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 and 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 mpetronelli@mjhlifesciences.com.

Articles

Nicola F. Tavella, MPH, dives into his team's research on postpartum depression and unplanned cesarean delivery, which was presented at SMFM's 2025 Pregnancy Meeting.

Unplanned cesarean delivery linked to higher risk of postpartum depression

Discover the latest advancements in prenatal genetic screening, the challenges preventing access, and how increased awareness can help expecting parents make informed decisions.

Dallas Reed, MD, highlights trends and barriers in prenatal genetic testing

Discover how maternal fetal medicine specialists are tackling maternal mortality disparities through trust-building, diverse care teams, and comprehensive support programs.

How maternal fetal medicine specialists improve outcomes for high-risk pregnancies

The FDA-cleared and CLIA-waived cobas liat sexually transmitted infection multiplex assay panels offer rapid, point-of-care testing for chlamydia, gonorrhea, and mycoplasma genitalium.

How the cobas liat assay panels improve STI detection

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Both undertreatment and overtreatment were common in this cohort of penicillin-allergic pregnant women with Group B Streptococcus (GBS).

Safety of cefazolin has been underestimated for GBS prophylaxis during labor

A 27-year-old woman presents with an 18-month history of vulvar irritation. She is otherwise healthy except for episodes of depression. She has tried multiple agents for her condition including topical steroids, Vagisil, antibiotics, and fluconazole. She used oral steroids but developed knee pain. Tacrolimus has not helped. A biopsy revealed lichen simplex chronicus. Immunofluorescent studies were negative.

A 27-year-old woman presents with an 18-month history of vulvar irritation. She has tried multiple agents for her condition including topical steroids, Vagisil, antibiotics, and fluconazole without relief. What's your diagnosis?

Vulvar irritation in a 27-year-old woman

The odds of conception are reduced by low antimüllerian hormone (AMH) levels, according to a recent study published in 

Over time, trends have shifted to delayed childbearing in the United States, leading many individuals to seek information about their personal fertility window. AMH has been recognized as the best available biomarker of ovarian reserve because of associations with primordial follicle counts, treatment outcomes, and time to menopause.

Currently, there is not enough evidence to determine whether AMH levels can be used when counseling patients with untested fertility. While a positive association has been reported from some research, other studies have indicated no effect.

Investigators conducted a study to further evaluate the impact of AMH levels on fertility.

 Modern Fertility customers aged 21 to 45 years submitting a blood sample between August 2018 and March 2023 were included in the analysis. Blood collection was performed using an at-home collection kit or Quest blood draw.

Eligibility criteria included tracking cycles in the Modern Fertility app, trying to conceive, and reporting when conception attempts began through an app or digital questionnaire. Blood samples had to be collected no later than 3 months after the start of conception attempts.

Exclusion criteria included a history of certain gonadal disorders and dysfunctions or premature ovarian insufficiency diagnoses. The digital questionnaire was used to collect baseline data such as weight, height, race and ethnicity, smoking status, use of assistance during conception attempts, and prior pregnancies.

Comprehensive analyses were performed for the cycle tracking data using left and right censoring techniques. AMH measurements were completed in blood samples collected by participants on day 3 of their menstrual cycle.

There were 3150 participants aged a median 31.5 years and with median AMH levels of 2.71 ng/mL included in the analysis, 42.1% of whom achieved pregnancy during follow-up. Pregnancy was more common in women who were younger, with higher AMH values, slightly lower body mass index (BMI), and no polycystic ovary syndrome diagnosis.

Increasing maternal age and BMI was associated with reduced odds of conception. When determining the odds based on AMH, low AMH levels were linked to a lower chance compared to normal AMH levels, with an adjusted odds ratio (aHR) of 0.77. No differences were reported between normal and high AMH levels.

In all AMH categories, individuals were less likely to achieve conception as they aged. Additionally, in each age category, the odds of conception were higher as AMH levels increased. The exception to this was among patients aged under 30 years, where the greatest odds were in those with normal AMH levels.

Conception was most likely in cycle 4 in all AMH categories. Probabilities for conception at cycle 4 were 11.2%, 14.3%, and 15.7% among patients with low, normal, and high AMH levels, respectively. The association between low AMH levels and reduced conception probability was reported in all cycles.

These results indicated an association between a low AMH level and reduced odds of conception at all ages. Investigators concluded this data can be used to help women plan their reproductive timeline.

