Dr. Chapa’s OBGYN Clinical Pearls

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QUICKIE: AC v EFW for FGR Care Mar 07, 2026

Show notes

Well podcast family welcome to the first installment of what will be a periodic recurrence, of our episode called, “QUICKIE”. These are meant to be quick snippet episodes to give a quick fact or medical /clinical reminder in contrast to our regular episodes which are a little bit more in detail and lengthy. In this first installment of our first QUICKIE episode, we're going to tackle the distinction between the diagnosis of fetal growth restriction based on abdominal circumference vs estimated fetal weight and how this affects management.

1. ACOG CO 831

2. ACOG PB 227

Can Oral Probiotics Reduce Recurrent sPTB? Mar 05, 2026

Show notes

Probiotics. They are often marketed as the end of all and be all for all our health issues. And they CAN do some real good. There is NO DOUBT a connection with overall heath and gut health…and NO ONE can deny that. But probiotics gets grey for some women’s health issues. A new prospective, single-arm, non-blinded, multicenter study across 31 hospitals in Japan is making some pretty dramatic claims regarding oral probiotics and recurrent spontaneous preterm birth (ePUB). Can oral probiotics reduce spontaneous recurrent preterm birth? Listen in for details.

1. Prevention of Recurrent Spontaneous Preterm Delivery Using Probiotics: Results from a Prospective, Single-Arm, Multicenter Trial. PPP trial Collaborators et al.

American Journal of Obstetrics & Gynecology, Volume 0, Issue 0

2. Grev J, Berg M, Soll R. Maternal probiotic supplementation for prevention of morbidity and mortality in preterm infants. Cochrane Database Syst Rev. 2018 Dec 12;12(12):CD012519. doi: 10.1002/14651858.CD012519.pub2. PMID: 30548483; PMCID: PMC6516999.

3. Jarde A, Lewis-Mikhael AM, Moayyedi P, Stearns JC, Collins SM, Beyene J, McDonald SD. Pregnancy outcomes in women taking probiotics or prebiotics: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2018 Jan 8;18(1):14. doi: 10.1186/s12884-017-1629-5. PMID: 29310610; PMCID: PMC5759212.

4. Othman M, Neilson JP, Alfirevic Z. Probiotics for preventing preterm labour. Cochrane Database Syst Rev. 2007 Jan 24;2007(1):CD005941. doi: 10.1002/14651858.CD005941.pub2. PMID: 17253567; PMCID: PMC9006117.

5. Timing of Probiotic Milk Consumption During Pregnancy and Effects on the Incidence of Preeclampsia and Preterm Delivery: A Prospective Observational Cohort Study in Norway.

6. Nordqvist M, Jacobsson B, Brantsæter AL, Myhre R, Nilsson S, Sengpiel V. Timing of probiotic milk consumption during pregnancy and effects on the incidence of preeclampsia and preterm delivery: a prospective observational cohort study in Norway. BMJ Open. 2018 Jan 23;8(1):e018021. doi: 10.1136/bmjopen-2017-018021. PMID: 29362253; PMCID: PMC5780685.

7. Gao Q, Sun Y, Qu Y, Li F, Li P. The effect of probiotic supplementation during pregnancy on pregnancy complications: An umbrella meta-analysis. Medicine (Baltimore). 2025 Dec 19;104(51):e46409. doi: 10.1097/MD.0000000000046409. PMID: 41430994; PMCID: PMC12727282.

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Believe in Bed Rest for PTB? The AWARE Study Mar 02, 2026

Show notes

Neither the ACOG nor SMFM recommend strict bed rest for preterm birth prevention, or nor preeclampsia. Yet tradition often conflicts with evidence. A prior 2009 survey of MFM specialists, published in the AJOG, on the use of bed rest revealed that 71% used activity restriction in their practice for arrested preterm labor, despite the majority believing it had minimal or no benefit. The authors concluded, “Because most obstetricians in our survey indicated they would prescribe bed rest believing it was associated with minimal or no benefit, it is possible that even if a randomized, prospective trial showed no benefit associated with bed rest, it would still remain a common recommendation.” This brings us to a brand new publication from the Green Journal which is an ancillary study of two randomized trials of preterm birth prevention in women with a short cervical length. These authors sought to evaluate the amount of physical activity in patients at high risk for preterm birth and pregnancy latency and preterm birth. What did they find? It is a bit shocking. Listen in for details.

