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The Journal of Laryngology and Otology Mar 2022Otosclerosis affects women twice as often as men, especially during fertile age. A role of female hormones has been claimed, but controversy still exists regarding the...
OBJECTIVE
Otosclerosis affects women twice as often as men, especially during fertile age. A role of female hormones has been claimed, but controversy still exists regarding the influence of pregnancy. The purpose of this research was to analyse the role of pregnancy on the course of otosclerosis.
METHOD
PubMed was searched in May 2019 using the terms 'otosclerosis AND pregnancy', 'otosclerosis AND pregnant', 'otosclerosis AND parous', 'otosclerosis AND parity', and 'otosclerosis AND puerperium'. Age at diagnosis, number of pregnancies and the temporal relationship of the disease with childbearing were considered.
RESULTS
From 65 articles, 11 were chosen for review. They described 2323 women affected by otosclerosis: 1805 had at least 1 pregnancy, while 518 did not. During childbearing, otosclerosis began in 1 per cent of pregnant women, worsened in 21 per cent and worsened during puerperium in 4 per cent. Often, the authors reported hearing change with pregnancy without details, so a further group has been considered composed of women belonging to any of the groups just mentioned or to another group of women not further characterised. Overall, hearing change occurred during pregnancy in 44 per cent. A statistically significant correlation emerged between hearing change and number of pregnancies (p = 0.003).
CONCLUSION
Because of wide data heterogeneity and the difficulty in analysing a single factor, absolute statements could not be formulated. According to this review, pregnancy seems to have a worsening effect on the course of otosclerosis.
Topics: Female; Humans; Otosclerosis; Pregnancy; Pregnancy Complications
PubMed: 34819176
DOI: 10.1017/S0022215121003601 -
BMC Pregnancy and Childbirth Oct 2016Bipolar Disorder (BD) is a mental disorder usually diagnosed between 18 and 30 years of age; this coincides with the period when many women experience pregnancy and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Bipolar Disorder (BD) is a mental disorder usually diagnosed between 18 and 30 years of age; this coincides with the period when many women experience pregnancy and childbirth. As specific problems have been reported in pregnancy and childbirth when the mother has BD, a systematic review was carried out to summarise the outcomes of pregnancy and childbirth, in mother and child, when the mother has BD diagnosed before pregnancy.
METHODS
An a priori protocol was designed and a systematic search conducted in PubMed, CINAHL, Scopus, PsycINFO and Cochrane databases in March 2015. Studies of all designs were included if they involved women with a diagnosis of bipolar disorder prior to pregnancy, who were pregnant and/or followed up to one year postpartum. All stages of inclusion, quality assessment and data extraction were done by two people. All maternal or infant outcomes were examined, and narrative synthesis was used for most outcomes. Meta-analysis was used to achieve a combined prevalence for some outcomes and, where possible, case and control groups were combined and compared.
RESULTS
The search identified 2809 papers. After screening and quality assessement (using the EPHPP and AMSTAR tools), nine papers were included. Adverse pregnancy outcomes such as gestational hypertension and antepartum haemorrhage occur more frequently in women with BD. They also have increased rates of induction of labour and caesarean section, and have an increased risk of mood disorders in the postnatal period. Women with BD are more likely to have babies that are severely small for gestational age (<2nd-3rd percentile), and it appears that those women not being treated with mood stabilisers in pregnancy might not have an increased risk of having a baby with congenital abnormalities.
DISCUSSION
Due to heterogeneity of data, particularly the use of differing definitions of bipolar disorder, narrative synthesis was used for most outcomes, rather than a meta-analysis.
CONCLUSIONS
It is evident that adverse outcomes are more common in women with BD and their babies. Large cohort studies examining fetal abnormality outcomes for women with BD who are not on mood stabilisers in pregnancy are required, as are studies on maternal-infant interaction.
