A haemoglobin still below 10.5 at 20 weeks predicts stillbirth

The edition in brief

A secondary analysis of a multicentre Indian trial followed 4,252 women with moderate iron deficiency anaemia — haemoglobin 7.0 to 9.9 g/dL at 14 to 17 weeks — randomised to single-dose intravenous iron or oral iron. The question was not which treatment was given but whether the haemoglobin actually rose. Each unit increase in haemoglobin at 20 to 24 weeks was associated with a lower risk of stillbirth (relative risk 0.74, 95% CI 0.56 to 0.98), and risk of both stillbirth and early preterm birth climbed progressively as haemoglobin fell below 10.5 g/dL. The practical shift is to recheck haemoglobin four to six weeks after starting iron and treat a poor response as an obstetric risk factor. ACOG has published a new clinical practice guideline on obstetric cerclage, using a modified GRADE evidence-to-decision framework, covering indications, surgical approach, management and alternatives, with recommendations graded for strength and evidence quality. A meta-analysis of 21 studies and 5,650 women found continuous glucose monitoring in gestational diabetes lowered mean glucose by 0.24 mmol/L and time above 7.8 mmol/L by 2.19 percentage points, with 21% more medication use and 8 to 35% reductions in caesarean delivery, macrosomia, neonatal hypoglycaemia and hyperbilirubinaemia. A post hoc analysis of 11,908 women in low-resource settings found the effect of low-dose aspirin on preterm delivery did not vary with timing of initiation between 6 and 13 weeks or with adherence. Today's pearl: anaemia in pregnancy needs a cause, not just a prescription.