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- [00:01]
A
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- [00:31]
B
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C
So we took the test. It came back positive. We were so excited, so happy. And I go to throw it out and my husband goes, wait, Shannon, no, we should save that. I was like, I just peed on it. And he was like, yeah, but it's a keepsake. And I was like, yeah, but it's a urine sample. Does this not gross anybody else out? Like, I am constantly seeing couples announce their pregnancy on Instagram with the test. You know, they're like hugging, they're kissing, they're waving the stick around. And I'm just like, wash your hands.
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D
So I don't know about you all, but this comedienne really hit something. Hit the nail on the head. Because, I mean, we're guilty of this, me and my wife. We've saved each of our positive pregnancy tests for our three kids. Well, we had four pregnancies. We lost one pregnancy. And we saved each one of those pregnancy tests in their little memory book. I don't know people make little photo memory books anymore. But we did, because that's what you did back in the day. And thinking about it, it's kind of gross. It's like a dried urine sample in this book. But she hits the nail right on the head about how excited people are when they see that little positive pregnancy test Guys, trust me, this is exactly what we're dealing with in this episode because a brand new publication just came out ahead of print in the Green Journal that has to do with the problems of checking for pregnancy too quickly. Because that's our culture, right? We live in an immediate society. I mean, if you want to know something, just pick up your phone and you find it. If you want to order something, you want it on Amazon, same day delivery, and you just have to have it right away. That's the culture that we have. Not just, of course in the US but everywhere. It's a pretty global thing. We're in this immediate need to know culture and society. I get that. I'm guilty of it as well. However, here it is, guys. Here's the problem for couples trying to conceive. Now, this is of course talking about through, you know, the old fashioned way, you know, natural means, not through artificial reproductive technologies or ivf, just the regular way. Although this totally applies to patients who are undergoing IVF as well. But in general, in the general populations, patients trying to conceive, they just can't wait to check that pregnancy test to see if it turned positive. But here's the catch. Now, we've always told patients, of course, you know, give it time, let it declare itself. You'll find out soon enough. But without fail, they want to know even before they missed that next period. Right? Well, here's what this publication, this brand new study in the Green Journal statute of gynecology has to say about that. That actually is very problematic. So again, that's why we're calling this the problem of proving pregnancy too promptly. Because there's so much that goes into finding a positive pregnancy test. Even though the modern pregnancy tests that are over the counter, you know, on the shel, are very good, they're not as good as the ones that are used in some research settings that use like gas chromatography and other molecular analysis to actually try to pinpoint within 12 to 24 hours the moment of implantation. Okay? Even with today's technology, the over the counter pregnancy tests are not that good. Okay? This still has a little bit of lag. So here's the catch. There's a big problem both with psychological trauma and in false reassurance or false hope of either a negative or positive pregnancy test. And we're going to explain both of those scenarios in this episode. So the article that we're going to talk about and summarize and give some clinical implications here was officially released on March 1, 2026 even though it was out ahead of print a couple of weeks before that. But it is now officially out in obstetrics and gynecology and the title is Pregnancy Test Use and Timing of Pregnancy Detection in a Prospective Cohort of Pregnancy Planners. Whoa. See, they like to use the word the P in their words as well, like we did, calling our title the Problem of Proving Pregnancy Too Promptly. So again, the title is Pregnancy Test Use and Timing of Pregnancy Detection in a Prompt Prospective Cohort of Pregnancy Planners. I guess it just couldn't go with patients Trying to conceive. Whatever. But, but this is actually some very, very practical and everyday information that we can tell patients when they come in looking for prenatal. I'm sorry, pre pregnancy care, preconception care. And they say, hey, when is the quickest that we can check? This is called the pro Presto Cohort. Presto cohort. And I'm going to explain the clinical implications of why. Why checking too early to see if you're pregnant is bad. It's bad if it's a false negative. And there are some things as a false positive. Now, I'm not talking about heterophilic antibody and things like that we've covered in the past. I'm talking about where there's a chemical pregnancy, meaning HCG is detected in the urine, but it's not actually a clinical pregnancy because there's a high rate of loss in those cases. Right? Because not, not every pregnancy that implants is just the nature of things will make it to a clinically detectable pregnancy. So if it's negative, it could be falsely negative if you check too early. And if it's positive because you checked too early, it may not continue as a clinical pregnancies. So chemical pregnancies may not always translate into a clinical pregnancy. So we'll give you these numbers here. And I'm going to explain why even checking a pregnancy test on the first day of the anticipated next cycle that's missing, why even that could be problematic. Now that's much better. That's much better than checking a week before, like at week three from your last menstrual period. It's definitely better to check on the day of your missed period. But even then, 10% of clinical pregnancies may not be detected. 10%. I'm going to give you that reference out of JAMA after the intro. So what's best? Let it declare itself. The best time for the highest sensitivity that you're going to catch a true clinical pregnancy is one week. One week after the missed cycle. By that time, the sensitivity increases to 97 to 98%. I'll give you that reference right after the intro. This is Dr. Chapma's ob gyn no spin podcast.
