The edition · Obstetrics & Gynaecology
An SGLT2 inhibitor before the pregnancy test: reassuring, but imprecise
Pooled cohorts find no clear rise in malformations after early SGLT2 or GLP-1 exposure, a skin condition linked to three times the sphincter injuries, and why a pregnancy history belongs in every cardiovascular risk score.
The edition in brief
Two meta-analyses address the women who conceive on newer diabetes and weight drugs. Three cohorts with 669 SGLT2 inhibitor-exposed pregnancies found no clear rise in major congenital malformations against insulin (RR 0.94, 0.68-1.29), but certainty was low and one Korean cohort flagged a cardiac signal for exposure in weeks 4-10. Ten studies of more than two million pregnancies found no detectable rise in adverse outcomes after periconceptional GLP-1 receptor agonist exposure; neither analysis establishes safety. A Danish cohort of 277 births to women with vulvar lichen sclerosus linked the condition to more second-degree tears (RR 1.37) and anal sphincter injuries (RR 3.37), with introital narrowing and active symptoms marking the highest risk. The pearl covers postpartum blood pressure follow-up after hypertensive pregnancy. The practice changer: in a Dutch cohort of 28,234 first-time mothers, adding pregnancy factors - mainly hypertensive disorders of pregnancy - lifted a 10-year hypertension model's C-index from 0.66 to 0.77.
Early SGLT2 inhibitor exposure: no clear malformation signal, wide uncertainty
Inadvertent early SGLT2 inhibitor exposure warrants switching and a careful anomaly scan, not alarm - but planned use in pregnancy is still unsupported.
GLP-1 receptor agonists around conception: two million pregnancies, no clear harm
Periconceptional GLP-1 receptor agonist exposure has not shown clear harm, so counsel calmly - but keep advising a stop before planned pregnancy.
Vulvar lichen sclerosus and perineal trauma at birth
Treat vulvar lichen sclerosus as a perineal risk factor worth recording antenatally, especially with introital narrowing or active symptoms.
The postpartum blood pressure check is a long-term appointment
A hypertensive pregnancy should leave a permanent flag in the primary care record, not just a six-week check.
Pregnancy history sharpens 10-year hypertension prediction
Ask every woman about hypertensive pregnancy when judging her cardiovascular risk - it was the strongest predictor of hypertension within a decade.
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