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Placenta Aug 2022Fetal growth restriction (FGR) in human pregnancy is associated with perinatal mortality, short- and long-term morbidities. No prenatal therapy is currently established... (Review)
Review
Fetal growth restriction (FGR) in human pregnancy is associated with perinatal mortality, short- and long-term morbidities. No prenatal therapy is currently established despite decades of research. We aimed to review interventions in animal models for prenatal FGR treatment, and to seek the next steps for an effective clinical therapy. We registered our protocol and searched MEDLINE, Embase, and The Cochrane Library with no language restrictions, in accordance with the PRISMA guideline. We included all studies that reported the effects of any prenatal intervention in animal models of induced FGR. From 3257 screened studies, 202 describing 237 interventions were included for the final synthesis. Mice and rats were the most used animals (79%) followed by sheep (16%). Antioxidants (23%), followed by vasodilators (18%), nutrients (14%), and immunomodulators (12%) were the most tested therapy. Two-thirds of studies only reported delivery or immediate neonatal outcomes. Adverse effects were rarely reported (11%). Most studies (73%), independent of the intervention, showed a benefit in fetal survival or birthweight. The risk of bias was high, mostly due to the lack of randomization, allocation concealment, and blinding. Future research should aim to describe both short- and long-term outcomes across various organ systems in well-characterized models. Further efforts must be made to reduce selection, performance, and detection bias.
Topics: Animals; Birth Weight; Female; Fetal Growth Retardation; Humans; Mice; Pregnancy; Prenatal Care; Rats; Sheep
PubMed: 35796064
DOI: 10.1016/j.placenta.2022.06.007 -
The Cochrane Database of Systematic... Oct 2015Congenital toxoplasmosis is considered a rare but potentially severe infection. Prenatal education about congenital toxoplasmosis could be the most efficient and least... (Review)
Review
BACKGROUND
Congenital toxoplasmosis is considered a rare but potentially severe infection. Prenatal education about congenital toxoplasmosis could be the most efficient and least harmful intervention, yet its effectiveness is uncertain.
OBJECTIVES
To assess the effects of prenatal education for preventing congenital toxoplasmosis.
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 May 2015), and reference lists of relevant papers, reviews and websites.
SELECTION CRITERIA
Randomized and quasi-randomized controlled trials of all types of prenatal education on toxoplasmosis infection during pregnancy. Cluster-randomized trials were eligible for inclusion.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy.
MAIN RESULTS
Two cluster-randomized controlled trials (RCTs) (involving a total of 5455 women) met the inclusion criteria. The two included trials measured the effectiveness of the intervention in different ways, which meant that meta-analysis of the results was not possible. The overall quality of the two studies, as assessed using the GRADE approach, was low, with high risk of detection and attrition bias in both included trials.One trial (432 women enrolled) conducted in Canada was judged of low methodological quality. This trial did not report on any of the review's pre-specified primary outcomes and the secondary outcomes reported results only as P values. Moreover, losses to follow-up were high (34%, 147 out of 432 women initially enrolled). The authors concluded that prenatal education can effectively change pregnant women's behavior as it increased pet, personal and food hygiene. The second trial conducted in France was also judged of low methodological quality. Losses to follow-up were also high (44.5%, 2233 out of 5023 women initially enrolled) and differential (40% in the intervention group and 52% in the control group). The authors concluded that prenatal education for congenital toxoplasmoses has a significant effect on improving women's knowledge, whereas it has no effect on changing women's behavior. In this trial 17/3949 pregnant women seroconverted for toxoplasmosis: 13/2591 (0.5%) in the intervention group and 4/1358 (0.3%) in the control group. The rate of seroconversion detected during the study did not differ between groups (risk ratio (RR) 1.70, 95% confidence interval (CI) 0.56 to 5.21; participants = 3949; studies = one, low quality evidence). The number of events was too small to reach conclusions about the effect of prenatal education on seroconversion rate during pregnancy.No other randomized trials on the effect of prenatal education on congenital toxoplasmosis rate, or toxoplasmosis seroconversion rate during pregnancy were detected.
