Dr. Chapa’s OBGYN Clinical Pearls

Approximately 5–10% of all breast cancers are hereditary, and among those, BRCA1 and BRCA2 mutations are responsible for about 60% of cases. Yet, overall, only about 1-2% of all breast cancers in the general population are caused by BRCA mutations. Once childbearing is complete, the NCCN recommends risk-reducing BSO in patients carrying these mutations. But what about the uterus? Since childbearing is complete, and the ovaries are now removed, the sole purpose of the uterus- which is to initiate, nourish, and grow a child -is no longer applicable. Is there a call for inclusion of a hysterectomy at time of risk reducing BSO? This has vast and important implications regarding subsequent hormone therapy. In this episode, which comes from one of our podcast family members, we will dive into the latest data pushing towards the inclusion of hysterectomy at time of prophylactic BSO. It's fascinating data from just last year (2025, in the Journal of the NCI). Listen in for details.
1. Kotsopoulos J, Seca M, Gronwald J, et al. Menopausal Hormone Therapy and the Risk of Breast Cancer in Women With a Pathogenic Variant in BRCA1 or BRCA2. Journal of the National Cancer Institute. 2025.
2. Kotsopoulos J, Gronwald J, Karlan BY, et al. Hormone Replacement Therapy After Oophorectomy and Breast Cancer Risk Among BRCA1 Mutation Carriers. JAMA Oncology. 2018

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