BACKGROUND:Gestational diabetes mellitus (GDM) diagnosed early in pregnancy (before 20 weeks' gestation) is associated with increased metabolic risk, yet its molecular profile remains poorly defined. While disrupted lipid metabolism is an important feature of GDM, no previous study has characterized the lipidomic profile of women with early GDM (eGDM). METHODS:We performed untargeted liquid chromatography mass spectrometry on maternal plasma samples from a cohort of 180 women at risk of GDM, enrolled in the Treatment of Booking GDM (TOBOGM) multicenter randomized controlled trial. Oral glucose tolerance tests (OGTT) were conducted before 20 weeks' gestation to diagnose eGDM using World Health Organization (2013) criteria. Lipidomic data were analyzed using multivariable linear regression, unsupervised clustering, weighted gene co-expression network analysis (WGCNA), and logistic regression-based risk modeling. RESULTS:In 89 eGDM and 91 non-GDM controls, we quantify 543 lipid species across 18 lipid classes. We identify a distinct lipidomic signature of eGDM, comprising elevated concentrations of glycerolipids (diacylglycerols), fatty acids, and ethanolamine-containing glycerophospholipids (phosphatidylethanolamine and lysophosphatidylethanolamine), alongside lower concentrations of choline-containing glycerophospholipids (lysophosphatidylcholine and ether-linked phosphatidylcholine) and glycosphingolipids (hexosylceramides). Fatty acid and diacylglycerol species are the strongest and most consistent lipid predictors of eGDM and glycemic indices, independent of clinical risk factors. Lipid ontology-based enrichment analysis reveals perturbations in pathways related to lipid storage, membrane remodeling, and signaling. CONCLUSION:To our knowledge, this is the first study to characterize the lipidomic profile of women with eGDM. We identify a distinct lipidomic signature associated with eGDM, offering molecular insights into pathophysiology and highlighting candidate lipid biomarkers for future investigation and validation in this context.

Background Women comprise 70% of the global health workforce yet hold only around 25% of leadership positions. Women's leadership development programmes (WLDPs) are widely implemented as organisational equity strategies; this review examined whether their reported outcomes extend beyond individual development to measurable organisational change. Methods Systematic review without meta-analysis (PROSPERO: CRD42024554419), reported in accordance with PRISMA and SWiM. Nine databases were searched from 25 September 2015 to 5 July 2026. We included peer-reviewed studies evaluating structured WLDPs delivered to adult professionals in formal organisational roles that reported outcomes for women. Student-only populations and mentorship- or coaching-only interventions were excluded. Summary data were extracted from published reports by two independent reviewers using a standardised template incorporating TIDieR intervention-description items; quality was assessed using design-appropriate Joanna Briggs Institute critical appraisal tools. Outcomes were mapped using an extended Kirkpatrick framework spanning individual to organisational outcomes. Findings From 2314 records, 57 studies evaluating 52 WLDPs across 23 countries were included. Most studies were from the United States (n = 36). Designs were predominantly mixed-methods or qualitative; none used randomisation, and four included comparison groups. All studies reported individual-level outcomes, most commonly self-reported improvements in confidence, knowledge, leadership capability, and behaviour. Thirty-two studies reported any organisational outcome, usually promotion or retention indicators. Subjective measures predominated over objective outcomes. Demographic reporting was limited: only 22 studies reported race or ethnicity, and very few reported sexual orientation, disability, or disaggregated advancement outcomes. Interpretation WLDPs appear to support individual development, but current evidence cannot establish organisational transformation. Their broader equity potential depends on structural accountability: transparent and equitable recruitment pathways, institutional investment, and disaggregated outcome reporting, a reorientation of responsibility from individuals to organisations. Funding The Australian National Health and Medical Research Council (NHMRC).

