BACKGROUND:Little is known about the effects of intravenous iron (IVFe) supplementation on maternal hemoglobin (Hb) by timing of infusion and dosage. OBJECTIVE:To identify the association of IVFe timing and dose on pre-delivery Hb. STUDY DESIGN:A retrospective cohort study of pregnant patients with iron deficiency anemia (IDA) who received iron sucrose (Venofer®) at our Level IV maternity care center following the implementation of a quality improvement (QI) transfusion reduction bundle from January 2020 to December 2023. The primary outcome was the association between IVFe timing and pre-delivery Hb. Secondary outcomes included the impact of IVFe dosage and infusion-to-delivery interval on Hb. Statistical analyses included paired t-tests, Mann-Whitney U tests, χ2 tests, ANOVA, and post-hoc Tukey multiple comparisons (significance set at p < 0.05). RESULTS:295 patients were included. Mean age, BMI, and ferritin were 26.6 ± 6.3 years, 28.1, and 7.2 ± 7.8 μg/L, respectively. Mean GA for IVFe administration was 34 weeks. Two patients required intrapartum/postpartum red blood cell transfusions. A greater mean Hb difference (2.5 g/dL vs 1.3 g/dL), was observed with IVFe at <34 weeks compared to ≥34 weeks (p < 0.001). Higher IVFe doses were associated with increased pre-delivery Hb levels (p = 0.002) and a longer infusion-to-delivery interval (p = 0.049). The strongest Hb improvement was seen with latency from ≥6-8 weeks with doses >800 mg versus <2 weeks at doses ≤ 800 mg (increase of 2.6 - 3.1 g/dL, p < 0.0001). CONCLUSION:Substantial benefit is seen when IVFe is given in the early third trimester, especially with ≥6 weeks of latency and doses ≥800 mg.

Our systematic review highlights that multiparametric PAI score assessment is a consistent tool with high sensitivity and specificity for prenatal prediction for placenta accreta spectrum (PAS) in high-risk population with anterior placenta previa or low-lying placenta and prior cesarean deliveries. A systematic search was conducted on November 1, 2022, of MEDLINE via PubMed, Scopus, Web of Science Core Collection, Cochrane Library, and Google Scholar to identify relevant studies (PROSPERO ID # CRD42022368211). A total of 11 articles met our inclusion criteria, representing the data of a total of 1,044 cases. Women with PAS had an increased mean PAI total score, compared to those without PAS. Limitations of the PAI are most studies were conducted in developing countries in high-risk population which limit the global generalizability of findings. Heterogeneity of reported data did not allow to perform meta-analysis.

Background: Women with gestational diabetes mellitus are rarely treated with a sulfonylurea drug, because of concern about teratogenicity and neonatal hypoglycemia. There is little information about the efficacy of these drugs in this group of women. Methods: We studied 404 women with singleton pregnancies and gestational diabetes that required treatment. The women were randomly assigned be- tween 11 and 33 weeks of gestation to receive gly- buride or insulin according to an intensified treatment protocol. The primary endpoint was achievement of the desired level of glycemic control. Secondary endpoints included maternal and neonatal complications. Results: The mean (±SD) pretreatment blood glucose concentration as measured at home for one week was 114±19 mg per deciliter (6.4±1.1 mmol per liter) in the glyburide group and 116±22 mg per deciliter (6.5±1.2 mmol per liter) in the insulin group (P=0.33). The mean concentrations during treatment were 105± 16 mg per deciliter (5.9±0.9 mmol per liter) in the glyburide group and 105±18 mg per deciliter (5.9±1.0 mmol per liter) in the insulin group (P=0.99). Eight women in the glyburide group (4 percent) required insulin therapy. There were no significant differences between the glyburide and insulin groups in the percentage of infants who were large for gestational age (12 percent and 13 percent, respectively); who had macrosomia, defined as a birth weight of 4000 g or more (7 percent and 4 percent); who had lung complications (8 percent and 6 percent); who had hypoglycemia (9 percent and 6 percent); who were admitted to a neonatal intensive care unit (6 percent and 7 percent); or who had fetal anomalies (2 percent and 2 percent). The cord-serum insulin concentrations were similar in the two groups, and glyburide was not detected in the cord serum of any infant in the glyburide group. Conclusion : In women with gestational diabetes, glyburide is a clinically effective alternative to insulin therapy