Topics: Bipolar Disorder; Case-Control Studies; Delivery, Obstetric; Female; Humans; Hypertension, Pregnancy-Induced; Infant, Newborn; Infant, Small for Gestational Age; Parturition; Postpartum Hemorrhage; Postpartum Period; Pregnancy; Pregnancy Complications; Pregnancy Outcome
PubMed: 27793111
DOI: 10.1186/s12884-016-1127-1 -
Journal of Affective Disorders Mar 2016There is a growing interest in exploring maternal mental health effects of unintended pregnancies carried to term. However, the evidence base from a small number of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
There is a growing interest in exploring maternal mental health effects of unintended pregnancies carried to term. However, the evidence base from a small number of available studies is characterised by considerable variability, inconsistency and inconclusive findings. We present a systematic review and meta-analysis of all available studies on unintended pregnancy as these are related to maternal depression.
METHODS
Using PRISMA guideline, we systematically reviewed and meta-analysed studies reporting an association between unintended pregnancy and maternal depression from PubMed, EMBASE, PsychINFO and Google Scholar. We used a priori set criteria and included details of quality and magnitude of effect sizes. Sample sizes, adjusted odds ratios and standard errors were extracted. Random effects were used to calculate pooled estimates in Stata 13. Cochran's Q, I(2) and meta-bias statistics assessed heterogeneity and publication bias of included studies.
RESULTS
Meta-bias and funnel plot of inverse variance detected no publication bias. Overall prevalence of maternal depression in unintended pregnancy was 21%. Unintended pregnancy was significantly associated with maternal depression. Despite statistically significant heterogeneities of included studies, sub-group analyses revealed positive and significant associations by types of unintended pregnancies, timing of measurements with respect to pregnancy and childbirth, study designs and settings.
CONCLUSIONS
The prevalence of perinatal depression is two-fold in women with unintended pregnancy. Perinatal care settings may screen pregnancy intention and depression of women backed by integrating family planning and mental health services.
Topics: Adult; Depression; Female; Humans; Mental Health Services; Odds Ratio; Perinatal Care; Pregnancy; Pregnancy Complications; Pregnancy, Unplanned; Prevalence
PubMed: 26707348
DOI: 10.1016/j.jad.2015.12.008 -
Human Reproduction Update 2016Traditionally, pregnancy was considered to have a positive effect on endometriosis and its painful symptoms due not only to blockage of ovulation preventing bleeding of... (Review)
Review
BACKGROUND
Traditionally, pregnancy was considered to have a positive effect on endometriosis and its painful symptoms due not only to blockage of ovulation preventing bleeding of endometriotic tissue but also to different metabolic, hormonal, immune and angiogenesis changes related to pregnancy. However, a growing literature is emerging on the role of endometriosis in affecting the development of pregnancy and its outcomes and also on the impact of pregnancy on endometriosis. The present article aims to underline the difficulty in diagnosing endometriotic lesions during pregnancy and discuss the options for the treatment of decidualized endometriosis in relation to imaging and symptomatology; to describe all the possible acute complications of pregnancy caused by pre-existing endometriosis and evaluate potential treatments of these complications; to assess whether endometriosis affects pregnancy outcome and hypothesize mechanisms to explain the underlying relationships.
METHODS
This systematic review is based on material searched and obtained via Pubmed and Medline between January 1950 and March 2015. Peer-reviewed, English-language journal articles examining the impact of endometriosis on pregnancy and vice versa were included in this article.
RESULTS
Changes of the endometriotic lesions may occur during pregnancy caused by the modifications of the hormonal milieu, posing a clinical dilemma due to their atypical appearance. The management of these events is actually challenging as only few cases have been described and the review of available literature evidenced a lack of formal estimates of their incidence. Acute complications of endometriosis during pregnancy, such as spontaneous hemoperitoneum, bowel and ovarian complications, represent rare but life-threatening conditions that require, in most of the cases, surgical operations to be managed. Due to the unpredictability of these complications, no specific recommendation for additional interventions to the routinely monitoring of pregnancy of women with known history of endometriosis is advisable. Even if the results of the published studies are controversial, some evidence is suggestive of an association of endometriosis with spontaneous miscarriage, preterm birth and small for gestational age babies. A correlation of endometriosis with placenta previa (odds ratio from 1.67 to 15.1 according to various studies) has been demonstrated, possibly linked to the abnormal frequency and amplitude of uterine contractions observed in women affected. Finally, there is no evidence that prophylactic surgery would prevent the negative impact of endometriosis itself on pregnancy outcome.