BACKGROUND:Commercial automated insulin delivery (AID) systems are increasingly used in pregnancies complicated by Type 1 diabetes, but the evidence is dispersed across trials, observational studies, case series and qualitative research. Existing syntheses have largely emphasised glycaemic efficacy and selected perinatal outcomes, with less attention to device platform, timing of initiation, psychosocial burden, clinician workload and implementation context. AIMS:To describe the protocol for a mixed-methods systematic review and meta-analysis evaluating the effectiveness, safety, feasibility, acceptability and implementation of commercial AID systems in Type 1 diabetes pregnancy. METHODS:MEDLINE, Embase, CINAHL, Scopus, Emcare, the Cochrane Library, CENTRAL and ClinicalTrials.gov will be searched from 1 January 2010, with an update search before final synthesis. Eligible evidence will include randomised and non-randomised comparative studies, observational cohorts, case series, qualitative studies and mixed-methods studies involving pregnant women with Type 1 diabetes using commercial AID systems, including off-label pregnancy use. Two reviewers will independently screen, extract and appraise studies and inter-rater agreement will be reported. Randomised and non-randomised comparative evidence will be synthesised separately and, where studies are sufficiently comparable, meta-analysed within study-design and comparator strata. Quantitative outcomes will include pregnancy-specific time in range, other continuous glucose monitoring (CGM) metrics, maternal and neonatal outcomes, diabetes-specific adverse events, psychosocial measures, cost, resource use, feasibility, implementation and early postpartum outcomes. Qualitative evidence will be synthesised thematically and integrated with quantitative findings using a convergent segregated approach. DISCUSSION:The review will clarify what is known about commercial AID use in Type 1 diabetes pregnancy and identify patient-, device-, clinician- and service-level factors relevant to implementation. TRIAL REGISTRATION:This systematic review protocol is registered with PROSPERO: CRD420251025194.

BACKGROUND:Polycystic ovary syndrome (PCOS) affects women globally, but its prevalence across World Health Organization (WHO) regions has not previously been reported. OBJECTIVE AND RATIONALE:We aimed to synthesize evidence on the prevalence of PCOS by diagnostic criteria and by WHO geographic regions to inform the International Evidence-Based PCOS Guideline. SEARCH METHODS:A systematic search of OVID MEDLINE, All EBM, PsycInfo, EMBASE, and Cumulative Index to Nursing and Allied Health Literature was conducted from 1990 to November 2024. Studies assessing PCOS prevalence in an unselected population were included. Non-primary studies or those with unclear diagnostic criteria were excluded. The primary outcome was PCOS prevalence among adult women. The secondary outcome was PCOS prevalence among women of all ages. Random effects meta-analysis using the DerSimonian and Laird method was applied for estimating the overall effect size. Two reviewers independently assessed risk-of-bias (RoB) and evidence certainty. OUTCOMES:The search yielded 16 664 articles, of which 119 unique studies (in 137 articles) were eligible, and 92 (including 157 181 participants) were pooled in a meta-analysis. By diagnostic criteria, PCOS global prevalence among adult women only was 12.1% (95% CI: 9.8, 14.8; I2: 98.8%) using Rotterdam criteria, 7.9% (95% CI: 6.2, 9.9; I2: 96.2%) using the original National Institute of Health (NIH) criteria, 12.7% (95% CI: 8.2, 17.9; I2: 98.0%) using the Androgen Excess (AE)-PCOS criteria, and 7.8% (95% CI: 5.8, 10.0; I2: 99.4%) by self-report. By WHO regions, PCOS prevalence among adult women when using Rotterdam criteria was highest in the Eastern Mediterranean region (15.1%; 95% CI: 11.1, 19.7) and the South-East Asian region (14.3%; 95% CI: 5.8, 25.9), followed by the European region (11.7%; 95% CI: 5.1, 20.3), the region of the Americas (10.5%; 95% CI: 3.0, 21.7), and the Western Pacific region (9.1%; 95% CI: 6.2, 12.5), with no data from Africa. Subgroup analysis using Cochran's Q test indicated a statistically significant difference in prevalence by WHO region (P = 0.022). Subgroup analyses including adolescents yielded a lower prevalence globally, with a global prevalence of 11.4% (95% CI: 9.5, 13.5) by Rotterdam criteria, 7.1% (95% CI: 5.7, 8.7) by NIH criteria, 11.2% (95% CI: 7.4, 15.5) by AE-PCOS criteria, and 7.6% (95% CI: 5.8, 9.6) on self-report. Of the 119 studies, 30 had low, 49 had moderate, and 40 had high RoB. Certainty of evidence ranged from very low to low. WIDER IMPLICATIONS:This is the most comprehensive and contemporary review of PCOS prevalence and highlights past inconsistencies in diagnostic criteria and individual diagnostic features. Pooled PCOS prevalence was 12.1% by the Rotterdam criteria and was highest in the Eastern Mediterranean and the South-East Asian regions, with a potentially different health burden of PCOS across world regions. These findings directly inform International PCOS Guidelines, including updated guideline diagnostic criteria and refined individual features, emphasizing early, accurate diagnosis. REGISTRATION NUMBER:PROSPERO CRD42022372029.

