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ObjectiveTo evaluate 4‐point per day self‐monitoring of blood glucose (SMBG) every 2 weeks compared with every week.MethodsA total of 104 patients with lifestyle‐controlled gestational diabetes (GDMA1) were randomized to 2‐weekly or weekly 4‐point per day (fasting on awakening and 2‐h post‐meals) SMBG. Primary outcome was the change in glycated hemoglobin (HbA1c) level from enrollment to 36 weeks of pregnancy across trial arms. The non‐inferiority margin was an HbA1c increase of 0.2%.ResultsThe mean difference for change in HbA1c from enrollment to 36 weeks was 0.003% (95% confidence interval [CI] –0.098% to +0.093%), within the 0.2% non‐inferiority margin. The change in HbA1c level increased significantly within both trial arms—0.275% ± 0.241% (P < 0.001) in 2‐weekly arm versus 0.277% ± 0.236% (P < 0.001) in the weekly arm. Participants randomized to 2‐weekly SMBG were significantly less likely to receive anti‐glycemic treatment—5/52 (9.6%) versus 14/50 (28.0%) (relative risk 0.34, 95% CI 0.13–0.88; P = 0.017). All secondary outcomes—maternal weight gain, preterm delivery, cesarean delivery, birthweight, and neonatal admission—were not significantly different.ConclusionsIn GDMA1, 2‐weekly is non‐inferior to weekly SMBG on the change in HbA1c level. Two‐weekly SMBG appeared to be adequate for monitoring women with GDMA1.Clinical Trial RegistrationThis study was registered in ISRCTN registry on March 25, 2022 with trial identification number: ISRCTN13404790 (https://doi.org/10.1186/ISRCTN13404790). The first participant was recruited on April 12, 2022.

Caesarean section on maternal request (CSMR) is performed in the absence of a standard medical/obstetrical indication in order to avoid vaginal delivery. Globally, there has been an upsurge in CS delivery, which necessitates the urgency to address maternal and foetal health implications, and long-term repercussions. Conceptually, the chapter aims to explore the determinants of increased CSMR, highlight its potential risks and benefits, and discuss the ethical, medico-legal concerns. Findings indicate that medical, psychological, psychosocial, economical, social and cultural determinants might serve as some of the potential influencing factors owing to this serious healthcare concern. Although CSMR has been linked to certain beneficial outcomes (e.g. reduced urinary incontinence and pelvic organ prolapse, reduced rate of PTSD and depression, and lesser intrapartum complications), it still imposes serious maternal (e.g. post-partum haemorrhage and infection, visceral damage, placenta accrete, placental abruption and complications in future pregnancy) and foetal adverse outcomes (stillbirth, asphyxia, respiratory distress and other pulmonary infections). Hence, future approaches and interventions should be directed towards mitigating clinically unrequired CS procedures due to medical malpractices, lack of awareness in women and the underlying determinants of elective CS.

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