Every placental complication flags future heart disease, not only pre-eclampsia

The edition in brief

A Dutch linkage study of 1,669,681 nulliparous women followed for a median of 11 years found that any uteroplacental disorder — gestational hypertension, pre-eclampsia, fetal growth restriction or fetal death — was associated with about 70% more premature cardiovascular disease (adjusted HR 1.70, 95% CI 1.67–1.74). Risk was highest soon after the pregnancy and stayed raised beyond ten years; spontaneous preterm birth carried a smaller excess. A two-centre Nigerian trial of 260 term inductions reported more vaginal births within 24 hours with hourly titrated oral misoprostol than with four-hourly 25 mcg vaginal tablets (96.2% vs 83.1%), with fewer abnormal contraction and fetal heart rate patterns, though its statistical reporting is inconsistent. An economic analysis of the Dutch SUGAR-DIP trial found sequential metformin then glibenclamide probably no more costly than insulin for gestational diabetes, with a QALY gain of about three days and no clear difference in large-for-gestational-age babies. The practice changer is a New Zealand trial of 732 women after early medical abortion: self-assessment with a low-sensitivity urine pregnancy test achieved complete follow-up in 94.5% versus 67.4% with serial serum hCG (RR 1.41, 1.30–1.52), with similar complication rates.