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Journal of Obstetrics and Gynaecology... Oct 2020This study sought to evaluate available evidence of the safety of penicillin skin testing (PST), challenge, and desensitization in pregnancy, with efforts to improve... (Review)
Review
OBJECTIVE
This study sought to evaluate available evidence of the safety of penicillin skin testing (PST), challenge, and desensitization in pregnancy, with efforts to improve perinatal care for patients with a penicillin allergy history and mitigate the negative sequelae of unverified penicillin allergy labels.
METHODS
A systematic review of studies was conducted using Cochrane Library, Medline, EMBASE, and International Pharmaceutical Abstracts. Included were peer-reviewed studies without date restrictions, published in English or French, relating to PST, challenge, or desensitization in pregnancy. Editorials, opinion pieces, and letters were excluded. Review authors independently screened citations and full-text articles, extracted data, and conducted quality assessment. Given the heterogeneity of study designs, a narrative synthesis was conducted.
RESULTS
The search identified 1195 references, of which 18 studies met inclusion criteria. In total there were 231 patients with varying histories of penicillin allergy, the majority requiring treatment for syphilis or group B streptococcal (GBS) disease during pregnancy. Of the 203 participants who underwent PST, 83.7% had negative test results. Allergy-related reactions were rare in PST (1.5%) and challenge (0%), and although these reactions were more common in desensitization (19.7%), most were benign. Among the 231 cases, only one adverse pregnancy outcome was reported (0.4%).
CONCLUSION
This review demonstrates that the known prevalence of true penicillin allergy extends to pregnant women. PST and desensitization can be safely applied during pregnancy and are tools that should be used more frequently. Further data on the safety of challenge during pregnancy are recommended.
Topics: Anti-Bacterial Agents; Desensitization, Immunologic; Drug Hypersensitivity; Female; Humans; Penicillins; Pregnancy; Pregnancy Complications, Infectious; Skin Tests; Streptococcal Infections; Streptococcus agalactiae; Syphilis; Treponema pallidum
PubMed: 32005632
DOI: 10.1016/j.jogc.2019.11.067 -
European Journal of Obstetrics &... Sep 2023Gallstone disease is the second most common non-gynecological disease that may require surgical intervention during pregnancy. This study investigates the global... (Review)
Review
BACKGROUND
Gallstone disease is the second most common non-gynecological disease that may require surgical intervention during pregnancy. This study investigates the global prevalence of gallstones in pregnancy through a systematic review and meta-analysis.
METHODS
A systematic review and meta-analysis of studies that reported the global prevalence of gallstones in pregnancy was conducted. PubMed, Scopus, Web of Science, Embase, ScienceDirect, and Google Scholar were searched for studies published up to September 2022.
RESULTS
In a review of 31 studies with a sample size of 190,714 people, the I heterogeneity test showed high heterogeneity (I = 98.8%). Therefore, the random effects method was used to analyze the results. The prevalence of gallstones was reported as 3.6% (95% CI: 1.9-6.7%). The highest prevalence of gallstones by continent was reported in America, at 6.8% (95% CI: 4.2-10.8%). The Egger test showed no evidence of publication bias (p = 0.609).
CONCLUSION
Based on the results of this study, health policymakers should emphasize to the target community and the medical staff dealing with pregnant women the importance of screening for gallstones during pregnancy.
PubMed: 37711873
DOI: 10.1016/j.eurox.2023.100237 -
The Cochrane Database of Systematic... Oct 2015It is estimated that about 40% of pregnancies in the world are unintended and that the major part of these are unwanted. There are several reasons no or ineffective... (Review)
Review
BACKGROUND
It is estimated that about 40% of pregnancies in the world are unintended and that the major part of these are unwanted. There are several reasons no or ineffective contraception is used to prevent these pregnancies, including difficulty in obtaining contraceptives. The lactational amenorrhoea method (LAM) is a contraceptive method where the mother is informed and supported in how to use breastfeeding for contraception. LAM is available and accessible to many women.
OBJECTIVES
To assess the effectiveness of LAM, as defined in the 1988 Bellagio Consensus statement, as a contraceptive method in fully breastfeeding women, who remain amenorrheic, using pregnancy and menstruation life tables.
