Fetal cleft lip and cleft palate are among the most common craniofacial anomalies, affecting approximately 1 in 1,000 live births worldwide. Cleft lip/cleft palate is caused by a combination of genetic and environmental factors and requires prompt diagnosis and lifelong multidisciplinary care for adequate treatment of anatomic and psychosocial challenges that extend well beyond surgical procedures in infancy. Cleft lip/cleft palate is a complex anomaly present from the first trimester onward that has prenatal and postnatal considerations. Diagnosis of cleft lip/cleft palate is most common in the second trimester through ultrasound visualization of the anatomic defect. However, characterization of the defect may be further performed in the third trimester, possibly with the adjunct of magnetic resonance imaging. Prenatal management depends on the cause, genetic association, or additional anatomic abnormalities that may dictate specific timing and location of delivery. Multidisciplinary management involves perinatology, genetic counseling, orofacial surgery, and lactation specialists and speech and language therapists among experts from other specialties for comprehensive treatment. In this narrative review of cleft lip/cleft palate, the anatomic characteristics, imaging findings, causes, genetic associations, and management are discussed.

Direct oral anticoagulants are increasingly used for postoperative thromboprophylaxis, but use is limited in postpartum populations in the absence of data informing transfer into human milk. We evaluated the excretion of prophylactic-dose rivaroxaban into the milk of 20 low-risk lactating individuals from April through September 2024. Participants received two doses of prophylactic-dose rivaroxaban and provided blood and milk samples, with rivaroxaban concentrations quantified by liquid chromatography-tandem mass spectrometry. Pharmacokinetic metrics were evaluated, and the relative infant dose was calculated. Maternal plasma and milk rivaroxaban concentration peaked 2 hours after the second dose. At maximum maternal milk concentration of rivaroxaban, the relative infant dose was 2.9%, below the 10% safety threshold for drug use during breastfeeding. Findings suggest that neonatal exposure is likely low risk for use of prophylactic-dose rivaroxaban in lactating individuals.

To evaluate whether machine learning could be used with audio recordings from a smartphone to detect fetal movements that create disruptions of the amniotic fluid environment. We conducted a prospective study to simultaneously record fetal movements seen on ultrasound and audio recordings using a smartphone placed on the maternal abdomen and to compare these with maternal perception of fetal movements. Smartphone audio segments were preprocessed to reduce noise, window the signal, and divide them into typed 1-second audio snippets. These were subsequently converted into visual representations of their acoustic features known as Mel-frequency cepstral coefficients (MFCCs). Selected MFCCs were examined to evaluate how feature characteristics vary with gestational age and body mass index (BMI). Fetal movement detected on ultrasonography was considered the gold standard to estimate the accuracy of model prediction applied to tagged audio segments and maternal perception of movement. The area under the receiver operating characteristic curve (AUROC) was used to evaluate the accuracy of the binary classifier to detect the presence or absence of any fetal movement. Macro F1 scores were used to evaluate the accuracy of more refined movements (gross movement, breathing, and hiccups). Isolated trunk and limb movements were marked with a single timestamp, and continuous or repetitive gross fetal movements were annotated with a continuous timestamp spanning the duration of the activity. Overall, 136 participants were included; 30 patients were followed longitudinally, and 106 received only one study visit. Generalized additive models were applied to selected MFCCs and analyzed separately for cohort recordings and fetal movement types. Results revealed nonlinear associations with gestational age (adjusted P<.001) and maternal BMI (adjusted P<.001), informing algorithm refinement. In our final model adjusting for gestational age and maternal BMI, detection of fetal movement with smartphone audio recordings was noted to be highly accurate. Binary detection of the presence or absence of any fetal movement was clinically significant (AUROC 0.886, 95% CI, 0.883-0.888) compared with maternal perception of 3.0%. Gross fetal movement was detected at an accuracy of 64.0% (95% CI, 63.1-66.7%), whereas maternal perception of fetal movements yielded an accuracy of 18.0%. Similarly, the accuracy of audio recordings compared with ultrasound-detected fetal breathing movements was found to be 93.0% (95% CI, 92.0-94.2%) as compared with 3.0% for maternal perception. Finally, the accuracy of audio recordings for fetal hiccups was 73.0% (95% CI, 68.2-76.2%) compared with 32.0% for maternal perception. Audio-based assessment of fetal movement using a smartphone can reliably detect gross fetal movements, as well as fetal breathing and hiccups observed on ultrasonography, and proved superior to maternal perception of movements.

