Towards precision medicine in clinical trials for the treatment of urologic chronic pelvic pain syndrome: lessons from the MAPP Research Network.

Stephens Shields AJ, Clemens JQ, Pontari MA, Lai HH, Moldwin R, Williams DA, Bradley CS, Farrar JT, Landis JR, Mullins C, Naliboff BD, Sutcliffe S, Walker SJ, Yang CC, Clauw DJ.

Nat Rev Urol. 2025 Apr 30. doi: 10.1038/s41585-025-01030-w. Epub ahead of print. PMID: 40307537.

Randomized clinical trials have resulted in few approved therapies for the treatment of interstitial cystitis/bladder pain syndrome and chronic prostatitis/chronic pelvic pain syndrome, collectively referred to as urologic chronic pelvic pain syndrome. Heterogenous patient populations, mismatches of treatments to patient phenotypes, non-specific outcomes and use of standard study designs not leveraging phenotypic heterogeneity might have contributed to the inability of previous trials to demonstrate existing efficacy. The Multidisciplinary Approach to the Study of Chronic Pelvic Pain Research Network has identified important phenotypic characteristics associated with differential symptom severity and treatment responsiveness. Based on Multidisciplinary Approach to the Study of Chronic Pelvic Pain findings and external research, empirically informed strategies were generated for defining patient populations, specifying treatments and selecting primary outcomes for future randomized clinical trials in urologic chronic pelvic pain syndrome. Explicitly specifying the scope of eligibility criteria across heterogeneous patient subgroups defined by pain widespreadness, the presence of Hunner lesions, the presence of pain with bladder filling or relieved by voiding, the extent of chronic overlapping pain conditions, and pelvic floor tenderness is needed. Therapies should be selected based on the mechanism of action and relevance to the mechanism of pain and dominant symptomology that the patient experiences. Evidence suggests that pain and urinary symptoms should be evaluated separately. Promising trial designs for identifying effective therapies in this heterogeneous patient population include sequential multiple assignment randomized trials and adaptive designs.

For a full text of the article, go here: https://pubmed.ncbi.nlm.nih.gov/40307537/

Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN II) Urinary Urgency Phenotyping Study: Methods and Baseline Urinary Symptoms by Age and Sex.

Ippolito GM, Kenton K, Bradley CS, Lu T, Bieber B, Clemens JQ, Kirby AC, Kirkali Z, Guerrero M, Yang CC, Kreder K, Emi Bretschneider C, Graff J, Nashif J, Griffith JW, Henry Lai H, Amundsen CL, Cameron AP; LURN Study Group.

Neurourol Urodyn. 2025 Apr 24. doi: 10.1002/nau.70044. Epub ahead of print. PMID: 40275438.

Aims: To present the methods and baseline findings from a prospective, longitudinal cohort study of treatment seeking adults with urinary urgency (URG) with or without urgency urinary incontinence (UUI).

Methods: Adults seeking treatment for URG and/or UUI and controls were enrolled. Participants completed physical examination, urine and serum studies, post-void residual, and validated questionnaires.

Results: Data from 809 participants were analyzed. Cases and controls were both predominantly white. The mean overall age of the cases was older (62 vs. 59 years) as was the mean BMI and functional comorbidity index scores. Higher proportions of controls were never smokers. Among cases, bivariate analysis found higher proportions of women reporting URG, URG with fear of leaking, any UI and UUI. Men had higher proportions of often or almost always reporting nocturia. Higher proportions of men reported URG alone and UUI without stress UI. Mixed UI was prevalent among women but rare among men. In logistic regression models, women had higher odds of SUI, UUI, and dysuria compared to men. Men had higher odds of nocturia, intermittency, splitting/spraying, and hesitancy. Older participants had higher odds of UUI, nocturia, any UI, and URG with fear of leakage whereas younger participants had higher odds of stress UI, irritative symptoms.

Conclusion: Treatment-seeking adults with URG and/or UUI were older, had higher BMI, worse functional comorbidity index and higher proportions of prior smoking history compared to controls. Among cases, sex and age differences were seen in within the spectrum of URG and UUI.

For a full text of the article, click here: https://onlinelibrary.wiley.com/doi/10.1002/nau.70044

Sexual function in women with bothersome lower urinary tract symptoms: findings from the symptoms of lower urinary tract dysfunction research network (LURN) cohort study

Bretschneider CE, Smerdon C, Bieber B, Goodrich N, Griffith J, Lai HH, Hokanson JA, Kirby AC, Smith A, Guerrero M, Gutta S, Flynn KE, John K, Bradley CS; LURN Study Group.

J Sex Med. 2025 Apr 24:qdaf063. doi: 10.1093/jsxmed/qdaf063. Epub ahead of print. PMID: 40269441.

Background: Bothersome lower urinary tract symptoms (LUTS) can negatively affect the quality of life in women, including sexual function.

Aim: The primary aim of the study was to explore the association between LUTS severity and sexual functioning among women with LUTS.

Methods: Female participants enrolled in the Symptoms of the first Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN-I) observational cohort study with a frequency rating of at least "sometimes" and a bother rating of at least "somewhat" on at least one LUTS Tool question. LUTS and sexual function were quantified by patient questionnaires at baseline, 3 months, and 12 months after study enrollment. LUTS were assessed via the LUTS Tool, while sexual function was assessed using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire, International Urogynecological Association-Revised (PISQ-IR). Longitudinal analyses were restricted to females with completed baseline and 12-month (or 3-month, if missing) questionnaires. Associations between baseline sexual function, clinical characteristics, and LUTS were analyzed using linear regression.

Outcomes: The primary outcomes were bothersome LUTS, defined by the LUTS Tool, and sexual function, defined by the PISQ-IR.

Results: Female participants (n = 528) were identified. At baseline, 245 participants were not sexually active (NSA), while 283 were sexually active (SA). Baseline characteristics of the cohort are described in Table 1; compared with NSA, SA was younger (49 vs 63 years) and more likely to be married/civil union (67% vs 43%). Less severe LUTS (10 points lower) was associated with higher (better) PISQ-IR summary and subscale scores (condition-specific, condition-impact, global quality, and arousal/orgasm subscales) for SA participants. For NSA participants, less severe LUTS was associated with higher condition-specific and condition-impact subscale scores. A subset of participants (n = 406) had follow-up data at 12 months. Longitudinally, LUTS Tool scores improved on average from baseline to 12 months by seven points, while PISQ-IR scores generally remained stable.

Clinical implications: As LUTS improves, overall sexual function in SA and NSA women remains stable.

Strengths and limitations: Strengths of the study include the use of a validated sexual function questionnaire, PISQ-IR, which captures sexual function in women who are not SA. Limitations of the study include the fact that participants presented to tertiary academic centers for care, which may limit the study's generalizability.

Conclusion: In a large cohort of women with prospectively collected data on LUTS and sexual function, sexual function largely remained stable over time even as LUTS bother improved.

For a full text of the article, click here: https://academic.oup.com/jsm/advance-article/doi/10.1093/jsxmed/qdaf063/8118850?login=true

Training, Validating, and Testing Machine Learning Prediction Models for Endometrial Cancer Recurrence.

Gonzalez Bosquet J, Polio A, George E, Tarhini AA, Cosgrove CM, Huang MS, Corr B, Leiser AL, Salhia B, Darcy K, Tarney CM, Dood RL, Dockery LE, Edge SB, Cavnar MJ, Landrum L, Rounbehler RJ, Churchman M, Wagner VM.

JCO Precis Oncol. 2025 May;9:e2400859. doi: 10.1200/PO-24-00859. Epub 2025 May 5. PMID: 40324114; PMCID: PMC12054588.

Purpose: Endometrial cancer (EC) is the most common gynecologic cancer in the United States with rising incidence and mortality. Despite optimal treatment, 15%-20% of all patients will recur. To better select patients for adjuvant therapy, it is important to accurately predict patients at risk for recurrence. Our objective was to train, validate, and test models of EC recurrence using lasso regression and other machine learning (ML) and deep learning (DL) analytics in a large, comprehensive data set.

Methods: Data from patients with EC were downloaded from the Oncology Research Information Exchange Network database and stratified into low risk, The International Federation of Gynecology and Obstetrics (FIGO) grade 1 and 2, stage I (N = 329); high risk, or FIGO grade 3 or stages II, III, IV (N = 324); and nonendometrioid histology (N = 239) groups. Clinical, pathologic, genomic, and genetic data were used for the analysis. Genomic data included microRNA, long noncoding RNA, isoforms, and pseudogene expressions. Genetic variation included single-nucleotide variation (SNV) and copy-number variation (CNV). In the discovery phase, we selected variables informative for recurrence (P < .05), using univariate analyses of variance. Then, we trained, validated, and tested multivariate models using selected variables and lasso regression, MATLAB (ML), and TensorFlow (DL).

Results: Recurrence clinic models for low-risk, high-risk, and high-risk nonendometrioid histology had AUCs of 56%, 70%, and 65%, respectively. For training, we selected models with AUC >80%: five for the low-risk group, 20 models for the high-risk group, and 20 for the nonendometrioid group. The two best low-risk models included clinical data and CNVs. For the high-risk group, three of the five best-performing models included pseudogene expression. For the nonendometrioid group, pseudogene expression and SNV were overrepresented in the best models.

Conclusion: Prediction models of EC recurrence built with ML and DL analytics had better performance than models with clinical and pathologic data alone. Prospective validation is required to determine clinical utility.

For a full text of the article, click here: https://pmc.ncbi.nlm.nih.gov/articles/PMC12054588/

Examining Perinatal Regionalization in Practice: A Network Analysis of Maternal Transport in Georgia.

Li J, Radke SM, Steimle LN.

medRxiv [Preprint]. 2025 Feb 18:2025.02.14.25322280. doi: 10.1101/2025.02.14.25322280. PMID: 40034757; PMCID: PMC11875245.

Objective: The primary objective was to use network analysis to characterize maternal transport patterns in the state of Georgia and compare them with the state's designated perinatal regions (DPRs).

Study design: Using 2017-2022 birth records in Georgia, we constructed network graphs of maternal transport routes among obstetric facilities. We used multivariate logistic regression to identify factors associated with inter-DPR transports. We applied a community-detection algorithm to cluster facilities and compared the clusters to Georgia's DPRs.

