Estimated reading time: 9 minutes
1. BV and STI co-infection
- Vaginitis and Sexually Transmitted Infections Coinfections in Obstetrics & Gynecology Open
Bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), and trichomoniasis are some of the most common causes of vaginitis, but BV also disrupts the vaginal microbiome and mucosa in ways that increase susceptibility to STI co-infections like chlamydia, gonorrhea, and trichomoniasis. In this retrospective cross-sectional study of 1.5 million women undergoing testing for vaginitis, 38.7% were positive for BV and 28.5% were positive for VVC; 10.8% were positive for both. Among those with a positive BV result, 12% also tested positive for at least one nonviral STI, compared to only 3.8% of those with a negative BV result. Positive BV results were associated with significantly increased rates of chlamydia, gonorrhea, trichomoniasis, and mycoplasma; after adjusting for demographic variables, positive VVC results were not. These data emphasize the importance of comprehensive STI testing for patients diagnosed with BV.
2. Young people’s worries about contraception and abortion access
- Young People’s Worries about Contraception and Abortion Access in the United States: A National, Cross-Sectional Study in American Journal of Preventive Medicine
Adolescents and young adults face increased barriers to reproductive and sexual healthcare services like abortion and contraception. Because this age group frequently seeks care at free or low-cost clinics, budget cuts and abortion restrictions disproportionately impact them. However, little is known about young peoples’ understanding of existing and potential threats to reproductive healthcare access. In this national cross-sectional survey conducted by Power to Decide of individuals ages 15–29 who were assigned female at birth (AFAB), roughly one quarter of respondents reported worrying about their ability to access abortion or contraception. Providers of sexual and reproductive healthcare should be aware that younger patients may have unexpressed anxieties or gaps in knowledge. These results highlight a need for this population to receive accurate and clear information about the services that they can obtain in their state or region.
3. ACOG Committee Statement on HIV screening and PrEP
- Committee Statement: Human Immunodeficiency Virus Screening and Preexposure Prophylaxis in Obstetrics & Gynecology
HIV remains a significant epidemic and disproportionately affects Black women, who make up half of new diagnoses in the United States despite comprising only 13% of the US population. This updated Committee Statement, published by the American College of Obstetricians and Gynecologists (ACOG), provides improved recommendations regarding human immunodeficiency virus (HIV), including guidance for discussions about HIV testing (which should happen at least once in a patient’s lifetime) and appropriate screening for risk factors. Healthcare providers should make sure to counsel patients regarding the prevention of sexually transmitted infections (STIs), including barrier protection and regular screening. Providers should also become familiar with the provision of preexposure prophylaxis (PrEP), which is particularly underutilized for HIV prevention in cisgender women. Despite comprising 20% of new HIV diagnoses, female individuals comprise a very small fraction of PrEP users. Providers who are less familiar with PrEP eligibility, monitoring, and side effects will find this a useful entry point, with additional resources listed for more in-depth guidance.
4. Racial Disparities in Obstetrics
- Clinician Perspectives on Navigating Conversations Around Racial Disparities in Obstetrics in Obstetrics & Gynecology
Stark racial disparities in perinatal outcomes in the United States are well-documented, with adverse outcomes disproportionately affecting Black individuals as well as other people of color. Less is known, however, about how or how often obstetric providers discuss these disparities with patients. For this study, the authors conducted in-depth interviews with 14 obstetric care providers, including resident physicians, attending physicians, and advanced practice practitioners. Participants were knowledgeable about racial disparities and recognized this topic’s importance, but noted numerous barriers to discussing it with patients, including lack of training, limited time, and concern about patients’ reluctance to discuss race. While barriers were sometimes mitigated by racial concordance between provider and patient, they were pervasive for all participants. Providers offered concrete suggestions for improvement, including simulation training, structured education, and scripted talking points. This study serves as a useful starting point for clinicians seeking to engage more intentionally on this topic.
5. Anemia trends in the United States
- Trends in Anemia and Iron Deficiency Among Nonpregnant U.S. Women of Reproductive Age, 1999–2023 in Obstetrics & Gynecology
Anemia affects almost two billion people around the world, with the vast majority having iron deficiency anemia (IDA). Reproductive-age females are particularly affected due to menstruation and the effects of pregnancy. Anemia and iron deficiency anemia (IDA) carry significant consequences for energy, cognition, and obstetrical outcomes, yet screening guidelines for non-pregnant reproductive-aged individuals remain limited. In order to encourage more clear recommendations in this setting, this research team analyzed the results of a large, national survey to assess the prevalence of anemia, iron deficiency, and IDA among non-pregnant females between the ages of 20 and 45. The authors found that the prevalence of anemia and IDA increased over this 24 year period, with no improvements in iron deficiency. Racial disparities in IDA also widened, with a much higher prevalence noted in Black reproductive-aged women when compared to their white counterparts. These findings make a strong case for updated screening recommendations in this population and highlight the need for targeted interventions to address persistent racial disparities in IDA.
