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International Journal of Developmental... Oct 2021Postpartum depression (PPD) is one of the most important mental disorders in recent years. However, the effects of prenatal sleep disorders on the development of PPD... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Postpartum depression (PPD) is one of the most important mental disorders in recent years. However, the effects of prenatal sleep disorders on the development of PPD among pregnant women have not been elucidated. This review aims to provide a summary of the literature evaluating the relation between sleep disorders during pregnancy and PPD.
METHOD
A systematic literature search was conducted in PubMed, Web of Science, Scopus, Google Scholar, and Embase up to September 2020. All observational studies (cross-sectional, case-control, and cohort) and studies that assessed the association between sleep disorders during pregnancy and PPD were included. Total sample of 36,873 women from 13 studies was entered to meta-analysis. An aggregate effect size estimate (odds ratio) was generated using the comprehensive meta-analysis software. A random effects model was set a priori. Heterogeneity and publication bias were examined using the standard meta-analytic approaches.
RESULT
We found maternal sleep disorder increased odds of PPD (point estimate, 3.300; 95% confidence interval [CI], 2.136-5.098; p < .001; n = 13). However, there was significant heterogeneity (Q, 131.250; df, 12; p < .001; I , 90.857%). The estimated effect size was significant for all categorical studies. According to meta-regression, no moderating factor (age and publication year) significantly mediated the estimated effect size.
CONCLUSION
We found a significant relationship between sleep disturbances during pregnancy and PPD. Women with sleep disorders are at an increased risk of developing PPD, which warrants screening pregnant mothers for sleep disturbances. Also, we found that the increasing age in pregnancy was associated with increased risk of PPD.
Topics: Depression, Postpartum; Female; Humans; Pregnancy; Pregnancy Complications; Sleep Wake Disorders
PubMed: 33942364
DOI: 10.1002/jdn.10118 -
International Journal of Gynaecology... Jan 2016Pregnancy-related venous thromboembolism (VTE) is one of the leading causes of maternal morbidity and mortality. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Pregnancy-related venous thromboembolism (VTE) is one of the leading causes of maternal morbidity and mortality.
OBJECTIVES
To review the epidemiology, and humanistic and economic burden of pregnancy-related VTE.
SEARCH STRATEGY
Medline, the Cochrane Central Register of Controlled Trials, Econlit, Science Direct, JSTOR, Oxford Journals, and Cambridge Journals were searched for reports published between January 2000 and December 2012. Keywords related to VTE, pregnancy, and epidemiology and the humanistic and economic burdens were combined.
SELECTION CRITERIA
Eligible studies evaluated the incidence, mortality, recurrence, complications, quality-of-life, and economic burden of VTE among pregnant women, and had been published in English.
DATA COLLECTION AND ANALYSIS
Background information of the study, participants' characteristics, and study outcomes were collected. Meta-analyses of data were performed.
MAIN RESULTS
Twenty studies were included, none of which investigated the economic burden. The pooled overall incidence of pregnancy-related VTE was 1.2 per 1000 deliveries. The pooled VTE case fatality rate was 0.68% and the recurrence rate was 4.27%. The pooled risk of major bleeding was 1.05%. Post-thrombotic syndrome seemed to have a negative effect on quality of life.
CONCLUSIONS
Although the incidence of VTE was found to be relatively low during pregnancy and the postpartum period, the clinical burden is high. Further research is required to assess the economic burden of pregnancy-relate VTE.
Topics: Adult; Cost of Illness; Female; Humans; Incidence; Postpartum Period; Pregnancy; Pregnancy Complications, Cardiovascular; Quality of Life; Recurrence; Venous Thromboembolism
PubMed: 26489486
DOI: 10.1016/j.ijgo.2015.06.054 -
American Journal of Surgery Jan 2019Consensus lacks concerning management of ventral hernia in women who are, or might become pregnant. The aim of this systematic review was to examine the risk of...
BACKGROUND
Consensus lacks concerning management of ventral hernia in women who are, or might become pregnant. The aim of this systematic review was to examine the risk of recurrence following pre-pregnancy ventral hernia repair, and secondly the prevalence of ventral hernia during pregnancy and the risk of surgical repair pre- and post-partum.