Results: Among 774 639 deliveries, 2 757 (0.36%) involved transports among obstetric facilities. 8 facility clusters were identified and strongly aligned with DPRs (p < 0.001). Inter-DRP transports tended to occur between neighboring DPRs and between facilities belonging to the same healthcare system (p < 0.001).

Conclusion: Network analysis reveals patterns of maternal transports among obstetric facilities. States can improve the design of perinatal regionalization systems by formalizing existing partnership among obstetric facilities.

For a full text of the article, click here: https://pmc.ncbi.nlm.nih.gov/articles/PMC11875245/

Women's Cardiovascular Health at Risk: An Urgent Call to Protect the U.S. Biomedical Research System and Prevent Setbacks in Women's Health Research.

Goulopoulou S, Santillan DA, Unternaehrer J.

Am J Physiol Heart Circ Physiol. 2025 May 19. doi: 10.1152/ajpheart.00182.2025. Epub ahead of print. PMID: 40388348.

This paper calls on the scientific community and academic institutions to take urgent actions to protect research and infrastructure, ensuring that hard-won gains in understanding sex-specific cardiovascular disease mechanisms are not lost in an already underfunded field. We provide a roadmap with recommended actions and implementation strategies to address challenges and threats to women's cardiovascular health research.

For a full text of the article, click here: https://journals.physiology.org/doi/abs/10.1152/ajpheart.00182.2025

Building and implementation of a common infrastructure for specimen and data storage at an academic medical center.

Santillan DA, Jacobus LS, Henry MD, Weiner GJ, Winokur PL, Knosp BM, Davis HA.

J Clin Transl Sci. 2025 Mar 19;9(1):e76. doi: 10.1017/cts.2025.43. PMID: 40384744; PMCID: PMC12083205.

Precision or "Personalized Medicine" and "Big Data" are growing trends in the biomedical research community and highlight an increased focus on access to larger datasets to effectively explore disease processes at the molecular level versus the previously common one-size-fits all approach. This focus necessitated a local transition from independent lab and siloed projects to a single software application utilizing a common ontology to create access to data from multiple repositories. Use of a common system has allowed for increased ease of collaboration and access to quality biospecimens that are extensively annotated with clinical, molecular, and patient associated data. The software needed to function at an enterprise level while continuing to allow investigators the autonomy and security access they desire. To identify a solution, a working group comprised of representation from independent repositories and areas of research focus across departments was established and responsible for review and implementation of an enterprise-wide biospecimen management system. Central to this process was the creation of a unified vocabulary across all repositories, including consensus around source of truth, standardized field definitions, and shared terminology

For a full text of the article, click here: https://pmc.ncbi.nlm.nih.gov/articles/PMC12083205/

Long term effects of parity on maternal autonomic function.

Nuckols VR, Davis KG, Santillan MK, Santillan DA, Pierce GL.

Auton Neurosci. 2025 May 2;260:103285. doi: 10.1016/j.autneu.2025.103285. Epub ahead of print. PMID: 40334523.

The mechanisms by which parity and gravidity, number of pregnancies reaching twenty weeks gestational age and total number of pregnancies, respectively, contribute to cardiovascular disease risk remains unknown. Autonomic function was assessed in 65 parous women 1-5 years after normotensive pregnancy, quantified by spontaneous cardiovagal baroreflex sensitivity (BRS) and beat-to-beat blood pressure variability (BPV). Gravidity was negatively associated with BRS independent of age and body mass index (β = -2.01, P = 0.003). A similar trend was observed with greater parity (β = -1.74, P = 0.06). Gravidity and parity were not associated with BPV. These findings suggest a persistent and cumulative adverse effect of pregnancy on cardiac autonomic function in women.

For a full text of the article, click here: https://www.sciencedirect.com/science/article/pii/S1566070225000475?via%3Dihub

Pediatric predictive testing to inform preimplantation genetic testing: A case report and review of the literature

Schaa KL, Thoeny R, Benson RJ, Pitcher GJ, Romoser S, Sidhu A.

J Genet Couns. 2025 Jun;34(3):e70053. doi: 10.1002/jgc4.70053. PMID: 40372085; PMCID: PMC12080296.

Clinical genetic testing is rapidly expanding in reproductive, pediatric, and adult specialties. We report the case of a couple's request for pediatric genetic testing for a familial Lynch syndrome pathogenic variant, with the goal of utilizing this information to perform preimplantation genetic testing (PGT) on cryopreserved embryos. We outline existing professional guidelines related to genetic testing of embryos and minors for adult-onset conditions. By highlighting conflicting perspectives from various interested parties, the significant ethical ambiguity in pediatric predictive genetic testing is underscored. This case exemplifies the value of a multidisciplinary team approach and shared decision-making model to guide parental requests for predictive genetic testing of a minor for the purpose of PGT.

For a full text of the article, click here: https://onlinelibrary.wiley.com/doi/10.1002/jgc4.70053

Influence of Race and Ethnicity on Meeting Intention to Exclusively Breast Milk Feed at Postpartum Hospital Discharge.

Costello S, Santillan D, Awelewa T, Bowdler N.

Breastfeed Med. 2025 Mar 26. doi: 10.1089/bfm.2024.0392. Epub ahead of print. PMID: 40135281.

Background: Racial/Ethnic disparities in breastfeeding practices exist despite strong evidence for significant health benefits of breastfeeding for the mother-newborn dyad. Breastfeeding intentions are known to predict breastfeeding practices at hospital discharge and breastfeeding retention in the long term. Interventions during postpartum hospitalization can help mothers achieve breastfeeding intentions and reduce racial/ethnic gaps in breastfeeding on discharge. This study aims to identify racial/ethnic disparities in meeting intentions to exclusively breast milk feed (EBMF) on hospital discharge. 

Methods: This was a retrospective cohort study of mothers who intended to EBMF and their newborns delivered at term at a single academic medical center during 2022. The primary outcome was EBMF at discharge. 

Results: Participants included non-Hispanic Black (NHB) (n = 96), Hispanic (n = 97), and non-Hispanic White (NHW) (n = 955) mothers who intended to EBMF. Mothers who identified as NHB (40.6%) or Hispanic (64.9%) were significantly less likely to EBMF compared with NHW (87.5%) mothers (odds ratio [OR] = 0.14, 95%CI [0.08, 0.23] and OR = 0.37, 95%CI [0.22, 0.61], respectively) at newborn hospital discharge. Rurality, insurance type, gravidity, parity, gestational diabetes, and birth weight were not associated with breast feeding choice/practices at discharge, but increasing age was associated with an increased likelihood of EBMF (OR = 1.07, 95%CI [1.03, 1.11]), as was neonatal intensive care unit admission (OR = 2.93, 95%CI [1.18, 7.31]). Cesarean birth was associated with decreased likelihood of EBMF (OR = 0.57, 95%CI [0.38, 0.85]). 

Conclusion: Significant racial/ethnic disparities in EBMF at hospital discharge exist among those who intended to EBMF, which are not explained by differences in other examined covariates.

For a PDF of the article, go here: Influence of Race and Ethnicity on Meeting Intention to Exclusively Breast Milk Feed at Postpartum Hospital Discharge | Breastfeeding Medicine

Umbilical Morcellation and Postoperative Pain in Patients Undergoing Benign Hysterectomy.

Gnade C, Kasper K

JSLS. 2025 Jan-Mar;29(1):e2024.00052. doi: 10.4293/JSLS.2024.00052. Epub 2025 Apr 3. PMID: 40182836; PMCID: PMC11967719.

Background: Morcellation has allowed patients with enlarged uteri to obtain a minimally invasive hysterectomy with improved outcomes; however, there is little information regarding postoperative pain. Our study aims to compare pain scores and opioid requirements in patients undergoing umbilical morcellation during benign minimally invasive hysterectomy versus those who do not require morcellation.

Methods: A retrospective cohort study was performed at a tertiary care center including patients who underwent total laparoscopic or supracervical hysterectomy by one high volume surgeon from 2019 to 2022. Baseline characteristics, postoperative pain scores, and morphine milligram equivalents in the acute and late setting were recorded. Two-sample t test for continuous variables and χ2 or Fisher's exact test for categorical variables were used to compare differences. A multiple regression model evaluated the effect of groups with the adjustment of confounders.

Results: A total of 232 patients underwent hysterectomy in which 57 underwent umbilical manual morcellation and 175 did not. There was no difference in postoperative complications, readmissions, or blood products required (P > 0.05). Individuals that underwent umbilical morcellation had longer operative times (226.6 vs 120.1 minutes, P < 0.01), more blood loss (311.1 vs 82.0 mL, P < 0.01), longer length of stay (0.60 vs 0.44 days, P < 0.01), increased uterine weight (1,293.2 vs 151.6 g, P < 0.01), and fibroid pathology (93.0% vs 46.3%, P < 0.01). There were no differences in postoperative pain scores, immediate and later opioid use between groups on multivariate analysis.

Conclusions: Patients who undergo umbilical morcellation, typically for large fibroid uteri, have similar postoperative pain scores, opioid use, and postoperative complications to those who undergo hysterectomy for other indications.

For a full text of the article, click here: https://pmc.ncbi.nlm.nih.gov/articles/PMC11967719/

ECPPF stratification identifies occult high-risk subgroups in stage I, grade 1 or 2, ≤50 % invasive endometrial cancer: Candidates for adjuvant therapy.

Gonzalez-Bosquet J, Shahi M, Yadav S, Kanwar N, Alvand S, Sosa C, Dowdy SC, Halling KC, Weroha SJ, Bakkum-Gamez JN, Podratz KC.

Gynecol Oncol. 2025 Apr 7;196:113-120. doi: 10.1016/j.ygyno.2025.03.030. Epub ahead of print. PMID: 40199195.

Objective: To determine whether stratification with ECPPF (E2F1 + CCNA2 log2 expression and POLE, PPP2R1A, and FBXW7 variants) could identify occult cases of high-risk endometrial cancer (EC) in a traditionally low-risk cohort.

Methods: We identified 97 cases of clinicopathologic low-risk endometrioid EC (defined as stage I, grade 1 or 2, limited [≤50 %] myometrial invasion) from The Cancer Genome Atlas (TCGA). Twelve cases had POLE mutations (mu) and 15 had PPP2R1Amu or FBXW7mu. Log2 CCNA2 + E2F1 expression was low (<4.75) for 56 cases and high (>4.75) for 19 (termed CCNA2 + E2F1 low or high, respectively). CCNA2 + E2F1 high and PPP2R1Amu/FBXW7mu were simultaneously present for 5 cases. Survival comparisons were based on log-rank tests.