6. Impacts of metabolic and bariatric surgery on pregnancy
Metabolic and bariatric surgery (MBS) is increasingly common, with 84% of patients being female and the average age of patients declining, meaning more patients have pregnancy potential after surgery. This review covers key reproductive health considerations for providers seeing patients with a history of MBS. Rapid postoperative weight loss increases fertility, but conception during this phase carries higher risks of malnutrition and micronutrient deficiencies. Accordingly, most professional societies recommend delaying conception until 12 to 18 months after MBS. Contraception counseling should be offered to reproductive aged patients planning MBS, with attention to method-specific considerations: some malabsorptive procedures may reduce the efficacy of oral contraceptives. The author also discusses prenatal care guidelines for patients with a history of MBS, including additional fetal growth monitoring and maternal monitoring and supplementation for malnutrition.
7. Evaluating early cfDNA screening
- Prenatal Cell-Free DNA Screening With Fetal Fraction Amplification at 6–9 Weeks of Gestation in Obstetrics & Gynecology
Cell-free DNA (cfDNA) screening for fetal aneuploidies is typically performed at 9-10 weeks, when sufficient fetal fraction is present in maternal blood. Using fragments of maternal and fetal DNA within the maternal bloodstream, this test can provide an early indication for diagnostic testing, such as amniocentesis. Because cfDNA screening is non-invasive, requiring only a blood sample, and is highly sensitive and specific, ACOG recommends offering it to all pregnant patients. It would be helpful, however, to provide this test earlier in pregnancy, for patients presenting to care at earlier gestational ages and who may want additional time to process their results and arrange for additional testing as needed. In this study, the authors collected blood samples before and after 10 weeks, applied fetal fraction amplification to earlier samples, and compared results. They found that cfDNA with fetal fraction amplification was a feasible test starting at 7 weeks and 3 days gestation, and that test results were concordant when compared to those performed after 10 weeks. The authors suggest that, with this amplification technique, cfDNA could potentially be offered as early as 8 weeks, though larger-scale study is needed before broader application.
8. Comparing the TCu380A and a smaller copper IUD in nulliparous patients
- Comparing the TCu380A and a small Nova-T copper IUD: secondary analysis of discontinuation probabilities, bleeding outcomes and satisfaction in nulliparous participants from a 3-year randomized trial in Contraception
While the TCu380A (Paragard) was the only available copper IUD in the US market until 2025 and is considered the international standard, other countries have additional, smaller-framed copper IUDs available. In this secondary analysis of a randomized controlled trial, the authors focused on nulliparous patients using either the TCu380A or NTCu380-Mini, a smaller frame copper IUD available in Europe. Fewer patients had discontinued their NTCu380-Mini IUDs than discontinued their TCu380A IUDs at both the 1 year and 2 year intervals (24.8% vs. 32.8% and 39.6% vs. 48.0%, respectively). The NTCu380-Mini group also had fewer discontinuations for reasons of bleeding and/or pain. Expulsion rates were also lower with the smaller device (10.0% vs. 15.1% at three years), and patient satisfaction was higher. While this device is not currently available in the US, these findings provide relevant context as the copper IUD landscape continues to expand and as providers counsel nulliparous patients on nonhormonal LARC options.
9. Postpartum sexual well-being
- Sexual well-being before and after childbirth: a prospective longitudinal study using the Female Sexual Function Index in American Journal of Obstetrics & Gynecology MFM
Childbirth is a complex physical, emotional, and psychological event that can significantly influence women’s sexual function and wellbeing. In this prospective longitudinal study of nearly 200 patients assessed at 35 weeks’ gestation and again at 6 months postpartum using the validated Female Sexual Function Index (FSFI), overall sexual function scores decreased postpartum. The authors noted several variables that predicted postpartum scores: higher pre-delivery arousal scores were correlated with higher FSFI scores postpartum, and major perineal trauma during birth was associated with lower FSFI scores. C-section birth emerged as a protective factor against significant postpartum sexual dysfunction. These data can guide providers caring for patients postpartum to screen for sexual dysfunction and proactively offer resources.
10. Efficacy and safety of new estrogen formulation
- Estetrol/drospirenone for combined oral contraception: a systematic review of efficacy, cycle control, and safety in Frontiers in Endocrinology
Most combined oral contraceptives use ethinyl estradiol (EE), but the FDA approved a pill combining estetrol and drospirenone (E4/DRSP, brand name Nextellis) in 2021. Estetrol is a plant-derived estrogen chemically identical to a native fetal estrogen, and there is interest in whether it may carry a more favorable metabolic and hemostatic profile than EE-containing pills. In this systematic review of 25 studies examining the efficacy, bleeding patterns, and safety of E4/DRSP, the authors concluded that strong evidence supported that E4/DRSP efficacy, cycle control, safety, tolerability, and adverse events were broadly in line with expectations for a combined oral contraceptive. In terms of the metabolic and hemostatic profile, high quality evidence showed that E4/DRSP had a smaller effect on hemostatic parameters such as thrombin generation, protein C resistance, D-dimer, and sex hormone binding globulin than EE-containing pills, and that metabolic effects on glucose tolerance and insulin resistance did not appear worse. The authors caution that these laboratory findings do not necessarily translate to enhanced clinical vascular safety, which will require real-world data and larger population studies to establish. Prescribing clinicians may use this early data with caution when discussing birth control pill choice with low-risk patients concerned about associated clot risk.