The edition · Obstetrics & Gynaecology
A normal mid-pregnancy glucose screen does not settle the question when the baby measures large
A meta-analysis finds late gestational diabetes in about one in five women whose fetus is later suspected to be large. Also: a Cochrane review of post-discharge home visits for preterm babies built largely on an Indian trial, a heart-defect signal after assisted conception, and reassuring early data on GLP-1 receptor agonists around conception.
The edition in brief
Today's obstetrics and gynaecology edition leads on third-trimester glucose testing. An AJOG meta-analysis of six cohorts (2166 women) with normal mid-pregnancy screening found that a repeat oral glucose tolerance test after 28 weeks detected gestational diabetes in 15.0% overall, 20.8% when a large-for-gestational-age fetus was suspected and 4.8% for isolated polyhydramnios. Late-diagnosed women had more neonatal hypoglycaemia (OR 1.82) and caesarean delivery (OR 2.00). A Cochrane review of 35 trials found home visits after discharge for preterm and low-birthweight infants likely improve breastfeeding at six months (RR 1.26), and that intensified visits with community-initiated kangaroo mother care, tested mainly in a large Indian trial, likely reduce mortality at six months (HR 0.75). A JAHA meta-analysis of 13 studies associated assisted reproductive technology with more major congenital heart defects (RR 2.35, 95% CI 1.68 to 3.28), with marked heterogeneity. An Obstetrics & Gynecology meta-analysis of eight studies (186,598 pregnancies) found no association between peri-conception GLP-1 receptor agonist exposure and gestational diabetes, preterm birth or pre-eclampsia. A US systematic review of 30 studies linked doula support to fewer preterm births and caesareans at moderate certainty, though most studies carried high risk of bias. The pearl covers glucose monitoring for babies of mothers with diabetes.
Home visits after discharge help preterm babies feed — and intensified visits may save lives
Build a home-visit plan with kangaroo care support into the discharge of every preterm or low-birthweight baby.
Assisted conception linked to about twice the rate of major heart defects
After assisted conception, make sure the anomaly scan gets complete cardiac views and refer early when they are not.
GLP-1 receptor agonists around conception: no signal of maternal complications so far
An early-pregnancy exposure to a GLP-1 receptor agonist need not alarm, but plan to stop the drug before a planned conception.
Doula support: fewer caesareans and preterm births at moderate certainty
Support a continuous labour companion for every woman; the evidence links it to fewer caesareans.
Babies of mothers with any diabetes need an early feed and a glucose check
Treat a third-trimester diagnosis of gestational diabetes exactly like an early one when planning the baby's first feeds and glucose checks.
When the fetus measures large after a normal glucose screen, a repeat OGTT finds diabetes in one in five
Consider a repeat glucose tolerance test when the fetus measures large in the third trimester, whatever the mid-pregnancy result.
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