Affecting hundreds of millions of women worldwide, polyendocrine metabolic ovarian syndrome (PMOS, formerly polycystic ovary syndrome) carries a significantly higher risk of cardiovascular and metabolic diseases. Here we discuss how renaming this disease reframes a profoundly misunderstood condition for which basic metabolic research remains critically underfunded and fragmented.

Background:Gestational diabetes mellitus (GDM) is increasingly common, with short- and long-term health risks. Building on the GooD4Mum pilot, which demonstrated quality improvements in general practice for care after GDM, this project implemented and evaluated a primary care Quality Improvement Collaborative (QIC) program to optimize identification, recall, screening, and referral of patients after GDM. Objective:This study aimed to assess the effectiveness of QIC activities relative to usual practice for improving general practice clinicians' provision of follow-up and screening of patients with a history of GDM to ultimately support the onset of type 2 diabetes. Methods:A 21-month, prospective non-randomized controlled trial (at practice level) was conducted, matching intervention practices 1:1 with controls. The QIC intervention is compared with care-as-usual in general practice to review implementation, effectiveness, and economic outcomes. For 18 months, the intervention practices engaged with the GooD4Mum QIC program, including education, training, resources, and Plan-Do-Study-Act (PDSA) cycles to implement locally relevant improvement activities. A clinical decision support system aided in the identification, screening, and tracking of patients with a history of GDM. Control practices provided care as usual. Primary outcomes are practice-level proportions of women with recorded type 2 diabetes screening, modifiable cardiometabolic risk factors, and referral to a diabetes prevention program. Secondary outcomes examine changes in care processes, adherence to clinical standards, and fidelity of intervention delivery. Outcome analyses use clinical data derived from practices via automated extraction. Baseline comparisons use t tests or chi-square tests. Primary and secondary outcomes are analyzed by repeated-measures ANOVA and/or cluster-adjusted generalized estimating equations, accounting for practice-level clustering, and sensitivity analyses include a per-protocol approach. Implementation outcomes are assessed through longitudinal qualitative interviews with practice leads, support staff, and stakeholders, guided by the CFIR (Consolidated Framework for Implementation Research) and the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework. Cost consequence analysis uses clinical activity and practice-reported data. Results:The program ran in 9 general practices between April 2024 and September 2025, with data collection until December 2025. Practice characteristics and protocol deviation are summarized. Detailed outcome, cost consequence, and implementation process evaluations will be reported elsewhere. Conclusions:The protocol offers a novel quality improvement approach enhanced by clinical decision support and automated data extraction to optimize identification, screening, and provision of lifestyle advice toward reducing type 2 diabetes after GDM. The evaluation is designed to generate actionable insights and a scalable implementation toolkit to improve care after gestational diabetes.

BackgroundPolycystic ovary syndrome (PCOS) significantly impairs physical and mental health, quality of life, and fertility in women of reproductive age. Strategies to enhance fertility in PCOS have been prioritised in International Guidelines. Whilst Guidelines recommend Letrozole in first line ovulation induction (OI), therapeutic interventions to optimise endocrine and metabolic PCOS features prior to OI have not been adequately researched despite potential to improve live birth and pregnancy outcomes. Whilst both a calorie-restricted (CR) diet and metformin interventions may offer benefits in the context, evidence is limited including for live birth rates, and pregnancy outcomes. Therefore, this study will aim aims to compare the effects of a CR diet versus metformin on live birth, endocrine, reproductive, and metabolic parameters as well as pregnancy outcomes in women with PCOS and overweight/obesity.MethodThis multicenter, randomized (1:1) comparative effectiveness trial will evaluate and compare the effects of a CR diet versus metformin, administered for 12 weeks prior to OI, on live birth, endocrine, metabolic, reproductive, and pregnancy outcomes in women with PCOS and overweight/obesity. The primary analysis will follow the intention-to-treat principle, including all participants who underwent randomization.DiscussionThis trial investigates the comparative efficacy of a CR diet versus metformin over a 12-week period prior to OI therapy in women with PCOS and overweight/obesity. Early therapeutic intervention holds significant potential to disrupt the pathophysiological cycle characterized by hyperandrogenism, excessive adiposity, and insulin resistance for improving fertility and pregnancy outcomes.Clinical trial registrationClinicalTrials.gov, identifier NCT06049186.

