Adam K Lewkowitz, Alison G Cahill
Breastfeeding is available to nearly all women and has well-established short-term and long-term health benefits for mothers and infants. However, rates of breastfeeding initiation and continuation vary significantly according to sociodemographic factors, particularly in the United States. Mobile health (mHealth) interventions such as web-based/online education or smartphone applications have showed promise in increasing breastfeeding initiation and supporting breastfeeding continuation, and the importance of such mHealth-based breastfeeding support has increased significantly during the ongoing COVID-19 pandemic...
April 2, 2021: Clinical Obstetrics and Gynecology
Justine Reilly, Dayna Burrell
This review is intended to outline essential resources for trainees in order to optimize education on the care of pregnant patients with obesity. Addressing provider biases, exploring ethical considerations of care and streamlining screening and counseling of patients with obesity will provide an excellent framework for our trainees to care for women with obesity from preconception to postpartum care and beyond.
March 1, 2021: Clinical Obstetrics and Gynecology
Francesca Facco
Pregnant individuals may come into pregnancy with underlying sleep abnormalities but are also predisposed to developing sleep issues such as obstructive sleep apnea, due to the physiologic changes associated with the gravid state. This article will review the epidemiology of sleep duration, sleep timing, and sleep disordered breathing in pregnancy with a focus on how the prevalence of these sleep conditions relate to body mass index. In addition, it will summarize the literature suggesting a link between these sleep disturbances and an increased risk for gestational diabetes...
March 1, 2021: Clinical Obstetrics and Gynecology
Whitney Bender, Celeste Durnwald
Type 2 diabetes mellitus (DM) is a growing problem among reproductive-aged women. Contemporary trends in obesity and delayed child-bearing are expected to result in an increasing number of pregnancies affected by type 2 DM. Women with known type 2 DM can greatly benefit from preconception care as improved periconception glycemic control and weight loss can decrease the neonatal and maternal risks associated with type 2 DM and pregnancy. Antenatal mainstays of management include frequent blood glucose monitoring, insulin therapy, optimization of coexisting medical conditions, and fetal surveillance...
March 1, 2021: Clinical Obstetrics and Gynecology
Erika F Werner
No abstract text is available yet for this article.
March 1, 2021: Clinical Obstetrics and Gynecology
Karrie Walker, Alan H Decherney, Rhiana Saunders
Menstrual irregularities due to anovulation or severe oligoovulation are a key feature of polycystic ovary syndrome for many women. First-line intervention should entail dietary and lifestyle modifications for overweight or obese polycystic ovary syndrome women. For women not seeking fertility, combination low-dose hormonal contraception are the most effective and first-line choice for regulating menstrual cycles. This option, as well as progestin-only options, have the important added benefit of reducing risks of endometrial hyperplasia and cancer...
March 1, 2021: Clinical Obstetrics and Gynecology
Jessica R Zolton, Saioa Torrealday
In vitro fertilization is indicated for infertile women with polycystic ovarian syndrome (PCOS) after unsuccessful treatment with ovulation induction agents or in women deemed high-risk of multiple gestations who are ideal candidates for single embryo transfers. PCOS patients are at increased risk of ovarian hyperstimulation syndrome; therefore, attention should be made in the choice of in vitro fertilization treatment protocol, dose of gonadotropin utilized, and regimen to achieve final oocyte maturation. Adopting these strategies in addition to close monitoring may significantly reduce the ovarian hyperstimulation syndrome risk...
March 1, 2021: Clinical Obstetrics and Gynecology
Esther Eisenberg, Alan H DeCherney
No abstract text is available yet for this article.
March 1, 2021: Clinical Obstetrics and Gynecology
Steven Gay
Cosmetic endocrinology treats endocrine pathophysiologies to improve cosmetically bothersome physical exam findings for the patient. Here we review the general cosmetic changes in PCOS with an emphasis on targeted cosmetic medical therapies.
March 1, 2021: Clinical Obstetrics and Gynecology
Jenny Y Mei, Christina S Han
Diabetes and obesity increase the risk of congenital anomalies, but the putative mechanisms of this increased risk are not fully elucidated. In this chapter, we delve into sonographic characteristics associated with diabetes and obesity, including fetal structural anomalies, functional cardiac alterations, and growth abnormalities. We will also discuss the technical challenges of imaging in the patient with diabesity and propose methodologies for optimizing imaging. Lastly, we will address the prevention of workplace-associated musculoskeletal disorders injury for sonographers...
March 1, 2021: Clinical Obstetrics and Gynecology
Bridget C Huysman, Sara Mazzoni, Ebony B Carter
Group prenatal care is a health care delivery model that utilizes shared medical appointments to place greater focus on patient education, mutual support, and increased time with the clinician to promote a healthy pregnancy. Several studies suggest that medically low-risk women participating in group prenatal care have improved pregnancy outcomes, but the same tenants can likely be used to help women with diabetes and obesity achieve healthy outcomes during pregnancy and throughout their life course. This chapter will review the background, care model, and evidence regarding group medical visits for pregnant women with diabetes and obesity...
