Combined hormonal contraceptive (CHC) use has long been recognized as a significant risk factor for venous thromboembolism (VTE); CHC use is common, with many patients opting for oral formulations known as combined oral contraceptives (COC). More than 9000 cases of VTE related to COCs are recorded annually in the United States; however, the risk-benefit ratio of CHC/COC is favorable because VTE risk is highest during and immediately after pregnancy and delivery, meaning that these medications are largely considered safe and beneficial for most patients. The US Food and Drug Administration (FDA) and other regulatory bodies report adverse drug reaction data; a recent analysis of European data showed that body-identical estrogens have a more favorable safety profile for VTE compared to other CHCs. This study was designed to be a similar analysis using the FDA Adverse Event reporting System (FAERS) database to assess the proportionality reporting rates (PRRs) of VTE for different COCs. Data for this study included all adverse events (AEs) associated with body-identical estrogen products, ethinyl estradiol (EE) formulations, and 2 progestin-only products from the beginning of the FAERS database through October 2024. Comparing the proportion of VTE events for each medication, the risk ratio (RR) for estetrol/drospirenone (E4/DRSP) and 17β-estradiol valerate/dienogest (E2V/DNG) presented the lowest risk as 0.064 and 0.094, respectively, similar to drospirenone (0.076) and norethindrone (0.082), the progestin-only options. The highest risk ratio was observed in EE/drospirenone combinations at 0.614. When comparing EE/levonorgestrel (LNG) or the entire COC class to individual formulations, E4/DRSP and E2V/DNG showed significantly lower PRRs and reporting odds ratios (RORs), and EE/drospirenone had the highest disproportionality estimate. Changing the groupings of medications did not change these results, and sensitivity analysis showed an attenuated difference that was no longer significant for E2V/dienogest PRR compared with EE/levonorgestrel. No other significant disproportionality was observed in the sensitivity analyses that was not present in the primary analyses. These results show that COCs with body-identical estrogens were associated with significantly lower PRRs for VTE compared to EE-based formulations. Sensitivity analysis confirmed the initial findings, but with a loss of significance due to an artificial reduction of the reporting base with low-prevalence products. This is consistent with previous evidence in similar analyses, as well as a recent meta-analysis showing a reduction in VTE with body-identical estrogens. This contributes to growing evidence that these formulations have a safer thrombotic profile and should potentially be used as default formulations for most patients. Future research should compare the effectiveness of these formulations directly as well as quantify the risk differential between formulations more precisely than is currently known. (Summarized from Raskin L, Didembourg M, Dogne JM, et al. Venous thromboembolism with combined oral contraceptives based on estrogen and progestin content: a disproportionality analysis of the United States Food and Drug Administration Adverse Event Reporting System database. Am J Obstet Gynecol . 2026;235(1):78-85. doi:10.1016/j.ajog.2026.02.046).