Vaccines administered to women during pregnancy can provide protection against serious infectious diseases for the mother, the child, or both. Maternal immunization boosts the concentration of maternal antibodies that can be transferred across the placenta to directly protect children too young to be immunized. In addition, indirect protection through prevention of maternal infection and breast-milk antibodies can be achieved through maternal immunization. In general, inactivated vaccines are considered safe for pregnant women and fetuses, whereas live attenuated vaccines are avoided due to the theoretical potential risk of infection to the fetus. However, the potential risks of vaccines need to be weighed against the risk of the disease itself and the benefits of vaccination in terms of protection of the mother and child against infectious disease. Tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap); influenza; coronavirus disease 2019 (COVID-19); and respiratory syncytial virus (RSV) vaccines are routinely recommended for all pregnant women in the United States. Maternal immunization has the potential to improve the health of mothers and young children; therefore, other diseases of relevance during this period are now targets of active research and vaccine development, including group B streptococcus (GBS). Similarly, several vaccines can be administered during pregnancy in special circumstances when maternal health, travel, or other special situations arise. This article reviews the current recommendations for vaccination of women during pregnancy.

To evaluate the clinical utility and methodologic validity of noninvasive prenatal testing (NIPT) for dominant single-gene disorders by performing a systematic review and meta-analysis. From database inception through April 2025, we explored PubMed, EMBASE, Cochrane Library, and Web of Science. Studies that reported NIPT panels to screen for dominant single-gene disorders with confirmation testing and involved at least 50 cases were included. The Quality Assessment of Diagnostic Accuracy Studies 2 tool was used for study appraisal. Clinical utility was evaluated by using positivity rate and positive predictive value (PPV), with pooled estimates calculated through fixed- or random-effects models. Methodologic validity was assessed through sensitivity and specificity by using a bivariate random-effects model and summary receiver operating characteristic curve analysis. Ten articles comprising 12,577 cases were included. Positivity rate and PPV were calculated from nine studies, with sensitivity and specificity from seven studies. The pooled positivity rate was 2.2% (95% CI, 0.8-5.6%), and pooled PPV was 93.8% (95% CI, 86.4-97.3%). The bivariate model yielded a pooled sensitivity of 94.5% (95% CI, 85.7-98.0%) and specificity of 99.7% (95% CI, 98.8-99.9%), with an area under the curve of 0.98 (95% CI, 0.94-0.99). Subgroup analysis revealed positivity rates of 0.3% in low-risk populations, 1.2% in mixed-risk populations, and 6.0% in high-risk populations. High heterogeneity was observed in the positivity rate analysis ( I2 =96%). In contrast, heterogeneity was low ( I2 =16%) for PPV but with publication bias being detected ( P =.004). Noninvasive prenatal testing panels for dominant single-gene disorders achieve a high PPV with high sensitivity and specificity. PROSPERO, CRD42024571768.

Tamoxifen use has been associated with an increased risk of endometrial cancer in women with breast cancer, but data on premenopausal women in Asia remain limited. We investigated the association between tamoxifen treatment and risk of developing uterine diseases in women of premenopausal age with breast cancer. We conducted a retrospective cohort study using a target trial emulation framework. Women aged 20-50 years who were diagnosed with estrogen receptor-positive breast cancer and had undergone mastectomy or lumpectomy from 2010 to 2019 were identified with Taiwan's National Health Insurance claims data linked to the cancer registry. Those with a history of hysterectomy, neoadjuvant therapy, and diagnosis of postmenopausal status and uterine diseases were excluded. Tamoxifen use was defined as receipt tamoxifen treatment only as adjuvant hormone treatment within 1 year after surgery. Inverse probability of treatment weighting controlled baseline confounding between the tamoxifen treatment and nontreatment groups. Observational analogs of the intention-to-treat and per-protocol effects were estimated with pooled logistic regression models. A total of 23,062 tamoxifen users and 3,000 nonusers were included. During the follow-up period, 3,889 users and 109 nonusers developed uterine diseases, including 106 and 5 cases of endometrial cancer, respectively. In the intention-to-treat analysis, the hazard ratio was 4.15 (95% CI, 2.65-6.50) for endometrial polyps, 5.42 (95% CI, 4.09-7.18) for endometrial hyperplasia, and 2.41 (95% CI, 0.86-6.72) for endometrial cancer. Corresponding estimates from the per-protocol analysis were 4.75 (95% CI, 2.55-8.86), 8.37 (95% CI, 5.24-13.35), and 4.20 (95% CI, 1.20-14.63), respectively. The risk of all uterine diseases increased with longer duration of tamoxifen use. Among women of premenopausal age with breast cancer in Taiwan, tamoxifen as adjuvant hormone therapy was associated with increased risk of uterine diseases, including endometrial cancer. These findings highlight the importance of monitoring uterine diseases among tamoxifen users in this age range.

