In a program designed to train academic obstetrician-gynecologists, objective data from medical students' applications did not correlate with successful resident performance in our obstetrics-gynecology residency program. We need to continue our search for evaluation criteria that can accurately and reliably select the medical students that are best fit for our specialty.

Neonatal outcome is not improved in VLBW infants born by cesarean section. Given the morbidity of classical cesarean sections, vaginal delivery of the breech VLBW infant may be safely considered.

LORs can provide useful clues to differentiate between students who are likely to become the least versus the most successful residency program graduates. Greater usage of the ACGME core competencies within LORs may be beneficial.

If larger studies confirm the trends observed in our study, consideration should be given to including women with known thyroid disease in the subset of women who should be offered screening for diabetes early in pregnancy and appropriate clinical surveillance.

Lactating women in three U.S. geographic regions are iodine sufficient with an overall median UIC of 143 μg/L. Given ubiquitous exposure to perchlorate and thiocyanate, adequate iodine nutrition should be emphasized, along with consideration to decrease these exposures in lactating women to protect developing infants.

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Problem Immunologic, angiogenic, and anti‐angiogenic factors are associated with spontaneous abortion (SAB). B cell–activating factor (BAFF), a proliferation‐inducing ligand (APRIL), placental growth factor (PlGF), and soluble fms‐like tyrosine kinase‐1 (sFlt‐1) may play a role in SAB and may serve singly or in combination as an early biomarker of SAB. Method of Study In this prospective observational study, serum sFlt‐1, PIGF, BAFF, and APRIL levels were measured in the first trimester of pregnancy in a medically diverse group of women and in non‐pregnant controls. Associations and discriminative values of first‐trimester sFlt‐1, PIGF, BAFF, and APRIL levels and the corresponding APRIL:BAFF, BAFF:sFlt‐1, and sFlt‐1:PlGF ratios with development of SAB were tested. Results Median serum BAFF level was lower (p = .007) and median serum sFlt‐1 level was higher (p < .001), in the first trimester of pregnancy than in non‐pregnant controls. SAB developed in 27 of the pregnant women (11.3%), and first‐trimester levels of BAFF (but not APRIL) and sFlt‐1 (but not PIGF) were associated with SAB. Using optimal cutoffs determined through receiver operating characteristics curves, the best discriminator of SAB was the serum BAFF:sFlt‐1 ratio, specifically among non‐nulliparous women and women with prior SAB. Conclusion First‐trimester serum BAFF:sFlt‐1 ratio is a candidate indicator/predictor of SAB among non‐nulliparous women and women with prior SAB. If validated through additional studies, then early identification of pregnant women at high risk for SAB through this simple blood test would assist in counseling and facilitate clinical trials of therapeutic interventions.

Hypertensive disorders of pregnancy are a leading cause of maternal and perinatal morbidity and mortality. Early suppression of B-cell lymphopoiesis is necessary for a normal pregnancy. Dysregulation of factors critical to B-cell survival may result in pregnancy complications, including hypertension. In this prospective observational study at a single medical center, serum levels of BAFF (B-cell activating factor) were measured in pregnant participants at each trimester, at delivery, and postpartum and in nonpregnant controls at a single time point. Comparisons were made between nonpregnant and pregnant subjects and between time periods of pregnancy. First-trimester serum BAFF levels were further tested for association with hypertensive disorders of pregnancy. The study included 149 healthy pregnant women, 25 pregnant women with chronic hypertension, and 48 nonpregnant controls. Median first-trimester serum BAFF level (ng/mL) for healthy women (0.90) was lower than median serum BAFF levels for women with chronic hypertension (0.96; =0.013) and controls (1.00;=0.002). Serum BAFF levels steadily declined throughout pregnancy, with the median second-trimester level lower than the corresponding first-trimester level (0.77; =0.003) and the median third-trimester level lower than the corresponding second-trimester level (0.72;=0.025). The median first-trimester serum BAFF level was elevated in women who subsequently developed hypertension compared with women who remained normotensive (1.02 versus 0.85; =0.012), with the area under the receiver operating characteristic curve being 0.709. First-trimester serum BAFF level may be an early and clinically useful predictor of hypertensive disorders of pregnancy.