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Reproductive Toxicology (Elmsford, N.Y.) Aug 2014Studies have suggested that nausea and vomiting of pregnancy (NVP) may confer favorable pregnancy outcome, when compared to women not experiencing NVP. However, this was... (Review)
Review
UNLABELLED
Studies have suggested that nausea and vomiting of pregnancy (NVP) may confer favorable pregnancy outcome, when compared to women not experiencing NVP. However, this was never examined systematically.
METHODS
We systematically reviewed all human studies examining potential effects of NVP on rates of miscarriage, intrauterine growth restriction, congenital malformations, prematurity and developmental achievements.
RESULTS
Our analysis reveals a consistent favorable effect of NVP on rates of miscarriages, congenital malformations, prematurity, and developmental achievements. The effect size was clinically important for miscarriage, malformations and prematurity. In a few studies the protective effects were more prominent in women with moderate-severe NVP than among those with mild or no NVP.
CONCLUSIONS
NVP is associated with favorable fetal outcome, and therefore studies of drug exposure in pregnancy should either match their exposed and control cases for existence and severity of NVP, or adjust for these confounders in their multivariate analysis.
Topics: Female; Fetus; Humans; Nausea; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Vomiting
PubMed: 24893173
DOI: 10.1016/j.reprotox.2014.05.012 -
Pregnancy Hypertension Dec 2023Human chorionic gonadotropin (hCG), a glycoprotein produced in the placenta, is crucial for a healthy pregnancy. We investigated the relationship between hCG levels and... (Meta-Analysis)
Meta-Analysis Review
Human chorionic gonadotropin (hCG), a glycoprotein produced in the placenta, is crucial for a healthy pregnancy. We investigated the relationship between hCG levels and adverse pregnancy outcomes. We conducted a systematic review including studies measuring hCG blood levels in the first or second trimester, reporting on any of the 12 predefined adverse pregnancy outcomes with logistic regression-adjusted association estimates. The primary outcomes were placenta-associated complications, such as miscarriage, preeclampsia, intrauterine growth restriction, and preterm delivery. We searched PubMed, Embase and CINAHL Complete. The hCG levels were analysed as multiple of the median (MoM). Odds ratio (OR) and 95% confidence interval (CI) were used. Risk of bias and the certainty of evidence were assessed using ROBINS-I and GRADE, respectively. Meta-analysis also showed that hCG levels, reported as MoM ≥2/2.31/2.5, might be associated with an increased risk of preeclampsia (OR 2.08, 95% CI 1.26 to 3.44) and preterm delivery (OR 1.29, 95% CI 1.12 to 1.47), but the evidence is very uncertain. High second trimester hCG levels may be associated with preeclampsia and preterm delivery but confidence in evidence is low.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Premature Birth; Pre-Eclampsia; Pregnancy Outcome; Chorionic Gonadotropin; Abortion, Spontaneous; Pregnancy Trimester, Second
PubMed: 37951184
DOI: 10.1016/j.preghy.2023.11.003 -
Environmental Science & Technology May 2023Organophosphate flame retardants (OPFRs) are found in various environmental matrixes and human samples. Exposure to OPFRs during gestation may interfere with pregnancy,... (Review)
Review
Organophosphate flame retardants (OPFRs) are found in various environmental matrixes and human samples. Exposure to OPFRs during gestation may interfere with pregnancy, for example, inducing maternal oxidative stress and maternal hypertension during pregnancy, interfering maternal and fetal thyroid hormone secretion and fetal neurodevelopment, and causing fetal metabolic abnormalities. However, the consequences of OPFR exposure on pregnant women, impact on mother-to-child transmission of OPFRs, and harmful effects on fetal and pregnancy outcomes have not been evaluated. This review describes the exposure to OPFRs in pregnant women worldwide, based on metabolites of OPFRs (mOPs) in urine for prenatal exposure and OPFRs in breast milk for postnatal exposure. Predictors of maternal exposure to OPFRs and variability of mOPs in urine have been discussed. Mother-to-child transmission pathways of OPFRs have been scrutinized, considering the levels of OPFRs and their metabolites in amniotic fluid, placenta, deciduae, chorionic villi, and cord blood. The results showed that bis(1,3-dichloro-2-propyl) phosphate (BDCIPP) and diphenyl phosphate (DPHP) were the two predominant mOPs in urine, with detection frequencies of >90%. The estimated daily intake (EDI) indicates low risk when infants are exposed to OPFRs from breast milk. Furthermore, higher exposure levels of OPFRs in pregnant women may increase the risk of adverse pregnancy outcomes and influence the developmental behavior of infants. This review summarizes the knowledge gaps of OPFRs in pregnant women and highlights the crucial steps for assessing health risks in susceptible populations, such as pregnant women and fetuses.
