Psychotropics in pregnancy and gestational diabetes, and home blood pressure that held its ground

The edition in brief

A meta-analysis of 21 observational studies found that antipsychotic exposure in pregnancy was associated with a 43% higher risk of gestational diabetes and antidepressant exposure with a 19% higher risk, with second-generation antipsychotics carrying the clearest signal (RR 1.6). It is association, not cause, and the answer is metabolic surveillance rather than stopping treatment. A secondary analysis of a misoprostol induction trial found that women with a BMI of 40 or more laboured about three and a half hours longer and had lower odds of vaginal birth. A small randomised trial found an ultrasound-guided transversalis fascia plane block no better than wound infiltration after caesarean section when multimodal analgesia was in place. The practice-changer is an Australian non-inferiority trial in 270 women at high risk of pre-eclampsia: smartphone-linked home blood pressure monitoring gave the same perinatal outcomes as specialist clinic visits, with fewer appointments and fewer admissions.