Objective: There are limited, unmatched data reporting low complication rates in pregnant women with coronavirus disease 2019 (COVID‐19). The aim of this study was to compare COVID‐19‐related outcomes between pregnant and non‐pregnant women after adjusting for potential risk factors for severe outcomes. Methods: Data were obtained from the COVID‐19 National Data Registry of Mexico, which is an ongoing prospective cohort of people of any age with clinically suspected severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection and admitted to 475 monitoring hospitals. This study included pregnant and non‐pregnant women of reproductive age (15–45 years) with COVID‐19 confirmed by reverse transcription polymerase chain reaction. To adjust for underlying risk factors, propensity score matching was conducted for chronic obstructive pulmonary disease, asthma, smoking, hypertension, cardiovascular disease, obesity, diabetes, chronic renal disease, immunosuppression, age, language, nationality and level of health insurance. The primary outcome was death. Secondary outcomes were pneumonia, intubation and intensive care unit (ICU) admission. Results: The cohort comprised 5183 pregnant and 175 905 non‐pregnant women with COVID‐19. The crude (unmatched) rates of death, pneumonia, intubation and ICU admission in pregnant compared with non‐pregnant women were 1.5% vs 1.5%, 9.9% vs 6.5%, 8.1% vs 9.9% and 13.0% vs 6.9%, respectively. After propensity score matching (5183 pregnant and 5183 non‐pregnant matched women), pregnant women had a higher odds of death (odds ratio (OR), 1.84; 95% CI, 1.26–2.69), pneumonia (OR, 1.86; 95% CI, 1.60–2.16) and ICU admission (OR, 1.86; 95% CI, 1.41–2.45) than non‐pregnant women, but similar odds of intubation (OR, 0.93; 95% CI, 0.70–1.25). Conclusion: After adjusting for background demographic and medical factors, pregnancy is a risk factor for death, pneumonia and ICU admission in SARS‐CoV‐2‐infected women of reproductive age. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.

Gestational diabetes mellitus (GDM) is one of the most common medical complications of pregnancy and is defined as glucose intolerance that first emerges or is first recognized during pregnancy. Several factors increase the risk of a pregnant woman developing gestational diabetes mellitus, and several interventions have been tested for the prevention of GDM development. The most common pharmacological interventions that have been assessed are metformin administration, probiotics administration, and vitamin D administration. However, no intervention appears to be universally superior to placebo/no intervention for the prevention of GDM. Administration of insulin is the preferred medication for treating hyperglycemia in gestational diabetes mellitus. Metformin and glyburide are not regarded as first-line agents, as both cross the placenta to the fetus. Even though there are sufficient data indicating that administration of metformin is safe and effective in women with GDM, there are very limited data concerning the long-term effects of metformin on the offspring. Furthermore, glyburide should be used with caution, as it increases the risk of neonatal hypoglycemia. Some studies also show that it increases the risk of macrosomia. Overall, oral agents may be a therapeutic option in women with GDM after a discussion of the known risks and the need for more long-term safety data in the offspring. The present review aims to highlight the current scientific status regarding the prevention and treatment of GDM.

Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. National Institute for Health and Care Research.