Background/Objectives: Risk perception of future disease may play a role in supporting lifestyle change to prevent diabetes mellitus (DM) and cardiovascular disease (CVD). It is unknown how women in the postpartum period with different cardiometabolic conditions perceive their future risk of DM and CVD, and whether this perception influences engagement in a healthy lifestyle. Methods: Cross-sectional study of women who delivered in the past five years (n = 497) living in Australia. Logistic regression analyses examined associations between history of pregnancy (gestational diabetes mellitus (GDM), gestational hypertension (GHP), pre-eclampsia, spontaneous preterm birth (PTB), small-for-gestational-age (SGA) infants), and non-pregnancy (polycystic ovary syndrome (PCOS), infertility) conditions with perceived risk of DM or CVD, and with lifestyle behaviours (physical activity, sedentary behaviour, and diet). Results: Overall, most participants had a low perceived risk of developing future DM (73.4%) and CVD (75.2%), which varied by condition type. History of GDM and GHP were associated with higher DM risk perception (OR 1.83, 95% CI 1.06, 3.15; OR 2.73, 95% CI 1.28, 5.84), whereas history of pre-eclampsia and DM were associated with higher CVD risk perception (OR 4.48, 95% CI 1.88, 10.62; OR 3.78, 95% CI 1.20, 11.88). History of PTB, SGA infant, PCOS, infertility, and lifestyle behaviours were not consistently associated with perceived risk of DM and CVD. Conclusions: Postpartum risk perception of developing future DM and CVD was low, even in the presence of female-specific cardiometabolic conditions. This highlights the need for greater postpartum support to enhance risk awareness and support a healthy lifestyle.

The recent global consensus to rename polycystic ovary syndrome (PCOS) as polyendocrine metabolic ovarian syndrome (PMOS) accurately reframes the condition as a lifelong, multisystemic disorder rather than a localized ovarian pathology. This transition underscores the central role of metabolic dysfunction, specifically the high prevalence of insulin resistance and hyperinsulinaemia, and has important consequences for basic and clinical research.