1. Fox, Nathan S. et al. The recommendation for bed rest in the setting of arrested preterm labor and premature rupture of membranes. American Journal of Obstetrics & Gynecology, Volume 200, Issue 2, 165.e1 - 165.e6 https://www.ajog.org/article/S0002-9378(08)00909-5/fulltext

2. Sciscione, Anthony C. DO; Booker, Whitney A. for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (MFMU) Network, Bethesda, Maryland. Activity Restriction in Pregnancy and the Risk of Early Delivery: The AWARE Study. Obstetrics & Gynecology ():10.1097/AOG.0000000000006225, February 19, 2026. | DOI: 10.1097/AOG.0000000000006225 https://journals.lww.com/greenjournal/pages/articleviewer.aspx?year=9900&issue=00000&article=01460&type=Fulltext

Visit our SPONSOR’s Webpage for information on the Hemorrhage View C-Section Drape: www.perspectivemedical.org

Pregnancy and the Brain Feb 27, 2026

Show notes

A study published in Nature Communications, published Feb 19, 2026, found that “pregnancy physically alters a woman’s brain, with a second pregnancy bringing even more profound effects.” The researchers “performed brain scans on 110 women. Some were first-time mothers, others second-time moms, and some nulliparous women. Results showed that during a first pregnancy, the greatest changes occur in the structure and activity of the ‘default mode network’ – the brain system responsible for self-reflection and mind wandering. Are these changes bad? Are they associated with long term hard? Are they adaptive? It’s a complex question, with real answers. Listen in for details.

1. Straathof, M., Halmans, S., Pouwels, P.J.W. et al. The effects of a second pregnancy on women’s brain structure and function. Nat Commun 17, 1495 (2026). https://doi.org/10.1038/s41467-026-69370-8

2. de Lange AG, Kaufmann T, van der Meer D, et al. Population-Based Neuroimaging Reveals Traces of Childbirth in the Maternal Brain. Proceedings of the National Academy of Sciences of the United States of America. 2019.

3. Aleknaviciute J, Evans TE, Aribas E, et al.)Long-Term Association of Pregnancy and Maternal Brain Structure: The Rotterdam Study. European Journal of Epidemiology. 2022.

4. Jung JH, Lee GW, Lee JH, et al. Multiparity, Brain Atrophy, and Cognitive Decline. Frontiers in Aging Neuroscience. 2020.

5. Hu A, Xiong L, Wei H, et al. Association of Menarche, Menopause, and Reproductive History With Cognitive Performance in Older US Women: A Cross-Sectional Study From NHANES 2011-2014. BMC Public Health. 2025.

6. Orchard ER, Ward PGD, Sforazzini F, et al. Relationship Between Parenthood and Cortical Thickness in Late Adulthood. PloS One. 2020

7. Hoekzema E, Barba-Müller E, Pozzobon C, et al. Pregnancy Leads to Long-Lasting Changes in Human Brain Structure. Nature Neuroscience. 2017.

8. de Lange AG, Barth C, Kaufmann T, et al. Women's Brain Aging: Effects of Sex-Hormone Exposure, Pregnancies, and Genetic Risk for Alzheimer's Disease. Human Brain Mapping. 2020.

Visit our SPONSOR's LINK to learn more about the Hemorrhage view CS Drape: https://www.perspectivemedical.org/

Hyst + BSO for BRCA Risk Reduction? Feb 24, 2026

Show notes

Approximately 5–10% of all breast cancers are hereditary, and among those, BRCA1 and BRCA2 mutations are responsible for about 60% of cases. Yet, overall, only about 1-2% of all breast cancers in the general population are caused by BRCA mutations. Once childbearing is complete, the NCCN recommends risk-reducing BSO in patients carrying these mutations. But what about the uterus? Since childbearing is complete, and the ovaries are now removed, the sole purpose of the uterus- which is to initiate, nourish, and grow a child -is no longer applicable. Is there a call for inclusion of a hysterectomy at time of risk reducing BSO? This has vast and important implications regarding subsequent hormone therapy. In this episode, which comes from one of our podcast family members, we will dive into the latest data pushing towards the inclusion of hysterectomy at time of prophylactic BSO. It's fascinating data from just last year (2025, in the Journal of the NCI). Listen in for details.