AUTHORS' CONCLUSIONS
Even though primary prevention of congenital toxoplasmosis is considered a desirable intervention, given the lack of related risks compared to secondary and tertiary prevention, its effectiveness has not been adequately evaluated. There is very little evidence from RCTs that prenatal education is effective in reducing congenital toxoplasmosis even though evidence from observational studies suggests it is. Given the lack of good evidence supporting prenatal education for congenital toxoplasmosis prevention, further RCTs are needed to confirm any potential benefits and to further quantify the impact of different sets of educational intervention.
Topics: Female; Humans; Hygiene; Pregnancy; Pregnancy Complications, Parasitic; Prenatal Care; Randomized Controlled Trials as Topic; Rare Diseases; Toxoplasmosis, Congenital
PubMed: 26493047
DOI: 10.1002/14651858.CD006171.pub4 -
Journal of Human Lactation : Official... Feb 2017The Ten Steps to Successful Breastfeeding outline maternity practices that protect, promote, and support breastfeeding and serve as the foundation for the Baby-Friendly... (Review)
Review
BACKGROUND
The Ten Steps to Successful Breastfeeding outline maternity practices that protect, promote, and support breastfeeding and serve as the foundation for the Baby-Friendly Hospital Initiative. Research aim: This systematic review describes interventions related to Step 3 of the Ten Steps, which involves informing pregnant women about the benefits and management of breastfeeding. Our main objective was to determine whether prenatal clinic- or hospital-based breastfeeding education increases breastfeeding initiation, duration, or exclusivity.
METHODS
The electronic databases MEDLINE and CINAHL were searched for peer-reviewed manuscripts published in English between January 1, 2000, and May 5, 2016. Bibliographies of relevant systematic reviews were also screened to identify potential studies.
RESULTS
Thirty-eight studies were included. The research studies were either randomized controlled trials or quasi-experimental studies conducted in developed or developing countries. Findings suggest that prenatal interventions, delivered alone or in combination with intrapartum and/or postpartum components, are effective at increasing breastfeeding initiation, duration, or exclusivity where they combine both education and interpersonal support and where women's partners or family are involved. However, varying study quality and lack of standardized assessment of participants' breastfeeding intentions limited the ability to recommend any single intervention as most effective.
CONCLUSION
Future studies should test the strength of maternal breastfeeding intentions, assess the role of family members in influencing breastfeeding outcomes, compare the effectiveness of different health care providers, and include more explicit detail about the time and full cost of different interventions.
Topics: Breast Feeding; Female; Health Education; Health Policy; Health Promotion; Hospitals; Humans; Infant; Infant, Newborn; Postnatal Care; Pregnancy; Prenatal Care
PubMed: 28135481
DOI: 10.1177/0890334416679618 -
International Journal of Gynaecology... Jan 2017A women-centered approach can improve the quality of patient care. (Review)
Review
BACKGROUND
A women-centered approach can improve the quality of patient care.
OBJECTIVE
To review issues in the provision of obstetric care from a patient-centered care perspective in Nigeria.
SEARCH STRATEGY
Using terms related to maternal and perinatal mortality, in combination with "Nigeria", MEDLINE, Embase, CINAHL, Web of Knowledge, and African Journal Online were searched, between December 1, 2013 and January 31, 2014, for articles in any language.
SELECTION CRITERIA
Articles published in a Nigerian setting after 2000 that investigated causes of and circumstance surrounding maternal deaths and complications, or clinical practice related to maternal care were included.
DATA COLLECTION AND ANALYSIS
Data were extracted by two reviewers using a standardized abstraction form and were analyzed from a patient-centered perspective.
MAIN RESULTS
The analysis included 57 studies. Clandestine induced abortions, lack of prenatal care, delays in seeking care, and the use of spiritual churches for delivery were found to contribute to adverse pregnancy outcomes.
CONCLUSIONS
Healthcare systems respond inadequately to patients' needs in terms of abortion care, information sharing, transitioning between prenatal and obstetric care, and patients' non-medical needs. Data from clinician-led maternal death audits provided insights into how women-centered care can be provided; nonetheless, more-focused studies from a primarily patient-centered perspective are warranted.
