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The purpose of this study was to determine the frequency of prescription and over-the-counter (OTC) medications, and herbal remedies used by pregnant women. A prospective observational study was performed at a single tertiary-care hospital. Postpartum women completed a questionnaire that included a list of more than 120 medications, herbal remedies, and alternative therapies listed by both brand and common name. Patients were asked to identify any and all medications or treatments used during pregnancy. Of 418 patients who completed questionnaires, 96.9% took at least one medication during their pregnancy. After excluding prenatal vitamins and iron supplements, 76.5% took at least one other medication; 62.8% used OTC medications, and 4.1% used herbal and/or alternative remedies. Multiple drug use occurred in 33.5% of patients, with up to 13.6% consuming four or more medications. The use of prescribed and OTC, medications, and herbal/alternative therapy, is common in pregnancy, with many patients consuming more than one agent at a time.

A s the prevalence of obesity grows in the United States, rates of surgical weight-loss procedures have increased significantly, with women (particularly those of reproductive age) accounting for many of these surgeries. How this affects pregnancy is not clearly understood. The authors of this meta-analysis estimated bariatric surgery rates among women aged 18 to 45 years and reviewed the literature on the effects of these procedures on fertility rates and pregnancy outcomes.The authors searched the Nationwide Inpatient Sample (1998Sample ( to 2005 and databases of Medline, EMBASE, Controlled Clinical Trials Register, and the Cochrane Database of Reviews of Effectiveness between 1984 and February 2008 for references on bariatric surgery in women of reproductive age. Of the 260 screened articles, 75 reviews and studies were considered eligible, with information abstracted about study design, fertility, nutritional, neonatal, and pregnancy outcomes after all types of bariatric surgery.The incidence of bariatric surgery in the United States increased 800% between 1998 and 2005 (growing from 12,480 to 113,500 cases annually). Women aged 18 to 45 years made up 49% of all patients undergoing weight-loss surgery (>50,000 cases annually) for the 3 most recent years. Lower maternal complications, approaching the level of nonobese controls, were found among women who had bariatric surgery before pregnancy when compared with obese women without surgery in 3 matched cohort studies. Women who underwent laparoscopic adjustable gastric band surgery had lower rates of gestational diabetes (0% vs. 22.1%; P<0.05) and preeclampsia (0% vs. 3.1%; P<0.05). These findings were supported by 13 other retrospective bariatric cohort trials. Overall, neonatal outcomes after laparoscopic adjustable gastric band were similar or better than in obese women without surgery, in terms of premature delivery (7.7% vs. 7.1%), low birth weight (7.7% vs. 10.6%; P<0.05), and macrosomia (7.7% vs. 14.6%; P<0.05). There were no significant differences in neonatal outcomes after gastric bypass surgery compared with nonobese controls or obese women who did not have surgery. These findings were supported by 10 studies. Six studies addressed fertility outcomes after bariatric surgery, but these were small and provided no clear results. Twenty reports found complications requiring surgical intervention during pregnancy, primarily for the relief of bowel obstruction, in parturients who had undergone bariatric surgery. The effect of bariatric surgery on the rate of cesarean section was unclear. There also was no strong evidence to guide pregnancy delay following bariatric surgery, although the typical recommendation reported in this article was 1 year.The authors concluded that available evidence suggests that rates of adverse maternal and neonatal outcomes may be lower in women who undergo weight-loss surgeries before becoming pregnant. Most of these studies, however, had design deficiencies, such as small patient numbers and potential selection bias. They reco...

The introduction of cell-free DNA screening for aneuploidy into obstetric practice in 2011 revolutionized the strategies utilized for prenatal testing. The purpose of this document is to review the current data on the role of ultrasound in women who have undergone or are considering cell-free DNA screening. The following are Society for Maternal-Fetal Medicine recommendations: (1) in women who have already received a negative cell-free DNA screening screen, ultrasound at 11-14 weeks of gestation solely for the purpose of nuchal translucency measurement (Current Procedural Terminology code 76813) is not recommended (grade 1B); (2) we recommend that diagnostic testing should not be recommended to patients solely for the indication of an isolated soft marker in the setting of a negative cell-free DNA screen (grade 2B); (3) in women with an isolated soft marker without other clinical implications (ie, choroid plexus cyst or echogenic intracardiac focus) and a negative cell-free DNA screen, we recommend describing the finding as not clinically significant or as a normal variant (grade 2B); (4) in women with an isolated soft marker that has no other clinical implication (ie, choroid plexus cyst or echogenic intracardiac focus) and a negative first- or second-trimester screening result, we recommend describing the finding as not clinically significant or as a normal variant (grade 2B); (5) we recommend that all women in whom a structural abnormality is identified by ultrasound should be offered diagnostic testing with chromosomal microarray (grade 1A); and (6) we recommend against routine screening for microdeletions with cell-free DNA screening (grade 1B).

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