Shannon M. Clark,MD,MMS,FACOG

#stitch with @Trinidee | Lifestyle 🍒 Go to my diabetes playlist for more info! What causes GD? The body produces a hormone called insulin that keeps blood sugar levels in the normal range. During pregnancy, higher levels of pregnancy hormones can interfere with insulin. Usually the body can make more insulin during pregnancy to keep blood sugar normal. But in some people, the body cannot make enough insulin during pregnancy, and blood sugar levels go up. This leads to GD. What are the risk factors for GD? Several risk factors are linked to GD, including: being overweight or obese being physically inactive having GD in a previous pregnancy having a very large baby (9 pounds or more) in a previous pregnancy having high blood pressure having a history of heart disease having polycystic ovary syndrome (PCOS) GD also can develop in people who have no risk factors. When a person has GD, their body passes more sugar to her fetus than it needs. With too much sugar, her fetus can gain a lot of weight. A large fetus (weighing 9 pounds or more) can lead to complications for the patient, including: labor difficulties cesarean birth heavy bleeding after delivery severe tears in the vagina or the area between the vagina and the anus with a vaginal birth How do I track blood sugar levels? You will use a glucose meter to test your blood sugar levels. This device measures blood sugar from a small drop of blood. Keep a record of your blood sugar levels and bring it with you to each prenatal visit. Blood sugar logs also can be kept online, stored in phone apps, and emailed to your ob-gyn. Your blood sugar log will help your obgyn provide the best care during your pregnancy. Will I need to take medication to control my GD? For some people, medications may be needed to manage GD. Insulin is the recommended medication during pregnancy to help patients control their blood sugar. Insulin does not cross the placenta, so it doesn’t affect the fetus. Your ob-gyn should teach you how to give yourself insulin shots with a small needle. In some cases, your ob-gyn may prescribe a different medication to take by mouth. If you are prescribed medication, you will continue monitoring your blood sugar levels as recommended. Your ob-gyn should review your glucose log to make sure that the medication is working. Changes to your medication may be needed throughout your pregnancy to help keep your blood sugar in the normal range. Will I need tests to check the health of my fetus? Special tests may be needed to check the well-being of the fetus. These tests may help your ob-gyn detect possible problems and take steps to manage them. These tests may include the following: Fetal movement counting (“kick counts”)—This is a record of how often you feel the fetus move. A healthy fetus tends to move the same amount each day. You should contact your ob-gyn if you feel a difference in your fetus’s activity. Nonstress test—This test measures changes in the fetus’s heart rate when the fetus moves. The term “nonstress” means that nothing is done to place stress on the fetus. A belt with a sensor is placed around your abdomen, and a machine records the fetal heart rate picked up by the sensor. Biophysical profile (BPP)—This test includes monitoring the fetal heart rate (the same way it is done in a nonstress test) and an ultrasound exam. The BPP checks the fetus’s heart rate and estimates the amount of amniotic fluid. The fetus’s breathing, movement, and muscle tone also are checked. A modified BPP checks only the fetal heart rate and amniotic fluid level. #gestationaldiabetes #pregestationaldiabetes #diabetes

@natural.dr.stephanie will happily take your call if you listen to her and your fetus has a neural tube defect. ❤️ From Online Misinformation Fuels a Fight Over Folic Acid: Folic acid supplements are among the best studied and most widely endorsed nutritional recommendation for childbearing-aged women today. Despite the scientific consensus, some nutritionists and dieticians — along with prominent complementary health practitioners including naturopaths, chiropractors, and functional medicine doctors — are causing many people, and not just those who are or may become pregnant, to question whether they should be consuming any folic acid at all. Many medical experts worry that these vocal individuals are urging people who could become pregnant to avoid vital folic acid supplementation, putting unborn babies at unnecessary risk for neural tube defects. The links between MTHFR and the majority of the disorders are weak, according to Barry Shane, a nutrition researcher and professor emeritus at the University of California, Berkeley, who has been studying folate metabolism for over 45 years. These warnings about folic acid appear widely on sites that feature heavy doses of science skepticism or dubious claims, among them that MTHFR variations justify medical exemptions from vaccines. Typically, those sites also sell supplements, genetic testing, and analysis, or related services including nutritional coaching sessions, books, and online courses centered on MTHFR. The body uses folate to transport carbon for numerous crucial processes in cells. The gene MTHFR codes for an enzyme that helps to get the carbon into forms necessary for these processes. (In the process MTHFR generates L-methylfolate, another kind of folate, which other enzymes further modify to make things that cells need.) These processes can be less efficient in people with the common MTHFR variations. This can lead to lower blood folate levels, but folic acid can boost folate levels even in people with variations. L-methylfolate is more difficult, and therefore more costly, to make into a supplement and is less stable than folic acid. And because it is less stable, it can be hard to know exactly how much someone is getting if it’s been sitting on the shelf. #folicacid #methylfolate

