential protein abundance was assessed using linear models with adjustment for gestational age at sample collection. Significance was inferred using a moderated t test adjusted P value of <.1 and a fold change of >1.25. Hypergeometric tests were performed to identify gene ontology biological processes enriched among proteins with significant changes in abundance. Random forest models were trained and evaluated via cross-validation to distinguish between fetal death cases and controls and to pinpoint the most salient predictors. RESULTS: Among the 7146 protein assays tested, 97 assays (1.4%) corresponding to 87 unique proteins differed significantly in abundance between fetal death cases and controls: 63 of 87 proteins (72%) were less abundant in fetal death cases, and 24 of 87 proteins (26%) were more abundant in fetal death cases. Dysregulated proteins were involved in pregnancy-related processes, such as angiogenesis and lactation. Random forest models effectively differentiated fetal death cases from controls, achieving an area under the receiver operating characteristic curve of 72% for the combination of placental growth factor and soluble fms-like tyrosine kinase 1, which increased to 86% when up to 50 additional proteins were included in the models (Delong test: P=.004). In addition, the point estimate of sensitivity increased from 53% to 74% (false-positive rate of approximately 10% for both). Glycoprotein hormones alpha chain (CGA), DnaJ homolog subfamily B member 9 (DNAJB9), and DNA-directed RNA polymerase III subunit RPC10 (POLR3K) emerged as the top 3 candidates to improve discrimination relative to placental growth factor and soluble fms-like tyrosine kinase 1. The significant proteomic changes in a subset of fetal death cases diagnosed first with preeclampsia relative to controls were highly correlated (r=0.78; P<.001) with those reported in late preeclampsia cases leading to live births. On average, for each 2-fold change in protein abundance in late preeclampsia leading to live birth, there was an 8.6-fold change in preeclampsia leading to fetal death. Despite this overall correlation, transcobalamin 2, glucose-6-phosphate 1-dehydrogenase, and hepcidin, among others, demonstrated dysregulation only in preeclampsia leading to fetal death, suggesting both shared and distinct pathways perturbed in the 2 syndromes. CONCLUSION: Our findings suggest that new maternal plasma proteins improve the discrimination of fetal death from controls relative to known biomarkers and that, although the signatures of fetal death and of preeclampsia are correlated, fetal death not only represents a much heightened disease state but also involves distinct perturbed pathways. Future studies are needed to determine whether the biomarkers can predict fetal death.
Response to the necessity of algorithm version control in preeclampsia risk screening (reply to letter to the editor).
Mans-Gallart N, Axelsson D, Lilliecreutz C
Am J Obstet Gynecol · 2026 Mar · PMID 41921645 · Publisher ↗
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Differences in epigenetic age acceleration according to a diagnosis of endometriosis/adenomyosis: the Norwegian Mother, Father and Child Cohort Study.
Magnus MC, Skåra K, Hanevik HI … +5 more , Rytter D, Danielsson KC, Sharp G, Missmer SA, Lee Y
Am J Obstet Gynecol · 2026 Mar · PMID 41921644 · Publisher ↗
BACKGROUND: Women with endometriosis and adenomyosis have an increased risk of age-dependent diseases such as cardiovascular disease and cancer. Whether this reflects differences in biological age is unknown. OBJECTIVE:...
BACKGROUND: Women with endometriosis and adenomyosis have an increased risk of age-dependent diseases such as cardiovascular disease and cancer. Whether this reflects differences in biological age is unknown. OBJECTIVE: To compare the epigenetic age acceleration between women with endometriosis or adenomyosis to those without these conditions. STUDY DESIGN: We studied 234 women with endometriosis or adenomyosis and 3508 women without these conditions enrolled while pregnant into the Norwegian Mother, Father and Child Cohort Study. Epigenetic age acceleration, estimated using 7 different established clocks based on peripheral blood DNA methylation, was compared between those with and without endometriosis or adenomyosis using linear regression, with adjustment for the woman's chronological age, educational level, smoking status, body mass index, and batch at the time of blood sampling. RESULTS: In the unadjusted analysis, we observed modest epigenetic age deceleration estimated using the Horvath pan-tissue clock among those with endometriosis/adenomyosis compared to those without (mean difference in the z-score, -0.15; 95% confidence interval, -0.28 to 0.02). No notable differences were observed in the estimates of epigenetic age acceleration using the other established clocks, where the mean differences in the z-scores ranged between -0.10 and 0.06. After multivariable adjustment, the significant difference in the Horvath pan-tissue clock was attenuated (mean difference in the z-score, 0.00; 95% confidence interval, -0.13 to 0.13). CONCLUSION: We did not find evidence of meaningful differences in epigenetic age acceleration measured in peripheral blood collected during pregnancy by diagnosis with endometriosis or adenomyosis.
Response to concerns about early risk assessment and aspirin prophylaxis in Sweden (reply to letter to the editor).
Mans-Gallart N, Axelsson D, Lilliecreutz C
Am J Obstet Gynecol · 2026 Mar · PMID 41921643 · Publisher ↗
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Multidose Ibuprofen Prior to Intrauterine device insertion (MIPI): a triple blinded randomized controlled trial.
Ouyang C, Lamvu G, Quach H … +6 more , Carrillo J, Castellanos M, Wang A, Lewis H, Barish S, Feranec J
Am J Obstet Gynecol · 2026 Mar · PMID 41921642 · Publisher ↗
BACKGROUND: Intrauterine device insertion is often associated with moderate to severe pain, which poses a substantial barrier to its widespread use. While single-dose ibuprofen has shown limited efficacy, its pharmacokin...