Results: Five-year progression-free survival (PFS) curves for POLEmu and CCNA2 + E2F1 low differed substantially from CCNA2 + E2F1 high and PPP2R1mu/FBXW7mu cases (P < .001). The latter 2 subgroups, combined (n = 29) and designated as molecular high risk (MHR), had an estimated 5-year PFS <50 %. Adverse outcomes were associated with MHR for cases harboring CTNNB1mu (P < .001), ARID1Amu (P = .03), and PTENmu (P = .002). TCGA classification was not prognostically significant for this cohort (P = .10), but ECPPF MHR identified compromised subgroups within major TCGA subclasses (P = .004). CCNA2 + E2F1 high and expression of its downstream targets were positively correlated (P < .001) with expression of genes involved in chemoresistance (ie, homologous recombination, cell cycle regulation, antiapoptotic processes).

Conclusions: ECPPF supports a taxonomy in which occult, high-risk disease is identified among cases traditionally considered low risk. With high-risk cases unlikely to respond to current first-line chemotherapy, case identification should prompt proactive therapeutic intervention with alternative molecular-based treatment targets.

For a full text of the article, click here: https://www.sciencedirect.com/science/article/pii/S0090825825001076?via%3Dihub

Disrupted fetal carbohydrate metabolism in children with autism spectrum disorder.

Gumusoglu SB, Schickling BM, Santillan DA, Teesch LM, Santillan MK.

J Neurodev Disord. 2025 Mar 29;17(1):16. doi: 10.1186/s11689-025-09601-z. PMID: 40158086; PMCID: PMC11954230.

Background: Despite the power and promise of early detection and treatment in autism spectrum disorder (ASD), early-life biomarkers are limited. An early-life risk biosignature would advance the field's understanding of ASD pathogenies and targets for early diagnosis and intervention. We therefore sought to add to the growing ASD biomarker literature and evaluate whether fetal metabolomics are altered in idiopathic ASD.

Methods: Banked cord blood plasma samples (N = 36 control, 16 ASD) were analyzed via gas chromatography and mass spectrometry (GC-MS). Samples were from babies later diagnosed with idiopathic ASD (non-familial, non-syndromic) or matched, neurotypical controls. Metabolite set enrichment analysis (MSEA) and biomarker prediction were performed (MetaboAnalyst).

Results: We detected 76 metabolites in all samples. Of these, 20 metabolites differed significantly between groups: 10 increased and 10 decreased in ASD samples relative to neurotypical controls (p < 0.05). MSEA revealed significant changes in metabolic pathways related to carbohydrate metabolism and glycemic control. Untargeted principle components analysis of all metabolites did not reveal group differences, while targeted biomarker assessment (using only Fructose 6-phosphate, D-Mannose, and D-Fructose) by a Random Forest algorithm generated an area under the curve (AUC) = 0.766 (95% CI: 0.612-0.896) for ASD prediction.

Conclusions: Despite a high and increasing prevalence, ASD has no definitive biomarkers or available treatments for its core symptoms. ASD's earliest developmental antecedents remain unclear. We find that fetal plasma metabolomics differ with child ASD status, in particular invoking altered carbohydrate metabolism. While prior clinical and preclinical work has linked carbohydrate metabolism to ASD, no prior fetal studies have reported these disruptions in neonates or fetuses who go on to be diagnosed with ASD. Future work will investigate concordance with maternal metabolomics to determine maternal-fetal mechanisms.

For a full text of the article, click here: https://jneurodevdisorders.biomedcentral.com/articles/10.1186/s11689-025-09601-z

Alternative Splicing of CADM1 in Preeclampsia: Implications for Endothelial Dysfunction and Offspring Cardiovascular Risk.

Schickling B, Santillan MK, Santillan DA.

Physiol Genomics. 2025 Apr 4. doi: 10.1152/physiolgenomics.00047.2025. Epub ahead of print. PMID: 40183784.

For a full text of the article, click here: https://journals.physiology.org/doi/pdf/10.1152/physiolgenomics.00047.2025

Periods of susceptibility for associations between phthalate exposure and preterm birth: Results from a pooled analysis of 16 US cohorts.

Friedman A, Welch BM, Keil AP, Bloom MS, Braun JM, Buckley JP, Dabelea D, Factor-Litvak P, Meeker JD, Michels KB, Padmanabhan V, Starling AP, Weinberg CR, Aalborg J, Alshawabkeh AN, Barrett ES, Binder AM, Bradman A, Bush NR, Calafat AM, Cantonwine DE, Christenbury KE, Cordero JF, Engel SM, Eskenazi B, Harley KG, Hauser R, Herbstman JB, Holland N, James-Todd T, Jukic AMZ, Lanphear BP, McElrath TF, Messerlian C, Newman RB, Nguyen RHN, O'Brien KM, Rauh VA, Redmon JB, Rich DQ, Rosen EM, Sathyanarayana S, Schmidt RJ, Sparks AE, Swan SH, Wang C, Watkins DJ, Weinberger B, Wenzel AG, Wilcox AJ, Yolton K, Zhang Y, Zota AR, Ferguson KK

Environ Int. 2025 Mar 20;198:109392. doi: 10.1016/j.envint.2025.109392. Epub ahead of print. PMID: 40132438.

Background: Phthalate exposure during pregnancy has been associated with preterm birth, but mechanisms of action may depend on the timing of exposure.

Objective: Investigate critical periods of susceptibility during pregnancy for associations between urinary phthalate metabolite concentrations and preterm birth.

Methods: Individual-level data were pooled from 16 US cohorts (N = 6045, n = 539 preterm births). We examined trimester-averaged urinary phthalate metabolite concentrations. Most phthalate metabolites had 2248, 3703, and 3172 observations in the first, second, and third trimesters, respectively. Our primary analysis used logistic regression models with generalized estimating equations (GEE) under a multiple informant approach to estimate trimester-specific odds ratios (ORs) of preterm birth and significant (p < 0.20) heterogeneity in effect estimates by trimester. Adjusted models included interactions between each covariate and trimester.

Results: Differences in trimester-specific associations between phthalate metabolites and preterm birth were most evident for di-2-ethylhexyl phthalate (DEHP) metabolites. For example, an interquartile range increase in mono (2-ethylhexyl) phthalate (MEHP) during the first and second trimesters was associated with ORs of 1.15 (95 % confidence interval [CI]: 0.99, 1.33) and 1.11 (95 % CI: 0.97, 1.28) for preterm birth, respectively, but this association was null in the third trimester (OR = 0.91 [95 % CI: 0.76, 1.09]) (p-heterogeneity = 0.03).

Conclusion: The association of preterm birth with gestational biomarkers of DEHP exposure, but not other phthalate metabolites, differed by the timing of exposure. First and second trimester exposures demonstrated the greatest associations. Our study also highlights methodological considerations for critical periods of susceptibility analyses in pooled studies.

For a full text of the article, click here: https://www.sciencedirect.com/science/article/pii/S0160412025001436?via%3Dihub

Circulating extracellular vesicles protein expression for early prediction of platinum-resistance in high-grade serous ovarian cancer.

Wagner V, Morton M, Dorayappan KDP, Gonzalez A, Yu L, Sakaue T, Conrads T, Maxwell GL, Cosgrove C, Backes F, Wang QE, Cohn DE, O'Malley DM, Selvendiran K.

Oncogene. 2025 Apr 10. doi: 10.1038/s41388-025-03382-4. Epub ahead of print. PMID: 40210758.

Platinum resistance in high-grade serous ovarian carcinoma (HGSOC) portends a poor prognosis. Although initial platinum-based chemotherapy response rates are high, 15-20% of patients demonstrate primary resistance to platinum therapy and almost all patients will develop platinum resistance in the recurrent setting. No predictive or diagnostic biomarkers have been utilized specific to platinum resistance. This study aimed to identify candidate biomarkers for platinum resistance in HGSOC using an extracellular vesicle (EV) based approach. We found differentially expressed and distinct EV proteins, namely TMEM205 and CFH, in patients with platinum-resistant (PR) HGSOC compared to those of platinum-sensitive (PS) patients, utilizing liquid chromatography-tandem mass spectrometry (LC-MS/MS). Expression of these EV proteins were validated in patient-derived PR cell lines as well as in clinically relevant mouse models of HGSOC post-platinum therapy. We corroborated these findings using serum samples from patients with PS and PR-HGSOC. Both EV CFH and EV TMEM205 exhibited excellent diagnostic capability for PR as noted by receiver operating characteristic curves with area under the curve values of 0.95 and 0.84, respectively. The high diagnostic performance of TMEM205 and CFH within EVs compared to the relatively poor performance of conventional serum proteins such as Ca125 suggests their robust potential as non-invasive biomarkers for detecting platinum resistance in HGSOC. Furthermore, the ROC curve for the combined biomarker demonstrated excellent diagnostic performance, with an AUC of 0.973, a true positive rate (TPR) of 0.938, and a false positive rate (FPR) of 0.062. Incorporating this multi-protein biomarker panel alongside established biomarkers further enhances diagnostic accuracy. Serum EV CFH and TMEM205 are promising biomarkers for early detection of platinum resistance in HGSOC and may highlight underlying chemoresistance mechanisms, offering potential future therapeutic targets.

For a full text of the article, click here: https://www.nature.com/articles/s41388-025-03382-4

Gynecological Cancers Among American Indian and Alaska Native Women Living in the Upper Midwest, 1995-2019.

Ulmer KK, Greteman B, Gonzalez Bosquet J, Petereit D, Harper D, Nash SH.

Womens Health Rep (New Rochelle). 2025 Feb 25;6(1):199-208. doi: 10.1089/whr.2024.0124. PMID: 40130037; PMCID: PMC11932641

Background: American Indian and Alaska Native (AI/AN) women experience higher rates of mortality from many cancers than their non-Native counterparts.

Objective: To examine recent data on gynecological cancers (cervical, ovarian, and uterine) among AI/AN women living in the Upper Midwest (Iowa, Montana, Nebraska, North Dakota, South Dakota, and Wyoming) for any improvement in equity.

