GLP-1 exposure around conception, and moving BP checks out of the clinic

The edition in brief

Today's obstetrics and gynaecology edition leads on a question women on GLP-1 receptor agonists increasingly ask: what an inadvertent exposure around conception means. A systematic review of 22 studies and 49,395 exposed pregnancies found no consistent association with major or cardiac malformations, preterm birth, pregnancy loss, hypertensive disorders or caesarean; the one signal, a small rise in renal malformations (odds ratio 1.23, 95% CI 1.09 to 1.39), was driven by a single imbalanced cohort and likely reflects maternal disease. The data reassure after inadvertent exposure but do not support use in pregnancy. A secondary analysis of the MOMPOD trial (785 women) shows metformin's effect in type 2 diabetic pregnancy differs by baseline insulin: at low doses (under 30 units/day) adjunctive metformin was linked to fewer composite adverse neonatal outcomes (44% vs 55%, adjusted relative risk 0.76), while at high doses it mainly blunted the rise in insulin requirement. A Clinical Expert Series reframes the menopause transition as a window to find and treat cardiovascular risk, with ob-gyns often the only clinician a midlife woman sees. A clinic pearl restates how long to allow second-stage pushing before diagnosing arrest. The practice-changer: a randomised trial of home blood-pressure monitoring for women at high pre-eclampsia risk met its perinatal safety endpoint (hazard ratio 1.0) while cutting clinic visits and all-cause admissions.