While women make up an increasing proportion of the physician workforce, pregnancy and parental leave remain poorly supported in medical culture. Paid parental leave is associated with benefits such as longer breastfeeding duration and improved parental mental health, but practicing physicians often lack formal support for leave, lactation accommodations, and income protection. Pregnant physicians may continue high work intensity late into pregnancy and take short parental leaves, while also feeling pressure to avoid burdening colleagues in an already strained health care system. This study aimed to describe pregnancy work patterns and parental leave practices among physicians of varying specialties in Ontario. This retrospective cohort study included Ontario physicians registered with the College of Physicians and Surgeons of Ontario who delivered at >20 weeks’ gestation between 2002 and 2018. Physicians were included if they had billing claims in the 2 years before conception. Trainees or those with a missing specialty type were excluded. Workload was assessed using Ontario Health Insurance Plan billing claims, including days worked and overnight work during each trimester, compared with matched prepregnancy data from the prior year. Leave was defined by the absence of billing claims after delivery, and return to work was defined as the resumption of at least 10 billing claims within 1 week. Analyses compared work patterns across trimesters and specialties and estimated time to return to work, with additional deliveries treated as a competing event. The cohort included 5948 deliveries among 3932 physicians, with a median maternal age of 35 years and a median time as a practicing physician of 3.6 years. Most deliveries occurred among family physicians, followed by medical specialists, pediatricians, surgeons, anesthesia or emergency medicine physicians, OBGYNs, psychiatrists, and diagnostic radiologists. Overall workload increased during pregnancy compared with the matched prepregnancy period (RR: 1.06), driven by increases in the first and second trimesters (both RR: 1.12), before decreasing in the third trimester (RR: 0.95). Overnight work showed a similar pattern, with slightly increased rates in the first two trimesters (RR: 1.09 and 1.05) and a larger decrease in the third trimester (RR: 0.62). Return-to-work time varied substantially across specialties. Surgeons returned earliest, with a median of 133 days, followed by OB/GYNs at 156 days and diagnostic radiologists at 161 days. The longest leave was observed among pediatricians and psychiatrists, with median return-to-work times of 245 and 270 days, respectively. Among family physicians, timing varied by their practice model, ranging from 160 to 228 days. Return by 180 days postpartum was less common in physicians who delivered in 2010 or later compared with 2002-2009, although return by 365 days was similar between eras. Overall, the study found that physicians across specialties increased workload during the first and second trimesters compared with prepregnancy, followed by reduced workload in the third trimester for most specialties. Possible explanations for this trend may include anticipated income loss during leave and perceived obligation to colleagues before taking parental leave. Because many physicians begin childbearing after years of training and may require more than one leave during practice, acknowledging this need is important both for gender equity and workforce planning. Study limitations include an inability to assess residents, male physicians, or those undergoing surrogacy or adoption, differences in local practice policies, and a lack of generalizability beyond Ontario. (Summarized from Simpson AN, Sutradhar R, McArthur E, et al. Physician work patterns in pregnancy, parental leave, and return to the workforce. JAMA Netw Open . 2026;9:e267543. doi:10.1001/jamanetworkopen.2026.7543).
Pelvic inflammatory disease (PID) is an infection of the upper female genital tract and affects more than 1 million individuals annually in the United States. Sexually transmitted infections are a major risk factor for PID; patients between the ages of 15 and 24 account for more than 50% of all new sexually transmitted infections each year, and thus this age group, adolescents and young adults, (AYAs) has an elevated risk of PID. AYAs have also been shown to be particularly vulnerable to the development of sexually transmitted infections by several mechanisms. There are additionally several mechanisms that can delay the diagnosis of PID in AYAs and increase the likelihood of hospitalization for complications, though research has shown that early treatment can prevent many long-term complications of PID. This study was designed to compare characteristics and clinical and economic outcomes, as well as hospitalization trends, between AYAs and adults hospitalized for PID in the United States. This was a retrospective cohort study using data from the National Inpatient Sample (NIS) between 2016 and 2021. Patients were identified using diagnosis codes for acute PID and divided into age groups of AYAs (12-21) and adults (22-50). Pregnant individuals were excluded. Final analysis included 287,365 hospitalizations for PID in the study period, with 9.5% AYAs and 90.5% adults. There was an overall trend of increasing cases in AYAs, with this group representing 8.3% of cases in 2016 and 10.3% of cases in 2021. Patients in the AYA group were more likely to be black or Hispanic or have Medicaid insurance compared with adults ( P < 0.001 for all). In addition, AYA patients were more likely to be seen in urban teaching hospitals and in the Northeast and Midwest ( P < 0.001 for all). There were significantly more adults with greater comorbidity burden and chronic disease, including obesity, hypertension, type II diabetes mellitus, and gynecologic disorders such as endometriosis and uterine leiomyomas ( P < 0.001 for all). Patients in the AYA group were significantly more likely to have sepsis ( P = 0.001), chlamydial perihepatitis ( P < 0.001), and gonococcal perihepatitis ( P < 0.001). AYAs also had significantly lower likelihood of endometritis ( P < 0.01) and peritoneal adhesions ( P < 0.001), as well as shorter length of stay ( P = 0.016) and lower admission costs ( P < 0.001). These results indicate that, though there has been an overall decline in hospitalizations for PID over the study period, AYA admissions for PID remained fairly constant and had a relative increase in proportion over this time period. This suggests inequity and the possibility of particular barriers facing this patient population. Future research should focus on potential interventions to improve early detection in the younger population, as well as assess specific barriers to care, such as inconsistent screening, delays in care seeking, and provider hesitancy in the diagnosis of PID in younger patients. (Summarized from Rahmon D, Isaacson E, Baruch A, et al. Trends in adolescent and young adult hospitalization for pelvic inflammatory disease. J Pediatr Adolesc Gynecol . 2026;39(3):392-397. doi:10.1016/j.jpag.2025.12.002).
