GAP (gestational diabetes and pharmacotherapy) - study protocol for a randomized controlled, two-arm, single-site trial.

Background: Gestational diabetes (GDM) complicates 10% of pregnancies in the US. First-line treatment is medical nutrition therapy (MNT) and exercise. Second line is pharmacotherapy.

Cervical Ripening Balloon in Combination with Methotrexate and Potassium Chloride for the Treatment of a 13-week Cervical Ectopic Pregnancy.

Background: Cervical pregnancy, an uncommon type of ectopic pregnancy, can lead to devastating consequences if not diagnosed and treated early. Despite this, there are no specific guidelines on how to treat such pregnancies especially in advanced gestational ages (GAs).

Case: This is a 35-year-old patient who presented to our hospital at 13 weeks GA after failing systemic multidose methotrexate therapy for a cervical ectopic pregnancy.

O-GlcNAc transferase contributes to sex-specific placental deregulation in gestational diabetes.

Introduction: Gestational diabetes (GDM) is traditionally thought to emerge from placental endocrine dysregulations, but recent evidence suggests that fetal sex can also impact GDM development. Understanding the molecular mechanisms through which sex modulates placenta physiology can help identify novel molecular targets for future clinical care. Thus, we investigated the nutrient-sensing O-GlcNAc pathway as a potential mediator of sex-specific placenta dysfunction in GDM.

Antenatal maternal hypoglycemia in women with gestational diabetes mellitus and neonatal outcomes.

Objective: To examine the prevalence of antenatal maternal hypoglycemia after initiation of pharmacotherapy for gestational diabetes mellitus (GDMA2) and its association with pregnancy outcomes.

Study Design: Retrospective cohort of GDMA2 women receiving either insulin or oral hypoglycemic agents. Composite neonatal outcome included macrosomia, jaundice, respiratory distress syndrome, large for gestational age, shoulder dystocia, birth trauma, 5-minute Apgar < 7, and neonatal hypoglycemia, and was compared between women with and without hypoglycemia using bivariate and multivariate analyses.

The timing of initiation of pharmacotherapy for women with gestational diabetes mellitus.

Background: The decision to initiate pharmacotherapy is integral in the care for pregnant women with gestational diabetes mellitus (GDM). We sought to compare pregnancy outcomes between two threshold percentages of elevated glucose values prior to initiation of pharmacotherapy for GDM. We hypothesized that a lower threshold at pharmacotherapy initiation will be associated with lower rates of adverse perinatal outcomes.

Provider-based initiation and management of pharmacologic therapy for gestational diabetes mellitus.

Objective: After failure of diet and exercise prescribed for gestational diabetes mellitus (GDM), pharmacotherapy initiation is recommended. The objective of this study was to examine the association between provider type and timing of pharmacotherapy initiation.

Methods: This was a retrospective cohort study of women with a singleton pregnancy and diagnosis of A2GDM (GDM requiring pharmacotherapy) delivering in a tertiary care center between 2009 and 2019.

Placental endothelin-converting enzyme-1 is decreased in preeclampsia.

Endothelin-converting enzyme-1(ECE-1) is a key regulatory enzyme in the processing of endothelin-1 (ET-1). We quantified and localized ECE-1 in normal and preeclamptic placentas. Normal (n=6) and preeclamptic (n=6) placentas were serially sectioned for immunofluorescence (IF).

Expectant Management of a Twin Pregnancy with Complete Hydatidiform Mole and Coexistent Normal Fetus.

Twin pregnancies complicated by complete hydatidiform mole coexisting with a viable fetus are rare and may result in significant complications. We describe the expectant management and our surgical approach in a 27-year-old Rh-negative woman presenting with recurrent episodes of vaginal bleeding and a twin pregnancy consisting of a molar pregnancy coexisting with a normal fetus. Inpatient management was undertaken with close maternal and fetal monitoring until cesarean delivery of a healthy female infant and histopathologically confirmed complete hydatidiform molar pregnancy (karyotype 46XX) at 34 weeks with no evidence of malignancy.

The Impact of Fetal Anomalies on Contemporary Labor Patterns.

Objective: To compare labor patterns in pregnancies affected by fetal anomalies to low-risk singletons.

Study Design: Labor data from the Consortium on Safe Labor, a multicenter retrospective study from 19 U.S.

Fatiguing Trunk Flexor Exercise Decreases Pain Sensitivity in Postpartum Women.

