Babies After 35

09/30/2025

Resources: PMID 37630837 and 38256127, doi.org/10.1038/s41598-024-68599-x

Different delivery methods can cause variations in the composition and structure of intestinal microbiota in neonates. However, the impact of the microecological environment on host immune function requires further investigation. The neonate period is crucial for the initial colonization of normal intestinal microbiota and is the most important stage for the formation and establishment of intestinal microbiota for the future. The presence and activity of a “symbiotic” intestinal microbita in neonates plays a crucial role in maintaining intestinal barrier function, immune response, immune system maturation, and neurodevelopment. Many diseases, including allergic diseases and asthma related to the immune system, are associated with disorders of intestinal microbiota. The mode of delivery is widely acknowledged as a crucial determinant in the early acquisition and development of intestinal microbiota, particularly during the first year of life. In neonates born through va**nal delivery, the early intestinal microbiota largely originates from the maternal intestine, va**na, skin, and other sources. However, infants delivered via cesarean section lack direct contact with the mother’s digestive tract and birth canal, hindering their ability to acquire microbiota essential for early colonization. For instance, cesarean-born children have a heightened risk of immune function-related disorders such as asthma, idiopathic arthritis, and gastroenteritis, primarily affecting mucosal immune system functions. The procedure bypasses the natural transmission of microorganisms from the birth canal and maternal intestinal microbiota to the fetus, resulting in disturbances in the infant’s intestinal microbiota. Consequently, there is weaker activation of intestinal immune cell receptors regulating intrinsic and adaptive immunity, thereby increasing the risk of asthma in school-age children.

09/29/2025

Did you have a pregnancy with a circumvallette placenta? Go to my “placenta” highlight for more info!

09/28/2025

Go to my folic acid and MTHFR playlists for more evidence based info!

09/27/2025

I am not anti-doula. They are extremely valuable as support persons. However, there are many on social media who present themselves as medical professionals when they are not, and this is dangerous.Patients have the right to choose OB care or midwife care without feeling shame either way. The efforts by accounts to cause a divide, particularly by trashing OBs, is disappointing and self-serving. The bottom line is that patients are suffering due to poor care by ALL obstetrical care providers—not just the OBs. A more collaborative effort is needed to work towards making a change. Our patients deserve that.They do not need to see or hear either profession disparaging the other or questioning qualifications or training. They only creates confusion and doubt. The strengths and talents of midwives and OBs should be recognized, and we should support each other. The competition and “us vs them” mentality is only putting the patient in the middle.

09/26/2025

What is the thyroid?
Maybe you learned about the thyroid gland in health or anatomy and physiology class, but haven’t thought much else about it since your school days. This small but mighty part of our bodies plays a big role in our overall health, and there are important considerations for thyroid function during pregnancy. The thyroid gland, found near the lower part of the throat near the trachea, creates and produces thyroid hormones that are needed throughout many systems in the body. Those who have a thyroid producing too much or too little of these hormones have thyroid disease.

Go to my stories to access the article on substack!

and how it can affect you, the fetus and neonate.

09/26/2025

Did you have cervical insufficiency or a cerclage placed? Transabdominal cervicoisthmic cerclage generally is reserved for patients in whom cerclage is indicated based on the diagnosis of cervical insufficiency but cannot be placed because of anatomical limitations (eg, after a trachelectomy), or in the case of failed transva**nal cervical cerclage procedures that resulted in second-trimester pregnancy loss. Transabdominal cerclage can be accomplished through open laparotomy or operative laparoscopy depending on physician experience, or patient preference. No evidence exists to suggest that one surgical approach for cervicoisthmic cerclage placement has an advantage over the other techniques. Abdominal cerclage procedures usually are performed in the late first trimester or early second trimester (10–14 weeks of gestation) or in the nonpregnant state. The stitch can be left in place between pregnancies with subsequent cesarean delivery.A transabdominal cerclage is placed at the cervicoisthmic junction. Potential advantages of this procedure over the transva**nal approach include: placement at the level of the internal os, reduced risk of suture migration, no foreign body in the va**na that could promote infection, and option of retention of the suture in situ for future pregnancies.Transabdominal cerclage can be performed using an open or laparoscopic approach. Due to lower morbidity, the laparoscopic approach is preferable when the requisite surgical expertise is available.In a large series, singleton fetal losses before 20 weeks and within two weeks of transabdominal cerclage occurred in 1.3 percent of cases (3 of 226). Surgical complications occurred in 3.7 percent of cases and median estimated blood loss was 100 mL, but serious bleeding from inadvertent damage to adjacent vessels can occur.

09/25/2025

From ACOG: GDM (gestational diabetes) when to deliver: *Controlled on diet: 39w0d to 40w6d -Expectant management up to 40w6d appropriate with antepartum testing *Well controlled on medication: Deliver at 39w0d to 39w6d *Poorly controlled: Individualize | Expert guidance supports earlier delivery but data lacking regarding precise timing -Delivery between 37w0d and 38w6d may be justified -Delivery between 34w0d and 36w6d weeks 0 days reserved for (1) failure of in-hospital glycemic control or (2) abnormal fetal testing How to deliver if Estimated fetal weight ≥4500: Counsel regarding risks and benefits of a scheduled cesarean section Pregestational diabetes (PGDM) *Suspected fetal macrosomia -Consider cesarean delivery for EFW ≥4500 grams -Patients with pregestational diabetes are at increased risk for shoulder dystocia *Timing of delivery -Diabetic complications: Deliver between 36w0d to 38w6d -Vasculopathy | Nephropathy | Poor glycemic control | Prior IUFD *Well-controlled: -Expectant management until 39th week -Requires reassuring antenatal testing *Note: Expectant management after 40w0d weeks is not recommended

09/24/2025

Does this clear things up? What is else do you want to know?