Methods: We used data from the North American Association for Central Cancer Registries Cancer in North America database (1995-2019). We used descriptive statistics, including incidence mortality rates, trends, and time to treatment. Analyses were restricted to non-Hispanic individuals living in a purchased/referred care delivery area (PRCDA) at the time of diagnosis; sensitivity analyses included all AI/AN people, regardless of PRCDA residence or ethnicity.

Results: From 1995 to 2019, there were 647 gynecological cancers diagnosed among AI/AN women living in PRCDA counties in the Upper Midwest (cervical n = 194, ovarian n = 142, uterine n = 311). Incidence and mortality rates for ovarian and uterine cancers were similar between AI/AN and non-Hispanic White (NHW) women; however, the incidence of cervical cancer was 1.87 (95% confidence interval [CI]: 1.60, 2.17) times higher, and mortality was 2.92 (95% CI: 2.29, 3.68) times higher among AI/AN compared to NHW women. The majority of AI/AN women diagnosed with gynecological cancer initiated treatment within 1 month (cervical = 67.2%, ovarian = 80.6%, uterine = 63.1%), which was similar to NHW women.

Conclusions: Differences exist in incidence and mortality for cervical cancer between AI/AN and NHW women in the Upper Midwest, with AI/AN facing continued inequity.

For a full text of the article, click here: https://www.liebertpub.com/doi/pdf/10.1089/whr.2024.0124

Metformin for patients with advanced stage ovarian cancer: A randomized phase II placebo-controlled trial.

Romero IL, Lengyel E, Wahner Hendrickson AE, Rodriguez GC, Leath CA 3rd, Rocconi RP, Goodheart MJ, Dewdney S, Karrison T, Fleming GF, Yamada SD.

Gynecol Oncol. 2025 Feb 8;194:18-24. doi: 10.1016/j.ygyno.2025.02.001. Epub ahead of print. PMID: 39923680.

Objective: The primary aim of this study was to determine if metformin, an oral biguanide administered with first-line chemotherapy and continued as maintenance therapy, improves progression-free survival (PFS) for patients with advanced-stage ovarian cancer.

Methods: Patients with pathologically confirmed advanced-stage ovarian cancer undergoing primary debulking or neoadjuvant platinum-based chemotherapy followed by surgery were eligible to participate. Patients were randomized 1:1 to receive platinum/taxane-based chemotherapy with metformin 850 mg orally twice per day or placebo, followed by maintenance therapy (metformin or placebo) for two years from the date of randomization.

Results: 108 evaluable patients were enrolled; 54 were randomly assigned to metformin, and 54 to placebo. Sixty-six percent (n = 71) received neoadjuvant therapy, 31 % (n = 33) primary debulking surgery, and 88 % (n = 93) had tumors of high-grade serous histology. The primary endpoint, PFS, was not significantly different between the treatment groups (1-sided p-value = 0.31; adjusted hazard ratio [HR] = 0.87, 95 % confidence interval [CI]: 0.56-1.36). Median PFS was 15.4 months (95 % CI: 11.2-23,5) for metformin and 14.3 months (95 % CI: 11.6-18.0) for placebo. Overall survival (OS) was not significantly different (2-sided p-value = 0.21; adjusted HR = 1.49, 95 % CI: 0.86-2.59), with a median of 40.7 months (95 % CI: 28.0-48.2) for metformin versus 43.8 months (95 % CI: 35.3-57.2) for placebo. The addition of metformin was well tolerated, and there were no differences in toxicity between the two groups.

Conclusion: Although it was well-tolerated, adding metformin to first-line platinum/taxane-based therapy does not improve PFS or OS for patients with newly diagnosed advanced stage ovarian cancer.

For a full text of the article, click here: https://www.sciencedirect.com/science/article/pii/S0090825825000289?via%3Dihub

Preterm Births and Maternal-Fetal Medicine Physician Workforce Location in the United States.

Greiner AL, Haeri S, Nidey NL.

Am J Perinatol. 2025 Mar 6. doi: 10.1055/a-2531-2783. Epub ahead of print. PMID: 40049592.

Objective: Examine for association between geographic disparity in the national maternal-fetal medicine (MFM) physician workforce distribution and preterm birth (PTB) rate in counties without MFM presence.

Study Design: Cohort study of PTBs in the United States from 2015 to 2019, utilizing National Center for Health Statistics natality data. The independent risk factor is the presence of an MFM physician in the county or county equivalent where the pregnant woman resides. Bivariate logistic regression analysis estimated the odds of county-level PTB rates higher than the national average (10.2%, March of Dimes 2019 national data) by MFM physician location.

Results: The Northeast, Southeast, and Pacific Coast regions of the United States had the highest density of physician practice locations whereas regions in the Midwest and Western United States had the lowest density. Of the 2,981 counties with PTB rates available, 90.3% (n = 2,691) did not have a practicing MFM physician. U.S. counties without an MFM physician are more likely to have a PTB rate higher than the national average, operating room (OR) = 1.56 (95% confidence interval [CI], 1.22-1.99), compared with a county with at least one MFM physician.

Conclusions: Counties with no practicing MFM physician had a 56% increase in the odds of having PTB rates higher than the national average. The lack of proximate high-risk obstetric care is a geographic health disparity associated with PTB. The location of the MFM workforce has implications for both clinical care and health policy. These data suggest that attention should be directed toward where physicians practice and to increase access to care for at-risk pregnant women. · U.S. regions with the highest concentration of MFM physicians remain unchanged from prior publications.. · Only 9.7% of counties reporting PTB data have practicing MFM physicians.. · Counties without an MFM physician have 56% higher odds of exceeding national PTB rates.. · Regional disparities in MFM physician distribution may impact maternal and neonatal outcomes..

For a full text of the article, click here: https://www.thieme-connect.de/products/ejournals/pdf/10.1055/a-2531-2783.pdf

The Impact of Frequency of Cannabis Use on Hypertensive Disorders During Pregnancy.

Nidey N, Raff E, Ferdous Khan MT, Watkins SL, McAllister JMJ, Kair L, Terplan M, Greiner A.

J Addict Med. 2025 Mar 3. doi: 10.1097/ADM.0000000000001454. Epub ahead of print. PMID: 40028912.

Objectives: Cannabis is 1 of the most commonly used substances during pregnancy, and there is mixed evidence of its impact on maternal outcomes, such as hypertensive disorders. Prior research on cannabis use during pregnancy has not accounted for use frequency, which might explain mixed results across studies. The objective of this study was to examine how frequencies of use during pregnancy are associated with hypertensive disorders.

Methods: This was a retrospective cohort study of the 2017-2018 Pregnancy Risk Assessment Monitoring System survey (n = 10,911/weighted n = 587,486). Frequency of cannabis use was categorized for analysis as follows: no use, minimal use (1 time per month or less), moderate use (2 times per month to 1 day per week), and frequent use (2-6 times per week to daily). Multivariable logistic regression models were used to examine how the frequency of cannabis use influenced the odds of experiencing hypertensive disorders during pregnancy.

Results: Cannabis use, measured as a binary exposure variable (yes/no), was not associated with higher odds of hypertension during pregnancy (odds ratio, 0.86; 95% confidence interval, 0.54, 1.35). However, among those with any cannabis use, frequent use (vs minimal use) was associated with higher odds of hypertensive disorders (odds ratio, 3.44; confidence interval, 1.40, 8.43).

Conclusions: Identifying cannabis use frequency during pregnancy can help identify maternal risk of hypertensive disorders.

For a full text of the article, click here: https://journals.lww.com/journaladdictionmedicine/fulltext/9900/the_impact_of_frequency_of_cannabis_use_on.465.aspx

Pregnancy as an opportunity to explore brain-immune connections in mental health.

Gumusoglu SB, Stelzer IA.

Sci Adv. 2025 Mar 7;11(10):eadu8270. doi: 10.1126/sciadv.adu8270. Epub 2025 Mar 5. PMID: 40043105; PMCID: PMC11881895.

Pregnancy's effects on the brain, behavior, and hormones provide a unique opportunity to study how the immune system integrates these adaptations and influences mental health.

For a full text of the article, click here: https://www.science.org/doi/pdf/10.1126/sciadv.adu8270

Pembrolizumab plus chemotherapy in advanced or recurrent endometrial cancer: overall survival and exploratory analyses of the NRG GY018 phase 3 randomized trial.

Eskander RN, Sill MW, Beffa L, Moore RG, Hope JM, Musa FB, Mannel RS, Shahin MS, Cantuaria GH, Girda E, Lokich E, Kavecansky J, Leath CA 3rd, Gien LT, Hinchcliff EM, Lele SB, Landrum LM, Backes F, O'Cearbhaill RE, Baghdadi TA, Hill EK, Thaker PH, John VS, Welch S, Fader AN, Powell MA, Aghajanian C.

Nat Med. 2025 Mar 5. doi: 10.1038/s41591-025-03566-1. Epub ahead of print. PMID: 40044930.

Historically, the treatment of patients with advanced stage or recurrent endometrial cancer included paclitaxel plus carboplatin. Immunotherapy in combination with chemotherapy resulted in improved clinical outcomes in several solid tumors. In the phase 3 NRG GY018 study, pembrolizumab plus chemotherapy significantly improved investigator-assessed progression-free survival (PFS; primary endpoint) versus placebo plus chemotherapy in patients with advanced/metastatic/recurrent endometrial cancer regardless of mismatch repair status. Here we report on key secondary endpoints and exploratory analyses. Patients were women ≥18 years old with newly diagnosed stage III or IVA endometrial cancer with measurable disease, or stage IVB or recurrent endometrial cancer with or without measurable disease. Patients (n = 810) were randomized (1:1) to pembrolizumab or placebo plus paclitaxel-carboplatin followed by maintenance pembrolizumab or placebo for up to 24 months. Overall survival was a secondary endpoint and PFS per RECIST v.1.1 by blinded independent central review was an exploratory endpoint. Overall survival data were immature; hazard ratios favored pembrolizumab (mismatch repair-proficient: 0.79 (0.53-1.17); 1-sided nominal P = 0.1157; mismatch repair-deficient: 0.55 (0.25-1.19); 1-sided nominal P = 0.0617). Hazard ratios (95% confidence intervals) for PFS per blinded independent central review favored pembrolizumab (mismatch repair-proficient: 0.64 (0.49-0.85); P = 0.0008; mismatch repair-deficient: 0.45 (0.27-0.73); P = 0.0005). These findings further support the use of pembrolizumab plus chemotherapy as first-line treatment for patients with advanced stage or recurrent endometrial cancer regardless of mismatch repair status. ClinicalTrials.gov identifier: NCT03914612 .