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E
Eczema is unpredictable, but you can flare less with epglis, a once monthly treatment for moderate to severe eczema after an initial four month or longer dosing phase. About four in 10 people taking EB GLISS achieved itch relief in clear or almost clear skin at 16 weeks, and most of those people maintain skin that's still more clear at one year with monthly dosing.
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F
MGLIS Lebricizumab LBKZ a 250mg per 2ml injection, is a prescription medicine used to treat adults and children 12 years of age and older who weigh at least 88 pounds or 40 kilograms with moderate to severe eczema, also called atopic dermatitis that is not well controlled with prescription therapies used on the skin or topicals or who cannot use topical therapies. EBGLIS can be used with or without topical corticosteroids. Don't use if you're allergic to ebglis. Allergic reactions can occur that can be severe. Eye problems can occur. Tell your doctor if you have new or worsening eye problems. You should not receive a live vaccine when treated with ebglis. Before starting ebglis, tell your doctor if you have a parasitic infection.
- [09:30]
E
Ask your doctor about eglis and visit eglis.lilly.com or call 1-800-lilyrx or 1-800-545-5979. This episode is brought to you by Indeed. Stop waiting around for the perfect candidate. Instead, use Indeed Sponsored Jobs to find the right people with the right skills fast. It's a simple way to make sure your listing is the first candidate. C. According to indeed data, Sponsored Jobs have four times more applicants than non sponsored jobs. So go build your dream team today with Indeed. Get a $75 sponsored job credit@ Indeed.com podcast. Terms and conditions apply.
- [10:05]
D
All right, so we are back to The Green Journal March 1, 2026. When this officially came out. Pregnancy Test Use and Timing of Pregnancy Detection in a Prospective Cohort of Pregnancy Planners. Very, very catchy. Again, this was called the Presto Cohort. Now this was basically a survey in self reported behavior of couples trying to conceive. Overall, this covered a big span of time. This was from 2018 all the way to 2024, y'. All. That's dedication. Six years to gather this data. Okay, so participants reported their day specific information about pregnancy testing. And they were supposed to do that four days before the expected menstrual cycle through four days after. That's what they said. That's, that was kind of the, the instructions, you know, choose about four days before your, your next anticipated period or four days later and then tell us what happened and what you did with that information. Right? Did you stop looking? Did you keep testing what happened? Right. So basically four days before and four days after the anticipated next cycle. Let me give you a spoiler. That's not what they did because they started checking way before the four days before their anticipated cycle, which became problematic, okay? Because that's human behavior. So anyway, this presto study was a pregnancy study online. It was North American participants to try to see if you're trying to get pregnant. What does this look like in a general population of self testing? Okay. Overall, they analyzed in that six year span 20,000 pregnancy tests from 6,569 participants. Okay? Now here's what they found. About 40% engaged in very early testing, meaning more than four days before the anticipated next cycle. And here's a problem. Those very early testers, okay, because they had to know. Had to know. So we're talking about roughly, like let's say on a four week, you know, menstrual cycle. Just for ease of use, these are the ones that checked, you know, on week three, right. A week before the anticipated next cycle. Here's what they found. Quote, very early testers were 5.89 times. So let's call it what it is called, 6.6times more likely to experience a negative test before actually having a positive test compared to those who waited until their expected period. So six times more likely to be disappointed to feel like it didn't work when they later on became positive. Do you all get this? This is a mind game. Okay? So quote, very early testers were 5.89. So let's call it six. Six times more likely to experience negative tests before positive test results compared to those who waited until their expected period, end quote. Now we get this, right? That's why we tell patients, don't check too early. It's going to freak you out and it's going to confuse things, things. Let's let, let it be, let it be and let it declare itself. Six times more likely to have a negative test. Now here's the catch, okay? Because it gets there. There's more to it than that. So you know, 5.8 whether you call it 5 or 6. The point is, it's a lot more likely to have a negative test before a positive test. And those who waited until the next day of their expected period, fine. But here's the other thing. Very early testers were also more than three times more likely to have an initial positive test that was then followed by a negative test result, likely reflecting increased detection of very early pregnancy loss. End quote. In other words, while you can get a false negative too early, you can also find a false positive. Now, remember, we said this in the intro, and we're not talking about heterophilic