And Gynecologists Research Articles

A guidelines-consistent carrier screening panel that supports equity across diverse populations

PurposeThe American College of Obstetricians and Gynecologists (ACOG) and the American College of Medical Genetics and Genomics (ACMG) suggest carrier screening panel design criteria intended to ensure meaningful results. This study used a data-driven approach to interpret the criteria to identify guidelines-consistent panels. MethodsCarrier frequencies in >460,000 individuals across 11 races/ethnicities were used to assess carrier frequency. Other criteria were interpreted on the basis of published data. A total of 176 conditions were then evaluated. Stringency thresholds were set as suggested by ACOG and/or ACMG or by evaluating conditions already recommended by ACOG and ACMG. ResultsForty and 75 conditions had carrier frequencies of ≥1 in 100 and ≥1 in 200, respectively; 175 had a well-defined phenotype; and 165 met at least 1 severity criterion and had an onset early in life. Thirty-seven conditions met conservative thresholds, including a carrier frequency of ≥1 in 100, and 74 conditions met permissive thresholds, including a carrier frequency of ≥1 in 200; thus, both were identified as guidelines-consistent panels. ConclusionClear panel design criteria are needed to ensure quality and consistency among carrier screening panels. Evidence-based analyses of criteria resulted in the identification of guidelines-consistent panels of 37 and 74 conditions.

Monitoring Physical Activity Intensity During Pregnancy.

For apparently healthy pregnant women, regular physical activity is recommended. The American College of Obstetricians and Gynecologists (ACOG) created recommendations for physical activity and exercise during pregnancy in 1985. At that time, pregnant women were advised to not exceed a heart rate of 140 beats per minute with physical activity. The heart rate recommendation was subsequently removed with the recommendations published in 1994, 2002, and 2015. In 2020, the ACOG updated its recommendations on physical activity for pregnant and postpartum women. The recommendation included exercising at a "fairly light to somewhat hard" perceived intensity and at less than 60-80% of age-predicted maximum heart rate, usually not exceeding a heart rate of 140 beats per minute. Women often seek advice from healthcare providers on physical activity during pregnancy, yet providers report concern about giving appropriate physical activity guidance. This paper summarizes the key scientific literature on monitoring absolute and relative exercise intensity in relation to the current ACOG recommendations, providing background on intensity-related concepts used in the recommendation. This paper also provides practical guidance to assist healthcare providers in relaying this information to pregnant women.

Antibiotic overuse in obstetric and gynecologic procedures at Zagazig university hospitals: A prospective observational study

Surgical site infection (SSI) constitutes a major problem in healthcare in terms of healthcare cost, morbidity and mortality. Surgical antibiotic prophylaxis (SAP) is one of the effective strategies for SSI prevention. Poor adherence to SAP guidelines across different countries has been observed. Misuse of prophylactic antibiotics threatens patient safety and leads to an increase in the acquisition of antibiotic resistance. The aim of this study was to assess the utilization of SAP in obstetric and gynecologic procedures in terms of indication for prophylaxis, antibiotic selection, timing of administration and prophylaxis duration. A prospective observational study was conducted at the obstetrics and gynecology department of Zagazig University Hospital during the period from January 2020 to June 2020. Medical records of 264 women were recorded and evaluated. The American Society of Health-System Pharmacists (ASHP) therapeutic guidelines, World Health Organization (WHO) recommendations and The American College of Obstetricians and Gynecologists (ACOG) practice bulletin were used for data evaluation and hence women were stratified into two groups. For women who underwent procedures in which guidelines recommended the use of SAP (200 patients; 75.75%), 198 women (99%) received preoperative prophylaxis. None of women (0%) received the recommended first line antibiotic by guidelines while the most commonly used prophylactic antibiotics were Cefotaxime (86 patients; 43.43%) and Ampicillin-sulbactam (62 patients; 31.31%). Preoperative antibiotic prophylaxis timing was 0-60 minutes before skin incision. All women received postoperative prophylaxis that extended to an average of 7 days. Regarding the other group who underwent procedures in which prophylactic antibiotics weren’t recommended by guidelines (64 patients; 24.24%), 37 women (57.81%) followed the guidelines and didn’t receive SAP while 27 women (42.18%) received SAP. Poor adherence to guidelines recommendations regarding prophylactic antibiotic selection and prophylaxis duration was observed. High utilization rate of prophylactic antibiotics in procedures that didn’t require their use was reported..

