Association of Gestational Weight Gain With Adverse Maternal and Infant Outcomes (Abstracted from JAMA 2019;321(17):1702–1715) Increased gestational weight gain is associated with higher risk of pregnancy complications, maternal postpartum weight retention, and offspring obesity. It can be caused by maternal fat accumulation, fluid expansion, fetal growth, placental growth, and uterine growth; the weight gain during pregnancy is necessary for a healthy fetus, but the optimal gestational weight gain is uncertain and not well defined for all prepregnancy weight ranges.

Maternal and Perinatal Mortality and Complications Associated With Cesarean Delivery in Low-Income and Middle-Income Countries: A Systematic Review and Meta-analysis (Abstracted from Lancet 2019;393(10184):1973–1982) Around the world every year, 300,000 women die during childbirth, with 99% of these cases occurring in low- and middle-income countries (LMICs). One potential cause is accessibility to cesarean deliveries in these countries, which are both overutilized and underutilized and contribute to maternal and perinatal adverse outcomes.

Building on the ACA to Achieve Universal Coverage (Abstracted from N Engl J Med 2019;380(18):1685–1688) Before the Affordable Care Act (ACA), the United States did not significantly reduce the percentage of Americans without health insurance coverage over the past several decades. After the ACA was enacted, US residents without coverage went from 16% to 9%.

Management of Preexisting Diabetes in Pregnancy: A Review (Abstracted from JAMA 2019;321(18):1811–1819) Preexisting diabetes complicates 0.9% of pregnancies in the US and increases the risk of adverse maternal and neonatal outcomes, specifically linked to preeclampsia, congenital anomalies, preterm delivery, and stillbirth. With type 1 and type 2 diabetes becoming more common, clinicians need to review planning and optimization of glycemic control with patients before pregnancy to mitigate the risk associated with diabetes.

Placental Growth Factor Testing to Assess Women With Suspected Preeclampsia: A Multicenter, Pragmatic, Stepped-Wedge Cluster-Randomized Controlled Trial (Abstracted from Lancet 2019;393(10183):1807–1818) Hypertension affects 10% of pregnant women, and approximately 3% of singleton pregnancies are complicated by preeclampsia. Preeclampsia often presents ambiguously, and the risks for women with suspected preeclampsia are complex.

Direct-to-Consumer Genetic Testing and Potential Loopholes in Protecting Consumer Privacy and Nondiscrimination (Abstracted from JAMA 2019;321(19):1869–1870) A recent report from the National Academies of Science, Engineering, and Medicine expressed concern that more use of direct-to-consumer (DTC) genetic testing by law enforcement could impact how individuals perceive genetic testing benefits and risks. In this commentary, the authors are especially concerned that these perceived risks could add feelings of distrust or discrimination, especially for vulnerable groups and populations including immigrants, prisoners and former convicts, sexual minorities, and racial or ethnic minorities, resulting in less use of genomic medicine.

Added Value of Chromosomal Microarray Analysis Over Conventional Karyotyping in Stillbirth Work-up: Systematic Review and Meta-analysis (Abstracted from Ultrasound Obstet Gynecol 2019;53:590–597) In developed countries, stillbirth occurs is approximately 3 to 6 of every 1000 pregnancies. Causes for stillbirth are varied, and chromosomal microarray analysis (CMA) has been introduced in clinical practice to help assess the genetic causes of stillbirth, in part because this technique has better resolution than what is possible using conventional karyotyping and in part because it does not require viable tissue as culturing is not required.

Clinical Utility of Expanded Carrier Screening: Results-Guided Actionability and Outcomes (Abstracted from Genet Med 2019;21(5):1041–1048) One in 300 pregnancies is impacted by a recessive or X-linked condition. Universal screening is recommended by guidelines for 2 of these conditions (cystic fibrosis and spinal muscular atrophy), but this misses approximately 70% of carriers of other diseases and fails to detect somewhere between 13% and 94% of pregnancies affected with severe conditions, depending on race/ethnicity.

Surgical Intervention in Patients With Tubo-Ovarian Abscess: Clinical Predictors and a Simple Risk Score (Abstracted from J Minim Invasive Gynecol 2019;26:535–543) Tubo-ovarian abscess (TOA) presents as an infectious mass of the adnexa and is a late complication of pelvic inflammatory disease (PID) in up to 30% of cases. TOA is associated with significant patient morbidities, including pain, sepsis, and recurrent hospitalizations and may lead to long-term complications such as chronic pelvic pain, pelvic adhesions, infertility, and ectopic pregnancies.

Evaluating Pelvic Floor Muscle Contractility Using Two-Dimensional Transperineal Ultrasonography in Patients With Pelvic Organ Prolapse (Abstracted from Neurourol Urodyn 2019;38:1363–1369) Pelvic function has a significant role in the pathogenesis of pelvic organ prolapse (POP). First-line treatment for POP is pelvic floor muscle training (PFMT), which is widely prescribed for this purpose.