Topics: Infant; Humans; Female; Pregnancy; Organophosphates; Pregnant Women; Flame Retardants; Pregnancy Outcome; Infectious Disease Transmission, Vertical; Phosphates
PubMed: 37079500
DOI: 10.1021/acs.est.2c06503 -
Thrombosis Research Sep 2019Pregnancy outcomes in women with mechanical heart valves (MHV) remain poor. The thrombogenicity of MHV, the hypercoagulable state of pregnancy and limitations of current... (Review)
Review
Pregnancy outcomes in women with mechanical heart valves (MHV) remain poor. The thrombogenicity of MHV, the hypercoagulable state of pregnancy and limitations of current anticoagulation strategies combine to give a very high risk state. Recent additions to the literature in the form of registry data as well as meta-analyses and systematic reviews have highlighted the risks of thrombotic and haemorrhagic events in mothers and increased fetal complication rates. There remains a lack of consensus about the optimal anticoagulation approach to mitigate the risks to mother and fetus and registry data confirm poor quality of care. Current guidelines recommend the sequential use of heparin and vitamin K antagonists, but low molecular weight heparin is often used throughout the pregnancy, with inadequate monitoring in many instances. There is an urgent need to standardise the management of such women, which should be undertaken in specialist centres, supported by research on optimal anticoagulation regimens and the impact on pregnancy outcomes.
Topics: Female; Heart Valve Prosthesis; Humans; Pregnancy; Pregnancy Outcome
PubMed: 31477226
DOI: 10.1016/S0049-3848(19)30365-2 -
Clinical Rheumatology Aug 2016Systemic autoimmune disorders may interfere with normal reproductive function resulting in negative outcome of pregnancy. Primary Sjögren's syndrome (pSS) is a common... (Meta-Analysis)
Meta-Analysis Review
Systemic autoimmune disorders may interfere with normal reproductive function resulting in negative outcome of pregnancy. Primary Sjögren's syndrome (pSS) is a common rheumatic disease that mostly affects females. There are many reports that this condition may increase risk of pregnancy complications and fetal loss. However, data regarding these adverse outcomes are scarce and inconclusive. We performed a systematic review and meta-analysis of available articles that assess the association between pSS and adverse pregnancy outcome. We comprehensively searched the databases of MEDLINE and EMBASE from their dates of inception to March 2016 and reviewed papers with validity criteria. A random-effects model was used to evaluate pregnancy complications in patients with pSS and healthy controls. From 20 full-text articles, 7 studies involving 544 patients and 1586 pregnancies were included in the meta-analysis. Fetal complications included spontaneous abortion, stillbirth, neonatal deaths, and intrauterine growth retardation. Compared with healthy pregnancy, patients with pSS had significantly higher chance of neonatal deaths (pooled odds ratio (OR) = 1.77, 95 % confidence interval (CI) 1.28 to 1.46, p = 0.01). However, there were no significant associations between pSS and premature birth (OR = 2.10, 95 % CI 0.59-7.46, p = 0.25), spontaneous abortion (OR = 1.46, 95 % CI 0.72-2.93, p = 0.29), artificial abortion (OR = 1.12, 95 % CI 0.52-2.61, p = 0.71), or stillbirth (OR = 1.05, 95 % CI 0.38-2.97, p = 0.92). There is an increased risk of fetal loss in pregnant patients with pSS. The presented evidence further supports multidisciplinary care for these patients to prevent complications during pregnancy.
Topics: Abortion, Spontaneous; Female; Humans; Odds Ratio; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Premature Birth; Risk Factors; Sjogren's Syndrome; Stillbirth
PubMed: 27271701
DOI: 10.1007/s10067-016-3323-9 -
Journal of Obstetric, Gynecologic, and... 2016To synthesize and critique the quantitative literature on measuring childbirth self-efficacy and the effect of childbirth self-efficacy on perinatal outcomes. (Review)
Review
OBJECTIVE
To synthesize and critique the quantitative literature on measuring childbirth self-efficacy and the effect of childbirth self-efficacy on perinatal outcomes.