Maternal infection and sepsis are leading causes of maternal morbidity and mortality worldwide, particularly in low- and middle-income countries. The Active Prevention and Treatment of Maternal Sepsis (APT-Sepsis) program was developed for low-resource settings to improve adherence to infection-prevention practices and improve the prevention and management of maternal infection during and after pregnancy. However, the effect of the program on maternal outcomes has not been evaluated. The aim of this study was to assess whether the APT-Sepsis program reduced the risk of infection-related maternal outcomes, compared with usual care. This was a cluster-randomized trial involving 59 health facilities that provided comprehensive obstetrical care in Malawi and Uganda from November 2023 to March 2024. The facilities participated in a baseline period of at least 6 months, in which usual care was provided. Facilities were then randomized 1:1 to continue with usual care (29 facilities) or implement the APT-Sepsis program for 12 months (30 facilities). The goals of the program were to improve adherence to hand-hygiene standards, adopt evidence-based practices to prevent and manage maternal infection, and increase early recognition of sepsis and use of the FAST-M treatment (fluids, antibiotics, source identification and control, assessment of the need for transfer for higher level of care, and monitoring of mother and infant). The primary outcome was a composite of infection-related maternal death, maternal near-misses, or severe illness during pregnancy or within 42 days after pregnancy. Analyses were performed according to the intention-to-treat principle using mixed-effects models that accounted for clustering and baseline outcome rates. During the intervention phase, the primary composite outcome occurred in 1.4% of 124,298 women who received the APT-Sepsis intervention versus 1.9% of the 116,596 who received usual care [risk ratio (RR), 0.68; 95% CI, 0.55 to 0.83; P <0.001]. The reduction was primarily driven by fewer severe infection-related illnesses (1.3% in the intervention group vs. 1.8% in the usual-care group; RR, 0.68; 95% CI, 0.55 to 0.84). Facilities implementing the APT-Sepsis program improved their adherence to hand hygiene standards (33% vs. 15%; mean difference, 14%; 95% CI, 10 to 19), appropriate antibiotic prophylaxis before cesarean delivery (74% vs. 58%; mean difference, 15%; 95% CI, 4 to 26), completion of vital-signs assessment at admission (48% vs. 15%; mean difference, 32%; 95% CI, 25 to 40), and timely sepsis management with antibiotics within 1 hour of suspected infection (44% vs. 38%; mean difference, 8%; 95% CI, –3 to 19). In conclusion, the use of the APT-Sepsis program significantly reduced severe maternal infection-related morbidity compared with usual care. (Summarized from Lissauer D, Gadama L, Waitt C, et al. A multicomponent intervention to improve maternal infection outcomes. N Engl J Med . 2026;394:1685-95. DOI: 10.1056/NEJMoa2512698).
