Dr. Chapa’s Clinical Pearls.

In November 2013, ACOG issued the Hypertension in Pregnancy Task Force Report recommending daily low-dose aspirin (81mg) beginning in the late 1st trimester for women with a history of early-onset preeclampsia and preterm delivery at less than 34 0/7 weeks, or for women with more than one prior pregnancy complicated by preeclampsia. The following year, the USPSTF published a similar guideline, although the list of indications for low-dose aspirin use was more expansive. Since then, the ACOG has issued new guidance on low-dose aspirin, in 2018 and 2021. Nonetheless, while criteria for use has evolved, the dosage recommended has remained as 81 mg. But MEDICINE MOVES FAST, and a new Expert Review in the AJOG MFM is making a case for 162mg. Are we underdosing low-dose aspirin for prevention of preeclampsia? A litany of data says YES. Listen in for details.

The first successful births from frozen eggs were twins, born in Australia in 1986. IVF serves a valuable role for those with persistent infertility issues or other conditions where natural conception is hindered. Although oocyte cryopreservation was initially used as a fertility preservation strategy for medical indications, currently, it is increasingly used to circumvent age-related infertility. This process of elective egg retrieval and cryopreservation- targeting women in their 20s- has gotten out of hand! Mainly due to social media, Gen Z women are panicking about their fertility. Should They Be? For decades, the age of 35 has been seen as a “demarcation line” for female fertility. Before 35, the theory often goes, most women will have little trouble conceiving, but at that point, fertility falls off a cliff. This misunderstanding of natural fertility processes, spurred on by false information on social media, has led to 20-somethings calling for egg retrieval and egg freezing. The dread of age 35 is so pervasive that its effect bleeds backward in time, with women in their early 30s—and yes, sometimes even in their late 20s—already feeling as if they are behind in the race against their “biological clock.” But the reality of fertility “loss” is much more complicated then just “falling off a cliff” and should be viewed more as of a natural “slope” rather than a “cliff”. About a decade after it shed its “experimental” label from the ASRM, oocyte retrieval and cyropreservation has become ubiquitous in our social media culture and has ballooned in popularity, with over a million frozen eggs or embryos stored in the United States today. It has done little, however, to materially change women’s lives. The ASRM has an ETHICS COMMITTEE OPINION (2024) on this very thing. Is 35 really a fertility cliff? Or it it 32? Is egg freezing in late or early 30s the best way to go for delayed fertility? Listen in for details as we set the record straight.

Introducing one of our Senior Residents, Dr. Mauldin: Dr. Mauldin just told me of a real patient encounter she had just today, that I felt we HAD to share with everyone. This real encounter is WHY we are passionate about EVIDENCE-BASED medicine! PLUS, we will introduce our NEXT episode which will focus on "elective egg harvesting and freezing" for young women who may have "delayed fertility" due to career path. The social media influence on what has come t be called "social egg harvesting" by some, has gotten out of hand! Listen in to her personal history and perspective on this!

In the United States, more than 400,000 babies are born prematurely each year, which is about 1 in 10 babies. Over the last several decades, multiple studies have shown a link between poor oral health and increased occurrence of preterm birth. Researchers have looked at various ways to improve dental health during pregnancy, including doing a “deep-teeth cleaning” (also called ‘scaling and planing’), which involves removing plaque and tarter on the teeth and below the gum line. However, despite improving periodontitis, deep teeth cleaning approaches have not proven to be effective in the prevention of preterm birth. But now new data has discovered an easy and inexpensive way to improve oral health and potentially reduce preterm births. This data was originally presented at the annual Pregnancy meeting at SMFM, but now it is a peer reviewed publication. In this episode, we will review how chewing xylitol gum has promising results for preterm birth reduction. Nonetheless, some important limitations must be reviewed. Listen In for details.