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Physiotherapy Research International :... Jan 2018Pelvic girdle pain is a common musculoskeletal disorder which affects women during pregnancy and the postpartum period. In previous years, physiotherapists have focused... (Review)
Review
BACKGROUND
Pelvic girdle pain is a common musculoskeletal disorder which affects women during pregnancy and the postpartum period. In previous years, physiotherapists have focused on managing pelvic girdle pain through stabilizing exercises.
PURPOSE
The aim of this study was to systematically review studies investigating the effectiveness of the stabilizing exercises for pelvic girdle pain during pregnancy and the postpartum period.
METHODS
The following electronic databases were utilized to search for eligible studies: MEDLINE, EMBASE, CINAHL, Physiotherapy Evidence Database, and Cochrane Library. Inclusion and exclusion criteria were defined a priori. The quality assessment was performed by the two reviewers independently using the PEDro scale (Physiotherapy Evidence-based Database).
RESULTS
Six studies were identified as eligible with the inclusion and exclusion criteria. All studies evaluated the pain as an outcome measure. The evidence conflicted between the studies. Two studies showed that stabilizing exercises decrease pain and improve the quality of life for pregnant women when they are carried out on a regular basis. There is some limited evidence that stabilizing exercises decrease pain for postpartum women too.
CONCLUSION
In summary, there is limited evidence for the clinician to conclude on the effectiveness of stabilizing exercises in treating pelvic girdle pain during pregnancy and the postpartum periods.
Topics: Exercise Therapy; Female; Humans; Pelvic Girdle Pain; Physical Therapy Modalities; Postpartum Period; Pregnancy; Pregnancy Complications; Quality of Life
PubMed: 29115735
DOI: 10.1002/pri.1699 -
Human Reproduction Update Sep 2019The reproductive impact of adenomyosis and endometriosis is widely researched but the extent of these impacts remains elusive. It has been demonstrated that... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The reproductive impact of adenomyosis and endometriosis is widely researched but the extent of these impacts remains elusive. It has been demonstrated that endometriosis, in particular, is known to result in subfertility but endometriosis and adenomyosis are increasingly linked to late pregnancy complications such as those caused by placental insufficiency. At the molecular level, the presence of ectopic endometrium perturbs the endometrial hormonal, cellular, and immunological milieu, negatively influencing decidualization, placentation, and developmental programming of the embryo. It is unclear if and how such early aberrant reproductive development relates to pregnancy outcomes in endometriosis and adenomyosis.
OBJECTIVE AND RATIONALE
The aims of this systematic review and meta-analysis were to (i) investigate the association of adenomyosis and endometriosis with fertility, obstetric, and neonatal outcomes of women through both assisted reproduction and natural conception and (ii) determine whether endometriosis disease subtypes have specific impacts on different stages of the reproductive process.
SEARCH METHODS
A systematic literature review of NHS evidence electronic databases and the Cochrane database identified all comparative and observational studies between 1980 and December 2018 in any language on adenomyosis and endometriosis with fertility, obstetric, and neonatal outcomes (23 search terms used). A total of 104 papers were selected for data extraction and meta-analysis, with use of Downs and Black standardized checklist to evaluate quality and bias.
OUTCOMES
We found that endometriosis consistently leads to reduced oocyte yield and a reduced fertilization rate (FR), in line with current evidence. Milder forms of endometriosis were most likely to affect the fertilization (FR OR 0.77, CI 0.63-0.93) and earlier implantation processes (implantation rate OR 0.76, CI 0.62-0.93). The more severe disease by American Society for Reproductive Medicine staging (ASRM III and IV) influenced all stages of reproduction. Ovarian endometriosis negatively affects the oocyte yield (MD -1.22, CI -1.96, -0.49) and number of mature oocytes (MD -2.24, CI -3.4, -1.09). We found an increased risk of miscarriage in both adenomyosis and endometriosis (OR 3.40, CI 1.41-8.65 and OR 1.30, CI 1.25-1.35, respectively), and endometriosis can be associated with a range of obstetric and fetal complications including preterm delivery (OR 1.38, CI 1.01-1.89), caesarean section delivery (OR 1.98 CI 1.64-2.38), and neonatal unit admission following delivery (OR 1.29, CI 1.07-1.55).