1. Kotsopoulos J, Seca M, Gronwald J, et al. Menopausal Hormone Therapy and the Risk of Breast Cancer in Women With a Pathogenic Variant in BRCA1 or BRCA2. Journal of the National Cancer Institute. 2025.

2. Kotsopoulos J, Gronwald J, Karlan BY, et al. Hormone Replacement Therapy After Oophorectomy and Breast Cancer Risk Among BRCA1 Mutation Carriers. JAMA Oncology. 2018

New Data: Screen Maternal Ferritin with Prenatal Care? Feb 21, 2026

Show notes

The ACOG states that, “Iron deficiency anemia during pregnancy has been associated with an increased risk of low birth weight, preterm delivery, and perinatal mortality and should be treated with iron supplementation in addition to prenatal vitamins. In addition, there may be an association between maternal iron deficiency anemia and postpartum depression, with poor results in mental and psychomotor performance testing in offspring”. Screening for anemia is included in most prenatal lab sets. However, up to 42% of women who enter prenatal care are iron deficient BEFORE anemia is detected. Iron deficiency itself, even without anemia, has also been linked to pregnancy morbidity. The ACOG currently does not have a statement endorsing universal ferritin screening in pregnancy outside of established anemia, but new data is challenging this (Jan 2026, Lancet). Listen in for details.

1. ACOG PB 233

2. Wasim T, Bushra N, Nasrin T, Humayun S, Tajammul A, Khawaja KI, Irshad S, Fatima S, Yasin A, Zamora J, Cano-Ibáñez N, Fernandez-Felix BM, Khan KS; Ferritin screening and iron treatment for maternal anaemia and fetal growth restriction prevention (FAIR) Study Group. Intravenous iron for non-anaemic iron deficiency in pregnancy: a multicentre, two-arm, randomised controlled trial. Lancet Haematol. 2026 Jan;13(1):e22-e29. doi: 10.1016/S2352-3026(25)00315-1. PMID: 41482443.

3. https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2024.15196

Alex’s Input: Aspirin’s Awkward Acumen Feb 18, 2026

Show notes

We recently covered an SMFM abstract that was presented at the annual Pregnancy Meeting held in early February 2026. The authors were from my Alma Mater, UT Southwestern/Parkland Hospital. This was a well-done study comparing 162 milligrams aspirin to 81 milligrams of aspirin. The results were very encouraging! However, aspirin definitely has an awkward acumen. It would be wonderful if ALL the data just leaned in the same direction... but it doesn’t! Enter our podcast family member, and my friend Alex. Alex sent me an incredible and insightful message which was a rebuttal to my Southwestern colleagues’ findings. In this episode you'll hear Alex's rebuttal and clinical conundrum, and we will explain why these two seemingly paradoxical findings makes sense. Listen in for details.

1. Khander, Amrin MD; Thomas, Charlene MS; Matthews, Kathy MD; Christos, Paul DrPH; Alcus, Claire BA; Alam, Tanvir BS; Bush, Leah BA; Deshmukh, Diksha BA; Chasen, Stephen T. MD; Riley, Laura E. MD; Skupski, Daniel W. MD; August, Phyllis MD, MPH; Malha, Line MD, MS. Comparison of 162 mg and 81 mg Aspirin for Prevention of Preeclampsia: A Randomized Controlled Trial. Obstetrics & Gynecology 147(1):p 87-96, January 2026. | DOI: 10.1097/AOG.0000000000006100

More Support for 162mg LDA Universal Use in OB Feb 16, 2026

Show notes

Well, even though low dose aspirin has been recommended for the reduction of preeclampsia risk for many years, 2 controversies persist: 1. who should get it, and 2. the dose we should use. While the current US recommendation still focuses on 81 mg low dose aspirin, initiated after 12 weeks of gestation (based on risk factors), there's increased movement and growing data supporting both universal adoption and the higher dose of 162 mg. In this episode, we will briefly summarize brand new data out of UT Southwestern which was just published at the SMFM Annual Pregnancy meeting in Las Vegas. Listen in for details.

