Dr. Chapa’s OBGYN Clinical Pearls

It has been estimated that up to 4.4% of the US adult population has been diagnosed with ADHD. Use of ADHD medication is increasing among pregnant women. In the last several years, there’s been a litany of publications looking at the effects of pregnancy on ADHD, as well as the effects of medication on the pregnancy. In this episode, we will highlight a new publication released March 2024 (Archives Women’s Mental Health) examining prenatal outcomes in women who continued dexamphetamine in pregnancy. We will also summarize the data regarding the effect of ADHD medication on congenital anomalies and neurodevelopmental outcomes in the children.

Four years, the US National Vital Statistics System has reported an abnormally high maternal mortality rate in the United States, showing it to be nearly doubled from 17.4 in 2018 to 32.9 per 100,000 live births in 2021. The United States’s maternal mortality rate has been on the media radar for many years because of this. But that rate is completely WRONG. How is it that maternal mortality rates are more than 2 to 3 times higher than other developed countries despite our vast progress in obstetrical care? The answer? It is a statistical error! In this episode, we will review a brand new publication from the AJOG published on March 12, 2024 that is making media headlines. We have known that this reporting system is greatly flawed for several years, and now it is getting the attention it deserves. Although this is reassuring news for the country overall, there is still ONE patient demographic where we need to dramatically reduce the maternal mortality rate. Curious? Listen in and find out more.

Debate on universal screening for thrombophilia before OCPs, risks of clot formation, misconceptions about birth control pills, genotype analysis in thrombophilia screening, research on VTE risk with BC pills, increased risk with genetic factors and contraceptive use

Exploring the use of Metformin in pregnancy and its impact on childhood neurodevelopmental outcomes. Discussing the rising prevalence of Gestational Diabetes and the comparison between Metformin and Insulin for perinatal outcomes. Highlighting the findings of a recent study on Metformin's safety and effectiveness in pregnancy.

On this podcast, we have been following this story of the OPill for several months. Previous episodes on the subject can be found in our podcast library. As expected, this first ever daily use progestin only pill is now available over-the-counter in the US. 👏👏. On Wednesday, March 6, 2024, the ACOG released its Practice Advisory presenting some key reminders for clinicians regarding this new over-the-counter contraceptive option. In this episode, we will summarize this practice advisory and answer some real-world questions patients may have regarding this: does the OPill help with acne? Is this approved for endometriosis pain? What happens if a patient misses the next dose at the scheduled time? Listen in for these answers and more.

Explore the safety concerns of using GLP-1 agonists during pregnancy, the history of diabetes treatment from insulin to modern medications, and the limited data available on the impact of these medications on fetal development.

Delve into the history and modern usage of balloon catheters for labor induction. Explore the debate between single and double balloons, volume considerations, and traction effects. Learn about outpatient procedures, outcomes, and the combination of agents for optimal cervical ripening.

It’s very important to stay up-to-date and current with new data. But sometimes you read something that is hot-off-the press and it makes you just stop and say, “hmmm”. In this episode, we will discuss the new USPSTF position statement on screening/treating iron deficiency anemia in pregnancy. We will also review the ACOG August 2023 clinical consensus #4 regarding UTI in pregnancy. In doing so, we present 2 things that “make you go hmmm”.

Exploring the Parkland Management Protocol for GDM, immediate medication initiation based on 3-hour test results, relevance of fasting hyperglycemia as predictor for medication needs, outcomes of gestational diabetes management, individualized blood sugar targets, risks of fasting hyperglycemia, early medication initiation implications, conflicting study data on medication usage, mixed results of metformin therapy for GDM

Exploring the controversy surrounding RhoGAM administration to RH negative patients under 12 weeks gestational age. Insights into the shortage of RhoGAM and alternative products. Geographic disparities in access to blood products for RH factor in pregnancy. Debate on R-H-D testing and R-H-I-G administration in early pregnancies to prevent adverse outcomes.