WIDER IMPLICATIONS
Adenomyosis and the subtypes of endometriosis may have specific complication profiles though further evidence is needed to be able to draw conclusions. Several known pregnancy complications are likely to be associated with these conditions. The complications are possibly caused by dysfunctional uterine changes leading to implantation and placentation issues and therefore could potentially have far-reaching consequences as suggested by Barker's hypothesis. Our findings would suggest that women with these conditions should ideally receive pre-natal counselling and should be considered higher risk in pregnancy and at delivery, until evidence to the contrary is available. In order to expand our knowledge of these conditions and better advise on future management of these patients in reproductive and maternal medicine, a more unified approach to studying fertility and reproductive outcomes with longer term follow-up of the offspring and attention to the subtype of disease is necessary.
Topics: Abortion, Spontaneous; Adenomyosis; Cesarean Section; Embryo Implantation; Endometriosis; Female; Humans; Infant, Newborn; Infertility, Female; Placentation; Pregnancy; Pregnancy Outcome; Pregnancy, Multiple; Premature Birth
PubMed: 31318420
DOI: 10.1093/humupd/dmz012 -
Risks associated with obesity in pregnancy, for the mother and baby: a systematic review of reviews.Obesity Reviews : An Official Journal... Aug 2015Maternal obesity is linked with adverse outcomes for mothers and babies. To get an overview of risks related to obesity in pregnant women, a systematic review of reviews... (Review)
Review
Maternal obesity is linked with adverse outcomes for mothers and babies. To get an overview of risks related to obesity in pregnant women, a systematic review of reviews was conducted. For inclusion, reviews had to compare pregnant women of healthy weight with women with obesity, and measure a health outcome for mother and/or baby. Authors conducted full-text screening, quality assurance using the AMSTAR tool and data extraction steps in pairs. Narrative analysis of the 22 reviews included show gestational diabetes, pre-eclampsia, gestational hypertension, depression, instrumental and caesarean birth, and surgical site infection to be more likely to occur in pregnant women with obesity compared with women with a healthy weight. Maternal obesity is also linked to greater risk of preterm birth, large-for-gestational-age babies, foetal defects, congenital anomalies and perinatal death. Furthermore, breastfeeding initiation rates are lower and there is greater risk of early breastfeeding cessation in women with obesity compared with healthy weight women. These adverse outcomes may result in longer duration of hospital stay, with concomitant resource implications. It is crucial to reduce the burden of adverse maternal and foetal/child outcomes caused by maternal obesity. Women with obesity need support to lose weight before they conceive, and to minimize their weight gain in pregnancy.
Topics: Adult; Breast Feeding; Cesarean Section; Depression; Directive Counseling; Female; Health Knowledge, Attitudes, Practice; Humans; Infant, Low Birth Weight; Infant, Newborn; Male; Molecular Sequence Data; Mothers; Obesity; Perinatal Mortality; Pre-Eclampsia; Preconception Care; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Premature Birth; Risk Factors; Social Support; Weight Gain; Weight Reduction Programs
PubMed: 26016557
DOI: 10.1111/obr.12288 -
JAMA Jan 2016Depression is a source of substantial burden for individuals and their families, including women during the pregnant and postpartum period. (Meta-Analysis)
Meta-Analysis Review
IMPORTANCE
Depression is a source of substantial burden for individuals and their families, including women during the pregnant and postpartum period.
OBJECTIVE
To systematically review the benefits and harms of depression screening and treatment, and accuracy of selected screening instruments, for pregnant and postpartum women. Evidence for depression screening in adults in general is available in the full report.