DATA SOURCES
PubMed, Embase, CINAHL, Cochrane Library and Web of Science were systematically searched for randomized controlled trials, case-control, cohort studies and larger case-series on ventral (umbilical, epigastric or incisional) hernia repair in relation to pregnancy.
CONCLUSIONS
If possible, elective ventral repair should be postponed until after last pregnancy. A non-mesh repair seems appropriate for smaller primary ventral hernia in women who plan future pregnancies. Umbilical hernia during pregnancy seems very rare and seldom requires repair pre- and post-partum. Routine practice of umbilical hernia repair in combination with cesarean section cannot be recommended.
PROSPERO
CRD42017073736.
Topics: Female; Hernia, Ventral; Herniorrhaphy; Humans; Pregnancy; Pregnancy Complications; Prevalence; Recurrence
PubMed: 29798763
DOI: 10.1016/j.amjsurg.2018.04.016 -
Journal of Obstetrics and Gynaecology :... 2016Thyroid antibody positivity is relatively common in women. While many epidemiological studies have investigated the links between thyroid antibodies and pregnancy... (Review)
Review
Thyroid antibody positivity is relatively common in women. While many epidemiological studies have investigated the links between thyroid antibodies and pregnancy complications, evidence regarding the effect of Levothyroxine treatment of euthyroid pregnant women with autoimmune thyroid disease on pregnancy outcome is limited. The objective of this paper is to provide a review on the impact of treatment of euthyroid thyroid antibody-positive pregnant women on adverse pregnancy outcome. This systematic review was conducted with a prospective protocol. PubMed, Science direct, Google scholar, Embase and the Cochrane Library databases were searched through January 2014 to identify studies that met pre-stated inclusion criteria. The search was limited to English manuscripts. We found that there is inadequate data regarding both the adverse effect of thyroid antibody positivity in euthyroid women on pregnancy outcomes and the effects Levothyroxine on these women. It seems that the results of most studies indicate adverse effects of thyroid antibody positivity in euthyroid women on pregnancy outcomes. Further randomised clinical trials are needed to investigate the effects of treating pregnant euthyroid women with positive thyroid antibodies on the maternal and early/late neonatal outcomes.
Topics: Autoantibodies; Autoimmune Diseases; Female; Humans; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Thyroid Diseases; Thyroxine
PubMed: 26203920
DOI: 10.3109/01443615.2014.968110 -
The Journal of Clinical Psychiatry Dec 2021The objective of this systematic review was to provide a critical appraisal of the evidence related to the safety of clozapine for schizophrenia during pregnancy and...
The objective of this systematic review was to provide a critical appraisal of the evidence related to the safety of clozapine for schizophrenia during pregnancy and lactation. PubMed/MEDLINE, Embase, and the Cochrane Library were searched from inception through December 2020. Reference lists of included studies were hand-searched. The International Clinical Trials Registry Platform and ClinicalTrials.gov were searched for unpublished trials, and PROSPERO was searched for unpublished reviews. The current marketing authorization holder of the originator brands Clozaril and Leponex was also contacted for pharmacovigilance data. Original reports published in English, German, French, or Dutch containing clinical and preclinical data were included if they provided data on maternal, fetal, and neonatal outcomes after clozapine exposure during pregnancy or lactation. Two reviewers independently extracted relevant data. A total of 860 records were identified, and the full texts of 117 articles were reviewed. Forty-two studies met the inclusion criteria. Data on perinatal clozapine exposure are of limited quality and quantity. Although clozapine demonstrates partial placental passage, data thus far do not support that clozapine is teratogenic; that it increases the risk of stillbirth, abortion, or fetal disorders; or that it increases the risk of delivery complications or premature birth. Information about clozapine exposure through breast milk is scarce, but based on its chemical properties, it is likely that clozapine enters the breast milk of nursing mothers taking clozapine. When weighing the risks and benefits of clozapine continuation during pregnancy and lactation versus switching to another antipsychotic, one should include severity of illness and treatment history but also be aware of the limitations of the available safety data regarding perinatal clozapine use, including the fact that there are few studies.
Topics: Antipsychotic Agents; Clozapine; Female; Humans; Postpartum Period; Pregnancy; Pregnancy Complications; Schizophrenia
PubMed: 34905664
DOI: 10.4088/JCP.21r13952 -
Pharmacological Research Jun 2021To systematically review contemporary data on the safety of clopidogrel and newer antiplatelet agents in pregnant women, with particular attention to maternal and...