INTRODUCTION: Optimal dosing of intravenous iron supplementation (IVFe) and latency of the infusion for pregnant patients with iron deficiency anemia has been minimally evaluated. We analyzed the effects of specific IVFe dosage parameters as part of an institution-based protocol on maternal peripartum hemoglobin (Hb) levels stratifying by time of infusion to delivery. METHODS: We reviewed average changes in maternal Hb pre-infusion and pre-delivery over a 3-year period (2020–2023) after the implementation of a maternal transfusion reduction bundle was incorporated at our Level IV maternal care center in 2020. Pregnant patients who received IVFe and delivered at our institution were included and compared by IVFe dosage forms (800 mg) and infusion latency (by 2-week increments). We excluded patients with known antepartum blood transfusion. Maternal demographics and all comparison groups were analyzed among each other using GraphPad Prism software. RESULTS: Two hundred ninety-five patients met inclusion criteria. Demographics of maternal age, body mass index (BMI), nulliparity, and ferritin levels were similar in all groups. We found a statistically significant difference in improved pre-delivery Hb with larger IVFe doses ( P =.002) and longer infusion-delivery periods ( P =.049). A Tukey post-hoc test revealed that the highest yield on mean delta Hb was after 6–8 weeks or longer of latency with doses greater than 800 mg versus less than 2 weeks at doses of 800 mg or lower (2.6–3.1 g/dL; P <.0001). CONCLUSION: Latency periods of at least 6 weeks with IVFe dosages of 800 mg or greater, regardless of maternal BMI or starting ferritin, may markedly improve pre-delivery Hb levels and ultimately reduce maternal morbidity hemorrhage complications.

Training in placenta accreta spectrum disorder (PASD) is essential to Maternal-Fetal Medicine (MFM) and Gynecology Oncology (Gyn/Onc) fellowships. Our objective was to assess the satisfaction and alignment with future career goals of placenta accreta training during MFM and Gynecology Oncology fellowship. An anonymous survey was distributed to all ACGME-accredited MFM and Gyn/Onc fellowship programs between 04.08.23-07.30.23. The survey contained demographic information, and questions reflecting satisfaction with PASD training during fellowship and matching future career goals. This was assessed with modified 5-point Likert scale. We received 43 responses, 28 (65.1%) responders were from MFM fellows, and 15 (35.9%) were from Gyn/Onc fellows. Out of all responders, satisfaction with PASD training in their fellowship was greater in Gyn/Onc fellows compared to MFM fellows (80% vs. 42.9%, p=0.02). Conversely, MFM fellows reported that they were not satisfied with their PASD-related training more frequently than Gyn/Onc fellows (32.1% vs 13.3%, p=0.39) PASD training in MFM fellowship matched trainees’ future career plans in 60.1% in contrast to 80% of Gyn/Onc fellows (p=0.19). Satisfaction with PAS training and alignment with future career goals were higher in Gyn/Onc fellowship programs compared with MFM fellowship.

Berkus, Michael D.; Langer, Oded; Samueloff, Arnon; Xenakis, Elly M. J.; Field, Nancy T. Author Information

In Brief Objective To determine the length of time required for dietary therapy alone to effect good glycemic control and whether the need for insulin treatment can be predicted at diagnosis of gestational diabetes mellitus (GDM). Methods Women with GDM were treated with dietary therapy for 4 weeks. Each measured her blood glucose using a memory-based reflectance glucometer, and those in poor glycemic control (mean glucose exceeding 105 mg/dL) after 4 weeks of dietary therapy were prescribed insulin. Women were stratified by fasting plasma glucose value of 3-hour glucose tolerance tests (GTTs). Results Women with fasting glucose at or below 95 mg/dL were significantly more likely to achieve good glycemic control after 2 weeks of dietary therapy than were those with values above 95 mg/dL whose control did not improve during the study. Receiver operating characteristic (ROC) analysis determined that fasting values of GTT between 91 and 95 mg/dL best predicted that insulin would be needed for good glycemic control. Conclusion Women with GDM should be prescribed dietary therapy alone for at least 2 weeks before they are prescribed insulin. In those with fasting glucose above 95 mg/dL, insulin may be prescribed after 1 week of dietary therapy, or at diagnosis. Women with gestational diabetes can be treated with dietary therapy for up to 2 weeks to assess its efficacy before they are prescribed insulin.