Obstetrics & Gynecology

Adjunctive flash glucose monitoring in GDM lowers LGA risk without better SMBG control

In 205 women with low-risk gestational diabetes, adjunctive flash monitoring plus SMBG did not improve SMBG glycemic metrics versus SMBG alone. The percentage of SMBG readings in target was slightly lower with flash monitoring (89.5% vs 92.6%, p=0.04), with similar fasting and 1-hour postprandial values. Large-for-gestational-age births were less frequent with flash monitoring (3% vs 11%; OR 0.27, 95% CI 0.07-0.99). Given the modest sample and low event counts, the LGA reduction is hypothesis-generating and not yet practice changing. 1

Estrogen-only HRT after RRBO appears breast-safe in BRCA carriers, with benefit in BRCA1

This multicenter cohort followed 919 BRCA1/2 carriers after risk-reducing bilateral salpingo-oophorectomy for a mean 8.8 years. Ever use of HRT after RRBO was not associated with increased invasive breast cancer risk for either combined or estrogen-only regimens. Combined estrogen-progestin HRT had HR 1.06 (95% CI, 0.67-1.68); estrogen-only HRT had HR 0.89 (95% CI, 0.48-1.63). Each year of estrogen-only HRT was linked to lower breast cancer risk overall (HR 0.90; 95% CI, 0.81-0.99) and in BRCA1 carriers (HR 0.87; 95% CI, 0.77-0.98). 2

Delayed oophorectomy after salpingectomy preserves menopause-related QoL in BRCA carriers

The TUBA nationwide preference trial enrolled 570 premenopausal BRCA1/2 carriers choosing salpingectomy with delayed oophorectomy or immediate salpingo-oophorectomy. Most participants (72%) selected salpingectomy with possible delayed oophorectomy; 18% underwent oophorectomy within five years. At five years, overall menopause-related quality of life was similar when comparing salpingectomy (with or without later oophorectomy) to salpingo-oophorectomy, regardless of HRT use. Sensitivity analyses restricted to women with salpingectomy only showed better quality of life versus immediate salpingo-oophorectomy, with or without HRT. 3

Frozen embryo transfer carries the highest congenital heart disease risk among ART singletons

This nationwide cohort included 651,964 primiparous singleton births conceived naturally, by IUI, or by fresh or frozen embryo transfer. Overall congenital heart disease prevalence was 6.19%, highest with frozen embryo transfer (10.4%). Relative to natural conception, CHD risk rose 21.5% with IUI, 29.6% with fresh transfer, and 54.5% with frozen transfer. Frozen embryo transfer was linked to more right outflow tract malformations and higher rates of septal defects and patent ductus arteriosus. 4