Colapietro, Luisa

Abstract Purpose This study synthesizes and characterizes pregnancy outcomes and complications among US female physician trainees. Method In this systematic review, the PubMed, Embase, Scopus, Web of Science, and Cochrane databases were searched in May 2024 and May 2025 for peer-reviewed, English-language articles published from January 2000 to May 2025 reporting pregnancy outcomes in US female residents or fellows. Medical Subject Headings and keywords for pregnancy complications, pregnancy outcomes, and women or female physicians were used. Cross-sectional, retrospective, prospective, and case-control studies were included. Opinion articles, editorials, systematic or scoping reviews, and other non–peer-reviewed articles were excluded. Abstracts and full-text articles were screened by 3 investigators. Extracted data were documented in standardized forms. Risk of bias was assessed regarding study population and outcome reporting and summarized using standardized quality assessment tools. Results Of 792 titles and abstracts screened, 10 articles involving 4,891 trainees were included. Eight of these 10 studies described pregnancy outcomes specifically in surgical trainees; all were cross-sectional surveys. The numbers of trainees experiencing pregnancy complications ranged from 38.9% to 56.0%. The most frequently described complication was preterm labor (9 of 10 studies), affecting 5.3% to 22.9% of surveyed trainees. The most cited fetal complication was miscarriage (5 of 10 studies), affecting 20.0% to 28.0% of trainee pregnancies. Other commonly reported complications included preeclampsia or eclampsia, hyperemesis gravidarum, and gestational hypertension. Conclusions Although pregnancy complications appear to be common among female physician trainees, current data on obstetric outcomes in this population remain limited. Most studies focus specifically on surgical trainees and rely on self-reported data, limiting generalizability. Residency programs may consider findings from this review to enhance support for childbearing trainees, although prospective studies are needed to better discern the impact of medical training on maternal and fetal outcomes.

e24049 Background: Vulvo-Vaginal Atrophy (VVA) or Genitourinary Syndrome of Menopause (GSM) is a common condition among breast cancer (BC) patients, especially those undergoing antiestrogen therapy. Despite being an option in refractory cases, the safety of hormonal treatment remains uncertain in this population. The aim of this study was to review the safety and serum estrogen levels of hormonal therapy in patients with BC history presenting with VVA symptoms. Methods: Pubmed, Embase, and Cochrane were searched for studies comparing different hormonal treatment options for VVA in breast cancer survivors. Statistical analysis was performed using a random effects model and heterogeneity using Cochran's Q-statistic and the I2 index. Results: We included 17 studies, of which 5 were randomized controlled trials (RCTs). Treatment modalities included in this study were topical vaginal estradiol and estriol preparations, vaginally applied testosterone, DHEA, and ospemifene. We found that, among patients treated with the estriol and estradiol preparations, there was an average increase of 7.67pg/ml (SMD 7.67 pg/mL; 95% CI -1.00, 16.35; p < 0.001). Analysis of the testosterone group found temporary peaks of serum estradiol levels, but one study showed persistent elevation above normal postmenopausal levels. One study with prasterone revealed no elevation of serum estradiol concentration. One study with ospemifene demonstrated no increase in the risk of BC recurrence. Conclusions: In conclusion, among treatments available for BC survivors, low-dose vaginal estrogen showed the smallest changes in serum estradiol levels and had the most evidence, but safety remains unclear, especially for patients on aromatase inhibitors. Alternative treatments such as ospemifene need more data supporting safety and efficacy. These results suggest that concerns related to cancer recurrence should keep aiming for the lowest possible concentration.