DATA SOURCES
MEDLINE, PubMed, PsycINFO, and the Cochrane Collaboration Registry of Controlled Trials through January 20, 2015; references; and government websites.
STUDY SELECTION
English-language trials of benefits and harms of depression screening, depression treatment in pregnant and postpartum women with screen-detected depression, and diagnostic accuracy studies of depression screening instruments in pregnant and postpartum women.
DATA EXTRACTION AND SYNTHESIS
Two investigators independently reviewed abstracts and full-text articles and extracted data from fair- and good-quality studies. Random-effects meta-analysis was used to estimate the benefit of cognitive behavioral therapy (CBT) in pregnant and postpartum women.
MAIN OUTCOMES AND MEASURES
Depression remission, prevalence, symptoms, and related measures of depression recovery or response; sensitivity and specificity of selected screening measures to detect depression; and serious adverse effects of antidepressant treatment.
RESULTS
Among pregnant and postpartum women 18 years and older, 6 trials (n = 11,869) showed 18% to 59% relative reductions with screening programs, or 2.1% to 9.1% absolute reductions, in the risk of depression at follow-up (3-5 months) after participation in programs involving depression screening, with or without additional treatment components, compared with usual care. Based on 23 studies (n = 5398), a cutoff of 13 on the English-language Edinburgh Postnatal Depression Scale demonstrated sensitivity ranging from 0.67 (95% CI, 0.18-0.96) to 1.00 (95% CI, 0.67-1.00) and specificity consistently 0.87 or higher. Data were sparse for Patient Health Questionnaire instruments. Pooled results for the benefit of CBT for pregnant and postpartum women with screen-detected depression showed an increase in the likelihood of remission (pooled relative risk, 1.34 [95% CI, 1.19-1.50]; No. of studies [K] = 10, I2 = 7.9%) compared with usual care, with absolute increases ranging from 6.2% to 34.6%. Observational evidence showed that second-generation antidepressant use during pregnancy may be associated with small increases in the risks of potentially serious harms.
CONCLUSIONS AND RELEVANCE
Direct and indirect evidence suggested that screening pregnant and postpartum women for depression may reduce depressive symptoms in women with depression and reduce the prevalence of depression in a given population. Evidence for pregnant women was sparser but was consistent with the evidence for postpartum women regarding the benefits of screening, the benefits of treatment, and screening instrument accuracy.
Topics: Adult; Advisory Committees; Antidepressive Agents; Antidepressive Agents, Second-Generation; Cognitive Behavioral Therapy; Depression; Depression, Postpartum; Female; Humans; Mass Screening; Pregnancy; Pregnancy Complications; Remission Induction; Sensitivity and Specificity; Surveys and Questionnaires; United States
PubMed: 26813212
DOI: 10.1001/jama.2015.18948 -
Taiwanese Journal of Obstetrics &... Nov 2019There are a weakness and laxity in pubourethral and external urethral ligaments during postpartum which has an important role in the females' sexual function and quality... (Meta-Analysis)
Meta-Analysis
There are a weakness and laxity in pubourethral and external urethral ligaments during postpartum which has an important role in the females' sexual function and quality of life. Some evidences showed that pelvic floor muscle training can strength pelvic muscles and prevent sexual dysfunction. Therefore, current study aimed to review the effect of pelvic floor exercise on female sexual function and quality of life in the postpartum period. PubMed, CINAHL, Medline, Scopus, Google scholar citations, Persian databases including SID and Iran Medex were searched using MeSH-based keywords to find published articles. Experimental and quasi-experimental studies in Persian and English were included. Data extracted was done in pre-defined checklist by two independent researchers. Risk of bias was assessed using the Cochrane Risk of Bias tool. Meta-Analysis of the data was carried out by "Comprehensive Meta-analysis Version 2" (CAM). The search resulted in 347 titles and abstracts, which were narrowed down to 12 potentially eligible articles. Pooled standardized differences in means (SMD) of sexual function in both pelvic floor exercise and control group were 0.462 [0.117 to 0.806], p = 0.009. The pooled SMD was 1.294 [0.926 to 1.663], p < 0001 for sexual quality of life. The pooled SMD was 0.232 [0.038-0.426], p = 0.019 for general quality of life. Evidences showed that pelvic floor muscle training in primi or multi-parous women can boost sexual function and quality of life in postpartum. Although the majority of studies and the result of meta-analysis reported positive results, more high-quality RCTs are needed in this area. One limitation of our study is significant heterogeneity because of different intervention method.
