The edition · Obstetrics & Gynaecology
Home urine testing beat blood tests for follow-up after early medical abortion
A New Zealand trial of 732 women found self-assessment kept far more of them in follow-up. Also: SGLT2 inhibitor exposure in early pregnancy, a pregnancy-aware hypertension risk model, and the costs of oral agents versus insulin in gestational diabetes.
The edition in brief
A multicentre randomised trial in New Zealand compared self-assessment with a low-sensitivity urine pregnancy test against serial serum beta-hCG after early medical abortion. Complete follow-up within six weeks was 94.5% with self-assessment versus 67.4% with blood tests (RR 1.41, 95% CI 1.30 to 1.52), with no difference in complications or extra visits. A meta-analysis of three observational cohorts (669 exposed pregnancies) found no overall rise in major congenital malformations after early SGLT2 inhibitor exposure compared with insulin (RR 0.94, 0.68 to 1.29), but the estimates were imprecise and one Korean cohort raised a timing-specific cardiac signal. A Dutch cohort of 28,234 first-time mothers showed that adding pregnancy factors, mainly hypertensive disorders of pregnancy, lifted a 10-year hypertension prediction model's C-index from 0.66 to 0.77. A cost-effectiveness analysis of the SUGAR-DIP trial found oral agents (metformin then glibenclamide) probably cost less than insulin for gestational diabetes, with a QALY gain too small to matter clinically and no significant difference in large-for-gestational-age births. The pearl covers what to tell a woman who conceives while on an SGLT2 inhibitor.
SGLT2 inhibitors in early pregnancy: no overall malformation signal, but the data are thin
Use this to reassure cautiously after an inadvertent early exposure, and still stop the SGLT2 inhibitor once pregnancy is known.
Pregnancy history sharpened a 10-year hypertension risk model
Make sure a hypertensive disorder of pregnancy is passed on to primary care as a cardiovascular risk factor, not left in the obstetric notes.
Oral agents for gestational diabetes probably cost less than insulin
Oral agents are a reasonable, likely cheaper first choice for gestational diabetes, but discuss the open question on large-for-gestational-age babies.
Conceived on a teratogen-uncertain drug: three questions first
Date the pregnancy, document the exposure window, and replace the drug rather than just stopping it.
Home urine testing after early medical abortion kept 94% in follow-up
Consider home low-sensitivity urine testing as standard follow-up after early medical abortion, with a clear route back if the result is positive.
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