Maternal Outcomes in Women with Bleeding Disorders According to Mode of Delivery: A Single-Center Retrospective Cohort Study

▪Introduction:Pregnant women with bleeding disorders (WBD) are at higher risk of postpartum hemorrhage (PPH) compared to women without bleeding disorders. Multidisciplinary care is essential to minimize bleeding and optimize maternal outcomes in pregnant WBD. The safest mode of delivery for pregnant WBD remains debated with variable clinical practices and guideline recommendations. Studies are needed to inform decision-making for pregnant WBD and their multidisciplinary team.Objectives:To describe the maternal and neonatal outcomes in pregnant WBD by mode of delivery, including spontaneous vaginal delivery (SVD), induction of labor (IOL), planned C-section (CS) and emergent CS.Methods:We performed a retrospective analysis of all pregnant WBD who delivered at our institution between 2010-2020. The comprehensive hemostasis program offered at our institution has been providing multi-disciplinary care for patients with bleeding disorders since 1985 and coordinates care for 5-10 pregnant WBD a year. Patient/disease characteristics, mode of delivery, peripartum hemostatic management, and maternal outcomes were collected. PPH was defined according to the American College of Obstetrics and Gynecology (ACOG) (doi:10.1097/AOG.0000000000002351). Primary PPH was defined as blood loss of ≥ 1000 mL or blood loss with signs and symptoms of hypovolemia within 24h delivery regardless of route of delivery, or blood loss of > 500 mL in a vaginal delivery. Secondary PPH was defined as any abnormal or excessive vaginal bleeding beyond 24h of delivery to 12 weeks postpartum as documented by healthcare professionals' clinical notes. Data is presented using descriptive statistics. Fisher's Exact test was used to measure association between the mode of delivery and PPH.Results:A total of 73 pregnancies in 50 WBD were included. The incidence of primary PPH and secondary PPH were 6.8% (5/73, 95% CI [2.5, 14.5]) and 19.0% (12/63, 95% CI [10.8, 30.1]), respectively (Table 1). According to mode of delivery, primary PPH occurred in 1/34 for SVD, 3/21 for IOL, 0/11 for planned CS and 1/7 for emergent CS, and secondary PPH occurred in 6/31 for SVD, 5/19 for IOL, 0/6 for planned CS and 1/7 for emergent CS (Table 1). When comparing combined vaginal deliveries to CS, we found a numerically higher rate of both primary PPH (4/55, 7.2% vs. 1/18, 5.6%, p = 1.0) and secondary PPH (11/50, 22.0% vs. 1/13, 7.7%, p = 0.431), but both were not statistically significant (Table 1).Discussion:Our cohort of pregnant WBD showed rates of primary PPH (6.8%) comparable to those in a 2014 study of all Canadian deliveries (6.2%) (doi:10.1016/S1701-2163(15)30680-0). This likely reflected efforts for multidisciplinary and coordinated care for WBD within a hemophilia treatment centre with readily available clinical and laboratory monitoring as well as universal access to hemostatic therapies for Canadian WBD. In our cohort, planned CS did not result in any PPH which may reflect the ability to ensure clinical and laboratory expertise in hemostasis available (like recommendations for perioperative care in hemophilia) as opposed to spontaneous or unplanned deliveries that may occur outside of regular operating hours. Rates of secondary PPH remained high and problematic especially following vaginal deliveries. Several factors may explain these delayed bleeding events such as wound healing defects inherent to some bleeding disorders and decline in factor levels back to baseline in the early postpartum period.Our study was limited by its retrospective and single-centred design, small sample size, missing secondary PPH data in 10 pregnancies, and potential confounding variables that were unaccounted for by the study. Nevertheless, we reported incidence rates of primary and secondary PPH according to the mode of delivery in women with bleeding disorders, which can be important to inform clinical practices.Conclusion:Women with bleeding disorders are at high risk of PPH. Although we did not find statistically significance correlation by mode of delivery, these findings are clinically relevant in supporting patient-centered care and shared decision-making between WBD, obstetricians and hematologists. Close monitoring and follow-up are of utmost importance and further larger prospective research focused on postpartum outcomes is much needed. [Display omitted] DisclosuresWang: Servier: Membership on an entity's Board of Directors or advisory committees; Leo Pharma: Research Funding. Khalife: Canadian Hemophilia Society: Research Funding; Pfizer Canada: Honoraria, Research Funding.