For a full text of the article, click here: https://www.nature.com/articles/s41591-025-03566-1

Outcomes at 12, 24, and 36 Months in Women Treated for Pelvic Organ Prolapse With Pessary or Surgery: Results From the Multicenter Pelvic Floor Disorders Registry.

Andy UU, Meyn L, Brown HW, Moalli PA, Ferrando CA, Shippey S, Omosigho UR, Kowalski JT, Guaderrama NM, Anger JT, Foster RT Sr, Gutman RE, Yurteri-Kaplan L.

Urogynecology (Phila). 2025 Feb 27. doi: 10.1097/SPV.0000000000001669. Epub ahead of print. PMID: 40043183.

Objective: The aim of this study was to describe real-world outcomes in women treated for pelvic organ prolapse (POP) with pessary or surgery over 36 months.

Study design: We report outcomes of patients in a multicenter, prospective registry who opted for treatment of POP with either pessary (discontinuation or retreatment with surgery rates and subjective improvement) or surgery (retreatment rates or subjective improvement).

Results: Among 1,153 patients, follow-up was available for 248 (84%), 123 (42%), and 98 (33%) in the pessary group and 717 (93%), 407 (53%), and 331 (43%) in the surgery group at 12, 24, and 36 months, respectively. In the pessary group, rates of discontinuation and retreatment decreased over time with 82/248 patients (33%) discontinuing pessary use at 12 months, of whom 32 (39%) had surgery, 17/123 (14%) discontinuing at 24 months, of whom 7 had surgery, and 5/98 (5%) discontinuing at 36 months, of whom 2 had surgery. Subjective recurrence rates were 76/147 (52%), 4/99 (4%), and 11/87 (13%) at 12, 24, and 36 months, respectively. In the surgery group, the rate of retreatment was 15/717 (2%), 6/407 (1%), and 5/331 (2%) and the rate of subjective recurrence was 71/717 (10%), 8/407 (2%), and 13/331 (4%) at 12, 24, and 36 months.

Conclusions: In this real-world registry, we observed that approximately one third of patients discontinued pessary use during the first 12 months, which decreased over time. There were low rates of reintervention following surgical management over the 36-month period. Our data provide valuable information that may be helpful for clinicians in counseling patients about management of their POP.

For a full text of the article, click here: https://journals.lww.com/fpmrs/fulltext/9900/outcomes_at_12,_24,_and_36_months_in_women_treated.360.aspx

A randomized phase II/III study of paclitaxel/carboplatin/metformin versus paclitaxel/carboplatin/placebo as initial therapy for measurable stage III or IVA, stage IVB, or recurrent endometrial cancer: An NRG oncology/GOG study.

Bae-Jump VL, Sill MW, Gehrig PA, Merker JD, Corcoran DL, Pfefferle AD, Hayward MC, Walker JL, Hagemann AR, Waggoner SE, O'Cearbhaill RE, McDonald ME, Edelson MI, DiSilvestro PA, McNally AL, Fleury A, Littell RD, Ueland FR, Lankes HA, Aghajanian C.

Gynecol Oncol. 2025 Mar 7;195:66-74. doi: 10.1016/j.ygyno.2025.03.003. Epub ahead of print. PMID: 40056832.

Introduction: We evaluated the efficacy of the addition of the anti-diabetic drug metformin to standard-of-care paclitaxel and carboplatin (PC) in patients with advanced and recurrent endometrial cancer (EC).

Methods: In this phase II/III trial, EC patients with chemotherapy-naïve stage III/IVA (with measurable disease) and stage IVB or recurrent (with or without measurable disease) disease were randomly assigned to PC/metformin (850 mg BID) versus PC/placebo. Metformin or placebo was continued as maintenance therapy after completion of PC until disease progression. The primary endpoint of phase II was progression-free survival (PFS). The primary endpoint of phase III was overall survival (OS). Secondary endpoints were objective response, duration of response, and toxicity.

Results: From 3/17/2014 to 12/22/2017, 448 patients were randomized to phase II/III studies, and the data were frozen for interim analysis. The phase II study deemed metformin worthy of further investigation in the phase III study. The interim phase III analysis stopped accrual for futility on 2/1/2018. The addition of metformin to PC had a slightly higher hazard of death compared to the PC regimen (HR = 1.088; 90% CI 0.803 to 1.475), which was sufficient to close the study early. The PFS had (HR = 0.814; 90% CI 0.635 to 1.043). At a median follow-up of 10 months and 121 deaths, median OS was not determined and 28 months, on PC/placebo and PC/metformin, respectively.

Conclusion: The hazard ratios for PFS and OS endpoints was not sufficiently decreased with the addition of metformin to PC to justify continuing the trial.

For a full text of the article, click here: https://www.sciencedirect.com/science/article/pii/S0090825825000721?via%3Dihub

Racial/ethnic disparities in the association of maternal diabetes and obesity with risk of preterm birth among 17 million mother-infant pairs in the United States: a population-based cohort study.

Xie J, Yan Y, Ye Z, Wu Y, Yu Y, Sun Y, Rong S, Santillan DA, Ryckman K, Snetselaar LG, Liu B, Bao W.

BMC Pregnancy Childbirth. 2025 Mar 21;25(1):333. doi: 10.1186/s12884-025-07352-2. PMID: 40119308; PMCID: PMC11929260.

Background: The racial/ethnic disparities in the prevalence of obesity, diabetes, and adverse birth outcomes such as preterm delivery indicate that it is essential to account for the varying risks associated with pregnant women of different races and ethnics during clinical prenatal examinations. However, the racial and ethnic disparities in how pre-pregnancy diabetes in mothers relates to preterm birth as well as the combined association of maternal diabetes and pre-pregnancy obesity with preterm birth remain unclear. In this study, we aimed to 1) examine the racial/ethnic disparities in the association of maternal diabetes including gestational diabetes mellitus (GDM) and pre-pregnancy diabetes with preterm birth 2) and the racial/ethnic disparities in the joint associations of maternal diabetes and pre-pregnancy obesity with preterm birth.

Methods: In this population-based cohort study, we included 17,027,792 mothers documented in the National Vital Statistic System in the U.S. from 2016 to 2020. All these data were analyzed in 2021. Maternal pre-pregnancy diabetes was defined as having diabetes diagnosed prior to this pregnancy, and GDM was defined as having newly diagnosed diabetes in this pregnancy. Pre-pregnancy BMI (kg/m2) was classified as underweight (< 18.5 kg/ m2), normal weight (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), obesity class I (30.0-34.9 kg/m2), obesity class II (35.0-39.9 kg/m2), and obesity class III (≥ 40 kg/m2). Preterm birth, defined as delivery occurring at less than 37 weeks of gestation, was the main outcome of interest. We further categorized preterm birth into three subtypes: extremely (< 28 weeks), very (28-31 weeks), and moderately (32-36 weeks) preterm birth. Logistic regression models were used for association analyses in this study.

Results: Among 17,027,792 mothers (mean age: 29.4 ± 5.4 years), 1,374,286 (8.07%) mothers delivered a preterm infant. Women with pre-pregnancy diabetes had the highest risk of preterm birth followed by women with GDM overall and across all racial/ ethnic groups. However, from pre-pregnancy underweight to obesity III, the magnitude of the association between pre-pregnancy diabetes and preterm birth decreased for non-Hispanic Black women (underweight, 4.47 [3.34-5.99], normal weight 4.28 [3.98-4.60], overweight 3.29 [3.11-3.49], obesity I 3.09 [2.93-3.26], obesity II 2.98 [2.82-3.16], obesity III 3.19 [3.04-3.35]), while it showed an increasing trend for non-Hispanic Asians ( underweight 1.45 [0.91-2.30], normal weight 2.16 [1.90-2.47], overweight 2.71 [2.47-2.97], obesity I 3.10 [2.82-3.41], obesity II 3.58 [3.13-4.09], obesity III 3.99 [3.34-4.77]). The corresponding OR was (underweight 4.33 [3.21-5.83], normal weight 3.69 [3.47-3.93], overweight 3.26 [3.10-3.42], obesity I 3.33 [3.19-3.49], obesity II 3.47 [3.29-3.65], obesity III 3.89 [3.68-4.11]) among Hispanics and (underweight 5.17 [4.34-6.17], normal weight 5.01 [4.83-5.21], overweight 4.98 [4.80-5.17], obesity I 4.66 [4.48-4.85], obesity II 4.58 [4.38-4.79], obesity III 4.50 [4.31-4.69]) among non-Hispanic White. Comprehensive analysis of the association between diabetes, pre-pregnancy diabetes, obesity, ethnicity, and preterm birth found that compared to white women with normal weight and normal blood glucose levels, any other racial\ethnic group has an elevated risk of preterm birth, particularly when accompanied by unhealthy weight, GDM, or pre-pregnancy diabetes. Specifically, non-Hispanic Black individuals with normal blood sugar levels (1.69 [1.67-1.70]) have a higher risk of preterm birth than non-Hispanic White individuals with GDM (1.37 [1.35-1.40]). Similarly, Asian pregnant women with class 2 and class 3 obesity (1.72 [1.65-1.78], 1.96 [1.83-2.10]), as well as Hispanic pregnant women with class 2 and class 3 obesity (1.46 [1.44-1.48], 1.64 [1.61-1.67]), also have a higher risk of preterm birth than white women with GDM 1.37 [1.35-1.40].

Conclusions: In conclusion, while both pre-pregnancy diabetes and GDM were significantly associated with preterm birth, the associations varied by race/ethnicity. The risk of preterm birth for GDM increased with increasing BMI in all race/ethnicity groups. However, the pattern of the joint association of pre-pregnancy diabetes and BMI levels with preterm birth differed by race/ethnicity. Future studies on the underlying mechanisms of the racial/ethnic disparities in the association of diabetes and obesity with preterm birth are needed.

For a full text of the article, click here: https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-025-07352-2

Enhancing Progestin Therapy with a Glucagon-Like Peptide 1 Agonist for the Conservative Management of Endometrial Cancer.