Background: Low back pain (LBP) is common in the general population and among postpartum women. Abdominal muscle exercise is often used to treat LBP, but it is unknown if fatiguing abdominal muscle exercise can produce exercise-induced hypoalgesia (EIH).

Objectives: To assess pressure pain thresholds (PPTs) at rest and following fatiguing trunk flexor exercise (EIH) in (1) nulligravid and postpartum women to evaluate the impact of pregnancy and childbirth and (2) nulligravid women and men to examine sex differences.

Fatigability of the Lumbopelvic Stabilizing Muscles in Women 8 and 26 Weeks Postpartum.

Background: Pregnancy and childbirth are associated with lumbopelvic pain and instability. Fatigability of the lumbopelvic stabilizing muscles after childbirth is unknown, and no clinical tests exist to assess this important metric of muscle function.

Objectives: To compare fatigability of the lumbopelvic stabilizing muscles in postpartum and nulligravid (control) women using the Active Straight Leg Raise (ASLR) Fatigue Task, and to determine if fatigability is associated with inter-recti distance (IRD), physical function, and pain/disability.

New Insights in Peripartum Cardiomyopathy.

Significant progress in understanding the pathophysiology of peripartum cardiomyopathy, especially hormonal and genetic mechanisms, has been made. Specific criteria should be used for diagnosis, but the disease remains a diagnosis of exclusion. Both long-term and recurrent pregnancy prognoses depend on recovery of cardiac function.

Impaired Trunk Flexor Strength, Fatigability, and Steadiness in Postpartum Women.

Purpose: To determine whether postpartum women (vaginal and cesarean delivery) have deficits in trunk flexor strength, fatigability and steadiness, compared with nulligravid women, up to 26 wk postpartum. We hypothesized that postpartum women would be weaker, more fatigable, and have greater torque fluctuations than controls, with cesarean delivery showing greater deficits than vaginal delivery.

Methods: Twenty-two control women (nulligravid) and 29 postpartum women (20-40 yr, 19 who delivered via vaginal birth, 13 via Caesarian section) participated.

Does Induction with Misoprostol Impact the Small for Gestational Age Neonate?

Objective: To compare outcomes in small for gestational age neonates induced with misoprostol to other cervical ripening agents. We hypothesized that misoprostol use will demonstrate no significant difference in outcomes compared with alternative agents.

Study Design: Small for gestational age neonates (<10th percentile for gestational age) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) sponsored Consortium on Safe Labor database were analyzed.

What is the optimal time for delivery in women with gestational hypertension?

Objective: To assess the optimal timing of delivery for women with gestational hypertension.

Study Design: A multicenter database that contained 228,668 deliveries was used to extract data on gravidas with gestational hypertension. The week-specific rates of maternal and neonatal morbidity/mortality were calculated after induction of labor.

Ambulatory arrhythmia monitoring in pregnant patients with palpitations.

Unlabelled: OBJECTIVE To assess the frequency of rhythm disturbances (RDs) obtained following placement of a Holter monitor or an event loop recorder (ERT) in patients referred to cardiologists.

Study Design: Ninety-six gravidas were referred to the cardiology clinic for palpitations, syncope, or dizziness and had Holter monitoring or ERT after a baseline electroencephalogram. Arrhythmias were classified by severity.

Obstetrical and perinatal outcomes among women with gestational hypertension, mild preeclampsia, and mild chronic hypertension.

Objective: The purpose of this study was to compare maternal and neonatal outcomes of women with gestational hypertension (GHTN), mild chronic hypertension (CHTN), and mild preeclampsia at delivery.

Study Design: A multicenter database that contained 228,668 deliveries was used to extract data on gravid women with GHTN, preeclampsia, and CHTN and on women without hypertensive disease (control group). Univariate and multivariate logistic regression analyses were performed.

Update on peripartum cardiomyopathy.

Although multiple mechanisms have been postulated, peripartum cardiomyopathy (PPCM) continues to be a cardiomyopathy of unknown cause. Multiple risk factors exist and the clinical presentation does not allow differentiation among potential causes. Although specific diagnostic criteria exist, PPCM remains a diagnosis of exclusion.

Discussion: 'Microcephaly associated with congenital heart defect' by Barbu et al.

In the roundtable that follows, clinicians discuss a study published in this issue of the Journal in light of its methodology, relevance to practice, and implications for future research. Article discussed: Barbu D, Mert I, Kruger M, Bahado-Singh RO. Evidence of fetal central nervous system injury in isolated congenital heart defect: microcephaly at birth.