CU Anschutz Maternal-Fetal Medicine Newsletter
Fall 2025
CU Anschutz Maternal-Fetal Medicine Fall 2025 Newsletter
October 7, 2025
Welcome to the Fall 2025 edition of the CU Anschutz Maternal-Fetal Medicine e-newsletter. In this issue, we highlight key indications for referral to our MFM program and provide updates on evidence-based guidelines and standards of care to support you in clinic. We also review current recommendations on antenatal late preterm steroids and share important announcements.
Indications for Referral to Maternal-Fetal Medicine
Below is a compilation of circumstances to consider when referring your patient for service. We welcome referrals as we partner with you to provide the best care for your high-risk pregnant patients.
✓ Preconception & Genetic Counseling
Advanced maternal age, medical comorbidities, family history, abnormal screening results, or prior pregnancy complications.
✓ Assisted Reproductive Technology (ART) Pregnancies
IVF and donor egg pregnancies receive tailored monitoring due to possible increased complication risk.
✓ First Trimester Screening & NIPT (Ideal timing: 11–13 weeks)
Early evaluation for suspected aneuploidy and major fetal anomalies.
✓ High-Resolution Ultrasound Services
Anatomy scans, fetal echocardiography, growth monitoring, and cervical length screening — all interpreted by MFM specialists.
✓ Diabetes in Pregnancy
Support for GDM and pregestational diabetes — including nutrition consults, insulin guidance, and glucose management.
✓ Hypertensive Disorders
Evaluation and co-management of chronic hypertension, preeclampsia, and related risks.
✓ Preterm Birth Risk (Refer by 12–20 weeks for cerclage consideration)
History of PTB, short cervix, or uterine anomalies.
✓ Multiple Gestation
Twins, higher-order multiples, and monochorionic pregnancies with specialized growth and interval surveillance.
✓ Fetal Growth Restriction (FGR)
Doppler studies, fetal surveillance, and delivery planning.
✓ Maternal Medical Conditions
Collaborative care for patients with drug or teratogen exposure, cardiac, renal, autoimmune, hematologic, or neurologic concerns.
✓ Placental Concerns
Suspected abnormality, oligo or poly hydramnios.
CU Anschutz MFM Recommended Antepartum Surveillance Guidelines
At the University of Colorado Anschutz Division of Maternal-Fetal Medicine, we are proud to collaborate with women’s health providers in our community to help deliver the best possible care to patients with high-risk pregnancies. The following guidelines are intended as a practical resource to support you in your clinical practice yet not intended to replace clinical judgement for individual providers/patients. They were constructed based on ACOG recommendations.
Antepartum Surveillance Guidelines
| Condition | Gestation Age to initiate | Frequency ** | Ultrasounds other than anatomy |
|---|---|---|---|
| AMA>40 | 36 weeks | 28-32 weeks | N/A |
| Cholestasis | At diagnosis | Twice weekly | Not indicated |
| Diabetes | |||
| A1GDM, well-controlled | Not indicated | Not indicated | Not indicated |
| A2GDM | 32 weeks | Weekly if well-controlled; Twice weekly if uncontrolled | 28-32 weeks |
Pre-gestational | 32 weeks | Weekly if well-controlled; Twice weekly if uncontrolled | 28-32 weeks |
| HIV (CD4 count <200 or worsening disease) | Not indicated | Not indicated | Not indicated |
| Chronic Hypertension | |||
| No medication | Not indicated | Not indicated | Not indicated |
| Controlled on meds (<150s/90s) | 32 weeks | Weekly | 28-32 weeks / 34-36 weeks |
| Uncontrolled (or end organ damage on medication) | 32 weeks | Twice weekly | 28-32 weeks / 34-36 weeks |
| Gestational HTN | 28 weeks | Twice weekly | 28 weeks, then every 3-4 weeks |
| Chronic Opioid Use | Not indicated | Not indicated | 28-32 weeks |
| Fetal Anomalies | Per MFM | Per MFM | Per MFM |
| Fetal Growth Restriction | Per MFM | Twice weekly | Per MFM |
| Isoimmunization | Per MFM | Per MFM | Per MFM |
| IVF | Not indicated | Not indicated | Fetal echo not needed if she has detailed (Level II) anatomy ultrasound unless BMI>35 or monozygotic twins. Growth ultrasound at 30-32 weeks |
| Late Term Gestation | 41 weeks | Twice weekly | Not indicated |
| Maternal Medical Disease (e.g. cyanotic heart disease, poorly controlled thyroid disease, sickle cell disease, severe persistent asthma, renal disease) | 32 weeks | Twice weekly | 26-28 weeks, then q4 weeks |
| Obesity, Class II (BMI 35.0-39.9) | 36 weeks | Weekly | Consider |
| Obesity, Class III (BMI>40) | 34 weeks | Weekly | 28-32 weeks |
| Oligohydramnios (MVP <2.0 cm) | At diagnosis | Once or twice weekly | Per MFM |
| Placental Disorders | |||
| Chronic Abruption | At diagnosis | Once or twice weekly | Per MFM |
| Placenta Previa | Not indicated | Not indicated | Placenta location at 28 weeks and again at 34 if needed |
| Single umbilical artery | Not indicated | Not indicated | Growth 28-32 weeks |
| Velamentous cord | Not indicated | Not indicated | Growth 28-32 weeks |
| Per MFM | Per MFM | Per MFM | Per MFM |
| Polyhydramnios | |||
| Mild (AFI 24-29.9 cm) | Not indicated | Not indicated | Follow up 4 weeks |
| Mod-Severe (AFI>30) | 32 weeks | Weekly | Follow up 4 weeks |
| Preeclampsia without severe features | 28 weeks | Twice weekly | At diagnosis, then q3-4 weeks |
| Previous IUFD ≤ 32 weeks(individualize if <32w) | 32 weeks | Weekly | 28-32 weeks |
| Prior Classical Cesarean | Not indicated | Not indicated | Not indicated |
| Systemic lupus erythematosus | 32 weeks | Weekly if uncomplicated; individualize if complicated | 26-28 weeks, then q4 weeks |
| Thrombophilia requiring anticoagulation | |||
| Antiphospholipid syndrome | Normal growth: 32 weeks Abnormal Growth: per MFM | Twice weekly | 26-28 weeks / 32-34 weeks |
| Inherited (not APS) | Not indicated | Not indicated | Consider at 28-32 weeks |
| Twins | |||
| Mo-Mo | Inpt admission at viability | ||
| Mo-Di | 32 weeks | Weekly; individualize if complicated | 16 weeks and on: TTTS/TAPS every 2 weeks Growth every 4 weeks Fetal echo 24 weeks |
| Di-Di | 36 weeks | Weekly; individualize if complicated | Q4 week growth |
*MVP (maximum vertical pocket) will replace AFI as initial amniotic fluid volume assessment. Normal is 2-8cm. For values outside the normal range, a full AFI will be performed.