DATA SOURCES
Eligible studies were identified through searches of MEDLINE, CINAHL, Scopus, and Google Scholar databases.
STUDY SELECTION
Published research articles that used a tool explicitly intended to measure childbirth self-efficacy and that examined outcomes within the perinatal period were included. All articles were in English and were published in peer-reviewed journals.
DATA EXTRACTION
First author, country, year of publication, reference and definition of childbirth self-efficacy, measurement of childbirth self-efficacy, sample recruitment and retention, sample characteristics, study design, interventions (with experimental and quasiexperimental studies), and perinatal outcomes were extracted and summarized.
DATA SYNTHESIS
Of 619 publications, 23 studies published between 1983 and 2015 met inclusion criteria and were critiqued and synthesized in this review.
CONCLUSION
There is overall consistency in how childbirth self-efficacy is defined and measured among studies, which facilitates comparison and synthesis. Our findings suggest that increased childbirth self-efficacy is associated with a wide variety of improved perinatal outcomes. Moreover, there is evidence that childbirth self-efficacy is a psychosocial factor that can be modified through various efficacy-enhancing interventions. Future researchers will be able to build knowledge in this area through (a) use of experimental and quasiexperimental design, (b) recruitment and retention of more diverse samples, (c) explicit reporting of definitions of terms (e.g., high risk), (d) investigation of interventions that increase childbirth self-efficacy during pregnancy, and (e) investigation about how childbirth self-efficacy-enhancing interventions might lead to decreased active labor pain and suffering. Exploratory research should continue to examine the potential association between higher prenatal childbirth self-efficacy and improved early parenting outcomes.
Topics: Delivery, Obstetric; Female; Humans; Infant, Newborn; Maternal Behavior; Parturition; Perinatal Care; Postpartum Period; Pregnancy; Pregnancy Outcome; Self Efficacy
PubMed: 27290918
DOI: 10.1016/j.jogn.2016.06.003 -
International Journal of Gynaecology... Feb 2022To investigate whether food insecurity is associated with adverse pregnancy outcomes such as miscarriage, stillbirth, and neonatal mortality among women in rural Malawi.
OBJECTIVE
To investigate whether food insecurity is associated with adverse pregnancy outcomes such as miscarriage, stillbirth, and neonatal mortality among women in rural Malawi.
METHODS
We analyzed data from the baseline (July 2014 to February 2015) and follow-up (January 2018 to May 2018) waves of a longitudinal study of reproductive-age women in rural Malawi. We sampled women from villages from the catchment area of a community hospital in rural Lilongwe district of Malawi using stratified cluster sampling. We classified women as food secure or insecure at baseline. Using unadjusted and adjusted log-binomial models, we used baseline data to examine the cross-sectional association between food insecurity and ever experiencing an adverse pregnancy outcome. We used baseline and follow-up data to assess the longitudinal association between food insecurity and experiencing a new adverse pregnancy outcome during follow-up. In a subgroup analysis, we repeated the longitudinal analysis after restricting the sample to women who had no adverse pregnancy outcomes at baseline.
RESULTS
We observed no significant cross-sectional association between baseline food insecurity and ever experiencing an adverse pregnancy outcome (adjusted prevalence ratio: 1.09; 95% confidence interval [CI]: 0.78-1.53). Baseline food insecurity was not associated with experiencing a new adverse pregnancy outcome during follow-up (adjusted risk ratio [aRR]: 1.14, 95% CI: 0.60-2.20) or in the subgroup analysis (aRR: 1.52, 95% CI: 0.78-2.96).
CONCLUSIONS
While food insecurity is a critical issue, in this cohort of rural Malawian women, food insecurity was not associated with adverse pregnancy outcomes.
Topics: Cross-Sectional Studies; Female; Food Insecurity; Humans; Infant, Newborn; Longitudinal Studies; Pregnancy; Pregnancy Outcome; Rural Population
PubMed: 33507564
DOI: 10.1002/ijgo.13630 -
The Journal of Maternal-fetal &... Dec 2023To review the usefulness of the sFlt-1/PlGF ratio to detect adverse pregnancy outcomes related to placental dysfunction in twin pregnancies. (Review)
Review
OBJECTIVE
To review the usefulness of the sFlt-1/PlGF ratio to detect adverse pregnancy outcomes related to placental dysfunction in twin pregnancies.