This is a heartbreaking and tragic loss 💔 As an MFM I can say that maternal sepsis is something we always need to have on our radar. Treatment must be initiated within ONE HOUR for best maternal outcomes. #maternalsepsis #sepsis #sepsticshock #maternalmortality #krystalanderson

OP @katylynnsmithdesign THANK YOU FOR SHARING! SHARE THIS POST! TAG AN OBGYN TO WEIGH IN! SHARE YOUR STORY! #obgyn #obstetricalcare #obstetricalviolence #obstetricalbias #gaslighting #listentopregnantpeople

OP @N.Bowwow01 Diagnostic Criteria for Preeclampsia Blood pressure: •Systolic blood pressure of 140 mm Hg or more or diastolic blood pressure of 90 mm Hg or more on two occasions at least 4 hours apart after 20 weeks of gestation •Systolic blood pressure of 160 mm Hg or more or diastolic blood pressure of 110 mm Hg or more. AND Proteinuria: •300 mg or more per 24 hour urine collection OR •Protein/creatinine ratio of 0.3 mg/dL or more OR •Dipstick reading of 2+ (used only if other quantitative methods not available) Or in the absence of proteinuria, new-onset hypertension with the new onset of any of the following: •Thrombocytopenia: Platelet count less than 100 ,000 × 10 9/L •Renal insufficiency: Serum creatinine concentrations greater than 1.1 mg/dL or a doubling of the serum creatinine concentration in the absence of other renal disease •Impaired liver function: Elevated blood concentrations of liver transaminases to twice normal concentration •Pulmonary edema •New-onset headache unresponsive to medication and not accounted for by alternative diagnoses or visual symptoms Preeclampsia with Severe Features: •Systolic blood pressure of 160 mm Hg or more, or diastolic blood pressure of 110 mm Hg or more on two occasions at least 4 hours apart (unless antihypertensive therapy is initiated before this time) •Thrombocytopenia (platelet count less than 100 ,000 × 10 9/L Impaired liver function that is not accounted for by alternative diagnoses and as indicated by abnormally elevated blood concentrations of liver enzymes (to more than twice the upper limit normal concentrations), or bysevere persistent right upper quadrant or epigastric pain unresponsive to medications •Renal insufficiency (serum creatinine concentration more than 1.1 mg/dL or a doubling of the serum creatinine concentration in the absence of other renal disease) •Pulmonary edema •New-onset headache unresponsive to medication and not accounted for by alternative diagnoses •Visual disturbances #gestationalhypertension #preeclampsia #preeclampsiaawareness #eclampsia #hellpsyndrome #greenscreen

Prevalence — Face and brow presentation are uncommon. Their prevalences compared with other types of malpresentations are shown below: ●Occiput posterior – 1/19 deliveries ●Breech – 1/33 deliveries ●Face – 1/600 to 1/800 deliveries ●Brow – 1/500 to 1/4000 deliveries ●Transverse lie – 1/833 deliveries ●Compound – 1/1500 deliveries Risk factors – Face and brow presentations are associated with multiparity, cephalopelvic disproportion, preterm birth, polyhydramnios, and fetal anomalies (eg, anencephaly, anterior neck mass). Clinical significance – The deflexed neck in face or brow presentation inhibits head engagement and subsequent fetal descent. Cautions – The fetal heart rate is monitored continuously during labor, ideally with an external device, because of the increased prevalence of fetal heart rate decelerations. An internal device may cause facial or ophthalmic injuries if improperly placed. If internal monitoring is required, the electrode should be carefully applied over a bony structure to minimize the risk of trauma. In face presentation, the fetal face from forehead to chin is the leading fetal body part descending into the birth canal. The fetal neck is sharply deflexed and the occiput may touch the back. Nearly 60% of face presentations are mentum anterior, 26% are mentum posterior, and 15% are mentum transverse, and may be designated as left or right. #laboranddelivery #birth #childbirth #facepresentation #birthtok #laborandbirth