Background:Physical inactivity and suboptimal diet in pregnancy are important modifiable risk factors for gestational diabetes, a major contributor to pregnancy complications. Objectives:We aimed to assess the effects of physical activity and/or diet-based lifestyle interventions during pregnancy on gestational diabetes and if these vary by maternal (body mass index, age, parity, ethnicity, education) and intervention characteristics using individual participant data meta-analysis of randomised trials, and a cost-effectiveness analysis. Data sources:International Weight Management in Pregnancy Collaborative Network database was updated by searching major databases from February 2017 to March 2022. Review methods:The main outcomes were gestational diabetes by any criteria and by the National Institute for Health and Care Excellence. Other outcomes were gestational diabetes as per International Association of Diabetes in Pregnancy Study Group and maternal and perinatal outcomes. We performed a two-stage random-effects individual participant data meta-analysis to obtain summary estimates (odds ratio) with 95% confidence intervals. Study quality of included trials was assessed, and heterogeneity summarised using τ2. Where possible, we added the aggregate data from non-individual participant data trials to the meta-analysis. We ranked interventions by effectiveness using network meta-analysis and undertook model-based economic evaluation to assess cost-effectiveness. The cost-effectiveness analysis took an NHS cost perspective compared an overall lifestyle intervention versus usual care with a time horizon covering the beginning of pregnancy until the discharge of the mother and infant from the hospital following delivery. Results:Ninety-two trials (32,284 women) were included; 54 (23,698 women) provided individual participant data. Lifestyle interventions reduced the odds of gestational diabetes (any criteria) by 10% in individual participant data trials (odds ratio 0.90, 95% confidence interval 0.80 to 1.02, 54 studies, 23,361 women), and the findings reached statistical significance when non-individual participant data were included (odds ratio 0.81, 95% confidence interval 0.73 to 0.89, 92 studies, 31,947 women). Physical activity significantly reduced the odds of gestational diabetes by 36% (odds ratio 0.64; 95% confidence interval 0.48 to 0.84), and diet by 19% (odds ratio 0.81; 0.69 to 0.96), but not mixed interventions. Women with middle (odds ratio 0.68, 95% confidence interval 0.51 to 0.90) and high educational level (odds ratio 0.71, 95% confidence interval 0.54 to 0.93) benefited more than those with low educational status, and no differences by maternal body mass index, age, parity or ethnicity. There was no significant reduction in gestational diabetes defined by National Institute for Health and Care Excellence criteria (odds ratio 0.98, 95% confidence interval 0.84 to 1.13) in individual participant data trials. For gestational diabetes defined using International Association of Diabetes in Pregnancy Study Group criteria, interventions reduced gestational diabetes by 14% (odds ratio 0.86, 95% confidence interval 0.75 to 0.97, τ2 = 0.00, 16 studies, 6174 women) in individual participant data trials and by 17% (odds ratio 0.83, 95% confidence interval 0.72 to 0.95, τ2 = 0.01, 25 studies, 7883 women) when non-individual participant data trials were added. Overall, physical activity reduced caesarean section (odds ratio 0.83; 0.72 to 0.96), small-for-gestational age (odds ratio 0.72; 0.56 to 0.92) and large-for-gestational age babies (odds ratio 0.81; 0.71 to 0.94); diet-based interventions reduced any preterm birth (odds ratio 0.37; 0.20 to 0.68) compared to controls. No differences were observed for other outcomes. Lifestyle interventions were on average more expensive and more effective at averted gestational diabetes and major outcome averted compared to usual care. Limitations:We could not identify the specific intervention components and delivery methods associated with improved outcomes, due to variations in reporting. Conclusion:Lifestyle interventions in pregnancy prevent gestational diabetes, and the effects vary according to the definition of gestational diabetes. Physical activity-based interventions may be the most effective. Future work:Lifestyle interventions should be implemented and evaluated in routine clinical practice to prevent gestational diabetes, with additional support for women with low socioeconomic status. Study registration:This study is registered as PROSPERO CRD42020212884. www.crd.york.ac.uk/PROSPERO/view/CRD42020212884. Funding:This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR129715) and is published in full in Health Technology Assessment; Vol. 30, No. 39. See the NIHR Funding and Awards website for further award information.

Polycystic ovary syndrome (PCOS) is the most common reproductive endocrine disorder impacting the health of young female populations. Using harmonized estimates from 953 locations, we assessed temporal trends, geographic inequalities, and forecasts of PCOS among individuals aged 10-24 years from 1990 to 2040. Between 1990 and 2021, global prevalence and disability burden increased by more than 30%, with the highest burden observed among those aged 20-24 years. Substantial geographic heterogeneity was identified, with particularly high prevalence in Europe and East Asia. While high-income regions carried the greatest absolute burden, low-and middle-income regions showed the fastest growth, accompanied by widening socio-economic inequalities. Forecasting analyses suggest that PCOS burden in young populations will continue to rise through 2040. These findings characterize the evolving global landscape of PCOS, providing evidence to support targeted public health surveillance and prevention strategies for adolescent and young adult populations.