Nelson SM, Shaw M, Ewing BJ, McLean K, Vechery A, Briggs SF. Antimüllerian hormone levels are associated with time to pregnancy in a cohort study of 3,150 women. 

2024;122(6):1114-1123. doi:10.1016/j.fertnstert.2024.06.024

Somigliana E, Lattuada D, Colciaghi B, et al. Serum anti-Müllerian hormone in subfertile women. 

 2015;94(12):1307-12. doi:10.1111/aogs.12761

In a recent study, patients of all age categories were less likely to conceive if they had low antimüllerian hormone levels, highlighting its potential in reproductive counseling.

Clinical

Low antimüllerian hormone levels linked to reduced odds of conception

Dysmenorrhea (DYS), nonmenstrual pelvic pain (NMPP), and fatigue are significantly improved by elagolix (ELA) with add-back (AB) therapy in patients with endometriosis, according to a recent study published in the 

American Journal of Obstetrics & Gynecology.

Approximately 10% of women worldwide are impacted by endometriosis, an inflammatory disease linked to pain and infertility. Patients with endometriosis often experience DYS, NMPP, dyspareunia (DYSP), and fatigue.

Moderate-to-severe endometriosis may be treated using ELA, an oral antagonist designed to be taken at either 150 mg once daily or 200 mg twice daily, described as low-dose therapy and high-dose therapy, respectively.

High-dose therapy has been linked to hypoestrogenic effects such as reduced bone mineral density (BMD), making the approved treatment duration limited to 6 months.

 However, these hypoestrogenic effects may be mitigated through hormonal AB therapy.

Investigators conducted a study to evaluate the safety and efficacy of ELA 200 mg twice daily plus AB (ELA+AB) in endometriosis patients. The analysis was of an ongoing phase 3, 48-month trial evaluating the regimen’s efficacy, tolerability, and impact on BMD.

Participants included women aged 18 to 49 years reporting moderate-to-severe endometriosis-associated pain within 35 days before baseline. A surgical diagnosis of endometriosis within 10 years before screening was also necessary for inclusion.

These participants were randomized 4:1:2 to receive ELA+AB therapy, 6 months of ELA 200 mg twice daily monotherapy followed by 6 months of ELA+AB therapy, or placebo, respectively. In the monotherapy group, BMD changes were compared following ELA monotherapy vs ELA+AB therapy.

Individuals with chronic pelvic pain, systemic corticosteroid use before screening, depression history or post-traumatic stress disorder diagnosis, bone disease, clinically significant medical conditions, or conditions contraindicated for AB therapy use were excluded from the analysis.

Daily DYS and NMPP assessments at month 6 were recorded as the coprimary efficacy endpoints. These symptoms were measures using the 4-point Endometriosis Daily Pain Impact Diary. Secondary efficacy endpoints included changes in DYS and NMPP at months 12, 6 and 4, fatigue, DYSP and overall endometriosis-associated pain within the past 7 days.

Treatment-emergent adverse events were reported to determine tolerability. Additionally, BMD comparisons were conducted including lumbar spine, total hip, and femoral neck assessments.

There were 681 patients randomized, with 44% discontinuing the study drug. TEAEs were reported as the most common reason for discontinuation, followed by withdrawal of consent, lost to follow-up, and other. Participants were aged a mean 32.5 years, and similar DYS, NMPP, DYSP, overall pain, and fatigue scores were reported between groups at baseline.

The ELA+AB therapy group reported significantly improved DYS and NMPP at 6 months compared to the placebo group. Responder rates for DYS were 62.8% for ELA+AB therapy vs 23.7% for placebo. For NMPP, these rates were 51.3% vs 36.8%, respectively.

An increased clinical response was also reported for DYS at 12 months in the ELA+AB therapy group vs the placebo group, at 63.8% vs 29.1%. Similarly, NMPP response rates at 12 months were 54.3% vs 42.3%, respectively. Additional improvements found from ELA+AB therapy vs placebo included DYS and NMPP at months 12, 6, and 3, and fatigue at 6 months.

TEAEs were reported in 73.8% of patients receiving ELA+AB vs 66.8% of those receiving placebo. There were no significant differences in rates of severe TEAEs between groups, and rates of TAEs leading to discontinuation were 12.6% vs 9.8%, respectively. Hot flushes, nausea, and headache were the most common TEAEs in the ELA+AB group.

Alongside the placebo group, patients in the ELA+AB therapy group had a change in BMD from baseline to month 6 and month 12 under 1%. At month 6, a statistically significant difference in mean lumbar spine changes of -0.83% was reported in the ELA+AB therapy groups vs the placebo group, but differences in total hip and femoral neck were not statistically significant.