OP @House Of Keto - Abby From ACOG: The health risks for you and your fetus may increase if a pregnancy is late term or postterm, but problems occur in only a small number of postterm pregnancies. Most people who give birth after their due dates have uncomplicated labor and give birth to healthy babies. Risks associated with postterm pregnancy include the following: Stillbirth Macrosomia Postmaturity syndrome Meconium in the lungs of the fetus, which can cause serious breathing problems after birth Decreased amniotic fluid, which can cause the umbilical cord to pinch and restrict the flow of oxygen to the fetus Other risks include an increased chance of an assisted vaginal delivery or cesarean delivery. There also is a higher chance of infection and postpartum hemorrhage when your pregnancy goes past your due date. A pregnancy between 40 weeks and 41 weeks of gestation does not necessarily require testing, but at 41 weeks your ob-gyn or other health care professional may recommend testing. These tests may be done weekly or twice weekly. The same test may need to be repeated or a different test may need to be done. In some cases, delivery may be recommended. #postermpregnancy #duedate # #greenscreen #latetermpregnancy #overdue #overduebaby #stillbirth

Replying to @Pamela A Do you work on L&D? What scares you the most? #laboranddelivery #obgyn #mfm #obstetricalemergency #emergency #shoulderdystocia #uterinerupture

#stitch with @emma 🤍 Most cases of PROM can be diagnosed on the basis of the patient's history and physical examination. Examination should be performed in a manner that minimizes the risk of introducing infection. Because digital cervical examinations increase the risk of infection and add little information to results available with speculum examination, they generally should be avoided unless the patient appears to be in active labor or delivery seems imminent. Sterile speculum examination provides an opportunity to inspect for cervicitis and prolapse of the umbilical cord or fetal parts, assess cervical dilatation and effacement, and obtain cultures as appropriate. The diagnosis of membrane rupture typically is confirmed by conventional clinical assessment, which includes the visualization of amniotic fluid passing from the cervical canal and pooling in the vagina, a simple pH test of vaginal fluid, or arborization (ferning) of dried vaginal fluid, which is identified under microscopic evaluation. The normal pH of vaginal secretions is generally 3.8–4.5 whereas amniotic fluid usually has a pH of 7.1–7.3. False-positive test results may occur in the presence of blood or semen, alkaline antiseptics, certain lubricants, trichomonas, or bacterial vaginosis. Alternatively, false-negative test results may occur with prolonged membrane rupture and minimal residual fluid. In equivocal cases, additional tests may aid in the diagnosis. Ultrasonographic examination of amniotic fluid volume may be a useful adjunct but is not diagnostic. Fetal fibronectin is a sensitive but nonspecific test for ruptured membranes; a negative test result suggests intact membranes, but a positive test result is not diagnostic of PROM. Several commercially available tests for amniotic proteins are currently on the market, with reported high sensitivity for PROM. However, false-positive test result rates of 19–30% have been reported in patients with clinically intact membranes and symptoms of labor. #amnioticfluid #prom #pprom #prelaborruptureofmembranes #pregnancy