Topics: Abortion, Induced; Cause of Death; Delivery of Health Care; Developing Countries; Female; Humans; Maternal Death; Nigeria; Patient Acceptance of Health Care; Pregnancy; Pregnancy Outcome; Prenatal Care; Religion
PubMed: 28099713
DOI: 10.1002/ijgo.12007 -
The Journal of Allergy and Clinical... 2017Allergic diseases have seen a rise worldwide, with children suffering the highest burden. Thus, early prevention of allergic diseases is a public health priority. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Allergic diseases have seen a rise worldwide, with children suffering the highest burden. Thus, early prevention of allergic diseases is a public health priority.
OBJECTIVE
To synthesize the evidence from randomized controlled trials (RCTs) assessing the effect of vitamin interventions during pregnancy on developing allergic diseases in offspring.
METHODS
We searched CENTRAL, MEDLINE, SCOPUS, World Health Organization's International Clinical Trials Registration, E-theses, and Web of Science. Study quality was evaluated using Cochrane's risk of bias tool. Included RCTs had a minimum of 1-month follow-up postgestation.
RESULTS
A total of 5 RCTs met the inclusion criteria, including 2456 children who used vitamins C + E (1 study), vitamin C (1 study), and vitamin D (3 studies) compared with placebo/control. Two studies were judged to have a high risk of bias for performance bias or a high rate of loss to follow-up. All were rated as low risk of bias for blinding of outcome assessment. We did not perform meta-analysis with vitamin C or vitamin C + E studies due to high heterogeneity between the 2 included studies. However, we did conduct a meta-analysis with trials on vitamin D (including 1493 children) and the results showed an association between the prenatal intake of vitamin D and the risk of developing recurrent wheeze in offspring (relative risk (RR), 0.812; 95% CI, 0.67-0.98).
CONCLUSIONS
The current evidence suggests that prenatal supplementation of vitamin D might have a beneficial effect on recurrent wheezing in children. Longer-term follow-up of these studies is needed to ascertain whether this observed effect is sustained. There is lack of evidence on the effect of other vitamins for the prevention of respiratory and/or allergic outcomes.
Topics: Child; Child of Impaired Parents; Dietary Supplements; Drug Hypersensitivity; Female; Humans; Pregnancy; Prenatal Care; Randomized Controlled Trials as Topic; Vitamins
PubMed: 27888033
DOI: 10.1016/j.jaip.2016.09.024 -
Seminars in Perinatology Mar 2016Timely and appropriate response to severe hypertension during gestation is an important component of quality, safe care for pregnant or puerperal mothers regardless of... (Review)
Review
Timely and appropriate response to severe hypertension during gestation is an important component of quality, safe care for pregnant or puerperal mothers regardless of causation. The reduction of severe maternal morbidity and maternal mortality in the hypertensive mother is clearly enhanced by the addition of standard protocols for provider response to severe hypertension, particularly severe systolic hypertension. The program developed in New York State via the Safe Motherhood Initiative promotes the implementation of unit-specific safety bundles, especially one that is focused upon a standardized approach to handling the obstetric emergency of severe hypertension usually associated with preeclampsia/eclampsia. The comprehensive preeclampsia/eclampsia safety bundle as summarized by Drs. Moroz and colleagues is reviewed especially from the perspective of its focus on the timely and specific responses for health care providers to make when severe hypertension is detected in the pregnant patient. Evidence-based guidance to practice considerations and clinical care of patients with preeclampsia/eclampsia is embedded within the program outlined for New York State by Moroz and her District II ACOG colleagues. There is a central focus on timely and appropriate antepartum/postpartum management of severe hypertension, a core concept to lessen maternal risk for cerebral hemorrhage. Ten considerations for further integration into the New York program are suggested. Beyond blood pressure control, there is a need for systematic review of interventions and outcomes over time, attention to possible future variations of the protocol for racial/ethnic patient groups at highest risk for maternal morbidity and mortality, and the identification of biomarker(s) that further specify and quantify risk to the maternal brain and other organ systems when severe hypertension develops. Safer motherhood will happen when evidence for best practice is integrated into systems of care for all patients.
