What are the American College of Obstetricians and Gynecologists (ACOG)'s current key focus areas for improving women's health?

Top 10 Focus Areas of the American College of Obstetricians and Gynecologists (ACOG)

ACOG's current top 10 focus areas are cardiovascular disease prevention, maternal health, abnormal uterine bleeding, placenta accreta spectrum, diabetes in pregnancy, racial and ethnic disparities, women's healthcare access, prenatal care and education, endometriosis management, and well-woman preventive care.

1. Cardiovascular Disease Prevention and Management

ACOG has made cardiovascular disease prevention a major priority, recognizing that:

• Heart disease remains the leading cause of death in women, yet only 45% of women identify it as such 1
• 90% of women have at least one risk factor for developing heart disease 1
• Women face unique cardiovascular risks during pregnancy and menopause 1
• ACOG recommends collaboration between OB/GYNs and cardiologists to improve early identification and modification of cardiovascular risk factors 1

2. Maternal Health and Pregnancy Complications

ACOG focuses heavily on improving maternal outcomes through:

• Management of high-risk conditions like placenta accreta spectrum, which requires multidisciplinary planning and early antepartum consultations 1
• Recommendations for cesarean hysterectomy in placenta accreta cases to be performed by the most experienced surgeons 1
• Recognition of pregnancy as a "physiological stress test" that can reveal underlying disease processes 1
• Protocols for rapid mobilization of blood products for transfusion in cases of maternal hemorrhage 1

3. Abnormal Uterine Bleeding Management

ACOG has developed comprehensive approaches to abnormal uterine bleeding:

• Implementation of the PALM-COEIN classification system to describe uterine bleeding abnormalities in reproductive-age women 1
• Recommendations for medical treatments including progestin-only contraception and combined hormonal contraception 1
• Surgical options including endometrial ablation and hysterectomy when medical treatment fails 1
• Diagnostic protocols including imaging and endometrial sampling 1

4. Diabetes Management in Pregnancy

ACOG has established detailed guidelines for diabetes care during pregnancy:

• Specific glucose targets: fasting <95 mg/dL, 1-hour postprandial <140 mg/dL, and 2-hour postprandial <120 mg/dL 1
• A1C goals of <6% if achievable without significant hypoglycemia, or <7% if necessary to prevent hypoglycemia 1
• Comprehensive preconception planning for women with diabetes 1, 2
• Recommendations for postpartum follow-up with 75g OGTT 4-12 weeks after delivery 2

5. Racial and Ethnic Disparities in Women's Health

ACOG has committed to addressing disparities in women's healthcare:

• Recognition that significant racial and ethnic disparities persist in women's health outcomes 3
• Commitment to eliminating these disparities through provider education and system-level changes 3
• Acknowledgment that factors at patient, practitioner, and healthcare system levels contribute to disparities 3
• Encouragement for OB/GYNs to engage in activities to help achieve health equity 3

6. Healthcare Access and Policy Advocacy

ACOG advocates for improved women's healthcare access through:

• Support for Medicaid expansion to increase the percentage of U.S. women with health insurance 4
• Advocacy for appropriate reimbursement to healthcare providers 4
• Recognition of these policies as key strategies to improve women's health outcomes 4
• Collaboration with partner organizations to address pressing issues in women's reproductive health 5

7. Prenatal Care and Education

ACOG emphasizes comprehensive prenatal care including:

• Nutrition counseling and appropriate weight gain recommendations based on pre-pregnancy BMI 2
• Folic acid supplementation (400-800 mcg daily for normal BMI, 5 mg daily for BMI ≥30) 2
• Exercise recommendations of 30 minutes of moderate activity at least 5 days/week 2
• Substance use counseling using the 5 A's approach (Ask, Advise, Assess, Assist, Arrange) 2

8. Endometriosis Management

ACOG has developed evidence-based approaches to endometriosis:

• Recognition of the complex relationship between endometriosis and infertility 1
• Understanding that pain severity often doesn't correlate with lesion appearance but does correlate with lesion depth 1
• Recommendations for histologic confirmation of endometrial lesions, especially those with non-classical appearance 1
• Medical management options for endometriosis-related pain 1

9. Well-Woman Preventive Care

ACOG has established comprehensive well-woman care guidelines:

• Age-specific recommendations developed by the Well-Woman Task Force 6
• Focus on optimizing preventive health care across a woman's lifetime 6
• Evidence-based and evidence-informed guidelines for preventive services 6
• Recommendations intended for use by any provider caring for adolescents or women 6

10. Clinical Decision Support and Practice Improvement

ACOG works to improve clinical practice through:

• Translation of narrative guidelines into implementable clinical decision support 7
• Development of problem-specific recommendations for integration into electronic health records 7
• Classification of recommendations as actionable, informational, educational, or policy-related 7
• Continuous updating of guidance to reflect current best practices 7

Common Pitfalls in Women's Healthcare

• Failure to recognize cardiovascular disease risk in women, particularly after pregnancy complications 1
• Inadequate preconception planning for women with diabetes or other chronic conditions 1, 2
• Relying solely on A1C for monitoring during pregnancy instead of using both pre- and postprandial glucose values 2
• Weight stigmatization during prenatal counseling rather than empowering approaches 2
• Inadequate screening for endometriosis in women with chronic pelvic pain 1