An Unusual Monochorionic Pregnancy.

An Unusual Monochorionic Pregnancy.

The Cost of Preventive Care During Pregnancy: A Call to Action.

Perinatal care is necessary to prevent and manage adverse outcomes during pregnancy, birth, and the 12 months after delivery, as recommended by the American College of Obstetricians and Gynecologists (ACOG) and American Academy of Pediatrics (Kilpatrick, Papile, & Macones, 2017). However, a recent study found that pregnant families incur significant expenses for perinatal care, paying $4,500 on average for maternal pregnancy and childbirth services (Moniz et al., 2020). In this study, cost-sharing—that is, deductibles, co-insurance, and co-payments for health care services—disproportionately affected those with lower incomes and chronic conditions, populations at an increased risk of adverse outcomes who may particularly benefit from health care during pregnancy.

FAMILY MEDICINE APPROACH BASED ON A WEB-SERIES REVIEW: A CASE REPORT ON HYPEREMESIS GRAVIDARUM

Family medicine (FM) is a patient-centered and community-based clinical method. The FM has multiple strengths that are useful for medical students, such as provides continuing care to patients and families. Because of the COVID-19, medical students have been removed entirely from the clinical learning environment. Online teaching has played key roles in medical education by covered key clinical conditions, case studies, and examinations. According to the latest American College of Obstetricians and Gynecologists (ACOG), Hyperemesis Gravidarum (HG) is the term for the most severe form of nausea and vomiting of pregnancy. We used the method to collect data for a case report taken from a web-series review on Netflix, titled “Virgin River”, Season 2, Episode 1 to 3. From the symptoms and physical examination of the patient, Ms. CR was diagnosed with HG complicated by dehydration, cardiac arrhythmia, and hypoglycemia. The treatment that has been given to her includes non-pharmacological and pharmacological therapy. The family medicine approach has an important role because it has a strong mutual trust based on the doctor-patient relationship. Also, the family has a significant role in the treatment of patients since it can provide effective psychological and emotional support.

Diagnostic capacity and interobserver variability in FIGO, ACOG, NICE and Chandraharan cardiotocographic guidelines to predict neonatal acidemia

Objective Despite its routine use in intrapartum care, the technique of fetal cardiotocography has some limitations. The aim of this study is to analyze the predictive capacity and interobserver agreement in the latest versions of four international cardiotocography guidelines: Federation of Gynecology and Obstetrics (FIGO), American College of Obstetrics and Gynecology (ACOG), the National Institute for Health and Care Excellence (NICE) and Chandraharan, used to predict neonatal acidemia. Study design The last 30 min of 150 cardiotocographic records were analyzed over all the pH ranges and were blindly evaluated by three independent reviewers. The sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (AUC) were calculated to assess the predictive capacity of each fetal cardiotocographic guideline. The degree of interobserver agreement was evaluated with the Fleiss Kappa coefficient. Results Observers found fetal cardiotocography guidelines to have a variable sensitivity and specificity. The Chandraharan classification reached the highest sensitivity (78.79%), while ACOG had the highest specificity (95.73%). On average for the three observers, Chandraharan had the highest discrimination capacity for neonatal acidemia, although this was only moderate (AUC 0.66; 95%CI, 0.55–0.77) and did not differ significantly from the remaining guidelines. The degree of agreement among the three observers, assessed according to the Fleiss Kappa coefficient, was generally acceptable or moderate for all items and classifications, being highest with the FIGO classification (ĸ = 0.35; 95%CI, 0.28–0.41) and lowest with the ACOG (ĸ = 0.23; 95%CI, 0.16–0.30). Conclusion Although all the guidelines have a moderate capacity to predict neonatal acidemia, the Chandraharan guideline has the highest capacity. This follows a different approach from the others in that it relies on interpretations of cardiotocographic traces based on fetal physiology. The degree of interobserver agreement is, in general, acceptable for the four guidelines, and is the highest for FIGO.

Use of Methadone Maintenance Therapy for Opioid Use Disorder in Pregnancy.

Use of Methadone Maintenance Therapy for Opioid Use Disorder in Pregnancy.