SEARCH METHODS
We searched MEDLINE, EMBASE, POPLINE, and LILACS to 10 October 2014; reference lists of studies; review articles; books related to LAM; published abstracts from breastfeeding, reproductive health conferences; e-mails with study coordinators.
SELECTION CRITERIA
Out of 459 potentially relevant studies, 159 investigated the risk of pregnancy during LAM or lactational amenorrhoea. Our inclusion criteria were as follows: prospective study; cases (intervention group) and, if available, controls, had to be sexually active; pregnancy had to be confirmed by physical examination or a pregnancy test. Our endpoints were life table menstruation rates and life table pregnancy rates. We included 15 studies reporting on 11 intervention groups and three control groups. We identified one additional uncontrolled study in the 2007 update and one additional controlled study in this 2015 update.
DATA COLLECTION AND ANALYSIS
Two review authors independently extracted data, resolving disagreements through discussion. We analysed the studies using narrative methods because of their heterogeneity.
MAIN RESULTS
For the primary outcome, pregnancy, two controlled studies of LAM users reported life table pregnancy rates at six months of 0.45% and 2.45%, one controlled study reported 5% pregnancies in the absence of life table rates per month, and eight uncontrolled studies of LAM users reported pregnancy rates of 0% to 7.5%. Life table pregnancy rates for fully breastfeeding women who were amenorrheic but not using any contraceptive method were 0.88% in one study and 0.9% to 1.2% (95% confidence interval 0.0 to 2.4) in a second study, depending on the definition of menstruation used. The life table menstruation rate at six months in all studies varied between 11.1% and 39.4%.
AUTHORS' CONCLUSIONS
We found no clear differences in life table pregnancy rates between women using LAM and being supported in doing so, and fully breastfeeding amenorrheic women not using any method. As the length of lactation amenorrhoea in women using LAM differed greatly between the populations studied, and was population specific, it is uncertain whether LAM extends lactational amenorrhoea.
Topics: Amenorrhea; Breast Feeding; Contraception; Contraception Behavior; Family Planning Services; Female; Humans; Lactation; Life Tables; Menstruation; Postpartum Period; Pregnancy; Pregnancy Rate
PubMed: 26457821
DOI: 10.1002/14651858.CD001329.pub2 -
Human Reproduction (Oxford, England) May 2017Are boys who are born to mothers who use analgesics during pregnancy at increased risk of cryptorchidism compared to those born to mothers who do not take analgesia? (Meta-Analysis)
Meta-Analysis Review
STUDY QUESTION
Are boys who are born to mothers who use analgesics during pregnancy at increased risk of cryptorchidism compared to those born to mothers who do not take analgesia?
SUMMARY ANSWER
In this systematic review and meta-analysis of 10 published studies, we observed only weak evidence of an association between analgesia use during pregnancy and risk of cryptorchidism in the son.
WHAT IS KNOWN ALREADY
Concentrations of analgesia relevant to human exposure have been implicated as causing endocrine disturbances in the developing foetal testis. However, when viewed collectively there appears to be conflicting evidence regarding an association between maternal use of analgesics and development of cryptorchidism.
STUDY DESIGN, SIZE, DURATION
A systematic review and meta-analysis of studies on analgesia use during pregnancy and risk of cryptorchidism was performed. The search terms used were (analges* OR paracetamol OR acetaminophen) AND (cryptorchidism OR cryptorchism OR undescended test* OR non-descended test* OR non descended test*) for the databases Ovid Medline, Embase, Scopus and Web of Science. The search included all published articles up until 23 May 2016 and no limits were set in terms of language.
PARTICIPANTS/MATERIALS, SETTING, METHODS
Abstracts were screened by one reviewer to remove irrelevant studies, with a 10% random sample of these verified by a second reviewer. The full text of all remaining papers was assessed by two reviewers. Abstracts included in the final analysis were studies which reported associations between the exposure (analgesia) and the outcome (cryptorchidism). Studies were only included if data were provided from which summary associations (odds ratios (ORs) or relative risks) and their 95% CIs could be calculated, or if summary associations were provided by the authors themselves. For each included study, two reviewers independently extracted study meta-data in line with PRISMA recommendations. We assessed study quality and potential for bias using the criteria outlined in the Newcastle-Ottawa Quality Assessment Scale, but did not determine a quality score. Two reviewers independently assessed study quality against these criteria.
