Dr. Chapa’s OBGYN Clinical Pearls

The ACOG states that, “Iron deficiency anemia during pregnancy has been associated with an increased risk of low birth weight, preterm delivery, and perinatal mortality and should be treated with iron supplementation in addition to prenatal vitamins. In addition, there may be an association between maternal iron deficiency anemia and postpartum depression, with poor results in mental and psychomotor performance testing in offspring”. Screening for anemia is included in most prenatal lab sets. However, up to 42% of women who enter prenatal care are iron deficient BEFORE anemia is detected. Iron deficiency itself, even without anemia, has also been linked to pregnancy morbidity. The ACOG currently does not have a statement endorsing universal ferritin screening in pregnancy outside of established anemia, but new data is challenging this (Jan 2026, Lancet). Listen in for details.
1. ACOG PB 233
2. Wasim T, Bushra N, Nasrin T, Humayun S, Tajammul A, Khawaja KI, Irshad S, Fatima S, Yasin A, Zamora J, Cano-Ibáñez N, Fernandez-Felix BM, Khan KS; Ferritin screening and iron treatment for maternal anaemia and fetal growth restriction prevention (FAIR) Study Group. Intravenous iron for non-anaemic iron deficiency in pregnancy: a multicentre, two-arm, randomised controlled trial. Lancet Haematol. 2026 Jan;13(1):e22-e29. doi: 10.1016/S2352-3026(25)00315-1. PMID: 41482443.
3. https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2024.15196

We recently covered an SMFM abstract that was presented at the annual Pregnancy Meeting held in early February 2026. The authors were from my Alma Mater, UT Southwestern/Parkland Hospital. This was a well-done study comparing 162 milligrams aspirin to 81 milligrams of aspirin. The results were very encouraging! However, aspirin definitely has an awkward acumen. It would be wonderful if ALL the data just leaned in the same direction... but it doesn’t! Enter our podcast family member, and my friend Alex. Alex sent me an incredible and insightful message which was a rebuttal to my Southwestern colleagues’ findings. In this episode you'll hear Alex's rebuttal and clinical conundrum, and we will explain why these two seemingly paradoxical findings makes sense. Listen in for details.

1. Khander, Amrin MD; Thomas, Charlene MS; Matthews, Kathy MD; Christos, Paul DrPH; Alcus, Claire BA; Alam, Tanvir BS; Bush, Leah BA; Deshmukh, Diksha BA; Chasen, Stephen T. MD; Riley, Laura E. MD; Skupski, Daniel W. MD; August, Phyllis MD, MPH; Malha, Line MD, MS. Comparison of 162 mg and 81 mg Aspirin for Prevention of Preeclampsia: A Randomized Controlled Trial. Obstetrics & Gynecology 147(1):p 87-96, January 2026. | DOI: 10.1097/AOG.0000000000006100

Well, even though low dose aspirin has been recommended for the reduction of preeclampsia risk for many years, 2 controversies persist: 1. who should get it, and 2. the dose we should use. While the current US recommendation still focuses on 81 mg low dose aspirin, initiated after 12 weeks of gestation (based on risk factors), there's increased movement and growing data supporting both universal adoption and the higher dose of 162 mg. In this episode, we will briefly summarize brand new data out of UT Southwestern which was just published at the SMFM Annual Pregnancy meeting in Las Vegas. Listen in for details.
1. https://www.smfm.org/news/new-studyroutine-aspirin-therapypreventsseverepreeclampsiainat-risk-populations
2. ACOG CO 743
3. The Effect of Aspirin on the Risk of Preeclampsia Based on the Fetal Medicine Foundation First Trimester Risk.
4. Bujold E, Rolnik DL, Poon L, Syngelaki A, Wright D, Nicolaides KH. The effect of aspirin on the risk of preeclampsia based on the Fetal Medicine Foundation first-trimester risk. Am J Obstet Gynecol. 2025 Oct 31:S0002-9378(25)00808-7. doi: 10.1016/j.ajog.2025.10.032. Epub ahead of print. PMID: 41177290.

