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A recent study reveals shifts in contraceptive preferences, highlighting increased use of natural family planning, declining reliance on hormonal methods, and the need for better access to reliable information.

Contraceptive trends indicate reduced hormone use and rise in natural methods

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Smoking cessation during pregnancy not only reduces pregnancy complications but also lowers the risk of relapse and new smoking initiation in the first postpartum year, according to a recent study.

Study highlights need for interventions to prevent postpartum smoking relapse

A recent study highlights gaps in cervical cancer screening compliance, with fewer than 50% of human papillomavirus-positive, negative for intraepithelial lesion or malignancy patients receiving recommended follow-up testing within the guideline time frame.

Timely surveillance reported in under half of HPV-positive patients

A new study reveals that high radon exposure, especially when combined with smoking or air pollution, significantly raises the risk of gestational diabetes, highlighting the impact of environmental factors on maternal health.

Radon exposure linked to increased risk of gestational diabetes

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Supplement: Closing the Gap in Cervical Cancer Screening

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Glucose is widely known as the simple sugar molecule that powers our bodies’ cells. Now, a new study reveals that it also plays a far more critical role in guiding embryonic development (embryogenesis) than scientists previously thought. The findings could offer new insights into how developmental disorders such as congenital heart defects and limb malformations arise due to problems during the early stages of embryo development.

Decades of research have shown that mechanisms such as gene regulation and cellular signaling are major drivers of embryogenesis, but given its highly intricate nature, researchers felt certain that other mechanisms must be at work. However, the other regulators were unclear. Recently, a team led by 

, assistant professor of genetics at Yale School of Medicine, discovered that glucose metabolism is one such regulator, playing a key role beyond its known function of energy production in steering embryonic development. The researchers 

“This study shows that metabolism is not just working in the background, but actively guiding our life,” says Sozen, who was the study’s principal investigator. “With these findings, we gained a new understanding of how a single nutrient [glucose] is utilized in distinct ways to guide the development of different parts of the mammalian organism.”

The theory that metabolism drives embryogenesis dates back to 1915 in a paper by University of Chicago zoologist Charles Manning Child based on his experiments with flatworms. However, these findings coincided with the explosion of revolutionary developments in molecular genetics, says Sozen, and “the theory was eclipsed.”

But over the past few years, there has been growing interest among researchers about the role of metabolism beyond fueling the body. Emerging research has started to show that metabolism also helps regulate processes such as tissue development, stem cell differentiation, and cancer. Thus, Sozen’s team grew interested in how metabolism comes together with other developmental processes in a living organism in utero. These findings could help explain why a mother's glucose metabolism is integral to ensuring that the embryo receives the necessary resources and signals for healthy development.

Glucose takes center stage in embryogenesis

In their latest study, Sozen’s team used fluorescent imaging to visualize where glucose uptake occurred within live mouse embryos developing in an incubator. They discovered that glucose uptake was specific to certain portions of the embryo at certain points in development. Specifically, they discovered two distinct waves of glucose metabolism during gastrulation, the process in which the cells of the epiblast [an early embryonic layer] migrate and rearrange to form three germ layers—ectoderm, mesoderm, and endoderm—which give rise to the body’s tissues and organs.

As the cells of the epiblast began gastrulation, researchers found, to their surprise, that glucose uptake peaked in cells at the posterior side of the embryo. “Researchers have believed that embryos utilize glucose uniformly in every developing cell,” says Sozen. “But we saw that embryos instead take in glucose in a compartmentalized way.” Then, the team observed a second wave of glucose uptake as cells migrated to form the mesoderm.

To better understand the mechanism and functions of metabolism, the team then used chemical inhibitors to block different stages of the process, and also deprived embryos of certain nutrients such as glucose. They then observed how the embryos responded. During the first wave of metabolism, their experiments suggested, the cells process glucose through a route called the Hexosamine Biosynthetic Pathway. This helps determine the “cell fate,” or future roles of cells in the epiblast. During the second wave, cells processed glucose through a different pathway called glycolysis. This time, glucose metabolism helped drive the cellular migration. “The cells are using a single nutrient, but there are two different pathways it goes through,” says Sozen.

Furthermore, these experiments revealed that metabolism drives these processes through communication with cell signals and genetic factors—two other key players in embryonic development. “At the mechanistic level, we observed glucose bioproducts are key to activate cellular signaling programs. This gives us a bigger picture of how embryogenesis occurs," says Sozen. “For an organism to grow, it needs the integration and coordination of multiple regulatory mechanisms.”

