The edition · Obstetrics & Gynaecology
Continuous glucose monitoring in gestational diabetes improved control and reduced caesarean, macrosomia and neonatal hypoglycaemia
A meta-analysis of 21 studies and 5,650 pregnancies found CGM lowered mean glucose by 0.24 mmol/L and time above range by 2.19 percentage points, with 8 to 35% reductions in adverse maternal and neonatal outcomes — alongside a 21% increase in medication use.
The edition in brief
The most directly useful finding today concerns a technology already in many maternity units without clear evidence behind it. A meta-analysis of 21 studies and 5,650 women with gestational diabetes compared continuous glucose monitoring with self-monitored blood glucose. The glycaemic differences are small in absolute terms: mean glucose lower by 0.24 mmol/L, coefficient of variation by 0.78 percentage points, glycaemic excursions by 0.22 mmol/L, and time above 7.8 mmol/L by 2.19 percentage points. The clinical outcomes are what justify it — reductions of 8 to 35% in caesarean delivery, macrosomia, neonatal hypoglycaemia and hyperbilirubinaemia — with a 21% increase in medication use, which is plausibly the mechanism rather than a side effect: seeing the excursions leads to treating them. ACOG has published a clinical practice guideline on obstetric cerclage, covering indications, technique, alternatives and management across cervical insufficiency, prior obstetric history and cervical shortening. An umbrella review of nine systematic reviews found immediate postpartum and postabortion LARC insertion produced higher uptake and fewer six-month pregnancies than delayed insertion, at the cost of a fivefold higher IUD expulsion rate after vaginal delivery — a trade the review quantifies with high-certainty evidence on the expulsion side. And a 156-study meta-analysis linking cervicovaginal genital mycoplasmas to preterm birth explicitly declines to support screening or treatment.
CGM in gestational diabetes improved outcomes, largely by prompting treatment
In gestational diabetes, continuous glucose monitoring modestly improved glycaemic measures and reduced caesarean delivery, macrosomia, neonatal hypoglycaemia and hyperbilirubinaemia by 8 to 35%, with 21% more medication use.
Immediate LARC insertion prevents more pregnancies and expels more devices
Immediate postpartum or postabortion LARC insertion prevented more unintended pregnancies than delayed insertion but raised IUD expulsion fivefold after vaginal delivery, making follow-up reliability the deciding factor.
Genital mycoplasmas track with preterm birth, and the authors decline to recommend screening
Cervicovaginal genital mycoplasmas were associated with preterm birth and low birthweight with odds ratios of 1.5 to 1.8, on observational data the authors say do not support screening or treatment.
ACOG has published a clinical practice guideline on obstetric cerclage
ACOG has issued a GRADE-based clinical practice guideline on obstetric cerclage covering indications, technique, alternatives and management across cervical insufficiency, prior obstetric history and cervical shortening.
When benefit and harm carry different certainty, say which is which
When a review grades outcomes separately, check whether the benefit and the harm carry the same certainty — presenting two numbers side by side invites equal weight they rarely deserve.
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