OBJECTIVE
To systematically review contemporary data on the safety of clopidogrel and newer antiplatelet agents in pregnant women, with particular attention to maternal and neonatal complications.
METHODS
The review protocol was published via PROSPERO (ID 42020165235) and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Databases were searched using MeSH and free text terms encompassing the included antiplatelets, relevant indications, and pregnancy. Included studies reported the drug dose, the stage of pregnancy at which it was administered, and at least one primary or secondary outcome relating to pregnancy. The primary outcome was reporting of complications associated with antiplatelet use in pregnancy.
RESULTS
The search yielded 5271 results. 39 publications were included, incorporating 42 live births. The mean age of women was 34.6 years. Seven different antiplatelet agents were described, clopidogrel being most frequent (n = 37). 14 women received antiplatelet therapy in the first trimester. 14 women had regional anaesthesia (12 while taking clopidogrel), all without complication. Two women developed bleeding post caesarean section. There were no recorded neonatal delivery complications. Two neonates had congenital anomalies not felt to be related to maternal antiplatelet use.
CONCLUSIONS
This systematic review describes outcomes for both mothers and neonates when exposed to clopidogrel at varying durations throughout gestation, and does not suggest higher than acceptable risk, with a congenital anomaly rate comparable to background risk. Evidence for other antiplatelet agents remains limited. Regional anaesthesia should be offered, with recommendation to stop prior to delivery in line with national guidance and in the context of individualised decision making.
Topics: Adult; Anesthesia, Conduction; Anesthesia, Obstetrical; Female; Fetus; Humans; Infant, Newborn; Middle Aged; Platelet Aggregation Inhibitors; Pregnancy; Pregnancy Complications; Young Adult
PubMed: 33716166
DOI: 10.1016/j.phrs.2021.105547 -
Journal of Affective Disorders May 2015Depression in pregnancy is a serious health issue; however, anxiety in pregnancy, with a reported higher prevalence, may also be a serious issue. Anxiety symptoms in... (Review)
Review
BACKGROUND
Depression in pregnancy is a serious health issue; however, anxiety in pregnancy, with a reported higher prevalence, may also be a serious issue. Anxiety symptoms in pregnancy can relate to several anxiety types, such as general anxiety, anxiety disorders, and pregnancy-related anxiety (PrA), anxiety characterised by pregnancy specific fears and worries. Awareness of these distinctions however, is not always widespread. Both general anxiety and PrA are associated with maternal negative outcomes (e.g. increased nausea) however; PrA is more often associated with negative outcomes for the child (e.g. preterm birth). Furthermore, PrA is potentially a risk factor for postnatal depression with assessment of PrA potentially affording important intervention opportunities. Currently several different instruments are used for PrA however their psychometric properties are unclear. To our knowledge a review of current instruments and their psychometric properties is lacking, this paper aims to fill that gap.
METHODS
Studies, which assessed PrA, published between 1983 and 2013 in peer-reviewed journals, were identified.
RESULTS
Sixty studies were identified after applying inclusion/exclusion criteria, and classified as: pregnancy-related anxiety specific, scales for other constructs, sub scales of another instrument and general anxiety scales. Each scale's strengths and limitations were discussed.
LIMITATIONS
Our findings may be limited by restricting our review to peer-reviewed journals. This was done however as we sought to identify scales with good psychometric properties.
CONCLUSIONS
Currently no scales are available for pregnancy-related anxiety with sound theoretical and psychometric properties. Clinically the need for such a scale is highlighted by the potential intervention opportunities this may afford. Future research should be directed towards the development of such a scale.
Topics: Anxiety; Anxiety Disorders; Comorbidity; Depression, Postpartum; Female; Humans; Infant, Newborn; Maternal Behavior; Pregnancy; Pregnancy Complications; Prenatal Care; Prevalence; Psychometrics
PubMed: 25687280
DOI: 10.1016/j.jad.2015.01.039 -
Fertility and Sterility Oct 2017To evaluate the effect of endometriosis on pregnancy outcomes. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To evaluate the effect of endometriosis on pregnancy outcomes.
DESIGN
Systematic review and meta-analysis.
SETTING
Not applicable.
PATIENT(S)
Women with or without endometriosis.