These results indicated significant improvements in endometriosis-associated pain up to 12 months with attenuated BMD loss from ELA+AB therapy vs ELA monotherapy at 6 months. Investigators concluded ELA+AB therapy is tolerated after 12 months of treatment.

Miller CE, Kim JH, Kroll R, et al. Efficacy, tolerability, and bone density outcomes of elagolix with add-back therapy for endometriosis-associated pain: twelve months of an ongoing randomized phase 3 trial. 

 2024;231:630.e1-13. doi:10.1016/j.ajog.2024.06.040

Taylor HS, Giudice LC, Lessey BA, et al. Treatment of endometriosis-associated pain with elagolix, an oral GnRH antagonist. 

. 2017;377(1):28-40. doi:10.1056/NEJMoa1700089

In a recent study, endometriosis-associated pain was reduced among patients taking elagolix, with bone mineral density mitigated using add-back therapy.

Elagolix with add-back therapy found effective and tolerable for endometriosis pain

Chloe Getrajdman, MD, MSCR, Resident at Mount Sinai, discusses a recent study evaluating the association between the screening-to-diagnosis interval and gestational diabetes outcomes.

What is the importance of having a short interval between screening and diagnosis for gestational diabetes (GDM)?

Screening for gestational diabetes (GDM) is important in order to identify those individuals with the condition and prevent adverse maternal and fetal outcomes that can come from having this diagnosis in pregnancy. The gold standard method of screening involves a 1-hour screening test, followed by a 3-hour test if the 1-hour test is positive. Since the 3-hour test requires individuals to fast for at least 8 hours, it has to be scheduled on a day when the patient can return to the clinic fasting. This inherently creates delays in diagnosis and, ultimately and more importantly, delays in treatment. We hypothesized that a prolonged interval between screening and diagnosis of GDM would be associated with a higher likelihood of adverse maternal and fetal outcomes.

Please provide a brief overview of your study presented at SMFM 2025.

The objective of the study was to determine whether the interval between GDM screening via the 1-hour glucose challenge test (GCT) and the 3-hour glucose tolerance test (GTT) is associated with adverse perinatal outcomes. The study was a retrospective cohort study of 389 singleton, non-anomalous pregnancies from 2019 to 2022, diagnosed with GDM with this 2-step test.

What results did the study find on the association of the interval between GDM screening and diagnosis with perinatal outcomes?

The study demonstrated that the majority of patients (66.3%) had an interval of screening less than 10 days, while approximately about a third of patients (33.7%) had an interval of greater than or equal to 10 days. Patients with delayed screening were more likely to be obese (30% vs 43.7%), Black (9.4% vs 12.9%), and have public insurance. The results of the study did not demonstrate any significant difference in a composite outcome of perinatal morbidity that included macrosomia, shoulder dystocia, hypertensive disorders of pregnancy, cesarean delivery for presumed macrosomia, neonatal intensive care unit (NICU) admission, among other adverse neonatal outcomes.

What are the key clinical takeaways of this information for health care providers?

While there were no differences in our primary outcome, this study did reveal demographic differences in the population of patients who were able to undergo their 3-hour screening test within 10 days, as compared to those who completed their test greater than 10 days from the screening test. More research is needed to better understand the barriers to returning for the 3-hour test, and whether this delay between screening and diagnosis may result in other adverse outcomes not captured by this study.

Timely diagnosis of gestational diabetes is crucial for optimal maternal and fetal health, but a recent study highlights demographic disparities in screening delays and the need for further research on potential health impacts.

Screening-to-diagnosis interval vital for gestational diabetes outcomes

Researchers have identified higher concentrations of microplastics and nanoplastics in the placentae of infants born prematurely compared to those born at term, according to a study presented at the Society for Maternal-Fetal Medicine’s (SMFM) annual meeting, The Pregnancy Meeting.

Microplastics, which are less than 5 mm in size, and nanoplastics, which are too small to be seen with the naked eye, are pervasive in the environment. 

Previous research has shown that exposure to plastics can be harmful to both humans and the environment. 

The new study suggests that these tiny plastic particles may accumulate in the placenta during pregnancy and could potentially play a role in preterm births.

In collaboration with investigators at the University of New Mexico, researchers analyzed 175 placentae—100 from full-term births and 75 from preterm births (less than 37 weeks of pregnancy). Using highly sensitive mass spectrometry, they detected significantly higher levels of microplastics and nanoplastics in the placentae of preterm infants.

