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Best Practice & Research. Clinical... Jan 2021A wide range of adverse pregnancy outcomes are associated with women of advanced maternal age (AMA). These include increased risks for miscarriage, chromosomal... (Review)
Review
A wide range of adverse pregnancy outcomes are associated with women of advanced maternal age (AMA). These include increased risks for miscarriage, chromosomal abnormalities, stillbirth, foetal growth restriction, preterm birth, pre-eclampsia, gestational diabetes mellitus and caesarean section. While a wide body of literature has reported on these risks, varying definitions in both AMA and reported outcomes can make synthesizing the information difficult when counselling an individual women about her specific risks. In this chapter, we discuss the role of AMA on adverse pregnancy outcomes with a view to clarifying the magnitude of the risks for each outcome in the context to enable more informed clinical counselling and decision-making.
Topics: Cesarean Section; Female; Humans; Infant, Newborn; Maternal Age; Pregnancy; Pregnancy Outcome; Premature Birth; Stillbirth
PubMed: 32741623
DOI: 10.1016/j.bpobgyn.2020.07.005 -
Pediatric Clinics of North America Apr 2017Adolescent pregnancy, although on the decline, represents a significant public health concern. Often adolescents present late to prenatal care, either from lack of... (Review)
Review
Adolescent pregnancy, although on the decline, represents a significant public health concern. Often adolescents present late to prenatal care, either from lack of knowledge, fear of consequences, limited access, stigma, or all of the above. Although multifaceted, there are many risks both to mother and child that are increased in adolescent pregnancy. Many are unintended and are at risk for repeat adolescent pregnancy, especially within the first 2 years. Risks include but are not limited to: low birth weight, preterm delivery, stillbirth, and preeclampsia, as well as feelings of social isolation, delayed or neglected educational goals, and maternal depression.
Topics: Adolescent; Adolescent Behavior; Adolescent Health; Family Planning Services; Female; Humans; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Pregnancy in Adolescence; Prenatal Care
PubMed: 28292453
DOI: 10.1016/j.pcl.2016.11.007 -
Best Practice & Research. Clinical... Jan 2021Advanced maternal age is becoming an increasingly relevant issue in high-income developed countries. Lower fertility, greater need for assisted reproductive therapy, and... (Review)
Review
Advanced maternal age is becoming an increasingly relevant issue in high-income developed countries. Lower fertility, greater need for assisted reproductive therapy, and an increase in comorbidities, such as hypertension and diabetes, are some of the reasons for the rise in adverse maternal and fetal outcomes. This chapter reviews and summarizes the recent publications on the impact of advanced maternal age on pregnancy outcomes.
Topics: Female; Fertility; Humans; Maternal Age; Pregnancy; Pregnancy Outcome; Reproductive Techniques, Assisted
PubMed: 32773291
DOI: 10.1016/j.bpobgyn.2020.06.006 -
Journal of Perinatology : Official... May 2021To determine the effect of a maternal vegan diet on pregnancy outcome. (Observational Study)
Observational Study
OBJECTIVE
To determine the effect of a maternal vegan diet on pregnancy outcome.
STUDY DESIGN
This is a prospective observational study. Women with a singleton pregnancy who maintained the same diet prior to, and throughout current pregnancy were enrolled. Stratification was performed according to diet type: vegans, lacto-ovo-vegetarians, fish-eaters, and omnivores.
RESULTS
Overall, 273 women were enrolled, of them, 112 omnivores, 37 fish-eaters, 64 lacto-ovo-vegetarians, and 60 vegans. The vegan diet was significantly associated with an increased risk of small-for-gestational-age newborns compared only to an omnivore diet (RR = 5.9, 95% CI, 1.2-21.8). The incidence of preterm birth was similar in all groups. Vegans had lower birthweight compared to lacto-ovo-vegetarians (3015 ± 420 g vs. 3285 ± 482 g, P = 0.004), and to omnivores (3328 ± 495 g, P < 0.001), but not to fish-eaters. Vegans also had a lower mean gestational weight gain compared only to omnivores (11.6 ± 4.2 kg vs. 14.3 ± 4.6 kg, P = 0.001).
CONCLUSION
The vegan diet is associated with an increased risk for small-for-gestational-age newborns and lower birthweight.