antibodies or weird, you know, results. It's a true positive. Initially. That's called a chemical pregnancy. But not all chemical pregnancies end up being a clinical pregnancy, and that was three times more likely to happen. So that also causes psychological devastation, anxiety and stress. So you'll get this right. Checking too early can give you a false negative. Checking too early can give you a quote, unquote, chemical false positive, even though it's not a false positive or was something there, but that's not translated to a clinical success. These are psychologically impactful and damaging to the couple. This is why back in 2001, in the separate publication, guys, this was in jama and the title of this publication was Natural Limits of Pregnancy Testing in Relation to the Expected Menstrual Period. They said, even. Even, guys, even on the first day of your missed period. Okay, so you're like, I was supposed to get my period here and my clockwork, and it didn't come. I'm checking a pregnancy test. While that's much better, with an accuracy or a sensitivity of 90%. According to that 2001 GEM article, about 10% of true clinical pregnancies may not be detected even if you check on that day when your period was supposed to come. 10%, guys, that's a lot. So while 90% are found, 10% are actually getting implantation. But because the test lags about four to five days from implantation to a positive read, even with these new sensitive pregnancy tests over the counter, you can actually be positive even on the day of your missed period, but your tests come out negative now, that's 10%. Now you're like, well, how is that possible? It's easy. The stress of trying to conceive can shift ovulation down. So you may not have conceived when you thought you did. And 10% of clinical pregnancies may not have yet implanted when you thought they did by the first day of the missed period to Become positive. Okay, so that was again, that reference was Jama in 2001. And that's why they said the way that you get around all of this and having the Highest sensitivity at 97 to 98% is one week after the anticipated menstrual cycle is missed. Okay, so I found this fascinating because this really does have a lot of clinical implications here. Number one, it has to do with goal setting and realistic expectations. If you're going to try to get pregnant, know your cycle, you can do an ovulation check if you want to be that scientific about it, which takes out some of the spontaneity and fun. Just saying. But if you, if you think that, that you conceived during that menstrual cycle and your fake indidity is, is age appropriate, then let it declare itself. Checking too soon may give a false negative and may show you a positive. But then you get your quote unquote period, you know, a week later because it's a failed chemical pregnancy. So this is a problem in this society of trying to know things way too quickly. This is where it can backfire on us. The recommendation, not just from these authors, but back in 2001, guys, we've known this for a long time and of course we've known that before 2001, but 2001, that was a Wilcox publication from JAMA, really put it in perspective in terms of percentages and the psychological impact of looking too early. Well, that same concept has now been redone now 25 years later in this new green journal publication and it's saying the same thing. So these are two different cohorts, two completely different sets of authors, but with the same message 25 years apart. Checking too early is problematic. So the take home message is if you look too early, you're six times, well, 5.8 times more likely to have a false negative when you truly are going to be positive. If you just give it a few more days. And even if you find that it is positive, it's three times more likely to not be a success because of natural loss after implantation. Okay, that's the sad reality of trying to get pregnant. So letting it declare and either leaving the pregnancy test for the day of your missed period, which has the sensitivity of 90% or ideally waiting for one week after that where sensitivity approaches 98% seems to be the way to go. Now there's, you know, there's other things that that 2001 publication get into. These authors in this new green journal also kind of, you know, mentioned to the psychological distress and anxiety of getting information that we're not just sure what to do with. So the clinical implication we've already covered, these current commercial pregnancy tests are very, very good, but they're not the same as the ones that can check for literally within 12 or 24 hours of implantation. And so just let it declare itself. Podcast Family we are very quickly summarizing a new publication on March 1, 2026, which is the official date of this release, Pregnancy test use and timing of Pregnancy Detection in a Prospective Cohort of pregnancy planners. So when is the best time to check? Either when you miss a period or ideally one week later. Looking too early is problematic. Podcast Family True to our form of trying to let you know just quickly what the message is and then be done, and I think we have done that with this episode. All right, Podcast Family, as always, we're thankful for you. We're glad you're part of our podcast community. Michael now that we've done all that, let's take it home. This is Dr. Chapma's obgyn no spin. Podcast sam.