CONCLUSIONS
Complications of endometriosis during pregnancy are rare and there is no evidence that the disease has a major detrimental effect on pregnancy outcome. Therefore, pregnant women with endometriosis can be reassured on the course of their pregnancies although the physicians should be aware of the potential increased risk of placenta previa. Current evidence does not support any modification of conventional monitoring of pregnancy in patients with endometriosis.
Topics: Abortion, Spontaneous; Diagnostic Errors; Endometriosis; Female; Gestational Age; Humans; Intestinal Diseases; Lung Diseases; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Premature Birth; Prenatal Diagnosis; Skin Diseases; Urologic Diseases
PubMed: 26450609
DOI: 10.1093/humupd/dmv045 -
Journal of Obstetrics and Gynaecology :... Oct 2022Zonulin is a novel biomarker of intestinal permeability. The existing data suggest that upregulation of zonulin might be linked to systemic inflammation and pregnancy... (Meta-Analysis)
Meta-Analysis
Zonulin is a novel biomarker of intestinal permeability. The existing data suggest that upregulation of zonulin might be linked to systemic inflammation and pregnancy complications. A systematic search was performed in medical electronic databases to identify eligible studies that reported circulating zonulin levels in complicated pregnancies compared to controls. Eight studies with 1196 serum samples of pregnant women were included in the systematic review. Meta-analysis on four studies revealed a significant increase in serum zonulin in women with Gestational diabetes mellitus (GDM) compared to healthy controls (Cohen's = 2.06; 95% Confidence Interval (CI): 0.15, 3.98). By pooling four studies that investigated zonulin levels in Hypertensive disorders of pregnancy (HDP), higher zonulin concentrations were found in cases, while the difference was not significant (Cohen's = 0.86; 95% CI: -0.04, 1.75). Current evidence suggests that higher levels of zonulin during pregnancy seem to be associated with inflammation-related complications, including GDM and HDP.Impact Statement Increased zonulin levels are considered as a marker of intestinal hyper-permeability. Upregulation of zonulin and concurrent systemic inflammation, are known to be associated with some pregnancy complications. We performed a meta-analysis to evaluate changes in serum zonulin levels in pregnancies complicated with Gestational diabetes mellitus (GDM), Hypertensive disorders of pregnancy (HDP), and Intrahepatic cholestasis of pregnancy (ICP). According to our results, zonulin levels were significantly higher in complicated pregnancies than in normal pregnancies, particularly for GDM. Our findings revealed a probable association between increased zonulin levels and inflammation-related complications during pregnancy. Moreover, zonulin could serve as a reliable diagnostic clinical biomarker to identify (or predict) complications during pregnancy. Further studies are needed to examine the clinical accuracy of zonulin for detecting pregnancy-related complications.
Topics: Pregnancy; Female; Humans; Diabetes, Gestational; Hypertension, Pregnancy-Induced; Pregnancy Complications; Pre-Eclampsia; Inflammation; Biomarkers
PubMed: 36094006
DOI: 10.1080/01443615.2022.2114822 -
Chemico-biological Interactions Sep 2018Research purpose was to put together the available pieces of present scientific data and to close the gap in the knowledge of Hcy levels in pregnancy and its association... (Review)
Review
Research purpose was to put together the available pieces of present scientific data and to close the gap in the knowledge of Hcy levels in pregnancy and its association with some pregnancy complications. Scientific data were taken from research papers published between January 1990 and December 2017, and found on the Internet (PubMed, ClinicalKey and Embase databases) by the following tags entered in English, Russian, French and German languages: pregnancy, homocysteine, pregnancy complications, pregnancy loss, preeclampsia, intrauterine growth restriction, and placental abruption. The review showed that Hcy levels range in uncomplicated pregnancy. Upon that, Hcy level tends to decrease during the second and third trimesters. Some studies have revealed a link between polymorphism and abortion. Sufficient data were obtained indicating the relationship between HHcy and PE. Placental abruption was also associated with high Hcy levels increasing the risk 5.3-fold, but still there are data not supporting the hypothesis that Hcy levels correlate with placental abruption.