Topics: Animals; Diet; Diet, Vegan; Diet, Vegetarian; Female; Humans; Infant, Newborn; Pregnancy; Pregnancy Outcome; Premature Birth; Vegetarians
PubMed: 32873905
DOI: 10.1038/s41372-020-00804-x -
Human Reproduction Update Jun 2022There is a wealth of information regarding interventions for treating subfertility. The majority of studies exploring interventions for improving conception rates also... (Review)
Review
BACKGROUND
There is a wealth of information regarding interventions for treating subfertility. The majority of studies exploring interventions for improving conception rates also report on pregnancy outcomes. However, there is no efficient way for clinicians, researchers, funding organizations, decision-making bodies or women themselves to easily access and review the evidence for the effect of adjuvant therapies on key pregnancy outcomes in subfertile women.
OBJECTIVE AND RATIONALE
The aim was to summarize all published systematic reviews (SRs) of randomized controlled trials (RCTs) of interventions in the subfertile population, specifically reporting on the pregnancy outcomes of miscarriage and live birth. Furthermore, we aimed to highlight promising interventions and areas that need high-quality evidence.
SEARCH METHODS
We searched the Cochrane Database of Systematic Reviews and PubMed clinical queries SR filter (inception until July 2021) with a list of key words to capture all SRs specifying or reporting any miscarriage outcome. Studies were included if they were SRs of RCTs. The population was subfertile women (pregnant or trying to conceive) and any intervention (versus placebo or no treatment) was included. We adopted Grading of Recommendations, Assessment, Development and Evaluation (GRADE) for determining the quality of the evidence. Exclusion criteria were overview reviews, reviews that exclusively reported on women conceiving via natural conception, reviews including non-randomized study designs or reviews where miscarriage or live birth outcomes were not specified or reported.
OUTCOMES
The primary outcome was miscarriage, defined as pregnancy loss <24 weeks of gestation. Data were also extracted for live birth where available. We included 75 published SRs containing 121 251 participants. There were 14 classes of intervention identified: luteal phase, immunotherapy, anticoagulants, hCG, micronutrients, lifestyle, endocrine, surgical, pre-implantation genetic testing for aneuploidies (PGT-As), laboratory techniques, endometrial injury, ART protocols, other adjuncts/techniques in the ART process and complementary interventions. The interventions with at least moderate-quality evidence of benefit in reducing risk of miscarriage or improving the chance of a live birth are: intrauterine hCG at time of cleavage stage embryo transfer, but not blastocyst transfer, antioxidant therapy in males, dehydroepiandrosterone in women and embryo medium containing high hyaluronic acid. Interventions showing potential increased risk of miscarriage or reduced live birth rate are: embryo culture supernatant injection before embryo transfer in frozen cycles and PGT-A with the use of fluorescence in situ hybridization.
WIDER IMPLICATIONS
This review provides an overview of key pregnancy outcomes from published SRs of RCTs in subfertile women. It provides access to concisely summarized information and will help clinicians and policy makers identify knowledge gaps in the field, whilst covering a broad range of topics, to help improve pregnancy outcomes for subfertile couples. Further research is required into the following promising interventions: the dose of progesterone for luteal phase support, peripheral blood mononuclear cells for women with recurrent implantation failure, glucocorticoids in women undergoing IVF, low-molecular-weight heparin for unexplained subfertility, intrauterine hCG at the time of cleavage stage embryo or blastocyst transfer and low oxygen concentrations in embryo culture. In addition, there is a need for high-quality, well-designed RCTs in the field of reproductive surgery. Finally, further research is needed to demonstrate the integrated effects of non-pharmacological lifestyle interventions.
Topics: Abortion, Spontaneous; Female; Humans; Infertility; Live Birth; Male; Pregnancy; Pregnancy Outcome; Pregnancy Rate; Systematic Reviews as Topic
PubMed: 35137098
DOI: 10.1093/humupd/dmac001 -
BJOG : An International Journal of... Jun 2021
Topics: Female; Humans; Pregnancy; Fertilization in Vitro; Live Birth; Obstetric Labor, Premature; Perinatal Mortality; Polycystic Ovary Syndrome; Pregnancy Outcome; Term Birth; Infant, Newborn
PubMed: 33960597
DOI: 10.1111/1471-0528.16721 -
Journal of Affective Disorders Jan 2018Approximately 3.3% of women in pregnancy have posttraumatic stress disorder (PTSD) and 4% of women postpartum PTSD. The impact of maternal PTSD during the perinatal... (Review)
Review
BACKGROUND
Approximately 3.3% of women in pregnancy have posttraumatic stress disorder (PTSD) and 4% of women postpartum PTSD. The impact of maternal PTSD during the perinatal period (from conception until one year postpartum) on child outcomes has not been systematically examined.