As BMIs and weights increase across the US population, there have been increased calls for universal screening for existing DM at entrance to prenatal care, if under 20 weeks. Others, including the ACOG, prefer to screen early those with additional risk factors (like prior GDM HX, prior macrosomia, BMI >30, PCOS, first degree relative with diabetes, or age >40). In July 2024, the ACOG released its publication, “Screening for Gestational and Pregestational Diabetes in Pregnancy and Postpartum”. In this guidance, it states, “At this time, there are insufficient data to support the best screening modality for pregestational diabetes in pregnancy, but consideration can be made to use the same diagnostic criteria as for the nonpregnant population (A1c value 6.5 or higher, or fasting plasma glucose value 126 mg/dL or higher, or 2-hour plasma glucose value 200 mg/dL or higher during a 75-g OGTT, or random plasma glucose value 200 mg/dL or higher in patients with classic hyperglycemia symptoms)”. However, a new proposed protocol has been published in AJOG for early screening for DM in pregnancy. This also describes the differences in diagnosis and care for Standard GDM diagnosed at 24-28 weeks, vs a diagnosis of pregestational DM diagnosis made prior to 20-weeks vs “early” GDM also diagnosed under 20 weeks of gestation. Listen in for details.

1. McLaren, Rodney et al.nA Proposed Classification of Diabetes Mellitus in Pregnancy
American Journal of Obstetrics & Gynecology, Volume 0, Issue 0. Epub Feb 2, 2026; https://www.ajog.org/article/S0002-9378(26)00061-X/fulltext
2. ACOG Clinical Practice Update: Screening for Gestational and Pregestational Diabetes in Pregnancy and Postpartum; July 2024; https://journals.lww.com/greenjournal/abstract/2024/07000/acog_clinical_practice_update__screening_for.34.aspx
3. Simmons, David et al. “Treatment of Gestational Diabetes Mellitus Diagnosed Early in Pregnancy.” The New England journal of medicine vol. 388,23 (2023): 2132-2144. doi:10.1056/NEJMoa2214956

There has been a shift in cervical cancer screening from primary cytology based to HPV based. Even HPV screening has had its evolution from physician collected samples to patient self-collection, either in a clinical setting or at home with an approved collection system. In May 2025, the FDA cleared the first at-home self-collection kit for HPV screening, specifically the Teal Wand by Teal Health. Now, we are seeing the advent of POSSIBLY another avenue for cervical HPV testing- although it is a bit awkward: the use of menstrual blood as an HPV screening test. In this episode we will review a new cross-sectional, population-based study from China which compared testing menstrual blood for human papillomavirus during cervical cancer screening to clinician-collected cervical samples for human papillomavirus (HPV). This concept, and these results, are not new at all! And there are important limitations to consider at this time. Listen in for details.
1. Testing menstrual blood for human papillomavirus during cervical cancer screening in China: cross sectional population based study. BMJ 2026; 392 doi: https://doi.org/10.1136/bmj-2025-084831 (Published 04 February 2026)
BMJ 2026;392:e084831
https://www.bmj.com/content/392/bmj-2025-084831
2. Naseri S, Young S, Cruz G, Blumenthal PD. Screening for High-Risk Human Papillomavirus Using Passive, Self-Collected Menstrual Blood. Obstet Gynecol. 2022 Sep 1;140(3):470-476. doi: 10.1097/AOG.0000000000004904. Epub 2022 Aug 3. PMID: 35926207; PMCID: PMC9377370.
3. Fokom Domgue J, Chandra M, Oladoyin O, Desai M, Yu R, Shete S. Women’s Preferences for Home-Based Self-Sampling or Clinic-Based Testing for Cervical Cancer Screening. JAMA Netw Open. 2026;9(2):e2558841. doi:10.1001/jamanetworkopen.2025.58841