MAIN RESULTS AND THE ROLE OF CHANCE
After screening 350 manuscripts, 10 were included in our review (5 case-control studies, 5 cohort studies). We observed weak evidence of an association between ever use of analgesia and risk of cryptorchidism (pooled crude OR: 1.11, 95% CI: 1.00-1.23), with case-control studies revealing a marginally stronger association (1.23, 95% CI: 0.85-1.78) than cohort studies (1.09, 95% CI: 0.97-1.22). We observed weak evidence of a dose-response relationship between increasing weeks of analgesia exposure and risk of cryptorchidism, as well as weak evidence of an effect of timing on analgesia exposure and risk of cryptorchidism. Assessment of study quality via the Newcastle-Ottawa criteria revealed little (if any) evidence of substantial bias that may have meaningfully affected a given study's results.
LIMITATIONS, REASONS FOR CAUTION
While confounding does not appear to be important, misclassification of the exposure is possibly an important source of measurement error in this context. The systematic review is open to reporting bias. Owing to scant data, no meta-analyses for two key questions (relating to dose-response and timing of exposure) could be performed. Medications were grouped based on their common effect and this offers little insight into the relation between specific types of analgesia and cryptorchidism. Finally, there are limitations in assuming that analgesia use reported by mothers is synonymous with actual intrauterine exposure.
WIDER IMPLICATIONS OF THE FINDINGS
The ubiquity of analgesia use during pregnancy makes this exposure particularly important from a population health perspective. About 9 of the 10 studies were conducted in Europe or USA, limiting generalizability of our observations. While the observations from our systematic review and meta-analysis suggest that analgesia use during pregnancy is not strongly associated with cryptorchidism development in the son, they also highlight the need for further detailed assessments of this relationship.
STUDY FUNDING/COMPETING INTEREST(S)
This study was funded by the Health Research Council of New Zealand (reference #: 14/052). The authors have no conflict of interest to declare.
REGISTRATION NUMBER
CRD42016041414.
Topics: Analgesia; Analgesics; Cryptorchidism; Female; Humans; Male; Pain Management; Pregnancy; Risk
PubMed: 28333256
DOI: 10.1093/humrep/dex047 -
BMC Cancer Apr 2021Over than one third (28-58%) of pregnancy-associated breast cancer (PABC) cases are characterized by positive epidermal growth factor receptor 2-positive (HER2)...
BACKGROUND
Over than one third (28-58%) of pregnancy-associated breast cancer (PABC) cases are characterized by positive epidermal growth factor receptor 2-positive (HER2) expression. Trastuzumab anti-HER2 monoclonal antibody is still the benchmark treatment of HER2-positive breast tumors. However, FDA has categorized Trastuzumab as a category D drug for pregnant patients with breast cancer. This systemic review aims to synthesize all currently available data of trastuzumab administration during pregnancy and provide an updated view of the effect of trastuzumab on fetal and maternal outcome.
METHODS
Eligible articles were identified by a search of MEDLINE bibliographic database and ClinicalTrials.gov for the period up to 01/09/2020; The algorithm consisted of a predefined combination of the words "breast", "cancer", "trastuzumab" and "pregnancy". This study was performed in accordance with the PRISMA guidelines.
RESULTS
A total of 28 eligible studies were identified (30 patients, 32 fetuses). In more than half of cases, trastuzumab was administered in the metastatic setting. The mean duration of trastuzumab administration during gestation was 15.7 weeks (SD: 10.8; median: 17.5; range: 1-32). Oligohydramnios or anhydramnios was the most common (58.1%) adverse event reported in all cases. There was a statistically significant decrease in oligohydramnios/anhydramnios incidence in patients receiving trastuzumab only during the first trimester (P = 0.026, Fisher's exact test). In 43.3% of cases a completely healthy neonate was born. 41.7% of fetuses exposed to trastuzumab during the second and/or third trimester were born completely healthy versus 75.0% of fetuses exposed exclusively in the first trimester. All mothers were alive at a median follow-up of 47.0 months (ranging between 9 and 100 months). Of note, there were three cases (10%) of cardiotoxicity and decreased ejection fraction during pregnancy.