Prediction of preterm pre-eclampsia according to NICE and ACOG criteria: descriptive study of 597 492 Danish births from 2008 to 2017.

The aim of this national study was to examine the incidence of preterm pre-eclampsia (PE) and the proportion of women with risk factors for PE, according to the criteria suggested by the National Institute for Health and Care Excellence (NICE) and the American College of Obstetricians and Gynecologists (ACOG), during a 10-year period in Denmark. Data from The Danish National Patient Registry and the Danish Medical Birth Registry were used to obtain the incidence of preterm PE with delivery < 37 weeks' gestation and risk factors for PE for all deliveries in Denmark from 1 January 2008 to 31 December 2017. The proportion of women with at least one high-risk factor and/or at least two moderate-risk factors for PE, according to the NICE and ACOG criteria, and the detection rate for preterm PE were examined. Race, socioeconomic status and the woman's weight at birth were not available from the registries used, and information on Type-2 diabetes was found to be invalid. Of the 597 492 deliveries during the study period, any PE was registered in 3.2%, preterm PE < 37 weeks in 0.7% and early-onset PE < 34 weeks' gestation in 0.3%. These proportions remained largely unchanged from 2008 to 2017. Overall, the NICE criteria were fulfilled in 7.5% of deliveries and the ACOG criteria in 17.3%. In the total population, the NICE criteria identified 47.6% of those with preterm PE and the ACOG criteria identified 60.5%. The current criteria for offering aspirin treatment in Denmark largely correspond to having at least one NICE high-risk factor. In 2017, a total of 3.5% of deliveries had at least one NICE high-risk factor, which identified 28.4% of cases that later developed preterm PE. The incidence of preterm PE remained largely unchanged in Denmark from 2008 to 2017. Prediction of PE according to high-risk maternal factors could be improved by addition of moderate-risk factors. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Maternal Hypotension and Tachysystole Following Neuraxial Anesthesia: Effect on Fetus in Labor.

Maternal Hypotension and Tachysystole Following Neuraxial Anesthesia: Effect on Fetus in Labor.

Introduction: Women in Medicine.

Introduction: Women in Medicine.

Women in Medicine: Call to Action.

A diverse health care workforce, across a variety of factors that include gender, is needed to meet the needs of the diverse US population. Yet, even as more women physicians enter the workforce, they face persistent challenges, including pay scale inequities, discrimination, and an imbalance between responsibilities at work and home.1–3 These inequities are often reflected in measured pay gaps, disparities in advanced leadership roles, and higher rates of burnout for women physicians when compared with their colleagues who are men.2–4 Furthermore, women physicians experience gender bias and discrimination in the workplace and report higher rates of imposter phenomenon compared with physicians who are men.5,6 These experiences are even more significant for women physicians who are Black, Indigenous, and/or people of color (BIPOC). Although progress has been made in getting more women into fields of medicine, the remaining equity issues are deeply rooted in organizational and societal culture, calling for an intentional and systemic approach to fostering change in the medical community.7To address these issues, in 2018, 6 leading US medical organizations formed an ambitious partnership around the inaugural Women’s Wellness through Equity and Leadership project (WEL).8 Led by the American Academy of Pediatrics (AAP), and in collaboration with the American Academy of Family Physicians (AAFP), American College of Obstetricians and Gynecologists (ACOG), American College of Physicians (ACP), American Hospital Association (AHA), and American Psychiatric Association (APA), WEL brought together a diverse group of 18 early- to midcareer women physicians for networking, leadership training, and mentorship. Capitalizing on the collective knowledge of this broad group of medical specialties, the WEL consortium empowered women physicians to build cross-specialty relationships critical to address the myriad of issues facing physicians in the evolving US health care system.The WEL consortium continues to actively examine the culture of medicine and the complex interplay between physicians and their institutions and environments. As stewards of medicine, the WEL partner organizations have substantial opportunities to foster important change. Leveraging their collective memberships of >400 000 physicians, they can advance an agenda for equitable leadership opportunities, advocate with one voice, and forge an inclusive health care workforce. Furthermore, additional organizations are being recruited to the WEL consortium to broaden reach and enhance intersectionality of specialties.The following call to action targets the organizational and advocacy opportunities reflected from within this consortium and implores health care organizations and medical institutions to reflect on their own practices and potential.As a collective group, we believe that the profession of medicine should collaboratively and intentionally address the numerous, multifaceted issues that hinder women physicians from reaching their full potential and ability to positively influence the profession of medicine, including by the following: We look forward to continuing to engage in this important work together and in joining with our colleagues from other specialties to continue building more equitable and inclusive work environments for all physicians. Individually, our voices are strong; together, our voices can create authentic, sustainable change.

