Most abnormal thyroid tests in early pregnancy correct themselves

The edition in brief

Four findings for obstetrics and gynaecology. A secondary analysis of the placebo arms of two parallel randomised trials followed 326 women with subclinical hypothyroidism and 254 with hypothyroxinaemia, identified before 20 weeks and tested monthly without treatment: 88.7% and 61.4% respectively had at least one normal thyroid function test later in the pregnancy, and progression to overt hypothyroidism was uncommon (2.5% and 2.0%). Thyroid peroxidase antibody status did not predict who normalised. A Clinical Expert Series argues that the menopause transition is a distinct window of cardiometabolic change beyond chronological ageing, and that obstetrician-gynaecologists are usually the clinicians present for it. A nationwide US cohort of 6923146 pregnancies found stillbirth rates of 4.4 per 1000 births without pre-pregnancy diabetes and 16.6 per 1000 with it - and, strikingly, that the gestational-age-specific association between raised body mass index and stillbirth ran in opposite directions depending on diabetes status: at 31 weeks, a body mass index of 40 against 20 carried an adjusted hazard ratio of 0.68 (95% CI 0.54 to 0.85) with diabetes and 1.22 (1.13 to 1.33) without. Prediction models for obstetric anal sphincter injury in Dutch nulliparous women achieved moderate discrimination (area under the curve 0.67 for spontaneous and 0.68 for operative vaginal delivery) with excellent calibration. And a structured comparison of six international guidelines on fetal growth restriction finds agreement on Doppler-based surveillance and persistent disagreement on definitions, growth charts and biomarkers.