Topics: Exercise Therapy; Female; Humans; Pelvic Floor; Postpartum Period; Pregnancy; Pregnancy Complications; Quality of Life
PubMed: 31759521
DOI: 10.1016/j.tjog.2019.09.003 -
Archives of Women's Mental Health Apr 2019Postpartum depression (PPD) is a major public health problem affecting 10-57% of adolescent mothers which can affect not only adolescent mothers but also their infants....
Postpartum depression (PPD) is a major public health problem affecting 10-57% of adolescent mothers which can affect not only adolescent mothers but also their infants. Thus, there is a need for interventions to prevent PPD in adolescent mothers. However, recent systematic reviews have been focused on effective interventions to prevent PPD in adult mothers. These interventions may not necessarily be applicable for adolescent mothers. Therefore, the purpose of this review was to examine the effectiveness of the existing interventions to prevent PPD in adolescent mothers. A systematic search was performed in MEDLINE, CINAHL, and SCOPUS databases between January 2000 and March 2017 with English language and studies involving human subjects. Studies reporting on the outcomes of intervention to prevent PPD particularly in adolescent mothers were selected. Non-comparative studies were excluded. From 2002 identified records, 13 studies were included, reporting on 2236 adolescent pregnant women. The evidence from this systematic review suggests that 6 of 13 studies from both psychological and psychosocial interventions including (1) home-visiting intervention, (2) prenatal antenatal and postnatal educational program, (3) CBT psycho-educational, (4) the REACH program based on interpersonal therapy, and (5) infant massage training is successful in reducing rates of PPD symptoms in adolescent mothers in the intervention group than those mothers in the control group. These interventions might be considered for incorporation in antenatal care interventions for adolescent pregnant women. However, this review did not find evidence identifying the most effective intervention for preventing postpartum depression symptoms in adolescent mothers.
Topics: Adolescent; Depression, Postpartum; Female; House Calls; Humans; Postnatal Care; Pregnancy; Pregnancy Complications; Pregnancy in Adolescence; Prenatal Care; Social Support
PubMed: 30116896
DOI: 10.1007/s00737-018-0901-7 -
CMAJ : Canadian Medical Association... May 2021
Meta-Analysis
Topics: COVID-19; Diabetes, Gestational; Female; Humans; Incidence; Infant, Low Birth Weight; Pre-Eclampsia; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Premature Birth; Severity of Illness Index; Stillbirth
PubMed: 34059502
DOI: 10.1503/cmaj.202604-f -
Journal of Neurology, Neurosurgery, and... May 2021Pregnancy largely affects disease activity and clinical course in women with immune-mediated neurological disorders. Chronic inflammatory demyelinating polyneuropathy... (Review)
Review
Pregnancy largely affects disease activity and clinical course in women with immune-mediated neurological disorders. Chronic inflammatory demyelinating polyneuropathy (CIDP) is rare but the most common chronic immune-mediated neuropathy; however, the effects of pregnancy on CIDP have never been investigated except case reports or series. We here provide a systematic review of the literature from 1 January 1969 to 30 June 2020 that revealed 24 women with CIDP, who had onset or relapse during pregnancy. Of these, 17 (71%) developed CIDP during the first pregnancy, and 8 (47%) had a relapse during subsequent pregnancies. Of the 17 patients, in whom the CIDP subtypes were determined, all of them had typical CIDP. First-line treatments for CIDP, such as corticosteroids, immunoglobulin and plasma exchange were efficacious and safe. We suggest that pregnancy can trigger typical CIDP in some women, and women with CIDP have a higher risk of relapse during pregnancy. The onset or relapse of CIDP during pregnancy is a rare but challenging constellation for physicians.