To assess the association between opioid exposure in the childbirth period and persistent postpartum opioid use and to evaluate whether there are differential associations based on specific medication exposure. Retrospective cohort study that used 2015-2021 Pennsylvania Medicaid claims of women aged 19-50 years with vaginal or cesarean delivery and Medicaid enrollment for at least 10 months during the postpartum year. Primary exposure was filled opioid prescription from 7 days before delivery to 8 weeks after delivery (childbirth period). The main outcome measure was persistent postpartum opioid use , defined as either a diagnosis of opioid use disorder or at least one filled opioid prescription in two or more calendar quarters from 8 weeks to 14 months postpartum. Multivariable logistic regression analyses included demographic information, mental health and behavioral comorbidities, obstetric trauma, and pre-existing pain conditions with subgroup analysis of the prepregnancy opioid-naïve population. Of 286,003 births in the Pennsylvania Medicaid program, 172,839 met inclusion criteria (patient demographics: 41,628 Black [24.1%], 102,733 White [59.4%], 26,841 Hispanic [15.5%], mean age at delivery 26.9 years). Childbirth opioid exposure was present in 25% of births (n=43,263). The prevalence of persistent postpartum opioid use was 5.7% (n=9,876). Transition to postpartum persistent use occurred in 7.9% of patients with childbirth opioid exposure and in 4.5% of those without (adjusted odds ratio [aOR] 1.88, 95% CI, 1.79-1.96). Among 132,941 births to opioid-naïve people, 2.6% of patients developed postpartum persistent opioid use; the adjusted odds were higher among those exposed during childbirth compared with those unexposed (aOR, 2.66; 95% CI, 2.49-2.85). The risk of persistent use was highest with tramadol exposure: 30.9% of people exposed to tramadol transitioned to persistent use compared with 7.3% of those exposed to oxycodone (tramadol vs oxycodone: aOR 4.58; 95% CI, 3.87-5.43). Opioid use for childbirth pain management was associated with persistent postpartum use, including among opioid-naïve patients and those without pre-existing pain conditions. These findings support clinical practice guidelines that balance effective postpartum pain management with minimizing opioid-related risks and underscore the importance of postpartum care coordination.

Patient receipt of outpatient postpartum glucose testing after gestational diabetes mellitus (GDM) remains suboptimal. We conducted a randomized controlled trial (RCT) to determine whether the frequency of receiving a postpartum oral glucose tolerance test (OGTT) differed depending on whether the test was planned for the inpatient or outpatient setting. DIP (Diabetes Testing Immediately Postpartum) was a pragmatic, nonblinded RCT. Participants were eligible if they received prenatal care and had a GDM diagnosis. After delivery, individuals were randomized in a 1:1 ratio to receive an OGTT either inpatient before delivery discharge (intervention) or outpatient within 12 weeks of birth (standard care). The primary outcome was completion of a fasting 2-hour 75-g OGTT by 12 weeks postpartum or less. Secondary outcomes included participant satisfaction per the adapted DTSQ (Diabetes Treatment Satisfaction Questionnaire) and diagnosis of prediabetes or type 2 diabetes. Based on an estimated baseline testing rate of 52% and a treatment effect of at least 50%, a sample size of 104 participants was required with 80% power and a two-sided α of 0.05. A total of 104 individuals with GDM were enrolled (52 intervention, 52 standard care). Demographics, unmet social needs, and clinical characteristics did not differ according to group assignment. Postpartum visit completion was more than 90% in both groups. The frequency of postpartum diabetes testing was significantly higher in the inpatient group compared with the outpatient group (92.3% vs 26.9%, relative risk 3.43 [95% CI, 2.18-5.40]), as was the median [IQR] score on the DTSQ (35.0 [31.0, 36.0] vs 28.0 [24.0, 32.0], P <.001). Prediabetes or type 2 diabetes was diagnosed among 50.0% in the inpatient group and 21.4% in the outpatient group ( P =.05). Diabetes testing before delivery discharge for individuals with GDM resulted in more than a threefold higher completion rate of postpartum glucose testing and greater patient satisfaction compared with outpatient testing. This RCT supports recent guidelines that encourage the option of inpatient postpartum diabetes testing before delivery discharge. ClinicalTrials.gov , NCT05909046.