Objectives Antenatal lifestyle interventions are effective in reducing negative outcomes associated with excess gestational weight gain. While strong cost-effectiveness has also been demonstrated, the cost of implementation is potentially a barrier to uptake. We aimed to estimate whether targeted implementation in high risk clinical groups (categorized by age, body mass index (BMI) and gravidity) returns greater health cost savings through a reduction in aggregate incidence of adverse pregnancy and birth outcomes. Study design Distributional budget impact analysis utilising population level linked data collections. Methods Total budget expenditure (cost of intervention minus cost savings from the associated reduction in adverse pregnancy outcomes) of implementing the lifestyle intervention in risk targeted population sub-groups was estimated, stratified by health system (public vs. private funding). Results Total annual budget expenditure if the intervention is routinely provided to 80 % of pregnant women in New South Wales and Queensland, Australia, is projected to be AU$11,654,857 for n = 94,539 public patients, and AU$6,527,434 for n = 33,516 private patients. If implemented in the BMI ≥30 kg/m2 group only, expenditure is reduced to AU$643,339 for n = 10,298 public patients, and AU$579,003 for n = 5018 private patients, while for implementation in the Age ≥35 years group, it was AU$1,290,965 (n = 21,071 public) and AU$2,169,851 (n = 12,776 private). The number of adverse pregnancy outcomes averted per women was greatest in the BMI ≥30 kg/m2 group. Conclusions Women in the highest BMI category should be prioritised for implementation of effective and cost-effective antenatal lifestyle intervention to reduce the aggregate budgetary impact of adverse pregnancy outcomes.

Abstract Women who develop cardiometabolic pregnancy complications including gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy (HDP), fetal growth restriction (FGR) and preterm birth (PTB) are at increased risk of type 2 diabetes and cardiovascular disease. This scoping review explores the extent, range and nature of qualitative research investigating experiences of women at-risk of or diagnosed with cardiometabolic pregnancy complications. Original research (n = 623) and review (n = 66) articles with qualitative data from women, partners, healthcare professionals and community and professional stakeholders were included. Studies involving women with GDM (n = 342, 49.6%), HDP (n = 163, 23.7%) and FGR (n = 17, 2.5%) primarily explored lifestyle, medical or pharmacotherapy interventions during pregnancy, whereas studies regarding PTB (n = 198, 28.7%) primarily explored psychosocial health postpartum. Risk of future diabetes or cardiovascular disease were prevalent concepts in GDM and HDP literature. Extensive qualitative research exists relating to maternal cardiometabolic health. Understanding women’s experiences may guide cardiovascular disease prevention and screening initiatives.

OBJECTIVES:To assess the effects of lifestyle interventions on gestational diabetes, determine whether the effects vary by maternal body mass index, age, parity, ethnicity, education level, or intervention, and rank interventions by effectiveness. DESIGN:Individual participant data (IPD) and network meta-analysis. DATA SOURCES:Major electronic databases (January 1990 to April 2025). METHODS:This meta-analysis included randomised trials on the effects of lifestyle interventions (physical activity based, diet based, or mixed) in pregnancy on gestational diabetes. Main outcomes were gestational diabetes defined by any criteria and by UK NICE (National Institute for Health and Care Excellence) criteria; other outcomes included IADPSG (International Association of Diabetes in Pregnancy Study Group) and modified IADPSG defined gestational diabetes. A two stage IPD meta-analysis estimated summary odds ratios and 95% confidence intervals and interactions (subgroup effects), along with absolute risk reduction estimates. Aggregate data from non-IPD trials were added to the meta-analysis when possible. Intervention effects were ranked using network meta-analysis. RESULTS:104 randomised trials (35 993 women) were included, with IPD for 68% of participants (24 391 women; 54 studies). Lifestyle interventions reduced gestational diabetes defined by any criteria by 10% in IPD trials (odds ratio 0.90, 95% confidence interval (CI) 0.80 to 1.02; absolute risk reduction 1.3%, 95% CI -0.3% to 2.6%), and by 20% when combining IPD and non-IPD trials (odds ratio 0.80, 95% CI 0.73 to 0.88; absolute risk reduction 2.6%, 95% CI 1.6% to 3.6%), and no reduction was observed using NICE criteria (odds ratio 0.98, 95% CI 0.84to 1.13). Lifestyle interventions reduced gestational diabetes defined using IADPSG criteria by 14% in IPD trials (odds ratio 0.86, 95% CI 0.75 to 0.97; absolute risk reduction 2.7%, 95% CI 0.6% to 5.0%) and by 18% when combining IPD and non-IPD trials (odds ratio 0.82, 95% CI 0.72 to 0.93; absolute risk reduction 3.5%, 95% CI 1.3% to 5.7%). Effects did not vary by maternal characteristics, except for education. Although women of all educational levels benefited from the intervention, the benefit was less in those with low education (low v middle interaction: odds ratio 0.68, 95% CI 0.51 to 0.90; low v high interaction: odds ratio 0.71, 95% CI 0.54 to 0.93). Benefits did not vary by intervention characteristics, except for greater effectiveness with group format (odds ratio 0.81, 95% CI 0.68 to 0.97; absolute risk reduction 2.5%, 95% CI 0.4% to 4.3%) and newly trained facilitators (odds ratio 0.82, 95% CI 0.69 to 0.96; absolute risk reduction 2.4%, 95% CI 0.5% to 4.2%). Physical activity based interventions ranked highest (mean rank 1.1, 95% CI 1 to 2) in preventing gestational diabetes. CONCLUSIONS:Lifestyle interventions in pregnancy are likely to prevent gestational diabetes, with effects varying according to diagnostic criteria. Implementation strategies should address inequalities by maternal education, and consider group formats, provider training, and physical activity based interventions to prevent gestational diabetes. STUDY REGISTRATION:PROSPERO CRD42020212884.

