Obstetrics & Gynecology

GDM plus hypertensive disorders markedly increases adverse pregnancy risk; SBP shows nonlinear risk rise

In 240 deliveries, hypertensive disorders of pregnancy (HDP) alone increased composite adverse outcomes (aOR 3.30, 95% CI 1.41–7.70). Comorbid gestational diabetes mellitus (GDM) + HDP had a much higher adjusted risk (aOR 9.25, 95% CI 2.63–32.45). Additive interaction analysis suggested over half the excess risk was attributable to their joint effect (RERI 5.62; AP 0.61). Restricted cubic spline analysis showed risk rose sharply above approximately 135 mmHg mean SBP and accelerated past 160 mmHg. 1

Estradiol–dydrogesterone combination provides greater 12-week symptom relief than dydrogesterone alone

In 150 perimenopausal patients, E2/DYD reduced Kupperman Menopause Index more than dydrogesterone alone (mean difference -4.51 points). Clinical response (≥50% KMI reduction) occurred more often with combination therapy (51.2% vs 31.5%; adjusted OR 2.08). Adverse events were more frequent with combination therapy (31.7% vs 11.1%; adjusted OR 3.55) but were generally mild. Endometrial thickness increased modestly with E2/DYD (+0.60 mm) with week-12 values remaining within physiologic ranges. 2

History of hypertensive disorders of pregnancy associated with higher long-term all-cause mortality

Meta-analysis of 29 datasets (n≈14.2 million) found prior HDP associated with 45% higher all-cause mortality (RR 1.45, 95% CI 1.30–1.61). Preeclampsia/eclampsia conferred larger risk (RR 1.64) than gestational hypertension (RR 1.34). HDP was also associated with higher cause-specific mortality, including cardiovascular and metabolic disorders. Associations persisted across subgroup and sensitivity analyses, and remained after excluding chronic pregestational hypertension. 3