From Helio: A new study of more than 185,000 children showed no association between acetaminophen use in pregnancy and a risk for neurodevelopmental disorders in children, including autism and ADHD. The findings conflict with previous research that suggested acetaminophen use in pregnancy raised the risk for neurodevelopmental disorders in children. One of the authors of the new study said the work began after a 2021 consensus statement in Nature Reviews Endocrinology recommended that pregnant people “minimize exposure (to acetaminophen) by using the lowest effective dose for the shortest possible time,” based on the findings that suggested prenatal exposure to the analgesic could increase the risk for neurodevelopmental and other conditions. “There was a strong response to that statement, including a number of letters published in the same journal disputing the conclusions and pointing out that such ‘calls for action’ run the risk of adding to anxiety and guilt among pregnant women,” Renee M. Gardner, PhD, principal researcher in the department of global public health at Sweden’s Karolinska Institutet. “We aimed to understand if those associations were also apparent in analyses when we controlled for different indications of acetaminophen use and when we compared full siblings,” Brian K. Lee, PhD, an associate professor at the Drexel Dornsife School of Public Health in Philadelphia and fellow at the A.J. Drexel Autism Institute, told Healio. The researchers began the new study by pulling antenatal and prescription records from pregnancies in Sweden. They had access to clinical diagnoses of autism, ADHD and intellectual disability through a register of all specialist and inpatient care in Sweden. “We compared children whose mothers had reported acetaminophen use during pregnancy or who obtained a prescription for use during pregnancy with children with no reported maternal use,” Lee said. In an analysis of matched full sibling pairs, the researchers found no increased risk for autism (HR = 0.98; 95% CI, 0.93-1.04), ADHD (HR = 0.98; 95% CI, 0.94-1.02), or intellectual disability (HR = 1.01; 95% CI, 0.92-1.1) — findings that Gardner said were not particularly surprising. “Given the highly heritable nature of autism and other neurodevelopmental conditions and the fact that genetic variants that are associated with neurodevelopmental conditions have also been associated with migraine and pain, we felt that there was a very high risk that the associations that others had reported were due to confounding,” Gardner said. #tylenol #adhd #autism #asd #autismspectrumdisorder #pregnancy #pregnant #tylenolinpregnancy #greenscreen

#stitch with @India Batson Tell me your thoughts in comments ❤️ Go to my “pregnancy loss” playlist for more info. #pregnancyloss #miscarriage #ectopic #earlypregnancyloss

Replying to @Melissa Apodaca Other info from ACOG on pregnancy after age 35! Pregnancy with anticipated delivery at age 35 years or older be recognized as a risk factor for adverse maternal, fetal, and neonatal outcomes when counseling patients and determining management plans. Nuanced counseling will be dependent on specific age and comorbidities. Daily low-dose aspirin for the reduction of preeclampsia for pregnant individuals aged 35 or older in the setting of at least one other moderate risk factor. Given increased rates of multiple gestations for pregnant individuals with anticipated delivery at age 35 years or older, a first-trimester ultrasound is recommended. Prenatal genetic screening (serum screening with or without nuchal translucency ultrasonography or cell-free DNA screening) and diagnostic testing (chorionic villus sampling or amniocentesis) options should be discussed and offered to all pregnant individuals regardless of age or risk of chromosomal abnormality. A detailed fetal anatomic ultrasonogram for pregnant individuals with anticipated delivery at age 35 years or older given the increased risk of aneuploidy and potential increased risk of congenital anomalies in this population is recommended. Due to increased risk of both large-for-gestational-age and small-for-gestational-age neonates, an ultrasound for growth assessment in the third trimester for pregnant individuals with anticipated delivery at age 40 years or older is recommended. Antenatal fetal surveillance for pregnant individuals with anticipated delivery at age 40 years or older given the increased risk of stillbirth should be offered. Delivery in well-dated pregnancies at 39 0/7–39 6/7 weeks of gestation for individuals with anticipated delivery at age 40 years or older due to increasing rates of neonatal morbidity and stillbirth beyond this gestational age is recommended. Vaginal delivery is safe and appropriate if there are no other maternal or fetal indications for cesarean delivery. Counseling should include a discussion of the risks of cesarean delivery, the patient’s comorbidities, and the patient’s preferences and goals. Advancing patient age alone is not an indication for cesarean delivery. #ama #advancedmaternalage #advancedmaternalagepregnancy #pregnancyover35 #pregnancyover40

#duet with @missmommymack Weight is not the root cause of all health problems people with a uterus experience. Has something like this wver happened to you?

