Objective To determine whether home cervical ripening is associated with acceptable safety margins compared to in-hospital cervical ripening during induction of labour. Design A prospective multicentre observational cohort study using routinely collected data. Setting Twenty-six UK maternity units; 18 offering only in-hospital cervical ripening and 8 offering both in-hospital and home cervical ripening. Population Women with singleton pregnancies, no previous caesarean section, at or beyond 37 weeks gestation having induction with details of cervical ripening method and location recorded. Methods Home cervical ripening using a balloon catheter was compared to in-hospital cervical ripening using prostaglandin. Multivariable logistic regression was performed for the primary outcome. Exposure: Cervical ripening at home using balloon catheter. Main outcome measures Primary outcome: neonatal unit admission within 48 hours of birth for 48 hours or more. Additional neonatal, maternal, labour progress and process outcomes were reported. Results Of 17,530 eligible women, 515 had balloon cervical ripening at home and 4332 had prostaglandin cervical ripening in a hospital that did not offer home cervical ripening. The primary outcome following home cervical ripening with balloon was not higher {16/515 (3.1%) vs 208/4332 (4.8%)}, but with substantial uncertainty on adjusted analysis consistent with a 64% lower risk through to an 81% higher risk. Conclusions Home cervical ripening using balloon catheter may be as safe for babies as using prostaglandin in hospital in low and moderate-risk groups, but further safety data are required.

Objective To investigate if increased length and intensity of breastfeeding mediates gestational diabetes mellitus (GDM) risk in a subsequent pregnancy. Design Multisite cohort study. Setting Western Sydney, Australia, March 2017–April 2019. Population Women with a second subsequent pregnancy after a GDM-affected first pregnancy. Methods Information on breastfeeding experience, intensity and GDM management in the first pregnancy was collected by questionnaire. The results of the oral glucose tolerance test (OGTT) in the second pregnancy were also recorded. Multivariable models for OGTT and for diagnosis of GDM were fitted and then adjusted for medical treatment of GDM in the first pregnancy, BMI, age at current pregnancy and ethnicity. Main outcome measures Second pregnancy oral glucose tolerance test (OGTT) blood glucose results and diagnosis of GDM. Results We recruited 227 women with 210 eligible for analysis. Of these women, 146 (70%) were diagnosed with recurrent GDM. We found a 19% reduction in the risk of GDM in a subsequent pregnancy if a woman breastfed for more than six months (RR 0.81, 95% CI 0.68–0.96) after adjusting for both age and BMI. In a fully adjusted model, the association was attenuated (RR 0.89, 95% CI 0.78–1.02). With the same adjusted confounders, however, both high intensity breastfeeding (2 h OGTT, P = 0.01) and breastfeeding for greater than six months (1 h OGTT, P = 0.01) were associated with a mean blood glucose decrease of 0.7mmol/L. Conclusion We found the risk of recurrent GDM was reduced by both increased duration and intensity of breastfeeding.