The Gray Journal
Audio Summaries

How Long Should Women Push? The Effect of Fetal Position, Parity, and Epidural Use on Spontaneous Delivery

May 10, 2026

This study aimed to estimate the probability of spontaneous delivery during the pushing phase of labor, considering factors such as fetal position, parity, and epidural use. The findings indicate that the likelihood of spontaneous delivery varies significantly based on these factors, with specific time limits for effective pushing that should be tailored to individual circumstances. The results suggest that pushing beyond certain time thresholds may not yield substantial benefits and could be associated with increased adverse outcomes.

The effect of metformin on perinatal outcomes in pregnant women with type 2 diabetes differs by baseline insulin requirements

May 9, 2026

The authors aimed to investigate whether baseline insulin requirements influence the effects of metformin on perinatal outcomes in pregnant women with type 2 diabetes. Their analysis of the MOMPOD trial revealed that metformin significantly reduced the risk of adverse neonatal outcomes in participants with low insulin requirements (<30 units), while also mitigating increases in insulin needs for those with higher requirements (>60 units). These findings suggest that the efficacy of metformin in this population may vary based on individual insulin needs, warranting further research to explore the underlying mechanisms.

Maternal cytomegalovirus infection in the first trimester of pregnancy: timing, fetal brain injury, and long-term neurodevelopmental outcomes including autism spectrum disorder

May 7, 2026

The authors aimed to investigate the association between maternal cytomegalovirus (CMV) infection during pregnancy, particularly in the first trimester, and long-term neurodevelopmental outcomes, including autism spectrum disorder (ASD). Their findings indicate that adverse outcomes, such as hearing loss and neurodevelopmental impairments, were exclusively linked to first-trimester maternal infections, with ASD diagnosed only in children exposed during this period, all of whom exhibited temporal lobe white matter abnormalities. This research highlights a critical window of fetal vulnerability to CMV-related brain injury and suggests the potential for neuroimaging to aid in risk assessment and counseling.

Association between hematologic response to iron therapy and risk of stillbirth in pregnant singletons with moderate iron deficiency anemia

May 2, 2026

The authors aimed to investigate the association between the hematologic response to iron therapy and the risk of stillbirth and other adverse perinatal outcomes in pregnant women with moderate iron deficiency anemia. Their analysis of data from a multicenter trial found that inadequate improvement in hemoglobin levels at 20-24 weeks gestation was linked to an increased risk of stillbirth and early preterm birth, suggesting the importance of early screening and treatment for maternal anemia to prevent adverse outcomes.

Neonatal and Obstetric Outcomes Following Periconceptional Exposure to Glucagon-Like Peptide-1 Receptor Agonists: A Systematic Review and Meta-analysis

Apr 30, 2026

The authors aimed to evaluate the impact of periconceptional exposure to glucagon-like peptide-1 receptor agonists on neonatal and obstetric outcomes. Their systematic review and meta-analysis of 22 studies found no significant associations with major adverse outcomes, although a small association with renal malformations was noted, likely influenced by confounding factors. The findings suggest that while there is no consistent evidence of harm, caution is warranted regarding the use of these medications during pregnancy, and further research is needed.

The role of misclassification in progression of CIN2 during active surveillance: results from a historical cohort

Apr 30, 2026

The study investigates the impact of misclassification of cervical intraepithelial neoplasia grade 2 (CIN2) diagnoses on the progression to CIN3 or worse during active surveillance in younger women. By reviewing histological diagnoses of cervical biopsies from a historical cohort, the authors found significant interobserver variability, with nearly half of the CIN2 cases being reclassified, highlighting the need for more accurate diagnostic methods and individualized management strategies that consider virological and cytological factors.

Late-Onset Diagnosis of Gestational Diabetes After Normal Mid-Pregnancy Screening in Women with Large for Gestational Age or Polyhydramnios: A Systematic Review and Meta-Analysis

Apr 29, 2026

The authors aimed to determine the detection rate of late-onset gestational diabetes mellitus (GDM) in women with normal mid-pregnancy glucose screening who undergo repeat testing due to suspected large-for-gestational-age (LGA) fetuses or polyhydramnios. They found that late OGTT detects GDM in approximately 15% of these women, with significantly higher rates of neonatal hypoglycemia and cesarean deliveries associated with late-onset GDM. These findings highlight the importance of repeat glucose testing in the third trimester for at-risk populations.

Early pregnancy oxylipin markers of inflammation and oxidative stress are associated with small-for-gestational-age birth and specific phenotypes of fetal growth restriction

Apr 26, 2026

The authors aimed to investigate the relationship between early pregnancy oxylipin biomarkers of inflammation and oxidative stress and the occurrence of small-for-gestational-age (SGA) and large-for-gestational-age (LGA) births, as well as specific phenotypes of fetal growth restriction. They found that certain oxylipins, particularly a urinary metabolite of thromboxane-A2, were significantly associated with SGA births and distinct phenotypes of fetal growth restriction, suggesting that these biomarkers could be valuable for early prediction and intervention in cases of fetal growth issues.

EVALUATION OF WEIGHT CHANGE DURING OVARIAN STIMULATION TREATMENT

Apr 26, 2026

The authors aimed to determine the mean weight change experienced by patients undergoing ovarian stimulation treatment and to assess variations in weight change among those diagnosed with ovarian hyperstimulation syndrome and those undergoing multiple cycles. Their retrospective study of over 22,000 stimulation cycles found an average weight gain of 0.64 kg, with higher gains associated with lower initial body mass index and greater oocyte retrieval, although differences related to ovarian hyperstimulation syndrome were not statistically significant. Overall, the study highlights that weight changes during ovarian stimulation are generally modest and temporary.

A randomized controlled trial comparing remote blood pressure monitoring with office-based blood pressure monitoring for women at high risk of preeclampsia

Apr 23, 2026

This study aimed to evaluate whether remote blood pressure monitoring could effectively replace traditional office-based monitoring for pregnant women at high risk of preeclampsia, assessing its impact on maternal and fetal outcomes as well as healthcare utilization. The results indicated that remote monitoring did not increase adverse outcomes and significantly reduced the number of antenatal visits and hospital admissions, while also leading to a higher frequency of antihypertensive prescriptions filled. Overall, the findings suggest that remote monitoring is a viable alternative that can enhance patient convenience without compromising safety.