09/24/2025

Fever during pregnancy as a risk factor for neurodevelopmental disorders: results from a systematic review and meta-analysis: Additional evidence supported the association between fever during pregnancy and increased risk for NDD in offspring. Careful monitoring should be considered for children born from mothers with a febrile episode during pregnancy (specifically during the first trimester).Maternal fever during pregnancy and offspring attention deficit hyperactivity disorder: The results indicate that maternal fever in early pregnancy may be a risk factor for ADHD, and particularly for inattention problems. This risk is neither mitigated nor inflated by use of acetaminophen.Infection and Fever in Pregnancy and Autism Spectrum Disorders: Findings from the Study to Explore Early Development: These findings of an association between maternal infection with fever in the second trimester and increased risk of ASD in the offspring suggest that the inflammatory response to the infectious agent may be etiologically relevant.Prenatal fever and autism risk: ASD risk appears to increase with maternal fever, particularly in the second trimester. Risk magnified dose dependently with exposure to multiple fevers after 12 weeks' gestation. Our findings support a role for gestational maternal infection and innate immune responses to infection in the pathogenesis of at least some cases of ASD.

09/23/2025

1. They give no bias to most studies which is incorrect. They are all biased to some degree because they are retrospective or case control studies. A lot of them depend on recall either for medication exposure. That is by definition bias. 2. The discussion goes through all the limitations of the studies that found no association, particularly the sibling studies, but does not highlight the limitations of those that did find an association. 3. Even in studies that say they controlled for confounders, if you read the studies carefully you can tell that they have no clue what they are reviewing. For example, fever or infection were not clearly defined. Also if you go by chart review, which many of the studies did, of course someone would document fever or pain when giving Tylenol but how often do we document fever or pain when we don’t give Tylenol? 4. One more important thing about the epidemiological studies is that more than 95 percent of those exposed to Tylenol did not have autism. How can we say that Tylenol causes autism when the vast majority of those exposed don’t get it. Tylenol is a flag that the patient has inflammation either from pain or some cause for fever. In those with genetic predisposition this inflammation may lead to autism in offspring. There is as much plausibility that Tylenol in pregnancy for fever and pain could be helping rather than harming. We will never be able to differentiate between these 2 effects.

09/23/2025

From ACOG: Bacterial vaginosis (BV) not an infection. It is a condition caused by an imbalance in the types of normal bacteria that live in the va**na. The main symptom is increased discharge with a strong fishy odor. The odor may be stronger during your menstrual period or after s*x. The discharge is usually thin and dark or dull gray, but it may have a greenish color. Itching is not common, but there may be itching if there is a lot of discharge. Several different antibiotics can be used to treat BV, including metronidazole and clindamycin. They can be taken by mouth or inserted into the va**na as a cream or gel. Sexual partners do not need to be treated. When metronidazole is taken by mouth, it can cause side effects in some patients. These include nausea, vomiting, and darkening of the urine. Do not drink alcohol when taking metronidazole. The combination can cause severe nausea and vomiting. BV often recurs. It may require repeated treatment. In some cases, longer treatment for 3 to 6 months may be needed.

09/23/2025

As a Maternal-Fetal Medicine Specialist, I say with confidence that pregnant individuals should not be afraid to take Tylenol when indicated. As with any medication prescribed in pregnancy, it should be taken when needed, and for the shortest duration to treat whatever condition it is being used to treat. I will continue to recommend Tylenol as the first-line treatment for maternal fever and pain, for which it has known benefits. Untreated pain and fever have known adverse effects in pregnancy.

The recommended dosage is 325 to 650 mg every 4 to 6 hours as needed or 1 g every 6 hours as needed; maximum dose: 4 g/day.

The best study to date, JAMA in 2024 (PMID: 38592388), of more than 185,000 children exposed to Tylenol in utero showed NO association between maternal Tylenol use and a risk for neurodevelopmental disorders (NDDs), like ASD and ADHD when the correct analysis was performed. In fact, when they looked at numerous different pain relievers in pregnancy, ALL were associated with neurodevelopmental disorders in offspring, but the associations went away in the sibling control analysis. This lends additional evidence to a genetic cause for NDDs.

The studies that do show an association have serious flaws and limitations. One of the major limitations of these studies is that they do not control for all “confounders”. These are factors that could cause autism and are also present in those who take Tylenol. These confounders make it look like Tylenol is associated with autism when it actually is not. Another important point is even we all agreed that Tylenol is associated with ASD, the difference in autism rates between those who took Tylenol and those who did not take Tylenol is very, very low. The vast majority of pregnant individuals who took Tylenol in the reported studies did not have children with autism. It is important to remember that NDDs are and will continue to be difficult to associate with one single cause and are multifactorial in origin with genetics playing a leading role.