Topics: Abortion, Spontaneous; Abruptio Placentae; Female; Fetal Growth Retardation; Homocysteine; Humans; Methylenetetrahydrofolate Reductase (NADPH2); Polymorphism, Single Nucleotide; Pre-Eclampsia; Pregnancy
PubMed: 30053452
DOI: 10.1016/j.cbi.2018.07.021 -
Cardiology in Review 2014Pregnancy places a significant burden on the cardiovascular system and may lead to heart failure, arrhythmias, and, rarely, maternal mortality in women with pre-existent... (Review)
Review
Pregnancy places a significant burden on the cardiovascular system and may lead to heart failure, arrhythmias, and, rarely, maternal mortality in women with pre-existent heart disease. The objective of this review was to provide an overview of maternal and fetal outcomes and complications of pregnancy in women with hypertrophic cardiomyopathy (HCM). A systematic review of the literature in the MEDLINE database was performed to identify cohort design studies reporting outcome and complications of pregnancy in HCM. The literature search returned 11 studies on 9 patient cohorts reporting the outcome and complications of pregnancy in HCM. In case of >1 publication on a particular cohort, the most recent publication was included in the analysis. A pooled analysis of the outcome data was performed, and weighted event rates and 95% confidence intervals were calculated. The analysis of data from 9 cohorts, including 237 women and 408 pregnancies, demonstrated that most pregnancies in women with HCM are uneventful. Still, pregnancy in women with HCM carries maternal and fetal risks. The maternal mortality rate was 0.5%, and any complication or worsening of symptoms occurred in 29% of the patients. Fetal mortality was caused by spontaneous abortion (15%), therapeutic abortion (5%), and stillbirth (2%). Premature birth was observed in 26%. In conclusion, maternal mortality related to pregnancy in women with HCM is low and appears to be confined to women with a high-risk profile before pregnancy. Fetal mortality is comparable to that in the general population; however, the risk of premature birth is increased.
Topics: Cardiomyopathy, Hypertrophic; Female; Humans; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy Outcome
PubMed: 25093741
DOI: 10.1097/CRD.0000000000000010 -
Journal of Gynecology Obstetrics and... Sep 2021Maternal thyroid hormones are vital for a normal pregnancy and the development of fetus and childhood; inadequate availability of thyroid hormones during pregnancy is...
Maternal thyroid hormones are vital for a normal pregnancy and the development of fetus and childhood; inadequate availability of thyroid hormones during pregnancy is associated with adverse pregnancy outcomes. Isolated maternal hypothyroxinemia (IMH) is defined as a low maternal T4 in the absence of TSH elevation. This systematic review aimed to investigate the association between IMH and adverse pregnancy outcomes. PubMed, Scopus and Web of science were searched for retrieving observational studies published up to September 2020, investigating the association of IMH with adverse pregnancy outcomes. From a total of 308 articles, 17 met our eligibility criteria and were used for the purpose of the present study. Definition of IMH varied in different studies. While some studies reported no adverse pregnancy outcomes for IMH, other studies found a positive association between first trimester IMH and feto-maternal outcomes including gestational hypertension, gestational diabetes, preterm delivery, fetal distress, small for gestational age, musculoskeletal malformations, spontaneous abortion, placental abruption and macrosomia. IMH, identified in the second trimester was associated with an increase in the risk of gestational diabetes, and hypertensive disorders of pregnancy in one study. There is no consensus on the adverse effects of IMH on pregnancy outcomes. Further comprehensive cohort studies using one standard definition for IMH, with large sample size and control of important confounders such as iodine status and maternal Thyroid peroxidase antibody (TPOAb) are needed for precise assessment of this association.
Topics: Adult; Female; Humans; Hypothyroidism; Pregnancy; Pregnancy Complications; Pregnancy Outcome
PubMed: 33401029
DOI: 10.1016/j.jogoh.2020.102057 -
American Journal of Obstetrics &... Jan 2023This study aimed to investigate the association between early pregnancy with subchorionic hematoma and preterm delivery and other adverse pregnancy outcomes in singleton... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
This study aimed to investigate the association between early pregnancy with subchorionic hematoma and preterm delivery and other adverse pregnancy outcomes in singleton pregnancies.
DATA SOURCES
English studies published from 2000 to July 15, 2022 were retrieved from PubMed, Web of Science, and the Cochrane Library.