Topics: Female; Humans; Hypertension, Pregnancy-Induced; Maternal Mortality; New York; Patient Care Bundles; Patient Safety; Postnatal Care; Practice Guidelines as Topic; Pregnancy; Prenatal Care
PubMed: 26723235
DOI: 10.1053/j.semperi.2015.11.018 -
Journal of Obstetrics and Gynaecology... Aug 2019This study sought to examine the effect of prenatal exercise on birth outcomes in women with pre-gestational diseases, including chronic hypertension, type 1 diabetes,... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
This study sought to examine the effect of prenatal exercise on birth outcomes in women with pre-gestational diseases, including chronic hypertension, type 1 diabetes, and type 2 diabetes.
METHODS
A structured search of online databases up to June 8, 2018 was conducted. Studies of all designs and languages were included if they contained information on the population (pregnant women with pre-gestational diseases), intervention (subjective or objective measures of frequency, intensity, duration, volume, or type of exercise), comparator (no exercise or different frequency, intensity, duration, volume, or type of exercise), and outcome (birth weight, macrosomia [birth weight >4000 g], large for gestational age, low birth weight [<2500 g], small for gestational age [<10th percentile], Apgar score, preterm birth [<37 weeks], Caesarean section (CS), preeclampsia, and glycemic control).
RESULTS
A total of five studies (n = 221 women) were included. Canadian Task Classification was designated as level I. "Low" to "very low" quality evidence revealed that prenatal exercise reduced the odds of CS by 55% in women with type 1 diabetes and chronic hypertension (OR 0.45; 95% CI 0.22-0.95, I = 0%). The odds of low (<2500 g) or high (>4000 g) birth weight, Apgar score at 1 and 5 minutes, preeclampsia, and preterm birth were not different between women who exercised and those who did not.
CONCLUSION
Prenatal exercise reduced the odds of CS and did not increase the risk of adverse maternal or neonatal outcomes in mothers with pre-gestational medical conditions. Findings are based on limited evidence, thus suggesting a need for high-quality investigations on exercise in this population of women.
Topics: Adult; Diabetes, Gestational; Exercise Therapy; Female; Humans; Prediabetic State; Pregnancy; Pregnancy Outcome; Prenatal Care; Young Adult
PubMed: 30598427
DOI: 10.1016/j.jogc.2018.10.007 -
Women's Health Issues : Official... 2016Care during pregnancy is multifaceted and often goes beyond traditional prenatal care from an obstetrical care provider. Coordinating care between multiple providers can... (Review)
Review
BACKGROUND
Care during pregnancy is multifaceted and often goes beyond traditional prenatal care from an obstetrical care provider. Coordinating care between multiple providers can be challenging, but is beneficial for providers and patients. Care coordination is associated with decreased costs, greater patient satisfaction, and a reduction in medical errors. To our knowledge, no previous review has examined maternity care coordination (MCC) programs and their association with pregnancy outcomes.
METHODS
Using a search algorithm comprised of relevant MCC terminology, studies were identified through a systematic search of PubMed, Scopus, ClinicalTrials.gov, and Google Scholar. Studies meeting eligibility criteria (e.g., defining the care coordination components and examining at least one quantitative outcome) were fully abstracted and quality rated using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist.
MAIN FINDINGS
Thirty-three observational studies of MCC were included in this review. Quality scores ranged from 27% to 100%. Most studies included strategies with a team approach to decision making and/or individual case management. Social service referrals to outside organizations were also common. Twenty-seven studies reported infant birth weight as a main outcome; 12 found a significant improvement in birth weights among care coordination participants.
CONCLUSIONS
Roughly one-third of the included studies reported improved birth weights among care coordination participants. However, it remains unknown what effect care coordination strategies have on patient and provider satisfaction in the prenatal care setting, two aspects of maternity care that may advance the quality and utilization of prenatal health services.
