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.
January 4, 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...
December 24, 2020: 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...
December 18, 2020: 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...
December 18, 2020: 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...
December 18, 2020: 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...
December 18, 2020: Clinical Obstetrics and Gynecology
Jessica 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.
December 16, 2020: 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...
December 16, 2020: 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...
December 16, 2020: 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...
December 16, 2020: 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...
December 9, 2020: 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...
December 9, 2020: Clinical Obstetrics and Gynecology
Joshua C Combs, Micah J Hill, Alan H Decherney
Polycystic ovarian syndrome and its associated endocrine abnormalities comprise one of the most common metabolic spectrum disorders within the human race. Because of the variance in phenotypic expression among individuals and within family lineages, attention has been turned to genetic and epigenetic changes in which the root cause of the disorder may lie. Further understanding of DNA/histone methylation and microRNA patterns may help to improve the accuracy of diagnosis and lead to future treatment options...
December 9, 2020: Clinical Obstetrics and Gynecology
Lindsay Maggio
Pregnant women with obesity are at increased risk of a multitude of complications of pregnancy and adverse perinatal outcomes. The risk of some of these complications, such as neural tube defects or preeclampsia, may be mitigated by some medications. Other complications, such as diabetes, venous thromboembolism, and infections, require treatment with medications. Given the changes in pharmacokinetics and pharmacodynamics during pregnancy, which is further enhanced by obesity, the optimal medication and its dose is often researched...
December 9, 2020: Clinical Obstetrics and Gynecology
Angela M Bengtson, Sebastian Z Ramos, David A Savitz, Erika F Werner
Gestational diabetes mellitus (GDM) complicates 6% to 8% of pregnancies and up to 50% of women with GDM progress to type 2 diabetes mellitus (DM) within 5 years postpartum. Clinicians have little guidance on which women are most at risk for DM progression or when evidence-based prevention strategies should be implemented in a woman's lifecycle. To help address this gap, the authors review identifiable determinants of progression from GDM to DM across the perinatal period, considering prepregnancy, pregnancy, and postpartum periods...
December 9, 2020: Clinical Obstetrics and Gynecology
Elisabeth L Stark, Emily S Miller
Perinatal mental illness, obesity, and diabetes mellitus are common complications of the perinatal period that are becoming ever more prevalent and frequently co-occur. This review seeks to examine the prevalence of comorbid obesity/diabetes (termed "diabesity") and mental illness in the perinatal period and current understandings of the psychosocial and pathophysiological relationships between these diseases. We will present current guidelines for screening and make recommendations for adaptations of mental health treatment in patients with this comorbidity...
December 4, 2020: Clinical Obstetrics and Gynecology
Benjamin K Kogutt, Linda M Szymanski
Obesity and diabetes are 2 commonly encountered complications in pregnancy that adversely affect pregnancy outcomes, maternal health, and the health of the offspring, both short-term and long-term. It is well established that physical activity provides numerous health benefits, both during and outside of pregnancy. By participating in physical activity, many of the negative consequences of both obesity and diabetes may be mitigated. Physical activity guidelines recommend that all adults, including pregnant women, perform at least 150 minutes of moderate-intensity exercise weekly in order to obtain health benefits...
December 4, 2020: Clinical Obstetrics and Gynecology
Anthony Deangelis, Lisa Deangelis, William Catherino, Nanette Rollene
The precise etiology of the biochemical changes and the resulting constellation of symptoms seen in polycystic ovary syndrome (PCOS) has remained a mystery. Despite advances in our knowledge, the pathogenesis and alterations in the biochemical pathways underlying this disease are still not fully understood. PCOS is a multifactorial syndrome where a combination of genetics, lifestyle, and hormone abnormalities all play an intertwining role. This article will provide an in-depth look at the multitude of biochemical pathways that are dysregulated in PCOS and their relation to alterations in female physiology...
November 24, 2020: Clinical Obstetrics and Gynecology
Ariel J Dunn
The pathogenesis of polycystic ovarian syndrome (PCOS) in women is poorly understood. With its varied endocrine and metabolic effects, it is unlikely a single genetic mutation or biological insult is the cause of the disease. Animals have been the proposed model for further studying the pathogenesis of PCOS and many modalities can be used to induce PCOS-like phenotypes in animals, most often with rodents. While there is not yet an animal model that perfectly recapitulates the classic PCOS phenotype in human women, many models allow for a better understanding of the complex disease process as well as possible treatments...
November 20, 2020: Clinical Obstetrics and Gynecology
Samuel C Siu, Kari L Evans, Michael R Foley
Women with heart disease are at increased risk for maternal and fetal complications in pregnancy. Therefore, all women with heart disease should undergo evaluation and counseling, ideally before conception, or as early in pregnancy as possible. In this article we will review the role of risk assessment, the history of development of the cardiac risk prediction tools, and the role of current cardiac risk prediction tools.
December 2020: Clinical Obstetrics and Gynecology
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