INTERVENTION(S)
Electronic databases searched from their inception until February 2017 with no limit for language and with all cohort studies reporting the incidence of obstetric complications in women with a diagnosis of endometriosis compared with a control group (women without a diagnosis of endometriosis) included.
MEAN OUTCOME MEASURE(S)
Primary outcome of incidence of preterm birth at <37 weeks with meta-analysis performed using the random effects model of DerSimonian and Laird to produce an odds ratio (OR) with 95% confidence interval (CI).
RESULT(S)
Twenty-four studies were analyzed comprising 1,924,114 women. In most of them, the diagnosis of endometriosis was made histologically after surgery. Women with endometriosis had a statistically significantly higher risk of preterm birth (OR 1.63; 95% CI, 1.32-2.01), miscarriage (OR 1.75; 95% CI, 1.29-2.37), placenta previa (OR 3.03; 95% CI, 1.50-6.13), small for gestational age (OR 1.27; 95% CI, 1.03-1.57), and cesarean delivery (OR 1.57; 95% CI, 1.39-1.78) compared with the healthy controls. No differences were found in the incidence of gestational hypertension and preeclampsia.
CONCLUSION(S)
Women with endometriosis have a statistically significantly higher risk of preterm birth, miscarriage, placenta previa, small for gestational age infants, and cesarean delivery.
Topics: Endometriosis; Female; Humans; Incidence; Infant, Newborn; Obstetric Labor Complications; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Reproductive Techniques, Assisted
PubMed: 28874260
DOI: 10.1016/j.fertnstert.2017.07.019 -
International Journal of Molecular... Mar 2024This systematic review delves into the connections between microRNAs and preterm labor, with a focus on identifying diagnostic and prognostic markers for this crucial... (Review)
Review
This systematic review delves into the connections between microRNAs and preterm labor, with a focus on identifying diagnostic and prognostic markers for this crucial pregnancy complication. Covering studies disseminated from 2018 to 2023, the review integrates discoveries from diverse pregnancy-related scenarios, encompassing gestational diabetes, hypertensive disorders and pregnancy loss. Through meticulous search strategies and rigorous quality assessments, 47 relevant studies were incorporated. The synthesis highlights the transformative potential of microRNAs as valuable diagnostic tools, offering promising avenues for early intervention. Notably, specific miRNAs demonstrate robust predictive capabilities. In conclusion, this comprehensive analysis lays the foundation for subsequent research, intervention strategies and improved outcomes in the realm of preterm labor.
Topics: Female; Pregnancy; Infant, Newborn; Humans; Obstetric Labor, Premature; Abortion, Spontaneous; Diabetes, Gestational; Hypertension
PubMed: 38612564
DOI: 10.3390/ijms25073755 -
Obstetrical & Gynecological Survey Apr 2018Hypothyroidism is one of the most prevalent diseases in pregnancy, but there is no consensus about its management in pregnant women. (Review)
Review
IMPORTANCE
Hypothyroidism is one of the most prevalent diseases in pregnancy, but there is no consensus about its management in pregnant women.
OBJECTIVE
In this systematic review, we evaluated the association between pregnancy complications and treated or untreated maternal hypothyroidism.
EVIDENCE ACQUISITION
PubMed and reference lists were searched for the Medical Subject Headings terms "pregnancy complications" and "hypothyroidism." The eligibility criteria for inclusion in the study were an original study published between 2002 and 2013. Six reviewers independently selected the studies, and 3 extracted the data. Two reviewers assessed the risk of bias and quality of the studies.
RESULTS
Eighteen studies were included in the systematic review. The most prevalent complications associated with maternal hypothyroidism were abortion, intrauterine fetal death, preterm delivery, and preeclampsia. The pregnancy outcome depended on the treatment that was received by the patient.
CONCLUSIONS
Strong evidence indicates that maternal hypothyroidism is associated with maternal-fetal complications, but no consensus was found among the studies reviewed herein. The dose of levothyroxine that is required to maintain euthyroidism is still questioned, but studies have suggested that levothyroxine should be adjusted according to the gestational period and laboratory profile.
Topics: Abortion, Spontaneous; Female; Fetal Death; Humans; Hypothyroidism; Infant, Newborn; Maternal-Fetal Exchange; Pre-Eclampsia; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Premature Birth; Thyroxine
PubMed: 29701867
DOI: 10.1097/OGX.0000000000000547