1. https://www.smfm.org/news/new-studyroutine-aspirin-therapypreventsseverepreeclampsiainat-risk-populations

2. ACOG CO 743

3. The Effect of Aspirin on the Risk of Preeclampsia Based on the Fetal Medicine Foundation First Trimester Risk.

4. Bujold E, Rolnik DL, Poon L, Syngelaki A, Wright D, Nicolaides KH. The effect of aspirin on the risk of preeclampsia based on the Fetal Medicine Foundation first-trimester risk. Am J Obstet Gynecol. 2025 Oct 31:S0002-9378(25)00808-7. doi: 10.1016/j.ajog.2025.10.032. Epub ahead of print. PMID: 41177290.

GDM vs “Early” GDM vs PrePreg DM: A Proposal Feb 13, 2026

Show notes

As BMIs and weights increase across the US population, there have been increased calls for universal screening for existing DM at entrance to prenatal care, if under 20 weeks. Others, including the ACOG, prefer to screen early those with additional risk factors (like prior GDM HX, prior macrosomia, BMI >30, PCOS, first degree relative with diabetes, or age >40). In July 2024, the ACOG released its publication, “Screening for Gestational and Pregestational Diabetes in Pregnancy and Postpartum”. In this guidance, it states, “At this time, there are insufficient data to support the best screening modality for pregestational diabetes in pregnancy, but consideration can be made to use the same diagnostic criteria as for the nonpregnant population (A1c value 6.5 or higher, or fasting plasma glucose value 126 mg/dL or higher, or 2-hour plasma glucose value 200 mg/dL or higher during a 75-g OGTT, or random plasma glucose value 200 mg/dL or higher in patients with classic hyperglycemia symptoms)”. However, a new proposed protocol has been published in AJOG for early screening for DM in pregnancy. This also describes the differences in diagnosis and care for Standard GDM diagnosed at 24-28 weeks, vs a diagnosis of pregestational DM diagnosis made prior to 20-weeks vs “early” GDM also diagnosed under 20 weeks of gestation. Listen in for details.

1. McLaren, Rodney et al.nA Proposed Classification of Diabetes Mellitus in Pregnancy

American Journal of Obstetrics & Gynecology, Volume 0, Issue 0. Epub Feb 2, 2026; https://www.ajog.org/article/S0002-9378(26)00061-X/fulltext

2. ACOG Clinical Practice Update: Screening for Gestational and Pregestational Diabetes in Pregnancy and Postpartum; July 2024; https://journals.lww.com/greenjournal/abstract/2024/07000/acog_clinical_practice_update__screening_for.34.aspx

3. Simmons, David et al. “Treatment of Gestational Diabetes Mellitus Diagnosed Early in Pregnancy.” The New England journal of medicine vol. 388,23 (2023): 2132-2144. doi:10.1056/NEJMoa2214956

HPV? Check Your Pad. Feb 10, 2026

Show notes

There has been a shift in cervical cancer screening from primary cytology based to HPV based. Even HPV screening has had its evolution from physician collected samples to patient self-collection, either in a clinical setting or at home with an approved collection system. In May 2025, the FDA cleared the first at-home self-collection kit for HPV screening, specifically the Teal Wand by Teal Health. Now, we are seeing the advent of POSSIBLY another avenue for cervical HPV testing- although it is a bit awkward: the use of menstrual blood as an HPV screening test. In this episode we will review a new cross-sectional, population-based study from China which compared testing menstrual blood for human papillomavirus during cervical cancer screening to clinician-collected cervical samples for human papillomavirus (HPV). This concept, and these results, are not new at all! And there are important limitations to consider at this time. Listen in for details.

1. Testing menstrual blood for human papillomavirus during cervical cancer screening in China: cross sectional population based study. BMJ 2026; 392 doi: https://doi.org/10.1136/bmj-2025-084831 (Published 04 February 2026)

BMJ 2026;392:e084831

https://www.bmj.com/content/392/bmj-2025-084831

2. Naseri S, Young S, Cruz G, Blumenthal PD. Screening for High-Risk Human Papillomavirus Using Passive, Self-Collected Menstrual Blood. Obstet Gynecol. 2022 Sep 1;140(3):470-476. doi: 10.1097/AOG.0000000000004904. Epub 2022 Aug 3. PMID: 35926207; PMCID: PMC9377370.

3. Fokom Domgue J, Chandra M, Oladoyin O, Desai M, Yu R, Shete S. Women’s Preferences for Home-Based Self-Sampling or Clinic-Based Testing for Cervical Cancer Screening. JAMA Netw Open. 2026;9(2):e2558841. doi:10.1001/jamanetworkopen.2025.58841

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