Bernstein Clinical Research Center

SummaryBackground and ObjectivesSystemic treatment of pregnant/breastfeeding atopic dermatitis (AD) patients is challenging due to limited safety data. We explored treatment practices with systemic agents, including the guideline‐recommended cyclosporine as the first systemic choice as well as emerging therapies, in this vulnerable population.Patients and MethodsThe Global Allergy and Asthma Excellence Network (GA2LEN) ADCARE initiative collected data from physicians worldwide who treat pregnant women with AD. Physicians completed an electronic questionnaire on the use of systemic agents in pregnant/breastfeeding AD patients.Results103 physicians from 32 countries completed the survey, primarily dermatologists (n = 48) or allergologists (n = 43). Antihistamines were the systemic drug most often considered to be used during pregnancy/breastfeeding (n = 73/81, 90.1%), with fewer physicians considering the use of systemic agents for the first trimester compared to later stages of pregnancy. For acute flares, systemic corticosteroids (n = 34/80, 42.5%) were preferred, followed by biologics and antihistamines (each n = 15/80, 18.8%). Although the guideline‐recommended cyclosporine is sometimes considered for AD during pregnancy (n = 38/81, 46.9%), it was rarely considered as the preferred drug by physicians (n = 1/80, 1.25%).ConclusionsOur study shows a misalignment between guideline recommendations and prescription patterns and highlights an unmet need for knowing and using the existing recommendations.

An increased risk of primary biliary cholangitis (PBC) has been reported in patients with systemic sclerosis (SSc). Our study aims to investigate the shared genetic susceptibility between the two disorders and to define candidate causal genes using cross-phenotype genome-wide association study (GWAS) meta-analysis. We performed cross-phenotype GWAS meta-analysis and Bayesian colocalization analysis for patients with SSc and patients with PBC. We performed both genome-wide and locus-based analysis, including tissue and pathway enrichment analyses, fine-mapping, Bayesian colocalization analyses with expression quantitative trait loci and protein quantitative trait loci (pQTL) datasets, and phenome-wide association studies. Finally, we used an integrative approach to prioritize candidate causal genes from the novel loci. We detected a strong genetic correlation between SSc and PBC (global genetic correlation = 0.84, P = 1.7 × 10-6). In the cross-phenotype GWAS meta-analysis, we identified 44 nonhuman leukocyte antigens loci that reached genome-wide significance (P < 5 × 10-8). Evidence of shared causal variants between patients with SSc and patients with PBC was found for nine loci, five of which were novel. Integrating multiple sources of evidence, we prioritized CD40, ERAP1, PLD4, SPPL3, and CCDC113 as novel candidate causal genes. The CD40 risk locus colocalized with trans-pQTLs of multiple plasma proteins involved in B cell function. Our study supports a strong shared genetic susceptibility between SSc and PBC. Using cross-phenotype analyses, we have prioritized several novel candidate causal genes and pathways for these disorders.

Climate-sensitive extreme weather events are increasingly impacting frontline clinic operations. We conducted a national, cross-sectional survey of 284 self-identified administrators and other staff at frontline clinics determining their attitudes toward climate change and the impacts, resilience, and preparedness of clinics for extreme weather events. Most respondents (80.2%) reported that humans are causing climate change, and nearly half (45.9%) reported concerns about extreme weather impacting their job, with barriers to preparedness including financing and knowledge and resources. Over a third (41.8%) of respondents reported taking steps to protect their clinic infrastructure from extreme weather, including by addressing power and improving ventilation.

In Brief In May 2025, the American College of Obstetricians and Gynecologists published a committee statement on quality-improvement strategies for safe reduction of primary cesarean birth. This important document includes a number of practical approaches that have been shown to be effective in minimizing risk of cesarean birth, especially for low-risk nulliparous women. Our maternity nursing expert, Dr. Berstein, reviews the new committee statement and implications for clinical practice.