PD32-09 SOCIOECONOMIC PREDICTORS OF RECEIVING A VAGINAL HYSTERECTOMY COMPARED TO OPEN AND LAPAROSCOPIC/ROBOTIC APPROACHES FOR TREATMENT OF APICAL PROLAPSE: AN ANALYSIS OF OVER 38,000 WOMEN IN THE HEALTHCARE COST AND UTILIZATION PROJECT (HCUP)

INTRODUCTION AND OBJECTIVE:The American College of Obstetrics and Gynecology (ACOG) recommend vaginal hysterectomy (VH) as the preferred hysterectomy route (HR) for benign disease, given faster rec...

Making sense of harms and benefits: Assessing the numeric presentation of risk information in ACOG obstetrical clinical practice guidelines

ObjectiveTo assess the presentation of risk information in American College of Obstetricians and Gynecologists (ACOG) obstetrical Practice Bulletins. MethodsWe reviewed B- and C-graded recommendations in Practice Bulletins published from January 2017 to March 2020. We calculated the proportion of recommendations and outcomes that were presented numerically and, of these, the proportion that were presented in accordance with best practices of risk communication – in absolute formats, or as absolute changes in risk from baseline risks. We categorized outcomes as harms or benefits to compare their risk presentation. ResultsIn 21 obstetrical Practice Bulletins, there were 125 recommendations, with 46 (37%) describing risks numerically. Sixteen of these 46 recommendations (35%) presented an absolute change in risk from a baseline risk. For harms, 65% were presented as absolute risks and 25% as relative risks. For benefits, this was 55% and 48% respectively. ConclusionMost recommendations do not present numeric risk information. Of those that do, most do not use absolute risk measures. Practice implicationsObstetrical practice guidelines should present numerical risk information wherever possible to support recommendations, increasing the use of absolute risk formats and absolute changes from baseline risks to increase risk comprehension.

Diagnostic Criteria and Treatment Modalities of Ectopic Pregnancies: A Literature Review

Background: Ruptured ectopic or extrauterine pregnancy (EP) is responsible for 6% of maternal deaths in the first trimester. This review was designed to summarise the diagnostic criteria and treatment modalities of EPs. Methods: Recent guidelines of the international societies of obstetrics and gynaecology, including the Royal College of Obstetricians and Gynaecologists (RCOG), the American College of Obstetricians and Gynecologists (ACOG), and the European Society of Human Reproduction and Embryology (ESHRE), were reviewed to summarise the diagnostic criteria and treatment modalities of EPs. Results: A minimum β-human chorionic gonadotropin (β-hCG) rise of ≥35% in 48 hours was suggested to diagnose intrauterine pregnancy. A β-hCG rise &lt;35% in 48 hours has 96.2% positive predictive value, 69.7% negative predictive value, and 80.2% overall accuracy in predicting EPs. The blob sign has &gt;90% positive predictive value in diagnosing EPs in symptomatic females with positive β-hCG and no definite intrauterine gestational sac by transvaginal sonography. The interstitial ectopic pregnancy and cornual pregnancy are two separate entities of EPs. Interstitial line sign has 80% sensitivity and 98% specificity in diagnosing interstitial ectopic pregnancy. A meta-analysis reported 89% overall success rate for methotrexate in treatment of EPs; the multi-dose regimen was significantly more successful than the single-dose regimen. Conclusion: Institutes and healthcare providers should follow clear guidelines and/or protocols for the management of EPs. Institutes should implement competency-directed training programmes to increase healthcare providers’ skills to diagnose and treat EP variants using different modalities.

Prenatal genetic screening and the evolving quest for "perfect babies": at what cost for genetic diversity?

Commercial screening services for inheritable diseases raise concerns about pressure on parents to terminate "imperfect babies".

Leveraging American College of Obstetricians and Gynecologists Guidelines for Point-of-Care Decision Support in Obstetrics.