Hagemann AR, Hagemann IS, Mutch DG, Devor EJ, Malmrose PK, Zhang Y, Morrison AM, Thiel KW, Leslie KK.

Cancers (Basel). 2025 Feb 10;17(4):598. doi: 10.3390/cancers17040598. PMID: 40002193; PMCID: PMC11853405.

Objective: Obesity is a major risk factor for endometrial cancer. In addition to hormone therapy with progestins, glucagon like peptide-1 receptor (GLP-1R) agonists such as semaglutide may be helpful to achieve weight loss during conservative treatment of endometrial hyperplasia or cancer.

Methods: We theorized that the combination of semaglutide and the progestin levonorgestrel would be useful as a novel treatment or prevention regimen and tested this hypothesis using endometrial cancer cell lines and patient-derived organoids (PDOs).

Results: Hec50, KLE, and Ishikawa endometrial cancer cells express GLP-1R, as determined by both qPCR and Western blotting, and GLP-1R agonist treatment induces GLP-1R mRNA transcription through positive feedback mechanisms in cell models. PDOs from six individuals with grade 1 endometrial carcinomas were treated with progesterone, levonorgestrel, semaglutide, or levonorgestrel + semaglutide. Multiple models demonstrated a significant reduction in viability in response to combinatorial treatment, and the effect was noted in models from both PR high- and PR low-expressing tumors. Most interesting was the induction not only of the membrane GLP-1R with treatment, but also the significant upregulation of nuclear and membrane progesterone receptors-PR and PGRMC1/2, respectively-indicating a potential positive feedback loop between semaglutide and progestins such as levonorgestrel.

Conclusion: In summary, we identify synergistic molecular cross-talk between the GLP-1R and steroid hormone receptor pathways, with the potential to enhance the anticancer activity of levonorgestrel when combined with semaglutide.

For a full text of the article, click here: https://www.mdpi.com/2072-6694/17/4/598

Identification of Ovarian High-Grade Serous Carcinoma with Mitochondrial Gene Variation.

Gonzalez Bosquet J, Wagner V, Polio A, Linder KE, Bender DP, Goodheart MJ, Schickling BM.

Int J Mol Sci. 2025 Feb 5;26(3):1347. doi: 10.3390/ijms26031347. PMID: 39941116; PMCID: PMC11818617.

Women diagnosed with advanced-stage ovarian cancer have a much worse survival rate than women diagnosed with early-stage ovarian cancer, but the early detection of this disease remains a clinical challenge. Some recent reports indicate that genetic variations could be useful for the early detection of several malignancies. In this pilot observational retrospective study, we aimed to assess whether mitochondrial DNA (mtDNA) variations could discriminate the most frequent type of ovarian cancer, high-grade serous carcinoma (HGSC), from normal tissue. We identified mtDNA variations from 20 whole-exome sequenced (WES) HGSC samples and 14 controls (normal tubes) using the best practices of genome sequencing. We built prediction models of cancer with these variants, with good performance measured by the area under the curve (AUC) of 0.88 (CI: 0.74-1.00). The variants included in the best model were correlated with gene expression to assess the potentially affected processes. These analyses were validated with the Cancer Genome Atlas (TCGA) dataset, (including over 420 samples), with a fair performance in AUC terms (0.63-0.71). In summary, we identified a set of mtDNA variations that can discriminate HGSC with good performance. Specifically, variations in the MT-CYB gene increased the risk for HGSC by over 30%, and MT-CYB expression was significantly decreased in HGSC patients. Robust models of ovarian cancer detection with mtDNA variations could be applied to liquid biopsy technology, like those which have been applied to other cancers, with a special focus on the early detection of this lethal disease.

For a full text of the article, click here: https://www.mdpi.com/1422-0067/26/3/1347

Vaccines in Pregnancy: An Update on Recommendations From CDC's Advisory Committee on Immunization Practices.

Rasmussen SA, Kim J, Jamieson DJ.

Birth Defects Res. 2025 Feb;117(2):e2459. doi: 10.1002/bdr2.2459. PMID: 39996387.

Vaccinations in pregnancy are an essential part of prenatal care and play a critical role in protecting both pregnant persons and their infants from certain infectious diseases. In the United States, recommendations for vaccines are made through a comprehensive review of currently available scientific literature, including clinical trials and post-marketing surveillance data, by the Advisory Committee on Immunization Practices (ACIP). The ACIP is an advisory committee to the US Centers for Disease Control and Prevention (CDC), comprised of medical and public health experts who develop evidence-based recommendations and guidelines for vaccinations, including for pregnant persons. The ACIP has several work groups that review scientific evidence on an ongoing basis, and full-committee public meetings are held at least three times a year. As more data regarding the safety and efficacy of vaccines in pregnancy become available, these recommendations continue to evolve. To develop these recommendations, the ACIP carefully considers the risks of exposure to infectious agents against the potential risks of vaccination. We review here current ACIP recommendations for vaccinations and their use in pregnant persons. Recommendations are divided into four categories: vaccines recommended during pregnancy, vaccines recommended during pregnancy under certain circumstances, vaccines not recommended or contraindicated during pregnancy, and vaccines without specific ACIP recommendations. To ensure optimal care during pregnancy, healthcare providers who care for pregnant persons need to be familiar with these recommendations.

For a full text of the article, click here: https://onlinelibrary.wiley.com/doi/full/10.1002/bdr2.2459

Validation of the Patient-Reported Outcomes Measurement Information System Pain Intensity and Brief Pain Inventory During Pregnancy.

Vignato J, Perkhounkova Y, Marilim H, Lee J, Hein M, Santillan D, Santillan M.

West J Nurs Res. 2025 Feb 8:1939459251317270. doi: 10.1177/01939459251317270. Epub ahead of print. PMID: 39921452.

• We sought to (1) validate the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Intensity Short Form 3a measure and Brief Pain Inventory (BPI) for assessing pain during pregnancy and (2) evaluate pain in a sample of pregnant individuals.
• Pregnant individuals (N = 196) were prospectively surveyed: n = 171 up to 22 weeks gestational age, n = 123 during their third trimester of pregnancy, and n = 98 both times. Additional measures included SPRINT Post-Traumatic Stress Disorder Tool, Neurological Quality of Life, Edinburgh Postnatal Depression Scale and anxiety subscale, and Adverse Childhood Experiences Questionnaire. Validity evidence examined included content validity, reliability, convergent and discriminant validity, and relevant criterion relationships.
• Content validity analysis suggests that the PROMIS pain measure was easy to use and interpret while the BPI provided more detail. However, BPI questions regarding medication usage and relief were unclear to some pregnant individuals. In addition, the relationships among pain ratings were stronger than relationships between pain ratings and measures intended to assess other constructs suggesting convergent and discriminant validity. Relationships with relevant criterions were presented for both the PROMIS and BPI by comparing ratings of pain intensity and severity for pregnant individuals with and without areas of pain reported on BPI.

Conclusion: Results indicate that PROMIS and BPI provided valid information on pain intensity or severity for our perinatal sample. Depending on the research question, the PROMIS pain or BPI may be more appropriate to an individual study. Either measure could also be included in an electronic health record for accurate pain assessment in clinical settings.

For a full text of the article, click here: https://journals.sagepub.com/doi/epub/10.1177/01939459251317270

What Are Consumers Looking for With Boric Acid?

Stockdale CK, Bartolo-Costello AA, Vieira-Baptista P.

J Low Genit Tract Dis. 2025 Jan 1;29(1):93-95. doi: 10.1097/LGT.0000000000000855. PMID: 39704442.

Two separate online surveys were presented to women who were confirmed to have purchased a boric acid vaginal suppository product in the previous year for themselves March 2020 (study 1) and July 2023 (study 2) to understand consumer expectations concerning the use of vaginal boric acid. Study 1 found that repeat purchasers are more likely to buy boric acid products to prevent symptoms, especially bacterial vaginosis. Study 2 confirmed boric acid was more likely to be purchased for prevention than treatment, especially odor/bacterial vaginosis, with 83% reporting they were satisfied and 40% reporting they were extremely satisfied. While boric acid has been used for decades as an alternative treatment for vaginitis, it has recently become commercially available (for vaginal application) with high levels of satisfaction.

For a full text of the article, click here: https://oce.ovid.com/article/00128360-202501000-00016/PDF

Vulvar inspection at the time of cervical cancer screening: European Society of Gynaecological Oncology (ESGO), International Society for the Study of Vulvovaginal Disease (SSVD), European College for theStudy of Vulval Disease (ECSVD), and European Federation for Colposcopy (EFC) consensus statements.

Preti M, Lewis F, Carcopino X, Bevilacqua F, Ellis LB, Halonen P, Hemida R, Jach R, Kesic V, Kyrgiou M, Maggino T, Pedro A, Querleu D, Stockdale C, Taumberger N, Temiz BE, Bieira-Baptista P, Gultekin M.

Int J Gynaecol Obstet. 2025;35 (1). doi: 10.1016/j.ijgc.2024.100007.

Background: Vulvar squamous cell carcinoma incidence is increasing, especially among women under 60, largely attributed to human papillomavirus infections. Precursor pre-invasive vulvar lesions are frequently underdiagnosed. Routine vulvar inspection during cervical cancer screening could offer an opportunity for the detection of these lesions.

Objective: To emphasize the importance of integrating routine vulvar inspection during cervical cancer screening procedures and to raise awareness about the early detection of vulvar squamous cell carcinoma and its precursors to reduce the diagnostic delay of vulvar pathologies.

Methods: A multidisciplinary task force comprising experts from 4 international scientific societies was formed. A focused literature review was conducted, and consensus statements were developed through a structured voting process to ensure clinical relevance and comprehensiveness.

• The consensus defines key elements of normal vulvar anatomy, identifies potential pre-cancerous dermatoses, and highlights risk factors for vulvar malignancy. The consensus statements promote the integration of vulvar inspection into cervical cancer screening procedures, urging health care professionals across various levels to receive training and guidance in vulvar examinations and enhancing patient education. Health care providers are recommended to gather a brief history of vulvar symptoms, conduct comprehensive inspections of the vulvar area, and report any abnormalities. For patients with positive human papillomavirus or Pap tests, they should closely monitor vulvar findings, encourage self-examinations, and discuss risks for intra-epithelial or invasive neoplasia.

