Recapping Day 2 of the 2021 ACOG Annual Clinical & Scientific Meeting

Catch up on some of the latest updates to come from the second day of the 2021 ACOG Annual Clinical and Scientific Meeting.

Updates from the COVID in Pregnancy Task Force

This panel featured Dr. Denise J Jamieson, chief of gynecology and obstetrics for Emory Healthcare; Dr. Alison Cahill, a maternal-fetal medicine specialist in UT Health Austin's Women's Health Institute; Dr. Laura E. Riley, Chair of the Department of Obstetrics and Gynecology at Weill Cornell Medicine; Dr. Brenna L. Hughes, a Maternal-Fetal Medicine Specialist at Duke Health; Dr. Mark A. Turrentine, an obstetrician-gynecologist in Houston, Texas; and Dr. Christopher M. Zahn, the Vice President of Practice Activities at ACOG.  

The panel took a deep dive into ACOG’s initial clinical response to the COVID-19 pandemic and addressed a timeline of steps taken to address questions and concerns regarding the risk of COVID-19 in pregnant individuals:

• February 2020: “The Practice Advisory: Novel Coronavirus 2019 (COVID-19)” was developed. This guide provides updated information regarding pregnant individuals and COVID-19. The guide is constantly updated, with the most recent update having been released in December 2020.
• March 2020: A supplementary Q&A Guide was developed. This document was created as a solution to address questions and concerns in a few areas, including clinical guidance on PPE, risk, testing, and prevention; staffing concerns regarding return to work and considerations for healthcare workers; outpatient scheduling and telehealth; and ethical issues.
• March to April 2020:4 COVID-19 expert groups were formed. These groups were developed to address questions and develop guidance surrounding ethics, gynecology, obstetrics, and telehealth. At least one infectious diseases expert was identified for each subject matter group, and experts in these groups were identified from existing communities and expert work groups.
• April 2020: “Vaccinating Pregnant and Lactating Patients Against COVID-19”was released. A second practice advisory, this guide provides an overview of currently available vaccines and offers guidance for their use in pregnant and lactating patients.

In a Q&A following the session, panelists addressed some of the challenges involved with misconceptions circulating about the COVID-19 vaccines and encouraged OB-GYNs to advise patients against relying on information they find on social media to determine whether or not to get the vaccine, as those discussions are often based in fear rather than fact. And they encouraged OB-GYNs to have upfront, honest conversations with their patients about potential side effects.

OTC Contraceptive Pill Management: The Role of the Obstetrician-Gynecologist in a World with an Over-the-Counter Contraceptive Pill

Although oral contraceptive pills (OCPs) are not yet widely available over the counter (OTC) in the United States, they may become available soon. In fact, two companies are currently undergoing the process to make OTC OCPs a reality.

According to Dr. Raegan McDonald-Mosley, who currently serves on the Steering Committee for Ibis’ Oral Contraception Over the Counter working group, this movement is so important because it helps ensure that patients are able to decide when and under what circumstances to have a child, especially at a time when there’s unequal access to care and unplanned pregnancies are increasing among low-income populations.  

But since OTC OCPs would inherently bring many changes, Dr. McDonald-Mosley addressed the following common concerns:

• What about the risks & complications? Most people on the pill are young, reproductive-age women—a patient population in which undiagnosed hypertension and other risks are very rare. Plus, self-screening tools would limit OTC access to any patients who have a chronic condition or risk factor.
• How can we ensure patients receive instructions for use? In addition to OB-GYNs educating patients and including a drug facts label with the pill, there’s the potential to organize large digital and social media campaigns to educate women.
• What about the other care should we provide? Even with an OTC pill available, patients will still come to their OB-GYN for screening and other care needs.
• How will this impact our business models? By removing appointments that involve birth control pills, OB-GYNs can increase access for patients who need more complex care.

Dr. McDonald-Mosley also noted that over 100 organizations—including ACOG—support the idea of an OTC OCP, and although it’s the FDA’s decision at the end of the day, it’s important that we ensure OTC OCPs are affordable, available to any women at age, and covered by insurance.

Premature Ovarian Insufficiency: This Is Not Your Mother’s Early Menopause

Primary ovarian insufficiency, or POI, is a loss of ovarian activity before the age of 40 and impacts 1 percent of women.

In this session, Dr. Laurie J. McKenzie, an Associate Professor in the Department of Gynecologic Oncology and Reproductive Medicine at The University of Texas MD Anderson Cancer Center, walked us through initial assessment and detection, the consequences of this condition, and hormone therapy options to mitigate long-term health consequences.

• Diagnosis & Assessment: Patients with POI often experience hot flashes, night sweats, dyspareunia and vaginal dryness, sleep disturbances, mood changes, poor concentration, stiffness, dry eyes, poor concentrations, altered urinary frequency, low libido, and lack of energy. Proper diagnosis is still lacking, and the European Society of Human Reproduction and Embryology & ACOG have different diagnostic guidelines, though a common cause of this condition in adolescents is gonadal dysgenesis with or without Turner syndrome.
• Sequelae & Consequences: Not only can cardiovascular risk, infertility, bone loss, and impacts on emotional well-being increase the risk of POI in patients, but these factors can also be consequences of this condition. Patients with this diagnosis can present with irritability, insomnia, and other mental health conditions.
• Therapeutic Options: There are two treatment strategies. One, to provide enough estrogen to mimic normal physiology, and this can happen with three types of hormone replacement: estradiol, ethinyl estradiol, and conjugated equine estrogens. The second strategy is to protect the endometrium from the mitogenic effect of estrogen using either synthetic progesterone or micronized progesterone.

Dr. McKenzie recommends prioritizing the mental health of their POI patients and addressing the psychosocial implications of this condition to help patients improve quality of life and long-term health.

The Latest in Breast Pump Technology

Breast pump technology is expanding at a rapid rate, which can be overwhelming for both patients and OB-GYNs. That’s why Dr. Katherine Au, an Assistant Professor of Obstetrics and Gynecology at Oregon Health and Science University in Portland, provided an overview of the following types of breast pumps:

• Manual Pumps are small, lightweight, portable, and inexpensive, and they’re ideal in situations in which a patient doesn’t have access to a power source. However, they only pump one side at a time, potentially increasing the amount of time she has to spend if both breasts need to be pumped.         
• Electric Pumps use batteries or an outlet as their power source and are a great option if the patient is going to be away from the baby for a longer time as they can maintain large amounts of milk. The downside is that they’re bigger, heavier, pricier, and not as portable as manual pumps. There are also electric pumps that can be worn inside a bra, but the convenience of being able to multitask while pumping comes at a much higher price point.
• Wireless Pumps are essentially the middle ground between manual and electric pumps in terms of size and price. These small pumps are very portable, but they’re often loud.

Regardless of the type of pump, patients may find it uncomfortable or struggle with the size of the flange. Fortunately, accessories like pump cushions and lactation massagers for clogged ducts can help patients optimize their pump experience without having to buy a new one.

Dr. Au also provided a list of questions to ask to help patients pick the pump that’s right for them:

• What’s your insurance policy, & will it cover the cost of the pump? Cost is often a determining factor.
• What will you be using the pump for & how frequently? Some patients use pumps for comfort, to store up on breastmilk, or to help with the weening process. In addition, some may exclusively want to pump while others will only pump occasionally.
• If you’ve breastfed before, what was your experience like in the past? Find out what your patient liked and didn’t like before.
• Where do you anticipate using your breast pump? Will your patient be pumping on the go, at home, or both?

By using these counseling strategies and staying up to date on the latest breast pump technology, OB-GYNs can improve their patients’ breastfeeding experience.