“Advanced technology now enables us to accurately measure microplastics in ways we haven’t been able to in the past,” said senior study author Kjersti Aagaard, MD, PhD, MSCI, a maternal-fetal subspecialist and research professor at Boston Children’s Hospital and the HCA Institute. Aagaard also serves as the medical director of the Gulf Coast Division of HCA Healthcare.

One of the study’s key findings was that plastic accumulation was not simply a byproduct of a longer pregnancy. Instead, researchers observed that preterm placentae had greater concentrations of microplastics and nanoplastics despite the shorter gestational period.

“The finding of higher placental concentrations among preterm births was surprising because it was counterintuitive to what you might expect if it was merely a byproduct of the length of time of the pregnancy,” said lead author Enrico R. Barrozo, PhD, an assistant professor in the Department of Obstetrics and Gynecology at Baylor College of Medicine and Texas Children’s Hospital in Houston.

“In other words, a preterm delivery not only accumulated more microplastics and nanoplastics in its placenta relative to term, but did so at an earlier time point in the pregnancy,” added Aagaard. “This hints at the possibility that the accumulation of plastics could be contributing to the risk and occurrence of preterm birth. When combined with other recent research, this study adds to the growing body of evidence, ranging from heart disease to potentially stroke, that demonstrates a real risk of exposure to plastics on human health and disease.”

The findings highlight the need for further research into the potential impact of plastic exposure on pregnancy and fetal development.

SMFM. New study finds high concentrations of plastics in the placentae of infants born prematurely. Eurekalert. January 30, 2025. Accessed January 30, 2025. https://www.eurekalert.org/news-releases/1071500

Researchers have identified higher concentrations of microplastics and nanoplastics in the placentae of infants born prematurely compared to those born at term, a new study finds.

Microplastics and nanoplastics found in higher concentrations in preterm placentas

First trimester hemorrhage and anemia: new insights into placenta accreta spectrum risk

A recent study led by researchers at Mount Sinai sheds light on a potential link between first-trimester hemorrhage, anemia, and placenta accreta spectrum (PAS) development. This research aims to refine risk stratification in obstetric care, potentially leading to earlier and more targeted surveillance for high-risk pregnancies.

"The motivation for this study was born out of a parental study that's currently unpublished, ongoing with our main goal of identifying non-traditional risk factors for PAS," said Henri M. Rosenberg, MD, a third-year fellow in maternal-fetal medicine at the Icahn School of Medicine at Mount Sinai in New York. "What the ultimate goal of being able at a preconception visit, or at a first OB, initial OB appointment, is being able to really scrutinize and risk stratify who needs more surveillance in this pregnancy."

The study’s findings revealed a significantly higher association between concurrent first-trimester hemorrhage and anemia with PAS. Rosenberg emphasized that while association does not imply causation, biological mechanisms could help explain the connection. "When we have hemorrhage and when we have anemia at a placental local level, there could be some local hypoxia going on, disruption of the placenta from the decidua. And in those cases, it's possible that at least so pro-inflammatory state, abnormal vascular remodeling of the arterials, and could ultimately lead to an abnormal attachment of the placenta to any prior uterine defect."

One of the most significant findings in the study was the strength of this association. "I don't think we expected to find the degree of association as high as it is, being 16 times higher for the development of PAS or diagnosis of PAS, if you have a concurrent hemorrhage and anemia," Rosenberg noted. "We think of all these traditional risk factors being prior C-sections, with or without prior previa, assisted reproductive technology, myomectomies, anything that can lead to uterine defect. But when we looked at when we compared our risk of association with the concurrent hemorrhage, it was much higher than these traditional risk factors."

Given these findings, Rosenberg reccomended heightened vigilance in obstetric care. "I think given these findings, any patient with a traditional risk factor, or non-traditional risk factors, as we're finding throughout our parent study and this secondary analysis, these patients should probably have earlier screening, possibly at a center that has experience looking and diagnosing placenta accreta spectrum."

Future research aims to further explore non-traditional risk factors and improve early diagnostic techniques. "It's important to continue to identify these non-traditional risk factors, to really risk stratify these patients and get them into earlier ultrasounds in the first trimester, possibly transvaginal if possible," Rosenberg concluded.

A new study links first-trimester hemorrhage and anemia to a higher placenta accreta spectrum risk, emphasizing early screening and non-traditional risk factors.

Bo Ram Keum, PharmD candidate

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