preconception care, infant birth defects, and more

Contemporary OB/GYN week in review: preconception care, infant birth defects, and more

This week at Contemporary OB/GYN®, we covered topics ranging from preconception care in diabetes patients to medications increasing infant birth defect risks. We also held video interviews about gut symptoms caused by endometriosis and limitations of preeclampsia guidelines. Click the links below to read and watch anything you might have missed from Monday, July 14 to Friday, July 18, 2025.

Proper preconception care and access to emerging diabetes therapeutics should be provided to women with diabetes before, during, and after pregnancy, according to joint guidelines released by the Endocrine Society and the European Society of Endocrinology on July 13, 2025.

According to the societies, health risks are reduced in reproductive aged women with diabetes through screening at every reproductive, diabetes, and primary care visit. This allows those intending to conceive to undergo proper preconception care, reducing the odds of adverse pregnancy outcomes linked to modifiable factors such as high blood sugar.

“We developed these guidelines as diabetes rates are rising among women of reproductive age and very few women with diabetes receive proper preconception care,” said Jennifer Wyckoff, MD, guideline chair from the University of Michigan. “In addition to preconception planning, the guideline discusses advances in diabetes technology, delivery timing, medications and diet.”

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Trimethoprim-sulfamethoxazole (TMP-SMX) exposure increases malformation risks among infants vs β-lactam antibiotic exposure, according to a recent study published in JAMA Network Open.

Malformations were identified in 1518 infants, 729 of whom had cardiac malformations. Overall, an unadjusted absolute risk for any malformation of 19.8 per 1000 infants was reported for β-lactams, vs 21.2 per 1000 for nitrofurantoin, 23.5 per 1000 for fluoroquinolones, and 26.9 per 1000 for TMP-SMX.

Similar patterns were found for cardiac malformations. Overall, the weighted risk ratio for any malformation among infants exposed to TMP-SMX vs β-lactams was 1.35. One additional malformation was indicated for every 145 pregnancies exposed to TMP-SMX.

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DM199 (rinvecalinase alfa; DiaMedica Therapeutics) has shown positive results for treating preeclampsia in part 1a of a phase 2 clinical trial, according to DiaMedica Therapeutics Inc.

The therapeutic potential of DM199 was highlighted through meeting the safety and efficacy endpoints of the study. These included significant dose-dependent reductions in both systolic blood pressure and diastolic blood pressure, alongside no placental transfer and no serious adverse events linked to the drug.

“With hypertension being the leading cause of delivery, often prematurely, in early onset preeclampsia, DM199’s ability to safely reduce blood pressure represents an exciting development in the search for an effective treatment for preeclampsia,” said Cathy Cluver, PhD, principal investigator of the trial and leader of the Preeclampsia Research Unit at Tygerberg Hospital.

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In a recent interview with Contemporary OB/GYN, Jane Varney, MD, senior research dietitian at Monash University, discussed the relationship between endometriosis and gastrointestinal (GI) symptoms, and how a low FODMAP diet can alleviate these symptoms, ultimately improving quality of life for affected women.

According to Varney, the study results were promising. After just 2 weeks on the low FODMAP diet, women experienced clinically and statistically significant reductions in GI symptoms. These improvements included reduced abdominal pain, less bloating, improved stool consistency, and enhanced quality of life. By the end of the 4-week intervention, 60% of participants had shown a positive response to the low FODMAP diet.

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A recent study from Thomas McElrath, MD, PhD, vice president of clinical development at Mirvie, discussed the limitations of current US Preventive Services Task Force (USPSTF) guidelines for assessing preeclampsia risk and the broader challenges in improving outcomes for pregnant women.

The study found that about 89% of pregnant women meet at least 1 moderate or high-risk criterion for preeclampsia. This broad categorization may dilute the specificity of care and create ambiguity—if nearly everyone is considered at risk, it becomes harder to determine who truly needs intervention. This can undermine the goal of targeted aspirin prophylaxis and suggests that current criteria are too generalized.

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