Today's newsletter contains the latest on claims regarding links between Tylenol and autism. How are your patients responding to conflicting messages about taking Tylenol when pregnant? Please take the poll in today's SmartBrief. We will share the results next Friday. Have a happy and safe Halloween today!

40% of pregnant women have some form of periodontal disease, which may contribute to preeclampsia and miscarriage. As providers, prioritizing oral health care can help improve these outcomes.

Pregnancy and oral health

A Swedish cohort study published in JAMA Oncology has identified a link between hormonal contraceptive use and increased breast cancer risk, with desogestrel presenting the highest risk among progestins. The study, involving over 2 million women, found that desogestrel-only and combined formulations are associated with a higher risk compared with levonorgestrel. The researchers emphasize that while the relative risk is significant, the absolute risk increase is small, highlighting the need for personalized contraceptive counseling.

Large language models had varying levels of accuracy and completeness when answering menopause-related questions, according to a study presented at the Menopause Society's annual meeting. ChatGPT versions 3.5 and 4.0 had the highest accuracy, with scores of 70% and 67% respectively, Gemini was the most complete with patient questions at 100%, and clinician-focused Open Evidence was 86% accurate. However, the chatbots were less accurate answering treatment-related questions than symptom-related ones, and some answers were difficult or very difficult to understand, highlighting challenges in providing reliable health information.

Increasing climate change concerns are influencing young Americans' decisions about having children. Many are worried about the impact of bringing new life into a world facing extreme weather events due to climate change. Studies, including one from Lancet, highlight that over half of young adults express hesitancy in starting families because of these environmental issues.

Fertility tourism is gaining popularity among US couples seeking affordable in vitro fertilization, with countries like Colombia offering significantly lower costs. Maggie Quinn and Ricardo Escobar of Florida saved thousands by undergoing treatment in Bogota, Colombia underscoring the financial burden of IVF in the US and the personalized care available abroad.

HHS Secretary Robert F. Kennedy Jr. said data do not show that Tylenol causes autism, despite recent claims about the medication by President Donald Trump, but that it is "very suggestive." The comments came after Texas Attorney General Ken Paxton sued Johnson & Johnson, which makes Tylenol, accusing the company of deceptive marketing to pregnant women despite possible links to autism.

Data on more than 2.1 million births linked prenatal exposure to air pollutants such as sulfate and ammonium to a higher risk of autism spectrum disorder in children. The research, published in JAMA Network Open, found the second and third trimesters were vulnerable periods because they are associated with neuronal growth, myelination and synapse formation in the fetal brain.

A study in Nature Communications found that breast milk from women with human immunodeficiency virus had 50% lower levels of tryptophan, an essential amino acid important for infant immune function, growth and brain development, when compared with those without HIV. They said this deficiency may contribute to health problems and delayed development in infants born to mothers with HIV.

A meta-analysis published in Pediatric Pulmonology found that budesonide combined with pulmonary surfactant was associated with a nearly one-third reduction in the incidence of bronchopulmonary dysplasia in premature infants, and less in-hospital mortality and pulmonary hemorrhage, compared with surfactant alone. Researchers evaulated data from 12 randomized controlled trials that included 2,428 premature infants.

The Eat, Sleep, Console approach for managing neonatal opioid withdrawal syndrome focuses on ensuring infants can eat sufficiently, sleep for at least an hour, and be comforted easily. This method, published in The Journal of Pediatrics, significantly reduced the need for pharmacologic treatment in infants compared to usual care, highlighting the importance of nonpharmacologic interventions.