Embargoed for release until 5:00 p.m. ET on Monday 8 June 2026
Follow @Annalsofim on X , Facebook , Instagram , Bluesky , and Linkedin
Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine . The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.
----------------------------
1. Available evidence limited but does not suggest major adverse outcomes with early GLP-1 use in pregnancy
Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-04820
Summary for Patients: https://www.acpjournals.org/doi/10.7326/ANNALS-25-04820-PS
URL goes live when the embargo lifts
A target trial emulation estimated the risks associated with glucagon-like peptide-1 receptor agonist (GLP-1RA) exposure in early pregnancy. The findings did not indicate substantially increased risk for nonlive birth, abnormal fetal growth, or major congenital malformation with continuation of GLP-1RAs into the first trimester. As GLP-1RA use among women of reproductive age becomes more prevalent, the findings can provide some reassurance for pregnant women with unintentional first-trimester exposure to GLP-1RAs. The study is published in Annals of Internal Medicine .
Researchers from Harvard T.H. Chan School of Public Health and colleagues analyzed insurance claims data from 3,572 pregnancies between 2011 and 2024, comparing continuation of GLP-1RAs into the first trimester (≥ 1 further dispensation after conception) relative to non-continuation. The findings showed similar risks between the two treatment regimens for most outcomes, with no definitive increase apparent for continued medication use. However, because estimates were imprecise, particularly for rarer outcomes of major congenital malformation and small size for gestational age at birth, the authors conclude that further research would be valuable to better understand safety of GLP1-RAs in pregnancy.
Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Jeremy P. Brown, PhD please email Maya Brownstein at mbrownstein@hsph.harvard.edu.
----------------------------
2. Some hospital admissions for persons with dementia tied to higher costs, not improved survival
Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-03725
A study estimated the association of hospital admission on health outcomes and health care spending among persons with dementia. The study found that hospital admission after an emergency department visit was not clearly associated with lower mortality, but it was associated with higher health care spending. The findings indicate that health care spending could be reduced without compromising health outcomes for some patients with dementia who present to the emergency department. The study is published in Annals of Internal Medicine .
Researchers from Kyoto University and the University of California, Los Angeles examined more than 870,000 emergency department visits by Medicare fee-for-service beneficiaries aged 66 years or older with dementia between 2017 to 2019. Of these visits, 55.3% resulted in hospital admission. They compared death rates, additional hospital days, and spending over 30 and 90 days between the two groups using an instrumental variable approach to address differences in patient severity. The study found no clear difference in survival or subsequent hospital use. However, patients who were admitted to the hospital had significantly higher health care costs. The findings suggest that some hospital admissions may provide little value for short-term health outcomes among persons with dementia.
Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Ryo Ikesu, MD, PhD please email ikesu.ryo.8x@kyoto-u.ac.jp.
3. Study finds fewer health care workers in rural areas, with largest gaps in highly trained roles
Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-26-00239
A nationwide analysis found that nonmetropolitan areas in the United States have substantially fewer health care workers than metropolitan areas, particularly among highly trained professionals such as physicians and surgeons, highlighting ongoing gaps in access to care. The findings are published in Annals of Internal Medicine .
Researchers from the University of Kentucky and Des Moines University analyzed data from a large, nationally representative survey to compare health care workforce levels in metropolitan and nonmetropolitan areas. The sample included 588,489 respondents representing 12,921,391 actively employed health care workers in 2019 to 2023. The researchers calculated workforce size relative to workplace urbanicity. The study found that nonmetropolitan areas had about 44% fewer health care workers per 10,000 residents, with the biggest gaps seen in roles requiring more advanced training including psychologists, physicians, and surgeons. These findings suggest that workforce shortages in rural areas are widespread and affect both the number and types of providers available, which may contribute to differences in health outcomes.
Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Todd Burus, PhD please email Elizabeth Hetherington at Elizabeth.Chapin@uky.edu.
4. Experts discuss diagnosing and treating iron deficiency in a young woman with heavy menstrual bleeding
This “Beyond the Guidelines” feature is based on a discussion held at the Medical Grand Rounds conference on 26 February 2026.
Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-26-01369
In a new Annals “Beyond the Guidelines” feature, two hematologists and coauthors of the 2025 Iron Consortium Guideline published in Lancet Hematology discuss how to diagnose, evaluate, and manage iron deficiency and iron deficiency anemia (IDA) in a patient whose symptoms and test results fall into areas of clinical uncertainty. Their discussion highlights differences in approach to testing thresholds, the role of gastrointestinal evaluation, and when to use oral versus intravenous (IV) iron, drawing on recent guidelines and evolving evidence.
They reviewed the case of Ms. B, a 35-year-old woman referred for evaluation after routine blood work showed small red blood cells and low iron levels but only mild anemia. Further testing confirmed iron deficiency, and she reported increasingly heavy menstrual periods. Despite a year of oral iron therapy, her iron levels did not improve as expected, and IV iron was recommended.
The first discussant, Kylee L. Martens, MD, is an Assistant Professor of Medicine and a member of the Division of Hematology & Medical Oncology at Oregon Health & Science University. Dr. Martens emphasizes that iron deficiency can be clinically significant even without anemia and may be missed if clinicians focus only on hemoglobin levels. She highlights ferritin as the most useful test but notes ongoing debate about the best cutoff values. Dr. Martens underscores the importance of assessing menstrual blood loss and suggests a low threshold for further evaluation, including gastrointestinal testing when the cause is unclear. She favors earlier use of IV iron, especially in patients with ongoing blood loss. Dr. Martens recommends a detailed menstrual history with a low threshold for bidirectional endoscopy, as well as prompt treatment with IV iron.
The second discussant, Jason A. Freed, MD, is an Assistant Professor of Medicine at Harvard Medical School and a member of the Division of Hematology and Hematologic Malignancies at Beth Israel Deaconess Medical Center. Dr. Freed agrees that no single test or cutoff definitively diagnoses IDA and recommends considering the full clinical picture, including symptoms, lab trends, and patient history. He places greater emphasis on starting with oral iron, which is inexpensive and effective for many patients, with reassessment after several weeks to ensure response. Dr. Freed suggests reserving IV iron for those who do not respond or cannot tolerate oral therapy. Dr. Freed recommends testing Ms. B for celiac disease, managing her heavy menstrual bleeding, and trialing oral iron for 4 to 6 weeks with a plan to transition to IV iron if necessary.
Both experts stress the importance of identifying and addressing the underlying cause of iron deficiency, particularly heavy menstrual bleeding, and tailoring treatment to the individual patient. They agree that clearer diagnostic thresholds and better approaches to evaluating common causes like menstrual blood loss remain important gaps in current guidelines.
All “Beyond the Guidelines” features are based on selected clinical conferences at Beth Israel Deaconess Medical Center (BIDMC) and include multimedia components published in Annals of Internal Medicine .
Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact one of the discussants, please email Kendra McKinnon at kmckinn1@bidmc.harvard.edu.
Also new this issue:
Hypertension
Sandra J. Taler, MD
In the Clinic
Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-26-01311
Annals of Internal Medicine
News article
People
Continuing Glucagon-Like Peptide-1 Receptor Agonists Into the First Trimester of Pregnancy and Pregnancy Outcomes: A Target Trial Emulation Study Using Claims Information
9-Jun-2026