What's new in maternal-fetal medicine: November 14, 2026

ACOG advises against GLP-1 receptor agonist use during pregnancy. Counsel about contraception and consider stopping treatment 1–2 months before planned conception, while following the specific product label (for example, semaglutide: at least 2 months). Human data after inadvertent early exposure remain limited.

Plan diabetes or weight-management transitions before conception, including glycemic reassessment after stopping therapy. For lactation, ACOG recommends shared decision-making, careful infant weight surveillance if treatment is chosen, and avoidance while breastfeeding a preterm infant or neonate.

International expert guidance identifies cesarean-scar pregnancy as a possible PAS precursor. It emphasizes early transvaginal localization in patients with prior cesarean delivery and suspicious low implantation, then systematic gray-scale and color Doppler evaluation of lacunae, myometrial contour, placental bulge, uterovesical interface, and bridging vessels.

Consider a pathway for first-trimester scar-site assessment when clinically indicated, standardized PAS descriptors at the anatomy survey, and referral for suspicious previa/low-lying placenta over a scar. MRI is adjunctive when ultrasound is indeterminate or anatomy is difficult to assess.

Keegan and colleagues interviewed 14 prenatal clinicians and identified knowledge gaps, patient expectations, and fear of rare adverse events as barriers to discontinuing activity restriction. In a separate US online survey, Lindley and colleagues found that recommendations came from physicians and others, and that respondents commonly followed them.

Remove automatic “bed rest” instructions from short-cervix, multifetal-pregnancy, and preterm-birth-prevention templates unless a separate individualized reason is documented. Provide patient-facing explanations and condition-specific guidance rather than vague “take it easy” orders.

Kaiser Permanente compared 473 patients managed with a blended model in 2022–2024 with 47,104 historical in-person controls from 2018–2019. The blended group had fewer total visits (9.4 versus 16.7) and fewer in-person visits (6.2 versus 15.7). Several major maternal outcomes did not differ significantly.

For low-risk patients, virtual encounters may reduce visit burden if blood pressure, weight, symptoms, laboratory testing, ultrasound, and escalation triggers are systematically managed. The model was not intended to replace appropriate in-person evaluation of high-risk pregnancies.

A systematic review of 23 randomized trials involving 3,055 women with gestational diabetes found pooled associations with improved glucose measures and selected obstetric/neonatal outcomes. Across outcomes, certainty was very low to low; glucose and gestational-weight-gain results showed extreme heterogeneity and prediction intervals spanning no benefit.

Use remote glucose uploads, medication titration, dietitian access, and clear follow-up thresholds to supplement in-person obstetric and ultrasound surveillance. Assess workflow reliability, patient access, and safety escalation rather than assuming a particular application is effective.

Nakamura and colleagues published a target-trial emulation titled “Prophylactic cervical cerclage was not associated with reduced recurrent preterm birth.” This is observational causal-inference work, not a randomized trial.

Avoid using the headline alone to remove history-indicated cerclage from local protocols. Confirm patient eligibility, prior loss phenotype, gestational timing, and comparator definitions against the full report before interpreting its applicability to a patient.

The Philani Ndiphile randomized trial enrolled 2,247 pregnant patients in South Africa, comparing one-time testing/treatment, repeat testing at 30–34 weeks, and syndromic usual care for chlamydia, gonorrhea, and trichomoniasis. Neither intervention significantly reduced the primary composite of preterm birth or low birthweight. Twice-screening was associated with fewer preterm births (RR 0.77, 95% CI 0.60–0.99) as a secondary finding.

Consider implications for patients with ongoing STI acquisition risk and access to repeat testing, while continuing to follow established US prenatal screening and treatment recommendations.

In 92 pregnancies and 94 neonates, maternal methadone or buprenorphine dose and cord-tissue drug concentration did not significantly predict severe neonatal opioid withdrawal syndrome. Severe withdrawal was more frequent among methadone-exposed than buprenorphine-exposed infants, but treatment selection was not randomized.

Titrate medication for opioid use disorder to maternal stability, withdrawal control, and retention in treatment. Coordinate neonatal monitoring; avoid dose reductions solely from concern about neonatal withdrawal severity.

A review of 14 studies (395 infants, one randomized trial and 13 cohorts) reported frequent early respiratory, growth, and gastrointestinal morbidity after fetal endoscopic tracheal occlusion. GERD was reported in approximately 25%–50% of reported cohorts, and hernia recurrence in 21%–43%. Neurodevelopmental findings were generally reassuring but sparsely standardized.

During FETO counseling, address not only anticipated survival but also long-term multidisciplinary follow-up for pulmonary, feeding, gastrointestinal, developmental, and hearing issues.

In 613 pregnancies (411 mechanical valves, 202 biological valves), an uncomplicated live-birth pregnancy occurred in 54% of mechanical-valve versus 79% of biological-valve pregnancies. Valve thrombosis occurred in 24 patients with mechanical valves (approximately 6%); mitral position carried additional risk.

Arrange preconception or early cardio-obstetric review, serial echocardiography, a documented anticoagulation monitoring plan, and coordinated delivery/postpartum bridging. Do not infer that either valve type is universally preferable without considering long-term durability and valve position.

The authors issued a corrigendum to the updated Enhanced Recovery After Surgery Society recommendations for antenatal and preoperative cesarean care, acknowledging inconsistencies and inaccuracies in the original article.

If local cesarean ERAS orders or teaching slides were derived from the original 2025 update, compare against the correction and revised document before making further protocol changes.

A November 12 notice in Obstetrics & Gynecology reports retraction of “Diabetes Testing Immediately Postpartum After Gestational Diabetes Mellitus: A Randomized Controlled Trial” (Field and colleagues). A correction had previously been published in August 2026.

Flag the trial in literature lists, teaching material, and postpartum testing protocols. Do not cite its comparative results as reliable evidence while reviewing the retraction notice and independent current guidance.