Check out the tagged video her for more info on how your body may change in pregnancy! @Shannon M. Clark,MD,MMS,FACOG #pregnancynose

OP @BereIb Have you ever heard if this? #amnioticbandsyndrome #amnioticbandsequence

#stitch with @Dr. Fran (DO, FACOG) Tell me about your “natural” birth experience! #birth #birthtok #childbirth #laboranddelivery #obgyn #mfm

OP @LadySunShowers Click on this video for info on recommended testing for a stillbirth or IUFD. @Shannon M. Clark,MD,MMS,FACOG #listeria #listeriosis #pregnancy #pregnant #greenscreen #stillbirth #iufd #pregnancyloss

#stitch with @Samara | T1D Mama From ACOG: A lot of people read online that they should sleep on their left side throughout their entire pregnancy, but that’s difficult and not necessary. You can sleep on either side, right or left. You just want to avoid sleeping on your back later in pregnancy. As your belly grows, sleeping on your back puts more pressure on the blood vessels that supply blood to your uterus. If you find yourself sleeping on your back in your second or third trimester, don’t panic. Just turn to one side or the other. You can sleep on your belly, but you’ll get to a point where it’s just not possible. #obgyn #mfm #pregnant #pregnantlife #pregnancy #pregnancytiktok #sleep #sleepposition

Type 1 pregestational diabetes mellitus is characterized by an autoimmune process that destroys the pancreatic β cells, which leads to onset earlier in life, the need for insulin therapy, and the potential development of vascular, renal, and neuropathic complications. In contrast, type 2 diabetes mellitus, which has become the most common form of pregestational diabetes, is characterized by onset later in life, peripheral insulin resistance, relative insulin deficiency, and obesity. Although 90% of cases of diabetes encountered during pregnancy are gestational diabetes mellitus, more than one half of these women develop type 2 diabetes mellitus later in life. Maternal glucose control should be maintained near physiologic levels before and throughout pregnancy to decrease the likelihood of complications of hyperglycemia, including spontaneous abortion, fetal malformation, fetal macrosomia, fetal death, and neonatal morbidity. The management of pregestational diabetes in pregnancy focuses on optimal glucose control, which is achieved using a careful combination of diet, exercise, and medical therapy. Poorly controlled pregestational diabetes mellitus leads to serious end-organ damage that may eventually become life threatening. In turn, preexisting diabetes-related end-organ disease may have deleterious effects on obstetric outcomes. Overall perinatal outcomes are best when glucose control is achieved before a patient becomes pregnant and in the absence of maternal vascular or hypertensive disease. Major congenital anomalies are the leading cause of perinatal mortality in pregnancies complicated by pregestational diabetes mellitus, and they occur in 6–12% of infants of women with diabetes. Studies have linked the increased rate of congenital malformations, as well as spontaneous abortion, to poor prepregnancy glucose control. Stillbirths are higher in patients with diabetes and are associated with higher HbA 1 C values and with delayed or absent prenatal care. Facilitated diffusion of glucose across the placenta leads to transient fetal hyperglycemia. Subsequent stimulation of the fetal pancreatic β cells results in fetal hyperinsulinemia with several fetal and neonatal consequences. Because insulin is a potent growth hormone, excessive fetal growth occurs, particularly in adipose tissue. The fetus of a patient with poorly controlled diabetes is at increased risk of fetal death and is more likely to weigh more than 4,000 g with a disproportionate concentration of fat around the shoulders and chest, which more than doubles the risk of shoulder dystocia at vaginal delivery. Fetal macrosomia is strongly associated with HbA 1 C values in the pregnancy, and there is a suggestion that elevated postprandial values may be most closely related to the risk of macrosomia. Patients with pregestational diabetes mellitus have a greater risk of a wide range of obstetric complications. For these patients, the rate of primary cesarean delivery is increased; spontaneous preterm labor appears to be more common; and for some women—particularly those with poor glycemic control—the increased incidence of polyhydramnios may be a cause of preterm labor. Preeclampsia is observed in 15–20% of pregnancies complicated by type 1 diabetes mellitus without nephropathy and in approximately 50% with nephropathy. Preeclampsia is more likely to occur in patients with hypertension and poor glucose control. #pregestationaldiabetes #gestationaldiabetes #diabetes #diabetesinpregnancy #nst #nonstresstest #polyhydramnios

#stitch with @blacksupermamas on TT! Another TikTokBabyDoc/BabiesAfter35 pro tip! Did this happen to you? #obgyn #mfm #laboranddelivery #birth #childbirth #pregnancy #pregnant