**BPPs can be approved by Provider in place of 2x/weekly NSTs
“Weekly” = weekly NST/MVP
“Twice weekly” = twice weekly NST with weekly MVP
Late Preterm Betamethasone: Boon or Bust for Babies?
The “Antenatal Late Preterm Steroids” or ALPS trial1 was published in the NEJM almost 10 years ago. This landmark randomized, multicenter, double-blind, placebo-controlled trial suggested for singleton babies born from 34 0/7 – 36 6/7 without prior exposure to betamethasone (BMZ) and anticipated delivery within 7 days may benefit from a course of BMZ. The primary outcome showed a decrease in the need for respiratory support in the first 72 hours without increasing the rates of maternal or neonatal infection. Giving BMZ under the ALPS protocol for 35 patients would prevent one case of respiratory distress. About a fourth of babies in the BMZ group had hypoglycemia in the nursery. However, outcomes of ALPS babies at 6 years showed no differences between intervention and controls.2
Since this study has been published, there have been an increase in administering late preterm steroids nationally3; however there appears to be an indication creep4 where about a third of patients received BMZ outside the ALPS protocol including twin gestation, patients with pregestational diabetes and people who don’t have a high risk of delivering within the 7 days after delivery. Additional studies suggest that the benefit of BMZ may become non-significant5, and potentially harmful if delivery occurs > 37 weeks.6
The Society for Maternal-Fetal Medicine recommends following the ALPS protocol except for multiple gestation reduced to singleton prior to 14 weeks, anomalous babies or delivery expected within < 12 hours7. Since the SMFM guidelines were published, the Antenatal Corticosteroids in Twins (ACTWIN) data was presented at the SMFM Annual Meeting in Feb 2025 which showed similar benefit in twin pregnancies. Based on these data, it is likely reasonable to discuss late preterm BMZ with twin gestation.8
These guidelines and recommendations can be quite confusing! The CU Anschutz Maternal-Fetal Medicine Physician group is available to discuss individual clinical scenarios outside the ALPS protocol.
4 Indication Creep of Antenatal Late Preterm Steroids - PubMed
News You Can Use
Acetaminophen Use in Pregnancy
Pain and high fevers in pregnancy can increase risk of maternal and fetal complications and should be treated. The safest medication for most pregnant patients with pain or fever is acetaminophen. Although small, early, studies suggested a possible link between acetaminophen use in pregnancy and autism, the current best available evidence does not support any increased risk (JAMA). Our division agrees with guidance from ACOG and SMFM, which support continued use of acetaminophen in pregnancy as needed. If patients are requiring chronic high doses of Tylenol, we would recommend reaching out to their providers to see if there are other modalities to help with their pain as well.
Referring Provider Survey
Each fall, CU Anschutz School of Medicine MFM surveys our valued referring providers to ensure your voice is heard. We are eager to hear your experiences and learn how we can enhance our partnership as we collaborate to provide the best care for high-risk moms. This online survey will deploy in October and take less than ten minutes to complete. It will remain open until November 21, 2025. All survey responses are anonymous. If you complete the survey by November 21st, you will be entered in a drawing to win your choice of a Nespresso Coffee Maker or Kindle Paperwhite.
Welcome back Dr. Odessa Hamidi to CU Anschutz MFM!
We are excited to share that Dr. Odessa Hamidi is returning to Colorado to join our division! Dr. Hamidi completed OB-GYN residency training at Penn State Hershey Medical Center and MFM fellowship training at University of Colorado Anschutz. She is passionate about patient-centered care that considers the entire patient from their unique background to specific medical needs. We are thrilled to welcome her back to our MFM family.
Refer Your Patient
To refer a patient or for more information, call 303-315-6100 or fax 303-468-3481.
In UCH Epic, referrals can be submitted via Ambulatory Referral to OBGYN/MFM: (REF86). You MUST also select a location for referral to drop into our work queue.
We Value Your Feedback!
We invite you to share your thoughts, experiences and suggestions related to our content and services. Do you have any questions or topics you'd like us to cover in future editions or educational events? Are there any success stories or challenges in Maternal-Fetal Medicine that you'd like to see featured? Have you experienced issues, concerns or discrepancies with our services? Please email Kelly Clark, [email protected], or fill out our online form. Your input helps us tailor our content and educational offerings to better serve your needs and interests. Join the conversation and be a part of shaping our community!