Sexually transmitted infections (STIs), particularly Neisseria gonorrhoeae and Chlamydia trachomatis , remain a significant public health concern in the United States and are associated with adverse maternal and neonatal outcomes during pregnancy. For patients who face structural barriers to care, such as insurance status, housing instability, and limited access to primary care, emergency departments (EDs) frequently become the point of health care access and provide STI evaluation and treatment. The Centers for Disease Control and Prevention (CDC) guidelines recommend empiric treatment when clinical concern is high or follow-up is uncertain. Yet, it is unclear whether treatment practices differ for pregnant patients or across demographic groups. The aim of this study was to compare rates of empiric STI treatment in EDs according to pregnancy status and patient characteristics. This was a repeated cross-sectional study, using aggregated, deidentified data from the Epic Cosmos electronic health record database. Included were patients, 15 years or older, who visited an ED between January 2016 and December 2024 and were tested for N. gonorrhoeae or C. trachomatis . The primary outcome was empiric treatment with antibiotics during the same ED encounter in which testing was performed. Treatment rates were compared between pregnant and nonpregnant patients and by age, race, ethnicity, primary language, and insurance source. Of the 4,904,343 ED encounters involving STI testing identified for analysis, 9.3% involved pregnant patients. Empiric treatment was administered to 10.9% of pregnant patients versus 38.2% of nonpregnant patients [odds ratio (OR), 0.20; 95% CI, 0.20-0.20]. In comparing just female patients, pregnant patients were significantly less likely to receive empiric treatment compared with nonpregnant patients (OR, 0.27; 95% CI, 0.27-0.28). Among pregnant patients, empiric treatment was more likely to occur in adolescents aged 15 to 17 years versus those aged 18 to 29 (OR, 1.43; 95% CI, 1.36-1.49) and Black patients versus White patients (OR, 1.58; 95% CI, 1.55-1.61). Empiric treatment was less likely to occur among pregnant patients who were Asian (OR, 0.67; 95% CI, 0.62-0.72), Hispanic or Latino (OR, 0.78; 95% CI, 0.76-0.80), and whose primary language was not English (OR, 0.76; 95% CI, 0.73-0.79). Empiric treatment was more common in those with Medicaid (OR, 1.17; 95% CI, 1.15-1.19), Medicare (OR, 1.37; 95% CI, 1.25-1.49), or self-pay insurance (OR, 1.30; 95% CI, 1.26-1.35), compared with patients with commercial insurance. For nonpregnant patients, empiric treatment was less common among patients aged 18 to 29 years versus those younger than 15 (OR, 0.84; 95% CI, 0.83-0.85) or 50 years or older (OR, 0.78; 95% CI, 0.78-0.79), and male versus female patients (OR, 0.38; 95% CI, 0.37-0.39). Compared with White patients, empiric treatment was more likely to occur among patients who were Black (OR, 1.57; 95% CI, 1.55-1.58), American Indian or Alaska Native patients (OR, 1.11; 95% CI, 1.07-1.15), and Native Hawaiian or Other Pacific Islander (OR, 1.15; 95% CI, 1.10-1.21). Asian patients (OR, 0.72; 95% CI, 0.69-0.75), Hispanic or Latino patients (OR, 0.72; 95% CI, 0.72-0.73), and those whose primary language was Spanish (OR, 0.64; 95% CI, 0.63-0.66) were less likely to receive empiric treatment. Treatment rates were highest among those with self-pay insurance (OR, 1.91; 95% CI, 1.89-1.93), followed by those with Medicaid (OR, 1.08; 95% CI, 1.07-1.09). In conclusion, pregnant patients who went to the ED for N. gonorrhoeae or C. trachomatis were less likely to receive empiric STI treatment than nonpregnant patients. Treatment rates also varied by demographic characteristics, including age, race, ethnicity, primary language, and insurance source. (Summarized from Gottlieb M, Moyer E, Slocum GW, et al. Sexually transmitted infection treatment rates among pregnant vs. nonpregnant patients in emergency departments. JAMA Network Open . 2026;9(4):e264911. doi:10.1001/jamanetworkopen.2026.4911).