This cross-sectional study examines ovarian morphology regarding polycystic ovary syndrome.

Metformin is widely prescribed for the management of type 2 diabetes mellitus, polycystic ovary syndrome, and gestational diabetes mellitus in pregnancy. Its use is driven by factors including oral administration, lower patient and health system burden and cost, and benefits including lower risk of excess gestational weight gain and hypoglycemia compared with insulin. Metformin use appears safe in pregnancy; however, there remain concerns regarding long-term effects of intrauterine metformin exposure on offspring health. Randomized controlled trial follow-up studies suggest that metformin-exposed offspring may have altered postnatal growth trajectories and increased adiposity in childhood, although data are limited. Whether this is a transient adaptation or a precursor to long-term metabolic dysfunction is unclear, as data on cardiometabolic and neurodevelopmental parameters, including glucose homeostasis, lipid metabolism, and cognitive function, are sparse and inconsistent. Methodological challenges include heterogeneous study designs, high attrition rates, and inadequate control for confounding variables. Given these uncertainties, further well-powered, long-term prospective studies and individual patient data meta-analyses, harmonizing data and adjusting for confounders, are needed to clarify risks and benefits of metformin use in pregnancy. Until such data are available, clinicians must weigh the benefits and advantages of metformin use in pregnancy against the unknowns regarding potential long-term impact on offspring health. PLAIN LANGUAGE SUMMARY: Metformin is a medicine often used during pregnancy to help manage conditions such as type 2 diabetes, gestational diabetes, and polycystic ovary syndrome (PCOS). It is commonly chosen because it is taken as a tablet rather than by injection, has a lower risk of causing low blood sugar, and is generally easier and less expensive to use than insulin. Research has shown that metformin is safe for use during pregnancy in the short term. However, there are still questions about whether it has any lasting effects on children who were exposed to it before birth. This review explores this topic in detail. Some studies have found that children exposed to metformin during pregnancy may have slightly different growth patterns, such as having more body fat or being heavier in early childhood. However, these results are inconsistent and most studies show no clear differences in overall health outcomes, including in heart health, metabolism, or brain development. The results are mixed, and many studies are small or have design limitations, which makes it difficult to draw strong conclusions. At this stage, there is no clear evidence that metformin causes harm to children in the long term. However, because some studies suggest there may be effects on childhood growth and development, researchers emphasize the need for further long-term research. These future studies should follow children into adolescence and adulthood to better understand any lasting impacts. Until more is known, doctors and patients will need to carefully consider the known benefits of metformin in pregnancy alongside the current uncertainties about long-term effects on child health.