CONCLUSIONS
Overall, treatment with trastuzumab should be postponed until after delivery, otherwise pregnancy should be closely monitored.
Topics: Adult; Amniotic Fluid; Antineoplastic Agents, Immunological; Antineoplastic Combined Chemotherapy Protocols; Breast Neoplasms; Cardiotoxicity; Female; Fetus; Humans; Middle Aged; Oligohydramnios; Pregnancy; Pregnancy Complications, Neoplastic; Pregnancy Trimesters; Receptor, ErbB-2; Time Factors; Trastuzumab; Young Adult
PubMed: 33902516
DOI: 10.1186/s12885-021-08162-3 -
The Journal of Maternal-fetal &... Dec 2023This study aimed to explore the effects of levothyroxine on pregnancy outcomes and thyroid function in recurrent pregnancy loss (RPL) women with subclinical... (Meta-Analysis)
Meta-Analysis Review
Effect of levothyroxine on the pregnancy outcomes in recurrent pregnancy loss women with subclinical hypothyroidism and thyroperoxidase antibody positivity: a systematic review and meta-analysis.
OBJECTIVE
This study aimed to explore the effects of levothyroxine on pregnancy outcomes and thyroid function in recurrent pregnancy loss (RPL) women with subclinical hypothyroidism (SCH) or thyroperoxidase antibody positivity (TPOAb).
METHODS
Literature search was performed from inception to 24 June 2022. The heterogeneity for each outcome was evaluated using Cochran's test and quantified with I-squared (). Pooled effect sizes were expressed as relative risk (RR) and weighted mean differences (WMD) with 95% confidence intervals (95% CIs). Stability of the results were assessed using the sensitivity analysis.
RESULTS
Fifteen eligible studies with 1911 participants were included in this meta-analysis. The pooled data showed that levothyroxine decreased premature delivery rate (RR = 0.48, 95%CI: 0.32, 0.72), miscarriage rate (RR = 0.59, 95%CI: 0.44, 0.79), premature rupture of membranes (PROM) rate (RR = 0.44, 95%CI: 0.29, 0.66), and fetal growth restriction rate (RR = 0.33, 95%CI: 0.12, 0.89) in RPL women with TPOAb. In RPL women with SCH, live birth rate was elevated (RR = 1.20, 95%CI: 1.01, 1.42) and miscarriage rate was reduced (RR = 0.65, 95%CI: 0.44, 0.97) by levothyroxine. In addition, levothyroxine substantially decreased TSH level (WMD = -0.23, 95% CI: -0.31, -0.16) and TPO level (WMD = -23.48, 95%CI: -27.50, -19.47).
CONCLUSIONS
Levothyroxine improved pregnancy outcomes and thyroid function in RPL women with TPOAb or SCH, indicating that levothyroxine may be beneficial for RPL women if TPOAb or SCH occurs. Future studies are needed to verify our findings.
Topics: Pregnancy; Female; Humans; Thyroxine; Pregnancy Outcome; Hypothyroidism; Premature Birth; Abortion, Habitual
PubMed: 37433649
DOI: 10.1080/14767058.2023.2233039 -
Reproductive Health Sep 2014Infections can impact the reproductive health of women and hence may influence pregnancy related outcomes for both the mother and the child. These infections range from... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Infections can impact the reproductive health of women and hence may influence pregnancy related outcomes for both the mother and the child. These infections range from sexually transmitted infections (STIs) to TORCHS infections to periodontal disease to systemic infections and may be transmitted to the fetus during pregnancy, labor, delivery or breastfeeding.
METHODS
A systematic review and meta-analysis of the evidence was conducted to ascertain the possible impact of preconception care for adolescents, women and couples of reproductive age on MNCH outcomes. A comprehensive strategy was used to search electronic reference libraries, and both observational and clinical controlled trials were included. Cross-referencing and a separate search strategy for each preconception risk and intervention ensured wider study capture.