New insights for developmental disorders and more

This study, Sozen says, challenges the previously held view of metabolism as primarily a background process during embryonic development. Rather, she says, in synergy with gene regulation and cell signaling, it plays an integral role in guiding cell fate in a developing organism. Studying how these essential components work together will help researchers better understand why processes sometimes go awry and how developmental disorders arise. “If we only try to tackle developmental disorders by studying their genetic mechanisms, that might not be enough to find a solution for them,” says Sozen. “If we think about these other regulators such as metabolism, we will have a better chance at battling these kinds of conditions.”

These processes are also tightly related to regeneration, Sozen adds. Thus, studying the various mechanisms of embryogenesis could also help scientists better understand how regeneration of tissues happens and offer insights into regenerative medicine.

After glucose is metabolized, it becomes broken down into many different bioproducts. In future studies, Sozen’s team is interested in exploring how some of these bioproducts might play a role in epigenetic regulation (control of gene activity without changing the DNA sequence). Her lab also plans to investigate the mechanisms underlying how a mother’s diet during pregnancy may impact embryonic development. “If we can understand more precisely how nutrients are linking with genetic or epigenetic regulations, we can start understanding pregnancy-related conditions as well.”

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Glucose metabolism acts as a compass to guide embryonic development

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

We are pleased to share that the Vaccine Education Center (VEC) now has a dedicated 

. Previously, our vaccine videos were posted on the 

Children’s Hospital of Philadelphia YouTube channel

 where you can still find many of our videos.

The new VEC YouTube channel will serve as the hub for our vaccine-related videos moving forward. It will also include playlists featuring videos from the other two channels, and we will curate content-specific playlists to make finding related videos easier. For example, we recently added a measles-specific playlist, as well as one with videos related to pertussis.

We continue to publish our monthly newsletter, 

, which reviews federal, state, and local government roles in vaccine policy and describes four ways to influence policy change.

New YouTube channel! Also, review of vaccines and governance  

What structure or anomaly is the arrow pointing to in this image of a 20-week fetal spine?

Challenge your anatomy skills: Can you identify the spinal structure?

Clinical

Image IQ: Anatomy of the Fetal Spine

Saying "obstetrician-gynecologist" is a mouthful for most people, and it's probably the most abbreviated specialty in medicine, both spoken and written. However, there doesn't seem to be a consensus on how to pronounce OB-GYN. First, is it the two-syllable "O-B" or the monosyllabic "Ob"? Second, is it "gin" or "gyne" (like "Lyme")? I wonder if you have a preference. I know I do.

Almost nobody says "obstetrician-gynecologist" when speaking about these specialist physicians. But what's the "correct" way to pronounce OB/GYN?

Is It Ob-Gin or Ob-Gyne?

Advancements from self-collection and extended genotyping

Cervical cancer screening

, Jeff Andrews, MD, FRCSC, vice president of Medical Affairs at BD Life Sciences, discussed advancements and challenges in cervical cancer screening. 

Andrews highlighted new screening options aimed at improving accessibility. One key innovation is FDA-approved self-collection in health care settings, typically done privately, such as in bathrooms at clinics or labs. There is ongoing work to introduce self-collection options for at-home use in the United States. Additionally, the American Society for Colposcopy and Cervical Pathology is updating guidelines to incorporate extended genotyping and self-collection methods.

Andrews mentioned that the United States Preventive Services Task Force is revising its cervical cancer screening guidelines, emphasizing primary human papillomavirus (HPV) screening and including self-collection as a recommended approach. While these developments promise increased accessibility, Andrews noted that the United States lacks a national cancer screening program. Instead, cervical cancer screening is "opportunistic," meaning patients must seek it out or rely on their health care providers to initiate the conversation.

Additionally, Andrews stressed the importance of educating women about these advancements. He clarified that cervical screening aims to detect pre-cancerous conditions rather than cancer itself, enabling early treatment and prevention. HPV testing, particularly with extended genotyping, assesses the risk of pre-cancer rather than simply detecting the virus, according to Andrews.

The discussion concluded with Andrews expressing enthusiasm for the progress being made and emphasizing the need for clear communication about the benefits of extended genotyping and self-collection options. These advancements hold potential for increasing awareness, accessibility, and prevention efforts in cervical cancer care.

This video is part 2 of a 2-part series. Click 

Discover how FDA-approved self-collection and updated guidelines for cervical cancer screening are improving accessibility and empowering early prevention efforts.

Mariam Savabi, MD, MPH

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