Conclusions: Establishing standardized practices in vulvar inspection during cervical cancer screening procedures along with public awareness, could significantly impact early detection and timely interventions of vulvar pathologies at cancer risk ultimately reducing the burden of vulvar cancers.

For a full text of the article, click here: https://www.sciencedirect.com/science/article/pii/S1048891X24000331?via%3Dihub

Phenotypes of Pelvic Organ Prolapse.

Sayler Z, Weston K, Johnson CM, Cunningham V, Bradley CS, Kenne KA, Wendt L, Ten Eyck P, Kowalski JT.

Urogynecology (Phila). 2025 Jan 13. doi: 10.1097/SPV.0000000000001640. Epub ahead of print. PMID: 39807787.

• The Pelvic Organ Prolapse Quantification (POP-Q) stages do not correlate with symptoms or characterize important prolapse subtypes.

Objectives: We hypothesize that clinically meaningful prolapse "phenotypes" utilizing POP-Q measurements can be defined. The primary aim was to define the phenotypes and their frequency. Secondary aims were to compare demographics, medical characteristics, and symptoms between phenotypes.

Study design: Patients who previously underwent prolapse surgery were retrospectively categorized into 1 of 8 phenotypes based on 2 principles: (1) prolapse exists when the anterior or posterior vaginal wall descend to the hymen or the apex descends half total vaginal length, and (2) prolapse may exist in anterior, posterior, and/or apical compartments. Demographics, medical characteristics, and Pelvic Floor Distress Inventory-20 (PFDI-20) responses were compared. Linear and logistic regression models were used for comparisons.

Results: The AC (anterior-predominant and apical) phenotype was most common (231 of 501 patients, 46.1%) and served as the reference for comparisons. The no prolapse, P (isolated posterior), C (isolated apical), and PC (posterior-predominant and apical) phenotypes were younger. The A (isolated anterior) phenotype was older. P, PC, and APC (anterior and posterior and apical) phenotypes had greater body mass index. The P phenotype Colorectal-Anal Distress Inventory scores were higher. Similarly, the PC phenotype had higher scores for bowel splinting and rectal prolapse. Conversely, the C phenotype total PFDI-20 scores were lower (P = 0.01). Only the APC phenotype had no significant differences in any PFDI-20 question compared with the AC phenotype.

Conclusion: These phenotypes may allow for improved understanding, communication, and counseling about prolapse and prolapse treatment.

For a full text of the article, click here: https://oce.ovid.com/article/02273501-990000000-00332/PDF

Attitudes, beliefs and preferences surrounding home-based exercise programs in endometrial cancer patients receiving treatment.

Gorzelitz J, Adeagbo M, Dungan-Seaver S, Hill EK, Kumar A, Goodheart MJ, Lutgendorf S.

Gynecol Oncol Rep. 2024 Dec 18;57:101659. doi: 10.1016/j.gore.2024.101659. PMID: 39811828; PMCID: PMC11730264.

Background: Despite recommendations, exercise participation among endometrial cancer survivors remains low. Previous interventions focused on weight loss or in-person programs with limited reach. Regular exercise, regardless of weight change, reduces mortality risk and improves functionality. Home-based programs could address participation barriers. We conducted a qualitative study with inactive survivors to identify key factors for future home-based exercise programs.

• Semi-structured interviews were conducted with ten on-treatment endometrial cancer survivors who reported low physical activity levels. Interviews, conducted via Zoom or telephone, were recorded with consent. Transcripts were coded using MAXQDA to identify attitudes, knowledge, barriers, interests, and preferences regarding home-based exercise programs.
• The interviews yielded four major themes, the first being the understanding survivors have of what exercise is and the perceived benefits of exercise. Second, participants were acutely aware of the barriers to exercise which included: health issues, treatment-related concerns, access to resources, limited strength, lack of support, and past negative experiences. The third theme focused on motivational factors to exercise including guidance, support systems, access to resources including technology, and a desire to be healthy as motivators towards changing exercise behaviors. Finally, participants expressed interest in exercise that incorporated fun with low impact and accessibility. Interestingly, all the participants preferred home-based exercise programs. The role of the provider/oncologist was often identified as central to the discussion or suggestion of exercise in our sample.

Conclusions: Understanding patient needs and preferences is crucial for creating accessible and sustainable exercise programs for endometrial cancer survivors. Our study guides the development of future home-based exercise programs for this population.

For a full text of the article, click here: https://pmc.ncbi.nlm.nih.gov/articles/PMC11730264/pdf/main.pdf

Evaluating the implementation and impact of a volunteer navigation oncology support programme: study protocol for a pragmatic, real-world hybrid type 2 study.

Rocque GB, Dent DN, Waugh C, Hill EK, Federman N, Bostock Rosenzweig I, Morris B, Kamal A.

BMJ Open. 2025 Jan 20;15(1):e088047. doi: 10.1136/bmjopen-2024-088047. PMID: 39832972.

Introduction: Patient navigation is recommended by accrediting bodies such as the Commission on Cancer and is a key element in payment reform demonstration projects, due to the established benefits in reducing barriers to healthcare, improving care coordination and reducing healthcare utilisation. However, oncology practices are often resource constrained and lack the capacity to extend navigation services at the desired intensity for their patient population. The American Cancer Society (ACS) developed the ACS Community Access to Resources, Education, and Support (CARES) programme to expand navigation capacity through the training of students from local universities as volunteers to serve as non-clinical navigators to support cancer patients. Although this approach has great potential for scalability, the best approach to early implementation and impact of volunteer navigation remains unclear.

Methods and analysis: This pragmatic single-arm pre-post study evaluates the implementation and effectiveness of volunteer navigation for patients participating in the 2023-2024 pilot. This study will use data collected during routine care for quantitative implementation and patient outcomes. The Updated Consolidated Framework for Implementation Research will guide evaluation of early programme implementation with three initial pilot sites. This pragmatic evaluation of real-world implementation of volunteer navigation in the oncology setting will support future efforts to scale-up this intervention across US health systems.

Ethics and dissemination: This study was approved by University of Morehouse School of Medicine Social and Behavioral (IRB), which served as the IRB for record for this project (IRB-2025819-2). No consent required for this study protocol. ACS CARES plans to disseminate this model and include additional sites as participants in future years.

For a full text of the article, click here: https://bmjopen.bmj.com/content/bmjopen/15/1/e088047.full.pdf

Reduced AT2R Signaling Contributes to Endothelial Dysfunction After Preeclampsia.

Schwartz KS, Sun M, Jalal DI, Santillan MK, Stanhewicz AE.

Hypertension. 2024 Dec 26. doi: 10.1161/HYPERTENSIONAHA.124.24098. Epub ahead of print. PMID: 39723536.

• Women who had preeclampsia (a history of preeclampsia) have a >4-fold risk of developing cardiovascular disease compared with women who had an uncomplicated pregnancy (history of healthy pregnancy). Despite the remission of clinical symptoms after pregnancy, vascular endothelial dysfunction persists postpartum, mediated in part by exaggerated Ang II (angiotensin II)-mediated constriction. However, the role of vasodilatory AT2Rs (Ang II type 2 receptors) in this dysfunction is unknown. We examined the functional role of AT2R in the microvasculature postpartum and whether acute activation of AT2R improves microvascular endothelial function after preeclampsia.
• Overall, 24 women (n=12/group) participated. We measured cutaneous vascular conductance responses to (1) graded infusion of compound 21 (AT2R agonist; 10-14-10-8M) alone or with NG-nitro-l-arginine methyl ester (NO synthase inhibitor; 15 mM) and (2) a standardized local heating protocol in control and 10-11M compound 21-treated sites. Expression of Ang II receptor subtypes I and II in biopsied venous endothelial cells was quantified using immunofluorescence.

Results: AT2R-mediated dilation (P<0.01) and the NO-dependent contribution (P=0.003) of this response were reduced in women with a history of preeclampsia. Endothelial AT2R expression was lower in women with a history of preeclampsia (P<0.01), but there were no differences in endothelial AT1R (Ang II type 1 receptor) expression (P>0.05). Acute activation of AT2R during local heating improved endothelium (P<0.01) and NO-dependent (P<0.01) dilation in women with a history of preeclampsia but had no effect in women with a history of healthy pregnancy (both P>0.05).

Conclusions: Reductions in AT2R-mediated dilation contribute to attenuated or impaired endothelial function in women who had a pregnancy complicated by preeclampsia. Furthermore, AT2R activation may improve endothelial function through NO-dependent mechanisms in otherwise healthy women who had preeclampsia before the onset of cardiovascular disease.

For a full text of the article, click here: https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.124.24098

A Cohort Study Exploring HPV Vaccination Beliefs Among Oral Health Providers: Broadening the Scope of Education and Administration.

Brechtel L, Kilgore LC, Oyedeji O, Mastronardi AM, Carlson ER, Zite NB, Gregory S, Boone J, Kimball K, Heidel RE, Maples JM

Vaccines (Basel). 2024 Nov 27;12(12):1331. doi: 10.3390/vaccines12121331. PMID: 39771993; PMCID: PMC11680363.

Background/objectives: There is potential utility and increasing interest in engaging professionals in non-traditional vaccination settings to participate in efforts to reduce human papillomavirus (HPV)-related cancer. This study assessed the impact of a multi-disciplinary HPV educational intervention on oral health care professionals' perceived role, comfort level, and scope of practice in HPV-related cancer prevention efforts.

Methods: The virtual educational intervention was provided by a multi-disciplinary panel of experts. Seventy-three oral health care professionals attended the educational intervention and completed a questionnaire at three time points (pre-session, immediate post-session, and at the 1-month follow-up). Data were analyzed using Friedman's ANOVA and post-hoc analyses.

Results: Respondent's median belief that it is the role of an oral health professional to recommend the HPV vaccine increased from pre-session (Median = 3.0, IQR = 3.0-4.0) to immediate post-session (median = 4.5, IQR = 4.0-5.0), and this increase was maintained 1 month after the session (median = 4.0, IQR = 4.0-4.5; p < 0.001). Additionally, respondent's belief that they were up-to-date on the latest guidelines for HPV vaccination also increased from pre-session to immediate post-session (p < 0.05), and this increase was maintained 1 month after the session (pre-session median = 2.0, IQR = 2.0-3.0 vs. 1-month post-session median = 4.0, IQR = 4.0-5.0; p < 0.005).