Topics: Continuity of Patient Care; Delivery of Health Care, Integrated; Female; Humans; Infant; Infant, Newborn; Maternal Health Services; Medical Record Linkage; Pregnancy; Pregnancy Outcome; Prenatal Care; Quality Improvement; United States
PubMed: 26586143
DOI: 10.1016/j.whi.2015.10.003 -
BMC Pregnancy and Childbirth Mar 2020An accurate assessment of the adequacy of prenatal care utilization is critical to inform the relationship between prenatal care and pregnancy outcomes. This systematic...
BACKGROUND
An accurate assessment of the adequacy of prenatal care utilization is critical to inform the relationship between prenatal care and pregnancy outcomes. This systematic review critically appraises the evidence on measurement properties of prenatal care utilization indices and provides recommendations about which index is the most useful for this purpose.
METHODS
MEDLINE, EMBASE, CINAHL, and Web of Science were systematically searched from database inception to October 2018 using keywords related to indices of prenatal care utilization. No language restrictions were imposed. Studies were included if they evaluated the reliability, validity, or responsiveness of at least one index of adequacy of prenatal care utilization. We used the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. We conducted an evidence synthesis using predefined criteria to appraise the measurement properties of the indices.
RESULTS
From 2664 studies initially screened, 13 unique studies evaluated the measurement properties of at least one index of prenatal care utilization. Most of the indices of adequacy of prenatal care currently used in research and clinical practice have been evaluated for at least some form of reliability and/or validity. Evidence about the responsiveness to change of these indices is absent from these evaluations. The Adequacy Perinatal Care Utilization Index (APNCUI) and the Kessner Index are supported by moderate evidence regarding their reliability, predictive and concurrent validity.
CONCLUSION
The scientific literature has not comprehensively reported the measurement properties of commonly used indices of prenatal care utilization, and there is insufficient research to inform the choice of the best index. Lack of strong evidence about which index is the best to measure prenatal care utilization has important implications for tracking health care utilization and for formulating prenatal care recommendations.
Topics: Databases, Factual; Delivery of Health Care; Female; Humans; Patient Acceptance of Health Care; Pregnancy; Pregnancy Outcome; Prenatal Care; Psychometrics; Reproducibility of Results
PubMed: 32183724
DOI: 10.1186/s12884-020-2822-5 -
Primary Health Care Research &... Feb 2023Appropriate prenatal care (PNC) is essential for improving maternal and infant health; nevertheless, millions of women in low- and middle-income countries (LMICs) do not... (Review)
Review
BACKGROUND
Appropriate prenatal care (PNC) is essential for improving maternal and infant health; nevertheless, millions of women in low- and middle-income countries (LMICs) do not receive it properly. The objective of this review is to identify and summarize the qualitative studies that report on health system-related barriers in PNC management in LMICs.
METHODS
This systematic review was conducted in 2022. A range of electronic databases including PubMed, Web of Knowledge, CINHAL, SCOPUS, Embase, and Science Direct were searched for qualitative studies conducted in LMICs. The reference lists of eligible studies also were hand searched. The studies that reported health system-related barrier of PNC management from the perspectives of PNC stakeholders were considered for inclusion. Study quality assessment was performed applying the Critical Appraisal Skills Programme (CASP) checklist, and thematic analyses performed.
RESULTS
Of the 32 included studies, 25 (78%) were published either in or after 2013. The total population sample included 1677 participants including 629 pregnant women, 122 mothers, 240 healthcare providers, 54 key informed, 164 women of childbearing age, 380 community members, and 88 participants from other groups (such as male partners and relatives). Of 32 studies meeting inclusion criteria, four major themes emerged: (1) healthcare provider-related issues; (2) service delivery issues; (3) inaccessible PNC; and (4) poor PNC infrastructure.
CONCLUSION
This systematic review provided essential findings regarding PNC barriers in LMICs to help inform the development of effective PNC strategies and public policy programs.
Topics: Infant; Female; Pregnancy; Male; Humans; Prenatal Care; Developing Countries; Pregnant Women; Qualitative Research
PubMed: 36843095
DOI: 10.1017/S1463423622000706