Background: Current tobacco treatment guidelines have established the efficacy of available interventions, but they do not provide detailed guidance for common implementation questions frequently faced in the clinic. An evidence-based guideline was created that addresses several pharmacotherapy-initiation questions that routinely confront treatment teams. Methods: Individuals with diverse expertise related to smoking cessation were empaneled to prioritize questions and outcomes important to clinicians. An evidence-synthesis team conducted systematic reviews, which informed recommendations to answer the questions. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach was used to rate the certainty in the estimated effects and the strength of recommendations. Results: The guideline panel formulated five strong recommendations and two conditional recommendations regarding pharmacotherapy choices. Strong recommendations include using varenicline rather than a nicotine patch, using varenicline rather than bupropion, using varenicline rather than a nicotine patch in adults with a comorbid psychiatric condition, initiating varenicline in adults even if they are unready to quit, and using controller therapy for an extended treatment duration greater than 12 weeks. Conditional recommendations include combining a nicotine patch with varenicline rather than using varenicline alone and using varenicline rather than electronic cigarettes. Conclusions: Seven recommendations are provided, which represent simple practice changes that are likely to increase the effectiveness of tobacco-dependence pharmacotherapy.

T he global prevalence of obesity (body mass index [BMI], 30 kg/m 2 ) has tripled since 1975, and it is estimated that, in 2016, >1.9 billion adults were overweight (BMI, 25e29.9 kg/m 2 ), of which >650 million adults were obese. 1 Among women giving birth in the United States in 2014, 50.4% were either overweight or obese. 2 In addition, adults with a BMI of kg/m 2 comprise the most rapidly growing class of obesity in the United States. 3 Pregnant women who are classified as overweight or obese are known to be at increased risk for adverse maternal and fetal/neonatal outcomes. 4,5 However, the increased risk of pregnancy complications with each obesity class over that for women with standard BMI has not been assessed systematically. Given the high prevalence of obesity among women of childbearing age, the importance of estimating pregnancy risk with increasing BMI categories has become more pertinent than ever. ObjectiveThe objective of this study was to metaanalyze data that compares pregnancy outcomes in women with obesity and that are stratified by obesity class, with the view to counselling women and informing preventative strategies preconceptionally and during pregnancy. MethodsThis study was conducted as part of study to scrutinize the effect of obesity on mode of delivery; the study protocol

V asa previa is a rare obstetrical condition in which fetal blood vessels, unprotected by the umbilical cord or placenta, are located within the membranes covering the internal cervical os. These membranous vessels are at increased risk for being compressed, leading to fetal heart rate abnormalities from anoxia, and for breaching when membranes rupture, ultimately causing fetal death because of exsanguination. 1,2 It has been estimated that should a vaginal birth ensue in cases undiagnosed prenatally, the neonate's chance of survival is less than 50%. 3 Several studies have therefore highlighted the importance of prenatal diagnosis of vasa previa, specifically using transvaginal ultrasound and color Doppler, to improve pregnancy outcomes. 4 However, population-based screening for a condition as rare as vasa previa in isolation is difficult to justify, making it necessary to consider a risk factorebased screening approach in most instances. A systematic review conducted in 2015 5 opted to present unadjusted odds ratios for various risk factors. This meant that they limited the analysis to only those studies that compared the prevalence of risk factors in pregnancies with and without vasa previa. This does not provide a clinician or patient with the true prevalence of each risk factor, which is important information to consider during clinical counseling. The rationale behind this study is to provide up-to-date information on the true incidence of vasa previa in contemporary obstetric practice and the prevalence of associated risk factors.