CU Anschutz Maternal-Fetal Medicine Summer 2026 Newsletter

July 7, 2026

Welcome to the 2026 Summer edition of our CU Anschutz Maternal-Fetal Medicine e-newsletter. This issue features practical updates on the evaluation and management of anemia in pregnancy, recommendations for delivery timing for macrosomia, latest guidelines on GLP-1 use before and during pregnancy, along with other important announcements.

Anemia in Pregnancy

By James Liu, MD

Anemia is commonly seen in pregnancy due to the natural increase in plasma volume. However, if hemoglobin concentrations fall below certain thresholds (<11.0 g/dL in first and third trimester or <10.5 g/dL in second trimester), further evaluation is recommended.  

Anemia can be classified in several ways (Box 1, 2, and 3 from ACOG Practice Bulletin 233), but as a practicing provider, evaluating anemia through a subset of Acquired versus Inherited methods is probably the most practical. The primary causes of anemia you are likely to encounter are acquired nutritional anemias (iron, folate/B12) and inherited hemoglobinopathies (thalassemia, sickle cell anemia).

The most common form of pathologic anemia seen in pregnancy is iron deficiency anemia, which comprises ~75% of all cases of anemia in pregnancy (Creasy and Resnik – Chapter 55). The average pregnancy requires ~1100 mg of iron where daily dietary intake with ~10% absorption accounts for ~1-1.5 mg/day. It is estimated that without iron supplementation, up to 20% of pregnant persons will have iron deficiency anemia by the end of pregnancy and up to 70% will be iron deficient, although they may still have normal hemoglobin (USPSTF Report 2024). If there is concern for iron deficiency without anemia, an iron binding panel (TIBC, serum iron, transferrin saturation, ferritin) is helpful for further evaluation. We recommend that all pregnant patients have some form of iron supplementation, either through prenatal vitamins or through other sources. Iron supplementation can be provided orally (response in ~4 weeks) or through iron infusions (response in ~1-2 weeks).

While more rare, Vitamin B12/folate deficiencies can also cause anemia. This is usually suspected in patients with macrocytic (MCV >100 fL) anemia and is more typically caused by alcoholism, medications, bariatric surgery, and pernicious anemia. Treatment is typically through supplementation (oral folic acid, IM Vitamin B12).

Hemoglobinopathies are typically diagnosed either through hemoglobin electrophoresis or by genetic testing. In most cases, carrier states for thalassemia and sickle cell anemia do not affect management in pregnancy. However, partner testing or diagnostic prenatal testing should be considered to evaluate fetal risk for more severe disease. Hemoglobinopathies are typically treated with serial blood transfusions as indicated, with newer and experimental treatments to include gene therapy and stem cell transplantation. 

With more complex anemias (auto-immune hemolytic anemia, aplastic anemia, G6PD deficiency) or patients with clinically significant alpha-thalassemia, beta-thalassemia, or sickle cell disease, please refer these patients to your Maternal Fetal Medicine colleagues for more in-depth counseling, recommendations, and management.

Should Big Babies Be Birthed Before 40 Weeks?

By Alexandra Adler, MD

AJOG-MFM recently published a meta-analysis evaluating outcomes of induction of labor at 38 weeks for suspected large-for-gestational-age (LGA) fetuses¹. The meta-analysis included five randomized controlled trials, including one of the largest studies to date from the UK, called the Big Baby Trial², which accounted for ~71% of the patients in the meta-analysis. Most of the studies excluded patients with diabetes. The definition of LGA differed slightly across the studies, with two studies defining LGA as >4000 g, two studies defining LGA as >95th percentile, and one study defining LGA as >90th percentile. The gestational age at induction also differed slightly with most patients being delivered between 38w0d and 38w4d.

The authors reported primary and secondary outcomes. The primary outcome was the rate of unplanned cesarean delivery, with secondary outcomes including composite maternal outcomes (rates of operative vaginal delivery, higher-degree lacerations, postpartum hemorrhage  etc.) and fetal outcomes (shoulder dystocia, brachial plexus injury, birth weight, postnatal bilirubin level, need for phototherapy, NICU admission, etc.). The analysis noted a 13% decrease in unplanned cesarean delivery rates (RR 0.87, CI 0.79–0.96). They calculated that 25 inductions would be needed to prevent one cesarean delivery. There was not a statistically significant reduction in shoulder dystocia (RR 0.72, CI 0.50-1.03). Notably, there was a 63% increase in hyperbilirubinemia requiring phototherapy (1.63, CI 1.17 -2.26) which the authors attributed to earlier gestational age of delivery. No other significant maternal or fetal complications were noted.

After discussion within our MFM Division, we do not recommend induction of labor for suspected LGA prior to 39 weeks in patients without diabetes. The reasoning behind this recommendation is that the reduction in unplanned cesarean delivery was only marginally statistically significant and there was an increase in postnatal hyperbilirubinemia.

1. Paladino I, Berghella V. Induction at 38 weeks for large-for-gestational-age or macrosomic fetuses decreases the incidence of cesarean delivery: meta-analysis of randomized controlled trials. Am J Obstet Gynecol MFM. 2026;8(4):101897. doi:10.1016/j.ajogmf.2026.101897
2. Gardosi J, Ewington LJ, Booth K, et al. Induction of labour versus standard care to prevent shoulder dystocia in fetuses suspected to be large for gestational age in the UK (the Big Baby trial): a multicentre, open-label, randomised controlled trial. Lancet 2025;405 (10491):1743–56. doi:10.1016/S0140-6736(25)00162-X.

Prenatal/Antenatal Guidelines for GLP-1 Use 

By Lauren Sayres, MD 

News You Can Use

Referring a Patient for History or Exam Indicated Cerclage?

1. History indicated cerclage:
• Please refer after initial dating scan. 
• We will see these patients for an initial consult and ultrasound between 11-13 weeks.  It is very helpful if they've completed NIPT testing with your group prior to this appointment.
2. Exam indicated cerclage:
• Please do SVE along with CL measurement via TVUS in your office prior to referral.
• If cervix is short and dilated, please call the DocLine at 720-848-2828 for provider to MFM discussion.
• If short cervix alone, with or without funneling, please send urgent referral and call clinic for provider to MFM discussion.

Additional Reminders for Placing Referrals 

When requesting Maternal-Fetal Medicine services, please select only one location for your patient referral.  If we are unable to accommodate the patient at the requested site, our team will coordinate scheduling at an alternate location if needed.

For patients requiring diabetes management, please refer to one of our School of Medicine sites for co-managed care.  For full transfer of GDM care, you must refer to UCHealth Anschutz campus. 

School of Medicine:

• Hobbins (Denver) – f: 303-468-3481  p: 303-315-6100
• Fort Collins (Rocky Mountain Perinatology)  – f: 970-482-1973  p: 303-315-6100 
• Littleton – f: 303-315-6056  p: 303-315-6100
• Parker – f: 303-840-4713  p: 303-315-6100

UCH Anschutz:  f: 720-848-1662  p: 720-848-2960 (ONLY FOR FULL TRANSFER OF GDM CARE)

Welcome Maggie Bishop, WHNP to CU Anschutz MFM!

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.

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