The American College of Obstetricians and Gynecologists (ACOG) provides numerous narrative documents containing formal recommendations and additional narrative guidance within the text. These guidelines are not intended to provide a complete "care pathway" for patient management, but these elements of guidance can be useful for clinical decision support (CDS) in obstetrical and gynecologic care and could be exposed within electronic health records (EHRs). Unfortunately, narrative guidelines do not easily translate into computable CDS guidance. This study aimed to describe a method of translating ACOG clinical guidance into clear, implementable items associated with specific obstetrical problems for integration into the EHR. To translate ACOG clinical guidance in Obstetrics into implementable CDS, we followed a set of steps including selection of documents, establishing a problem list, extraction and classification of recommendations, and assigning tasks to those recommendations. Our search through ACOG clinical guidelines produced over 500 unique documents. After exclusions, and counting only sources relevant to obstetrics, we used 245 documents: 38 practice bulletins, 113 committee opinions, 16 endorsed publications, 1 practice advisory, 2 task force and work group reports, 2 patient education, 2 obstetric care consensus, 60 frequently asked questions (FAQ), 1 women's health care guidelines, 1 Prolog series, and 9 others (non-ACOG). Recommendations were classified as actionable (n = 576), informational (n = 493), for in-house summary (n = 124), education/counseling (n = 170), policy/advocacy (n = 33), perioperative care (n = 4), delivery recommendations (n = 50), peripartum care (n = 13), and non-ACOG (n = 25). We described a methodology of translating ACOG narrative into a semi-structured format that can be more easily applied as CDS in the EHR. We believe this work can contribute to developing a library of information within ACOG that can be continually updated and disseminated to EHR systems for the most optimal decision support. We will continue documenting our process in developing executable code for decision support.

Expectant Versus Interventionist Care in the Management of Severe Preeclampsia Remote from Term: A Systematic Review.

To compare the effects of expectant versus interventionist care in the management of pregnant women with severe preeclampsia remote from term. An electronic search was conducted in the Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica Database (EMBASE), Cochrane Central Register of Controlled Trials (CENTRAL), Latin American and Caribbean Health Sciences Literature (LILACS, for its Spanish acronym), World Health Organization's International Clinical Trials Registry Platform (WHO-ICTRP), and OpenGrey databases. The International Federation of Gynecology and Obstetrics (FIGO, for its French acronym), Royal College of Obstetricians and Gynaecologists (RCOG), American College of Obstetricians and Gynecologists (ACOG), and Colombian Journal of Obstetrics and Gynecology (CJOG) websites were searched for conference proceedings, without language restrictions, up to March 25, 2020. Randomized clinical trials (RCTs), and non-randomized controlled studies (NRSs) were included. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to evaluate the quality of the evidence. Studies were independently assessed for inclusion criteria, data extraction, and risk of bias. Disagreements were resolved by consensus. Four RCTs and six NRS were included. Low-quality evidence from the RCTs showed that expectant care may result in a lower incidence of appearance, pulse, grimace, activity, and respiration (Apgar) scores < 7 at 5 minutes (risk ratio [RR]: 0.48; 95% confidence interval [95%CI]: 0.23%to 0.99) and a higher average birth weight (mean difference [MD]: 254.7 g; 95%CI: 98.5 g to 410.9 g). Very low quality evidence from the NRSs suggested that expectant care might decrease the rates of neonatal death (RR: 0.42; 95%CI 0.22 to 0.80), hyaline membrane disease (RR: 0.59; 95%CI: 0.40 to 0.87), and admission to neonatal care (RR: 0.73; 95%CI: 0.54 to 0.99). No maternal or fetal differences were found for other perinatal outcomes. Compared with interventionist management, expectant care may improve neonatal outcomes without increasing maternal morbidity and mortality.

Prevalence of Hypertension Among Pregnant Women When Using the 2017 American College of Cardiology/American Heart Association Blood Pressure Guidelines and Association With Maternal and Fetal Outcomes

(Abstracted from JAMA Netw Open 2021;4:e213808) Until 2017, the American College of Cardiology (ACC), American Heart Association (AHA), and American College of Obstetricians and Gynecologists (ACOG) had a common threshold for diagnosing hypertension: a blood pressure of 140/90 mm Hg or higher. That year, based on the outcomes of randomized trials on nonpregnant adults, the ACC-AHA lowered its recommended threshold to 130/80 mm Hg or higher.