Dr. Chapa’s Clinical Pearls.

• OB? Get Your ZZZZs: Insomnia’s Effects on Pregnancy

  In 2023, we released 2 episodes on obstructive sleep apnea (OSA) and adverse pregnancy. Now, on September 16, 2025, a new publication from JAMA Network Open adds more insights to disturbed sleep and adverse pregnancy outcomes. How does insomnia affect pregnancy? And is there any data on night shift work and its altered circadian rhythms on adverse pregnancy outcomes? Listen in for details. 1. Ross N, Baer RJ, Oltman SP, et al. Ischemic Placental Disease and Severe Morbidity in Pregnant Patients With Sleep Disorders. JAMA Netw Open. 2025;8(9):e2532189. doi:10.1001/jamanetworkopen.2025.321892. Cai C, Vandermeer B, Khurana R, et al. The Impact of Occupational Shift Work and Working hours during Pregnancy on Health Outcomes: a systematic Review and Meta-Analysis.American Journal of Obstetrics and Gynecology. 2019;221(6):563-576. doi:10.1016/j.ajog.2019.06.051.3. Dominguez JE, Cantrell S, Habib AS, Izci-Balserak B, Lockhart E, Louis JM, Miskovic A, Nadler JW, Nagappa M, O'Brien LM, Won C, Bourjeily G. Society of Anesthesia and Sleep Medicine and the Society for Obstetric Anesthesia and Perinatology Consensus Guideline on the Screening, Diagnosis, and Treatment of Obstructive Sleep Apnea in Pregnancy. Obstet Gynecol. 2023 Aug 1;142(2):403-423. doi: 10.1097/AOG.0000000000005261. Epub 2023 Jul 5. PMID: 37411038; PMCID: PMC10351908.4. Kader M, Bigert C, Andersson T, et al . Shift and Night Work During Pregnancy and Preterm Birth-a Cohort Study of Swedish Health Care Employees. International Journal of Epidemiology. 2022;50(6):1864-1874. doi:10.1093/ije/dyab135.STRONG COFFEE PROMO: 20% Off Strong Coffee Companyhttps://strongcoffeecompany.com/discount/CHAPANOSPINOBG

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• BNP and proBNP in PreE

  Brain-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) levels originate from the cardiac cells in response to cardiac strain. This may come from a pulmonary embolus, an acute severe infection (sepsis), or cardiomyopathy. But what is the relationship between these 2 cardiac biomarkers and preeclampsia? Can preeclampsia with severe features result in an abnormal rise in these 2 proteins exclusive to heart failure. Listen in to this real case scenario which our on call team cared for. 1. Serum Levels of N-Terminal Pro-Brain Natriuretic Peptide in Gestational Hypertension, Mild Preeclampsia, and Severe Preeclampsia: A Study From a Center in Zhejiang Province, China. Zheng Z, Lin X, Cheng X. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research. 2022;28:e934285. doi:10.12659/MSM.934285.2.Evaluation of B-Type Natriuretic Peptide (BNP) Levels in Normal and Preeclamptic Women. Resnik JL, Hong C, Resnik R, et al. American Journal of Obstetrics and Gynecology. 2005;193(2):450-4. doi:10.1016/j.ajog.2004.12.006.3.Increased B-Type Natriuretic Peptide Levels in Early-Onset Versus Late-Onset Preeclampsia. Szabó G, Molvarec A, Nagy B, Rigó J. Clinical Chemistry and Laboratory Medicine. 2014;52(2):281-8. doi:10.1515/cclm-2013-0307.4. Association of N-Terminal Pro–Brain Natriuretic Peptide Concentration in Early Pregnancy With Development of Hypertensive Disorders of Pregnancy and Future Hypertension.5. Hauspurg A, Marsh DJ, McNeil RB, et al. JAMA logoJAMA Cardiology. 2022;7(3):268-276. doi:10.1001/jamacardio.2021.5617.STRONG COFFEE PROMO: 20% Off Strong Coffee Companyhttps://strongcoffeecompany.com/discount/CHAPANOSPINOBG

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• Vag E2 in Women With CVA HX?

  Stroke (CVA) is very common in women, who have a higher risk than men over their lifetime; one in five women between the ages of 55 and 75 will experience a stroke. Stroke is a significant concern for women's health, being the third leading cause of death and causing more deaths than breast cancer. While systematic estrogen containing menopausal HT has been considered contraindicated in those with prior CVA history, is local/vaginal E2 therapy safe? A new population-based study gives us some insights. Listen in for details.1. Recurrent Ischemic Stroke and Vaginal Estradiol in Women With Prior Ischemic Stroke: A Nationwide Nested Case-Control Study; https://www.ahajournals.org/doi/10.1161/STROKEAHA.125.0509862. NAMS 2022 Position Statement; chrome-https://menopause.org/wp-content/uploads/professional/nams-2022-hormone-therapy-position-statement.pdf3. Stroke News & Brain Health | Published: August 21, 2025; https://newsroom.heart.org/news/vaginal-estrogen-tablets-may-be-safe-for-postmenopausal-women-who-have-had-a-stroke4. https://www.obgproject.com/2022/11/21/north-american-menopause-society-releases-2017-hormone-therapy-statement/5. https://www.goredforwomen.org/en/know-your-risk/risk-factors/risk-of-stroke-in-women-infographic#:~:text=Stroke%20in%20U.S.%20Women%20by,risk%20decreases%20in%20women%20who:

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• Does Vit B6 Reduce Mastalgia? New Meta-analysis 09/2025

  Mastalgia is a common breast complaint in reproductive aged women. Mastalgia can be separated into three categories: 1) cyclical, 2) noncyclical, and 3) extramammary. Vitamin B6 is often cited as a homeopathic (non-prescription/pharmacological) remedy for simple mastalgia. Does the published data support its use? A newly published meta-analysis sheds light on the subject.1. Sharifipour, F., Siahkal, S.F. & Bagherinia, M. The effectiveness of vitamin B6 in reducing mastalgia: a systematic review and meta-analysis. BMC Women's Health 25, 421 (2025). https://doi.org/10.1186/s12905-025-03991-x2. ACOG PB 164; reaffirmed 2023

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• 09.10.2025

  We are delaying today's program, as stated in this message. We will resume our program as soon as possible. Remembering Charlie Kirk.

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