METHODS
A systematic review in Pubmed-Medline, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Web of Science, and National Guideline was performed. Studies were selected if they were published in the last 10 years, included a sample size equal to or greater than 10 twin gestations, determined the sFlt-1/PIGF ratio, and revealed the pregnancy outcome of the included patients.
RESULTS
A total of 11 studies were selected. Outcomes related to the association between sFlt-1/PlGF ratio throughout pregnancy and perinatal outcome, particularly related to placental dysfunction (early and late-onset preeclampsia and FGR), were collected. The vast majority of studies showed an increased sFlt-1/PlGF ratio in twin pregnancies complicated with preeclampsia or other adverse perinatal outcomes compared with uneventful pregnancies. The included articles revealed promising results when evaluating the usefulness of the sFlt-1/PlGF ratio to rule out preeclampsia. The scarce available data regarding FGR suggests that the sFlt-1/PlGF ratio is a promising tool for detecting this pregnancy complication. Data concerning other aspects of the sFlt-1/PlGF ratio, such as its evolution during healthy twin pregnancies or variations according to chorionicity, is limited.
CONCLUSION
The sFlt-1/PlGF ratio in twin pregnancies is useful to detect, and particularly to rule out adverse pregnancy outcomes related to placental dysfunction, such as preeclampsia or FGR.
Topics: Pregnancy; Female; Humans; Pregnancy Outcome; Pregnancy, Twin; Placenta Growth Factor; Pre-Eclampsia; Biomarkers; Vascular Endothelial Growth Factor Receptor-1; Placenta
PubMed: 37408114
DOI: 10.1080/14767058.2023.2230514 -
Journal de Gynecologie, Obstetrique Et... Dec 2014Study of epidemiology of pregnancy loss. (Review)
Review
OBJECTIVES
Study of epidemiology of pregnancy loss.
MATERIALS AND METHOD
A systematic review of the literature was performed using Pubmed and the Cochrane library databases and the guidelines from main international societies.
RESULTS
The occurrence of first trimester miscarriage is 12% of pregnancies and 25% of women. Miscarriage risk factors are ages of woman and man, body mass index greater than or equal to 25kg/m(2), excessive coffee drinking, smoking and alcohol consumption, exposure to magnetic fields and ionizing radiation, history of abortion, some fertility disorders and impaired ovarian reserve. Late miscarriage (LM) complicates less than 1% of pregnancies. Identified risk factors are maternal age, low level of education, living alone, history of previous miscarriage, of premature delivery and of previous termination of pregnancy, any uterine malformation, trachelectomy, existing bacterial vaginosis, amniocentesis, a shortened cervix and a dilated cervical os with prolapsed membranes. Fetal death in utero has a prevalence of 2% in the world and 5/1000 in France. Its main risk factors are detailed in the chapter.
Topics: Abortion, Spontaneous; Female; Fetal Death; Humans; Pregnancy; Pregnancy Outcome
PubMed: 25447360
DOI: 10.1016/j.jgyn.2014.09.011 -
European Journal of Medical Research Jun 2023Miscarriage is the most common complication of pregnancy. The most common causes of early miscarriage are chromosomal abnormalities of the embryo, maternal endocrine... (Review)
Review
Miscarriage is the most common complication of pregnancy. The most common causes of early miscarriage are chromosomal abnormalities of the embryo, maternal endocrine abnormalities, organ malformations, and abnormal immune factors. Late miscarriages are mostly caused by factors such as cervical insufficiency. However, the causes of 50% of miscarriages remain unknown. Recently, increasing attention has been given to the role of metabolic abnormalities in miscarriage. In this review, we mainly discuss the roles of four major metabolic pathways (glucose, lipid, and amino acid metabolism, and oxidation‒reduction balance) in miscarriage and the metabolism-related genes that lead to metabolic disorders in miscarriage. Depending on aetiology, the current treatments for miscarriage include hormonal and immunological drugs, as well as surgery, while there are few therapies for metabolism. Therefore, we also summarize the drugs for metabolism-related targets. The study of altered metabolism underlying miscarriage not only helps us to understand the mechanisms involved in miscarriage but also provides an important basis for clinical research on new therapies.
Topics: Female; Pregnancy; Humans; Pregnancy Outcome; Abortion, Spontaneous; Chromosome Aberrations; Metabolic Diseases
PubMed: 37355665
DOI: 10.1186/s40001-023-01161-z