STUDY ELIGIBILITY CRITERIA
The inclusion criteria were: singleton pregnancy, subchorionic hematoma, and perinatal outcomes. Studies including multiple pregnancy, basic molecular studies, case reports (series), and conference reviews were excluded.
METHODS
Data analysis was mainly conducted with Review Manager (RevMan) and Stata, and the results were represented with odds ratios and 95% confidence intervals. The methodological quality of the included studies was evaluated by the Cochrane risk assessment scale.
RESULTS
In total, 370 studies were retrieved from the above databases. Our review included 16 studies and divided them into 2 subgroups: natural pregnancy (12 studies) and assisted reproductive pregnancy (4 studies). The relevant characteristics of each study were analyzed in detail. The primary outcome was preterm delivery. The secondary outcomes were miscarriage, fetal growth restriction, cesarean delivery, and preeclampsia. We found that subchorionic hematoma in the first trimester was not significantly associated with preterm delivery (odds ratio, 1.11; 95% confidence interval, 0.82-1.51) or other adverse outcomes in singleton pregnancy. Regression analysis found that the large heterogeneity of the included studies might be related to whether the included study population (early pregnancy with subchorionic hematoma) was complicated with threatened abortion (P<.05). However, no studies caused large heterogeneity according to sensitivity analysis. Finally, 15 studies related to preterm delivery did not have publication bias (Egger test: P=.26). However, subchorionic hematoma in the first trimester was associated with miscarriage in single pregnancies (natural pregnancy: odds ratio, 3.07; 95% confidence interval, 1.98-4.75; assisted reproductive pregnancy: odds ratio, 1.45; 95% confidence interval, 1.1-1.90).
CONCLUSION
In singleton pregnancy, we found no association between subchorionic hematoma in the first trimester and preterm delivery. Although there was a correlation with miscarriage, the possible gestational age of miscarriage was not stated. More studies are needed to further address the herein posed research questions.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Premature Birth; Pregnancy Complications; Pregnancy Outcome; Pregnancy Trimester, First; Abortion, Spontaneous; Hematoma
PubMed: 36328350
DOI: 10.1016/j.ajogmf.2022.100791 -
Clinical and Experimental Medicine Aug 2023Coronavirus disease 19 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome 2 (SARS-CoV-2). Throughout the pandemic, evidence on the effects... (Review)
Review
Coronavirus disease 19 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome 2 (SARS-CoV-2). Throughout the pandemic, evidence on the effects of COVID-19 during pregnancy has been inadequate due to the limited number of studies published. Therefore, the objective of this systematic review was to evaluate current literature regarding the effects of COVID-19 during pregnancy and establish pregnancy outcomes and vertical and perinatal transmission during pregnancy. Multiple databases were searched, including Embase, Medline, Web of Science, Scopus, and Cochrane Central Register of Control Clinical Trials, using the following keywords: [Pregnancy] AND [COVID-19 OR SARS-CoV-2 OR nCoV-19] OR [Perinatal transmission, Vertical transmission (VT), Pregnancy complications], [Pregnancy] AND [Hyperinflammation OR Cytokine storm]. We excluded in vitro and experimental studies, but also ex-vivo and animal study methods. To exclude the risk of bias during data collection and interpretation, all included studies were peer-reviewed publications. This review is estimated to tabulate the study intervention characteristics and compare them against the planned groups for each synthesis. Our findings showed that pregnant women are commonly susceptible to respiratory viral infections and severe pneumonia due to physiological immune suppression and pregnancy-induced changes. VT of SARS-CoV-2 infection during pregnancy is associated with a great deal of controversy and conflict. However, there is still no robust clinical evidence of VT. Furthermore, the clinical presentation and management of COVID-19 during pregnancy are nearly identical to those of non-pregnant women. Finally, chloroquine and remdesivir are the only two drugs evaluated as adequate for the management of COVID-19 during pregnancy.
Topics: Pregnancy; Female; Humans; COVID-19; SARS-CoV-2; Infectious Disease Transmission, Vertical; Pregnancy Complications, Infectious; Pregnancy Outcome
PubMed: 36251144
DOI: 10.1007/s10238-022-00907-z