RESULTS
Preconception behavioral interventions significantly declines re-infection or new STI rates by 35% (95% CI: 20-47%). Further, condom use has been shown to be the most effective way to prevent HIV infection (85% protection in prospective studies) through sexual intercourse. Intervention trials showed that preconception vaccination against tetanus averted a significant number of neonatal deaths (including those specifically due to tetanus) when compared to placebo in women receiving more than 1 dose of the vaccine (OR 0.28; 95% CI: 0.15-0.52); (OR 0.02; 95% CI: 0.00-0.28) respectively.
CONCLUSION
Preconception counseling should be offered to women of reproductive age as soon as they test HIV-positive, and conversely women of reproductive age should be screened with their partners before pregnancy. Risk assessment, screening, and treatment for specific infections should be a component of preconception care because there is convincing evidence that treatment of these infections before pregnancy prevents neonatal infections.
Topics: Female; HIV Infections; Humans; Preconception Care; Pregnancy; Pregnancy Complications, Infectious; Sexually Transmitted Diseases; Vaccination
PubMed: 25415557
DOI: 10.1186/1742-4755-11-S3-S4 -
Obesity Surgery Jun 2022The aims of this systematic review were to identify the prevalence of hypoglycemia among pregnant women treated with gastric bypass, and risk factors of hypoglycemic... (Meta-Analysis)
Meta-Analysis Review
The aims of this systematic review were to identify the prevalence of hypoglycemia among pregnant women treated with gastric bypass, and risk factors of hypoglycemic events in pregnancy. We searched MEDLINE, EMBASE, Cochrane, and Scopus databases from inception to April 6, 2021. Six studies investigating glucose metabolism in pregnancy following gastric bypass were included (n = 330). As assessed by the oral glucose tolerance test and continuous glucose monitoring, 57.6% (95% CI [40.1, 75.1]) of women with gastric bypass were exposed to hypoglycemia during pregnancy. No studies performed the mixed meal test, and no studies reported on risk factors associated with hypoglycemia. Further studies are required to determine the magnitude of hypoglycemia in these women's everyday-life using continuous glucose monitoring and mixed meal test.
Topics: Blood Glucose; Blood Glucose Self-Monitoring; Female; Gastric Bypass; Humans; Hypoglycemia; Obesity, Morbid; Pregnancy
PubMed: 35332397
DOI: 10.1007/s11695-022-06021-z -
Diabetes Research and Clinical Practice Oct 2023To assess the prevalence variation in pregnancy outcomes of the different phenotypes of gestational diabetes mellitus (GDM). (Meta-Analysis)
Meta-Analysis Review
AIMS
To assess the prevalence variation in pregnancy outcomes of the different phenotypes of gestational diabetes mellitus (GDM).
MATERIALS
Cohort, cross sectional and case control studies grouping together pregnant women with GDM, based on the results of oral glucose tolerance test(OGTT) and reporting pregnancy outcomes in each group, were included. The primary outcomes were (i)large for gestational age and ii)hypertensive disorders of pregnancy (HDP). The secondary outcomes included (i)insulin treatment, ii)admission to neonatal intensive care unit, iii)preterm birth, iv)small for gestational age and v)caesarean section. The pooled proportions of the outcomes of interest were calculated for each phenotype.
RESULTS
8 studies (n = 20.928 women with GDM) were included. The pooled prevalence of LGA, HDP and insulin treatment were 20 %, 8 % and 24 % respectively in women with abnormal fasting plasma glucose,10 %, 6 % and 9 % respectively in women with abnormal post-load plasma glucose and 14 %,14 % and 30 % in women with abnormal combined plasma glucose.
CONCLUSIONS
Pregnant women with abnormal fasting plasma glucose, present with the highest prevalence of LGA, while those with abnormal combined plasma glucose, present with the highest prevalence of HDP. Pregnant women with abnormal post-load plasma glucose present with the lowest need for insulin treatment.
Topics: Pregnancy; Female; Infant, Newborn; Humans; Diabetes, Gestational; Pregnancy Outcome; Glucose Tolerance Test; Blood Glucose; Cesarean Section; Cross-Sectional Studies; Premature Birth; Phenotype; Insulins
PubMed: 37742806
DOI: 10.1016/j.diabres.2023.110913