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Objective: To determine whether screening for gestational diabetes mellitus (GDM) in the third trimester and managing those who are screen positive on a diabetes pathway affects obstetric and neonatal outcomes. Design: Retrospective study of prospectively collected data. Setting: London Teaching Hospital. Population or sample: A total of 14 366 women delivering between 1 January 2018 and 31 December 2020. Methods: Retrospective chart analysis. Main outcome measures: Diagnosis of late‐onset GDM, obstetric and neonatal outcomes. Results: Five hundred and thirty‐one women were tested by home glucose monitoring for late‐onset GDM from 33 weeks of gestation. In all, 244 were diagnosed as having GDM (group 1) and managed accordingly, and 287 (group 2) were returned to normal care. A total of 1415 women had GDM diagnosed by oral glucose tolerance test before 33 weeks of gestation (group 3). Of the women in group 2, 49.5% had a spontaneous onset of labour compared with only 25.8% and 27% in groups 1 and 3. However, women in group 2 were significantly more likely to have a macrosomic baby (≥4000 g, 25.4%) than groups 1 (16.0%) or 3 (7.2%), and their babies were more likely to be admitted to special care (5.2% versus 2% in group 1). Macrosomic babies were associated with significantly higher rates of shoulder dystocia, third‐ and fourth‐degree tears and postpartum haemorrhage. Conclusions: Apparent late‐onset GDM affects a significant proportion of women, and targeted intervention was associated with better obstetric and neonatal outcomes. These results suggest that all pregnancies with risk factors for late‐onset GDM might benefit from active GDM management irrespective of specific glucose thresholds. Women with risk factors for GDM in the third trimester, and their babies, would probably benefit from active management of their blood sugars irrespective of threshold values. Women with risk factors for GDM in the third trimester, and their babies, would probably benefit from active management of their blood sugars irrespective of threshold values. Linked article: This article is commented on by Jane Hirst, pp. 2184 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471-0528.17184 [ABSTRACT FROM AUTHOR]

Objective: Failure of fetal growth during pregnancy, and preterm birth, are the major causes of stillbirth and early neonatal death. The objective of the study was to determine the association between maternal hemoglobin concentration during pregnancy and perinatal mortality. Study design: The design was prospective, using data on-222,614 first singleton pregnancies in the St Mary's Maternity Information System database in the Northwest Thames region of London. Results: The association of perinatal mortality with maternal hemoglobin at first antenatal check was not statistically significant (P > .10), but a statistically significant (P < .001) U-shaped pattern was found with lowest recorded maternal hemoglobin concentration. Both early neonatal mortality and stillbirth rates were statistically significantly (P < .005) associated with lowest maternal hemoglobin concentration. The relationship of lowest hemoglobin with early neonatal mortality was largely mediated by the effect of preterm birth, and that between lowest hemoglobin and stillbirth by fetal growth restriction. The lowest perinatal mortality was associated with a lowest recorded maternal hemoglobin concentration of between 9–11 g/dL. Conclusion: There is an optimal range of lowest hemoglobin concentration in pregnancy, and on either side of this perinatal mortality is increased. The effect of lowest hemoglobin is largely mediated through associations with preterm birth and fetal growth restriction. [ABSTRACT FROM AUTHOR]