Cardiometabolic pregnancy complications (gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy (HDP), intrauterine growth restriction (IUGR), preterm birth (PTB)) present a unique sex-specific risk factor for future cardiometabolic disease (1–5) . Lifestyle modifications and healthful behaviour change (diet and physical activity), which can be supported by the delivery of evidence-based lifestyle interventions, are important factors in modifying risks of cardiometabolic conditions (2,6,7) . Pregnancy and postpartum present unique windows of opportunity to intervene and prevent or delay the onset of cardiometabolic pregnancy complications and future cardiometabolic disease (2,8) . Co-design considers the end-users wants, needs, preferences, characteristics and abilities throughout the entirety of the design process (9,10) . Co-design processes engage women with lived experience alongside other key stakeholders including; community organisations, healthcare professionals, primary healthcare and health promotion experts 14 . In line with patient-centred care it offers the opportunity to design lifestyle interventions that are adapted to suit end-users, in the hope of increasing uptake, engagement, implementation success and sustainability (11) . This study aims to co-design and explore stakeholders’ perspectives of the acceptability and feasibility of a lifestyle and screening intervention to reduce cardiometabolic risk amongst women at risk of or diagnosed with a cardiometabolic pregnancy complication. A descriptive qualitative research design was utilised. Two 2-hour co-design group workshops and a series of one-on-one semi-structured interviews were conducted with women with prior GDM, HDP, IUGR and/or PTB (n = 11), and research partners (obstetricians, endocrinologists, community health representatives, researchers, midwives, general practitioners, dietitians) (n = 14). Participants were provided with an overview of a potential lifestyle intervention, discussed the acceptability of each intervention component (outlined by the TIDieR framework; brief name, why, what, who provided, how, where, when and how much, tailoring, modifications, how well (12) ), and the feasibility of implementation (outlined by the Theoretical Framework of Acceptability (13) and the APEASE criteria for intervention design (14) ). Workshops and interviews were audio recorded, transcribed and analysed using template analysis. Analysis highlighted 10 key themes. Participants recommended the intervention is holistic, user-friendly, empowering, empathetic, patient-centred and culturally sensitive. Participants highlighted the importance of good risk communication, focusing on a positive, healthy pregnancy as opposed to risk reduction. Participants recommended providing additional resources and access to health services to complement intervention content. Participants suggested the intervention be delivered by female healthcare professionals from a range of cultural backgrounds with expertise in cardiometabolic pregnancy complications and postpartum management. Participants discussed the importance and value of the proposed intervention in filling what was perceived as a current healthcare gap for women at risk and diagnosed with cardiometabolic conditions during and following pregnancy. Engaging stakeholders to co-design an intervention that aligns with women’s and the healthcare system’s preferences, needs and priorities will support the development of an acceptable intervention for implementation in a real-world setting.

Objectives This study aimed to follow best practice by temporally evaluating existing gestational diabetes mellitus (GDM) prediction models, updating them where needed, and comparing the temporal evaluation performance of the machine learning (ML)-based models with that of regression-based models. Study Design and Setting We utilized new data for the temporal validation dataset with 12,722 singleton pregnancies at the Monash Health Network from 2021 to 2022. The Monash GDM Logistic Regression (LR) model with six categorical variables (version 2) and the Monash GDM ML model (version 3), along with an extended LR GDM model (version 3), each with eight categorical and continuous variables, were evaluated. Model performance was assessed using discrimination and calibration. Decision curve analyses (DCA) were performed to determine the net benefit of models. Recalibration was considered to improve model performance. Results The development datasets for model versions 2, 3, and the new temporal validation dataset included 21.2%, 22.5%, and 33.5% of pregnant women aged ≥35 years, respectively; 22%, 23.7%, and 24.0% with a body mass index ≥30 kg/m2; and GDM prevalence rates of 18%, 21.3%, and 28.6%, respectively. There was similar discrimination performance across the models, with area under the receiver operating characteristic curve (AUC) of 0.72 [95% CI: 0.71, 0.73], 0.73 [95% CI: 0.72, 0.74], and 0.73 [95% CI: 0.73, 0.74] for version 2 and version 3 ML and LR models, respectively. All models exhibited overestimation with calibration slopes of 0.87, 0.99, and 0.87, respectively, which improved with recalibration. DCA showed that all models had better net benefits as compared to treat all and treat none. For all models, some variability has been observed in prediction performance across ethnic groups and parity. Conclusion Despite significant changes in the background characteristics of the population, we have demonstrated that all models remained robust, especially after recalibration. However, the performance of the original ML model decreased significantly during validation. Dynamic models are better suited to adapt to the temporal changes in baseline characteristics of pregnant women and the resulting calibration drift, as they can incorporate new data without requiring manual evaluation.