BACKGROUND: Intrauterine device insertion is often associated with moderate to severe pain, which poses a substantial barrier to its widespread use. While single-dose ibuprofen has shown limited efficacy, its pharmacokinetics suggest a multidose, preemptive approach might be more effective by achieving sustained therapeutic concentrations. OBJECTIVE: To determine if a preemptive, multidose ibuprofen regimen reduces pain during intrauterine device insertion, decreases pain levels 24 hours postinsertion, and minimizes the need for additional pain relief within 24 hours after insertion. STUDY DESIGN: We conducted a triple-masked, randomized controlled trial. Participants were randomized to receive 3 doses of ibuprofen 800 mg or placebo over approximately 24 hours before intrauterine device insertion. The primary outcome was pain severity during intrauterine device insertion, measured by the 0 to 10 Numeric Pain Rating Scale. Secondary outcomes included 24-hour postinsertion pain and use of additional pain relief. We targeted 34 participants per group (total 68) for 80% power, analyzing data via intention to treat. Ibuprofen superiority was defined as a ≥30% reduction in mean Numeric Pain Rating Scale levels compared to placebo. The primary outcome was compared between the ibuprofen and placebo groups using the Mann-Whitney U test (for non-normally distributed data), Chi-square testing, and Fisher's exact test. RESULTS: Eighty-three participants agreed to participate and were randomized, with 42 assigned to placebo and 41 to ibuprofen. Of these, 66 participants presented for and underwent intrauterine device insertion. Insertion-related pain was substantial, with 39.4% (26/66) reporting severe pain and 42.4% (28/66) reporting moderate pain. Participants receiving preemptive multidose ibuprofen experienced significantly lower insertion pain compared with placebo (median Numeric Pain Rating Scale 5 [interquartile range, 4-7] vs 7 [interquartile range, 5-8], P=.01), representing a clinically and statistically meaningful difference. Follow-up data at 24 hours postinsertion were available for 80.3% (53/66) of participants. At 24 hours, there were no significant differences between groups in pain severity (P=.96) or use of additional analgesia (P=.76). CONCLUSION: Compared to placebo, a preemptive multidose ibuprofen regimen significantly (P=.01) reduces pain during intrauterine device insertion.
The necessity of algorithm version control in preeclampsia risk screening (letter to the editor).
Jarmund AH, Svoren ÅTR, Iversen AC
Am J Obstet Gynecol · 2026 Mar · PMID 41912019 · Publisher ↗
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Routine 36-week scan: optimizing delivery timing of large for gestational age fetuses.
Farina A, Cavoretto PI, Syngelaki A … +3 more , Mitrogiannis I, Akolekar R, Nicolaides KH
Am J Obstet Gynecol · 2026 Mar · PMID 41912018 · Publisher ↗
BACKGROUND: Large for gestational age fetuses present an increased risk of labor and delivery complications, potentially preventable through timely childbirth. OBJECTIVE: To evaluate the risk for cesarean due to fetal co...
BACKGROUND: Large for gestational age fetuses present an increased risk of labor and delivery complications, potentially preventable through timely childbirth. OBJECTIVE: To evaluate the risk for cesarean due to fetal compromise and/or failure to progress in pregnancies with large for gestational age detected at routine 36-week ultrasound scan and to identify optimal birth timing. STUDY DESIGN: Analysis of prospectively collected data from 2 UK Fetal Medicine centers including ultrasonographic estimated fetal weight at 35 to 36 weeks' gestation and outcomes. Of 107,875 pregnancies, 84,397 were analyzed after excluding prelabor cesareans and estimated fetal weight <10th percentile. The final cohort included 7695 large for gestational age (estimated fetal weight >90th percentile), of which 3384 were inductions and 4311 were spontaneous labors. A competing risk model examined labor type (spontaneous vs induced) and cesarean for fetal compromise and/or failure to progress, assessing cumulative incidence and instantaneous hazard curves. RESULTS: This study showed that: first, the hazard of cesarean delivery due to fetal compromise and/or failure to progress increases progressively with advancing gestational age with steeper rise after 40 weeks; second, at a given gestational age, the hazard is higher in nulliparous vs parous and in induction vs spontaneous labor; third, there is a gradient of hazard progression when estimated fetal weight increases from the 90th to above the 95th percentile; fourth, a policy of induction at 38 to 39 weeks for fetuses with estimated fetal weight >95th or 90th to 95th percentile approximates the hazard and cumulative incidence of large for gestational age fetuses delivering spontaneously at 40 weeks; and fifth, induction beyond 41 weeks is associated with a substantially increased risk. CONCLUSION: The findings support induction of labor at 38 weeks in cases of estimated fetal weight above the 95th percentile and at 39 weeks for estimated fetal weight between the 90th and 95th percentile, as this strategy achieves a risk of cesarean delivery due to fetal compromise and/or failure to progress comparable to that of spontaneous labor at 40 weeks, while avoiding the progressive increase in risk observed beyond 40 weeks. Alternatively, conservative management until 41 weeks may be considered, followed by elective cesarean delivery if spontaneous labor has not occurred by then, to avoid potentially harmful effects of induction at that stage, associated with a marked increase in cesarean risk.
Early risk assessment and aspirin prophylaxis did not reduce preterm preeclampsia (letter to the editor).
Amro FH, Sibai BM
Am J Obstet Gynecol · 2026 Mar · PMID 41912017 · Publisher ↗
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