March 1, 2021: Clinical Obstetrics and Gynecology
Jennifer M Burgart
For many patients, weight loss is a first-line measure recommended to reduce comorbidities associated with polycystic ovary disease. When lifestyle modifications such as diet and exercise are insufficient at achieving this goal, the addition of weight loss medications has proven effective for many patients. In patients with severe obesity, bariatric surgery is often used when other methods have been unsuccessful and has shown promising results for improving health and fertility in patients with polycystic ovary disease...
March 1, 2021: Clinical Obstetrics and Gynecology
Jasmine M Aly, Alan H Decherney
Lifestyle modification is widely considered to be the cornerstone of polycystic ovary syndrome (PCOS) treatment. However, 45% of women with PCOS have reported that they have never been provided information about lifestyle management. This highlights a significant gap in knowledge and is reflective of the lack of evidence-based guidance for lifestyle modification. While more detailed and comprehensive studies are being performed, it is necessary for health professionals to develop effective action plans utilizing the available evidence...
March 1, 2021: Clinical Obstetrics and Gynecology
Samantha Kodama, Saioa Torrealday
Polycystic ovarian syndrome is the most common endocrinopathy in reproductive-aged women and has a vast array of clinical manifestations. Common clinical presentations of the disorder include anovulatory infertility, menstrual disorders, cutaneous symptoms secondary to androgen excess, metabolic abnormalities and mental health issues. If the condition is left unaddressed or inadequately treated, long-term sequelae such as endometrial hyperplasia, diabetes mellitus and dyslipidemia may ensue, therefore it is imperative for clinicians to address each component of the syndrome...
March 1, 2021: Clinical Obstetrics and Gynecology
Jessica A Lentscher, Breonna Slocum, Saioa Torrealday
Polycystic ovary syndrome (PCOS) is a common endocrinopathy that has been associated with impaired fertility. This chapter reviews the underlying pathophysiology of PCOS and the associated fertility barriers of the condition. Psychologic concerns, hypothalamic-pituitary, ovarian, and mitochondria dysfunction, obesity, and the role of vitamin D in PCOS are considered with respect to fertility. Lastly, pregnancy risk factors associated with PCOS are also reviewed.
March 1, 2021: Clinical Obstetrics and Gynecology
Anne E Martini, Mae W Healy
Women with the polycystic ovarian syndrome (PCOS) may have an increased risk for complications in pregnancy including miscarriage, gestational diabetes mellitus, hypertensive disorders of pregnancy, higher rates of cesarean delivery, and abnormalities in fetal growth. In addition, PCOS has been associated with the development of type II diabetes mellitus, hypertension, cardiovascular disease, obstructive sleep apnea, endometrial cancer, depression and anxiety, and nonalcoholic fatty liver disease. In understanding that PCOS is a disease impacting more than just a woman's fertility, prevention and early identification of risk factors for affiliated conditions is essential...
March 1, 2021: Clinical Obstetrics and Gynecology
Gianna Wilkie, Heidi K Leftwich
The prevalence of diabetes in reproductive age women has been reported to be as high as 6.8%, with pregestational diabetes affecting 2% of all pregnancies. As cases of diabetes in children and adolescents rise, more patients will be entering reproductive age and pregnancy with diagnoses of obesity, prediabetes, type 2 diabetes. Early interventions of diet modification and exercise to maintain healthy weights can delay or even prevent these complications. It is critical for health care providers to emphasize the importance of preconception counseling in this high-risk patient population to reduce the morbidities associated with obesity and diabetes in pregnancy...
March 1, 2021: Clinical Obstetrics and Gynecology
Peter G Lindner
Polycystic ovarian syndrome (PCOS) presents as a constellation of clinical manifestations that can be varied among patients; however, the hormonal derangement associated with PCOS is uniformly characterized by excess androgens and abnormal insulin activity. The alteration in the normal hormonal milieu in these patients and subsequently during their pregnancies is theorized to alter the normal development of the fetus. This in utero exposure and its relationship with behavioral development, metabolic disease, and reproductive outcomes in male and female offspring of mothers with PCOS are under investigation and remains controversial...
March 1, 2021: Clinical Obstetrics and Gynecology
Maeve K Hopkins, Lorraine Dugoff
The American College of Obstetrics & Gynecology (ACOG) recommends offering aneuploidy screening to all pregnant women. Obesity and diabetes are not associated with an increased risk of aneuploidy; however, they can complicate and compromise testing options. As the prevalence of obesity and diabetes, or "diabesity" increases, counseling women regarding potential limitations in testing performance of aneuploidy screening is of paramount importance. This chapter reviews options for aneuploidy screening for women with diabesity including sonography/nuchal translucency, serum analyte screening, and cell-free DNA...
March 1, 2021: Clinical Obstetrics and Gynecology
Jennifer M Burgart
Polycystic ovary disease is a heterogenous disorder that presents differently in each individual. Some of this variation is due to racial and ethnic differences, which has been shown to affect hirsutism scores, metabolic comorbidities, cardiovascular risk factors, and long-term health outcomes. Psychosocial factors, including mental health diagnoses, body image distress measures, and disordered eating behaviors have also been shown to affect women with polycystic ovarian syndrome at a higher rate than the general population, and contribute to a decreased quality of life among many patients with this chronic condition...
March 1, 2021: Clinical Obstetrics and Gynecology
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