• The multi-disciplinary HPV educational intervention was well-received by oral health professionals. Data suggest the intervention had a lasting impact on their beliefs about their role, comfort level, and scope of practice relating to HPV cancer prevention. More research needs to be conducted to better understand how obstetrician-gynecologists, other obstetric care providers, and oral health communities can support each other in promoting HPV-related cancer prevention.

For a full text of the article, click here: https://www.mdpi.com/2076-393X/12/12/1331

Reply to Letter to the Editor on "A Single Injection of Platelet-rich Plasma Injection for the Treatment of Stress Urinary Incontinence in Females: A Randomized Placebo-controlled Trial".

Johnson C, Vollstedt A.

Urology. 2024 Dec 20:S0090-4295(24)01217-2. doi: 10.1016/j.urology.2024.12.026. Epub ahead of print. PMID: 39710078.

For a full text of the article, click here: https://www.sciencedirect.com/science/article/pii/S0090429524012172?via%3Dihub

Promoting international, locally focused, and patient-oriented genetic counseling.

Weil J, Alaeddin D, Awwad R, Chanouha N, Elbassiouny B, Furqan A, Jacobs MF, Kavanaugh G, Neogi A, Rao SK, Sebastin M.

Genet Med Open. 2024 Aug 2;2(Suppl 2):101880. doi: 10.1016/j.gimo.2024.101880. PMID: 39712957; PMCID: PMC11658551.

For a full text of the article, click here: https://www.sciencedirect.com/science/article/pii/S2949774424010264?via%3Dihub

Social media provides support and education for pregnant people when healthcare does not.

Faro EZ, Santillan DA, Funk ML, Boeldt K, Santillan MK.

Front Glob Womens Health. 2024 Nov 28;5:1410831. doi: 10.3389/fgwh.2024.1410831. PMID: 39669112; PMCID: PMC11634836.

• The use of social media for health-related reasons is growing, but there is a dearth of research on the mechanisms of support provided. Understanding how social media groups work could improve communications between providers and patients. Preeclampsia (PreE) is a hypertensive disease of pregnancy that has short- and long-term physical and psychosocial effects. The Preeclampsia, Eclampsia & HELLP Syndrome Survivors Global Support Network (PEHSS) Facebook group is an online, international, moderated support group that provides evidence-based information and community support. Our study aimed to (1) characterize the forms of social support and types of information sought and provided from the perspective of the group moderators and members, and (2) describe group members' experiences of patient care. We triangulated interview and survey findings to identify gaps in care, ultimately to inform in improvements in care delivery.
• We began with 30-45-minute semi-structured interviews with PEHSS moderators exploring experiences and perceptions of membership; preliminary findings were member-checked with additional moderators. Interviews were analyzed using template and matrix analysis. Based on emergent themes, we conducted an online, validated patient experience survey with PEHSS members that was analyzed using descriptive statistics.
• Emotional and social support, mental health, resources and education, and personal health advocacy emerged as major themes in the 12 interviews. 1,148 PEHSS members responded to the survey. 68% of survey participants wanted to be more involved in the decisions about their care and treatment and over 30% felt they were not informed about danger signals post discharge while approximately half reported always feeling treated with respect and dignity while in the hospital. Geographic analysis showed differences in experiences of communication with providers within and outside the US.

Discussion: The triangulated results from interviews and surveys indicated a need for better communication with providers and the ability for patients to have more input on their care. The survey results indicate a global issue in providing support for people with hypertensive disorders of pregnancy during their hospitalization. The needs currently supported through communities on social media highlight opportunities to address critical gaps in care.

For a full text of the article, click here: https://www.frontiersin.org/journals/global-womens-health/articles/10.3389/fgwh.2024.1410831/full

A Multicenter Prospective Cohort Study of Antibiotics for OnabotulinumtoxinA.

Morocco E, Lua-Mailland L, Werth A, Carr D, Rabice S, Ashmore S, Duong V, Wilkes M, Nilsson W, Ferzandi T.

Urogynecology (Phila). 2024 Dec 13. doi: 10.1097/SPV.0000000000001621. Epub ahead of print. PMID: 39689227.

Importance: Urinary tract infection (UTI) is the most common complication of intradetrusor onabotulinumtoxinA (BTX-A) injection. Despite this, there are no evidence-based guidelines on antibiotic prophylaxis.

Objectives: Our primary aim was to determine whether antibiotic prophylaxis decreased symptomatic, culture-proven UTI rates within 6 weeks of intradetrusor BTX-A injection. Our secondary aims were to determine if there are differences between antibiotic regimens and to identify risk factors for developing a UTI.

Study design: This was a prospective, observational multicenter cohort study of female patients receiving BTX-A for idiopathic overactive bladder. We compared patients who received antibiotics (nitrofurantoin or trimethoprim-sulfamethoxazole) to those who did not. To detect a 15% difference in UTI rates between groups (80% power, alpha = 0.05), 270 participants were needed.

• : A total of 282 participants ultimately received BTX-A and were included in the analysis. One hundred eighty-one (62.6%) were in the antibiotic cohort and 101 (35.8%) were in the no-antibiotic cohort. The overall rate of symptomatic, culture-proven UTI was 12.1%, and there was no difference between the antibiotic and no-antibiotic cohort (10.6% vs 14.9%, respectively; P = 0.29). On multivariable logistic regression, UTI was associated with older age (adjusted odds ratio [aOR], 1.07; 95% CI, 1.02-1.11), BTX-A dose of 200 units (aOR, 4.24; 95% CI, 1.45-12.35), and self-catheterization (aOR, 26.0; 95% CI, 3.62-186.5). The odds of symptomatic UTI were lower among postmenopausal participants (aOR, 0.13; 95% CI, 0.02-0.68) and participants in the Northeast United States (aOR, 0.23; 95% CI, 0.08-0.72).
• Our study did not find a lower rate of symptomatic, culture-proven UTI among participants who took antibiotics compared with those who did not.

For a full text of the article, click here: https://oce.ovid.com/article/02273501-990000000-00313/PDF \

Embryoscopy with hysteroscopy for a more full-scope assessment and management of early miscarriage.

Salari S, Lindheim SR.

Fertil Steril. 2024 Nov 28:S0015-0282(24)02402-6. doi: 10.1016/j.fertnstert.2024.11.022. Epub ahead of print. PMID: 39615643.

For a full text of the article, click here: https://www.sciencedirect.com/science/article/pii/S0015028224024026?via%3Dihub

​Cervical Cancer 2010-2019: An Upper Midwest Catchment of 40,000 Square Miles.

Ulmer KK, Wilson PL, Petereit MA, Sargent M, Cina K, Kroboth L, Petereit DG, Harper DM.

J Low Genit Tract Dis. 2024 Dec 3. doi: 10.1097/LGT.0000000000000853. Epub ahead of print. PMID: 39626082.

• American Indian (AI) women have a higher incidence and mortality from cervical cancer than non-Hispanic White (NHW) women in the US. Our purpose is to detail the clinical events in the cervical cancer prevention continuum among the AI and White women with cervical cancer on the US frontier.

Materials and methods: A cancer center with a nearly 40,000 square-mile catchment area maintained a detailed cancer registry connected to the clinic records of all cervical cancer patients between 2010-2019. This catchment area provided records of both an AI and a White population. Descriptive and inferential statistics and modeling predictions detailed the prevention continuum.

• Among the 126 with cervical cancer, 20% were AI, and 78% were White. Sixty percent did not participate in cervical cancer screening within the 5 years before their diagnosis, and on average, 9.2 years passed since the last cervical cancer screening. 91% presented with symptoms, and most women presented with 2 or more symptoms. Thirteen percent underwent a colposcopic diagnostic step, significantly delaying the time to diagnosis compared to other diagnostic steps. Sixty-nine percent of the histopathologic diagnoses were squamous cell carcinoma, and 27% were adenocarcinoma. Forty-nine percent presented at stage I regardless of histopathology. Chemotherapy and radiation therapy were most commonly combined. Sixty-three percent of the population survived, and 42% survived at least 3 years from diagnosis. Younger age and earlier stages at diagnosis were the significant adjusted predictors of survival.

Conclusions: Our detailed cervical cancer prevention continuum events provide new data questioning the use of colposcopy for women symptomatic at presentation.

For a full text of the article, click here: https://journals.lww.com/jlgtd/fulltext/9900/cervical_cancer_2010_2019__an_upper_midwest.154.aspx

The use of a nursing implementation framework to enhance the uptake of an evidence-based intervention.

Karim K, Trower S, Segre LS.

Worldviews Evid Based Nurs. 2024 Nov 17. doi: 10.1111/wvn.12755. Epub ahead of print. PMID: 39552104.

• Evidence-based practices (EBPs) are instrumental in improving patient outcomes and ensuring high-quality nursing care, yet their implementation often encounters substantial barriers. The Iowa Implementation for Sustainability Framework and the Precision Implementation Approach© offer systematic strategies for overcoming barriers and enhancing EBP implementation and sustainability in health care settings.
• : This project aimed to use the Iowa Implementation for Sustainability Framework and the Precision Implementation Approach© to support the use of an evidence-based maternal depression intervention within Iowa's Title V Maternal Health Program that serves mothers of young children living in poverty.

Methods: This practice-based implementation was accomplished in three steps: (1) hold intervention-focused staff meetings, (2) identify barriers to using the intervention, and (3) identify and deliver implementation strategies. Collected data included barriers identified, selected implementation strategies, and evaluation of meeting attendance and impact on confidence.

Results: Four of the monthly virtual staff meetings focused on Listening Visits (LV) use. The 7 strategies comprising our approach to supporting LV use addressed three categories of identified barriers: lack of confidence, logistical issues, and not understanding intervention procedures. In the LV-focused meetings, representation of the 14 maternal health clinics was high, although attendance by individual staff was inconsistent. Post-meeting polls indicated that 40% to 65% of attendees felt more confident using intervention skills.

Linking evidence to action: This practical nursing-implementation framework facilitated EBP adoption, and our well-structured targeted strategies effectively increased staff confidence. Nursing managers and educators should consider using this framework to enhance their organizations' capacity to implement EBPs sustainably.

• community care; evidence‐based practice; implementation science; intervention focused staff meetings; listening visits; maternal health; nursing framework; sustainability.

For a full text of the article, click here: https://sigmapubs.onlinelibrary.wiley.com/doi/10.1111/wvn.12755