Topics: Adrenal Cortex Hormones; Female; Humans; Immunoglobulins, Intravenous; Plasma Exchange; Polyradiculoneuropathy, Chronic Inflammatory Demyelinating; Pregnancy; Pregnancy Complications; Treatment Outcome
PubMed: 33563801
DOI: 10.1136/jnnp-2020-325321 -
Journal of Obstetrics and Gynaecology :... Dec 2024Vaginal bleeding during pregnancy has been recognised as a significant risk factor for adverse pregnancy outcomes. This study aimed to investigate the association... (Meta-Analysis)
Meta-Analysis Review
Vaginal bleeding during pregnancy has been recognised as a significant risk factor for adverse pregnancy outcomes. This study aimed to investigate the association between vaginal bleeding during the first trimester of pregnancy and clinical adverse effects using a systematic review and meta-analysis. Databases of Scopus, Web of Science, PubMed (including Medline), Cochrane Library and Science Direct were searched until June of 2023. Data analysis using statistical test fixed- and random-effects models in the meta-analysis, Cochran and meta-regression. The quality of the eligible studies was assessed by using the Newcastle-Ottawa Scale checklist (NOS). A total of 46 relevant studies, with a sample size of 1,554,141 were entered into the meta-analysis. Vaginal bleeding during the first trimester of pregnancy increases the risk of preterm birth (OR: 1.8, CI 95%: 1.6-2.0), low birth weight (LBW; OR: 2.0, CI 95%: 1.5-2.6), premature rupture of membranes (PROMs; OR: 2.3, CI 95%: 1.8-3.0), abortion (OR: 4.3, CI 95%: 2.0-9.0), stillbirth (OR: 2.5, CI 95%: 1.2-5.0), placental abruption (OR: 2.2, CI 95%: 1.4-3.3) and placenta previa (OR: 1.9, CI 95%: 1.5-2.4). Vaginal bleeding in the first trimester of pregnancy is associated with preterm birth, LBW, PROMs, miscarriage, stillbirth, placental abruption and placenta previa. Therefore, physicians or midwives need to be aware of the possibility of these consequences and manage them when they occur.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Stillbirth; Premature Birth; Abruptio Placentae; Placenta Previa; Placenta; Pregnancy Outcome; Abortion, Spontaneous; Uterine Hemorrhage
PubMed: 38305047
DOI: 10.1080/01443615.2023.2288224 -
Obesity Surgery Jun 2023The aim of this review was to report on maternal diet, micronutrient supplementation, and gestational weight gain (GWG) during pregnancy following bariatric surgery and... (Review)
Review
The aim of this review was to report on maternal diet, micronutrient supplementation, and gestational weight gain (GWG) during pregnancy following bariatric surgery and explore the impact on maternal micronutrient deficiency, offspring growth, and perinatal outcomes. A search in PubMed, CINAHL, EMBASE, and ProQuest in July 2022 returned 23 eligible studies (n = 30-20, 213). Diet was reported in two studies, supplementation in six and GWG in 19 studies. Although many women did not achieve healthy GWG, no consistent link with adverse outcomes was reported. Studies were grades II and III on the National Health and Medical Research Council evidence hierarchy and received a neutral or negative score on the Academy of Nutrition and Dietetics Quality Criteria Checklist, suggesting that methodological limitations impact the reliability of reported findings.
Topics: Pregnancy; Female; Humans; Pregnancy Outcome; Prenatal Nutritional Physiological Phenomena; Reproducibility of Results; Pregnancy Complications; Obesity, Morbid; Bariatric Surgery; Micronutrients
PubMed: 37086371
DOI: 10.1007/s11695-023-06565-8