METHOD
A systematic review was conducted to synthesize and critically evaluate quantitative research investigating the association between perinatal PTSD and child outcomes. Databases EMBASE, BNI, Medline, PsycInfo and CINAHL were searched using specific inclusion and exclusion criteria.
RESULTS
26 papers reporting 21 studies were identified that examined associations between perinatal PTSD and postpartum birth outcomes, child development, and mother-infant relationship. Studies reviewed were heterogeneous, with poor-to-medium scores of methodological quality. Results showed that maternal postpartum PTSD is associated with low birth weight and lower rates of breastfeeding. Evidence for an association between maternal PTSD and preterm birth, fetal growth, head circumference, mother-infant interaction, the mother-infant relationship or child development is contradictory. Associations between maternal PTSD and infant salivary cortisol levels, and eating/sleeping difficulties are based on single studies, so require replication.
LIMITATIONS
Methodological weaknesses of the studies included insufficient sample size, use of invalidated measures, and limited external validity.
CONCLUSION
Findings suggest that perinatal PTSD is linked with some negative child outcomes. Early screening for PTSD during the perinatal period may be advisable and onward referral for effective treatment, if appropriate. Future research using larger sample sizes, validated and reliable clinical interviews to assess PTSD, and validated measures to assess a range of child outcomes, is needed.
Topics: Depression, Postpartum; Female; Humans; Infant, Low Birth Weight; Infant, Newborn; Mothers; Parturition; Postpartum Period; Pregnancy; Pregnancy Outcome; Premature Birth; Stress Disorders, Post-Traumatic
PubMed: 28777972
DOI: 10.1016/j.jad.2017.07.045 -
American Journal of Obstetrics &... Nov 2022In May 2022, the World Health Organization reported an emerging global outbreak of monkeypox virus infection. Clinical manifestations of monkeypox allow us to quickly...
In May 2022, the World Health Organization reported an emerging global outbreak of monkeypox virus infection. Clinical manifestations of monkeypox allow us to quickly suspect the disease. Until now, no pregnant women infected with this virus have been reported; however, because of its speed of spread worldwide, it is possible that we will soon observe such cases. Thus, it is necessary for obstetrician-gynecologists to know the disease, its clinical manifestations, and the experiences reported in the few previous cases in pregnant women.
Topics: Female; Humans; Pregnancy; Health Personnel; Mpox (monkeypox); Premature Birth; Stillbirth; Abortion, Spontaneous; Pregnancy Complications, Infectious; Pregnancy Outcome
PubMed: 36084787
DOI: 10.1016/j.ajogmf.2022.100746 -
Clinical Obstetrics and Gynecology Mar 2022As of November, 2021 there have been more than 250 million coronavirus disease-2019 (COVID-19) cases worldwide and more than 5 million deaths. Obstetric patients have... (Review)
Review
As of November, 2021 there have been more than 250 million coronavirus disease-2019 (COVID-19) cases worldwide and more than 5 million deaths. Obstetric patients have been a population of interest given that they may be at risk of more severe infection and adverse pregnancy outcomes. The purpose of this review is to assess current epidemiology and outcomes research related to COVID-19 for the obstetric population. This review covers the epidemiology of COVID-19, symptomatology, transmission, and current knowledge gaps related to outcomes for the obstetric population.
Topics: COVID-19; Female; Humans; Pregnancy; Pregnancy Outcome; SARS-CoV-2
PubMed: 35045034
DOI: 10.1097/GRF.0000000000000674 -
Best Practice & Research. Clinical... Mar 2022Medically-indicated deliveries are common in twin pregnancies given the increased risk of various obstetric complications in twin compared to singleton pregnancies,... (Review)
Review
Medically-indicated deliveries are common in twin pregnancies given the increased risk of various obstetric complications in twin compared to singleton pregnancies, mainly hypertensive disorders of pregnancy and foetal growth restriction. Due to the unique characteristics of twin pregnancies, the success rates and safety of labour induction may be different than in singleton pregnancies. However, while there are abundant data regarding induction of labour in singleton pregnancies, the efficacy and safety of labour induction in twin pregnancies have been far less studied. In the current manuscript we summarize available data on various aspects of labour induction in twin pregnancies including incidence, success rate, prognostic factors, safety and methods for labour induction in twins. This information may assist healthcare providers in counselling patients with twin pregnancies when labour induction is indicated.
Topics: Female; Fetal Growth Retardation; Humans; Labor, Induced; Labor, Obstetric; Pregnancy; Pregnancy Outcome; Pregnancy, Twin; Twins
PubMed: 34844886
DOI: 10.1016/j.bpobgyn.2021.10.001