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JAMA Network Open Nov 2023Exome sequencing (ES) has been established as the preferred first line of diagnostic testing for certain neurodevelopmental disorders, such as global developmental delay... (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Exome sequencing (ES) has been established as the preferred first line of diagnostic testing for certain neurodevelopmental disorders, such as global developmental delay and autism spectrum disorder; however, current recommendations are not specific to or inclusive of congenital hydrocephalus (CH).
OBJECTIVE
To determine the diagnostic yield of ES in CH and whether ES should be considered as a first line diagnostic test for CH.
DATA SOURCES
PubMed, Cochrane Library, and Google Scholar were used to identify studies published in English between January 1, 2010, and April 10, 2023. The following search terms were used to identify studies: congenital hydrocephalus, ventriculomegaly, cerebral ventriculomegaly, primary ventriculomegaly, fetal ventriculomegaly, prenatal ventriculomegaly, molecular analysis, genetic cause, genetic etiology, genetic testing, exome sequencing, whole exome sequencing, genome sequencing, microarray, microarray analysis, and copy number variants.
STUDY SELECTION
Eligible studies included those with at least 10 probands with the defining feature of CH and/or severe cerebral ventriculomegaly that had undergone ES. Studies with fewer than 10 probands, studies of mild or moderate ventriculomegaly, and studies using genetic tests other than ES were excluded. A full-text review of 68 studies was conducted by 2 reviewers. Discrepancies were resolved by consensus.
DATA EXTRACTION AND SYNTHESIS
Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and Meta-Analysis of Observational Studies in Epidemiology guidelines were used by 2 reviewers to extract data. Data were synthesized using a random-effects model of single proportions. Data analysis occurred in April 2023.
MAIN OUTCOMES AND MEASURES
The primary outcome was pooled diagnostic yield. Additional diagnostic yields were estimated for specific subgroups on the basis of clinical features, syndromic presentation, and parental consanguinity. For each outcome, a 95% CI and estimate of interstudy heterogeneity (I2 statistic) was reported.
RESULTS
From 498 deduplicated and screened records, 9 studies with a total of 538 CH probands were selected for final inclusion. The overall diagnostic yield was 37.9% (95% CI, 20.0%-57.4%; I2 = 90.1). The yield was lower for isolated and/or nonsyndromic cases (21.3%; 95% CI, 12.8%-31.0%; I2 = 55.7). The yield was higher for probands with reported consanguinity (76.3%; 95% CI, 65.1%-86.1%; I2 = 0) than those without (16.2%; 95% CI, 12.2%-20.5%; I2 = 0).
CONCLUSIONS AND RELEVANCE
In this systematic review and meta-analysis of the diagnostic yield of ES in CH, the diagnostic yield was concordant with that of previous recommendations for other neurodevelopmental disorders, suggesting that ES should also be recommended as a routine diagnostic adjunct for patients with CH.
Topics: Female; Pregnancy; Humans; Autism Spectrum Disorder; Exome Sequencing; Pathology, Molecular; Patients; Hydrocephalus
PubMed: 37991765
DOI: 10.1001/jamanetworkopen.2023.43384 -
Reproductive Health Nov 2020Postnatal depression is among the common mental health problems that occur during the postnatal period. However, it is left undiagnosed in low- and middle-income... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Postnatal depression is among the common mental health problems that occur during the postnatal period. However, it is left undiagnosed in low- and middle-income countries including Ethiopia. Therefore, this systematic review and meta-analysis aimed to systematically summarize the available evidence on the epidemiology of postnatal depression in Ethiopia and suggest recommendations for future clinical practice.
METHODS
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed to conduct this systematic review and meta-analysis. We searched PubMed, SCOPUS, EMBASE and Google Scholar databases for the relevant articles that assessed the prevalence of postnatal depression in Ethiopia. We used a random-effect model to conduct a meta-analysis. We conducted a subgroup and sensitivity analysis to explore the source of heterogeneity. Cochrane Q- and the I-test were used to check the heterogeneity of the included studies. The presence of publication bias was also checked by visual inspection of symmetry and Egger's test.
RESULTS
The pooled estimated prevalence of postnatal depression in Ethiopia was 20.1% (95% CI 12.7-30.2). The pooled prevalence of postnatal depression in the studies that were conducted in community settings and used the Patient Health Questionnaire to assess postnatal depression [16.6% (95% CI 8.90-28.99)] was lower than the prevalence in studies based in institutions and that used the Edinburgh Postnatal Depression Scale [23.2% (95% CI 14.50-28.5)]. Further, in a leave-one-out sensitivity analysis the prevalence of postnatal depression ranges between 15.4% and 25.4%. Unplanned pregnancy [AOR = 3.46, 95% CI (2.37-5.04)], age between 15-24 years [AOR = 1.72, 95% CI (1.11-2.68)], marital problems [AOR = 3.07, 95% CI (2.36-3.99)], experiencing the death of infant [AOR = 3.41, 95% CI (1.91-6.09)] and history of substance use [AOR = 3.47, 95% CI (2.17-5.56)] were associated with the increased odds of postnatal depression in Ethiopia.
CONCLUSION
The prevalence of postnatal depression in Ethiopia was high. Therefore, the concerned body should give due attention to improve reproductive health services through early detection of risk factors of postnatal depression.
Topics: Adolescent; Adult; Depression, Postpartum; Domestic Violence; Ethiopia; Female; Humans; Interpersonal Relations; Pregnancy; Pregnancy Complications; Pregnancy, Unplanned; Prevalence; Risk Factors; Social Support; Socioeconomic Factors; Young Adult
PubMed: 33213434
DOI: 10.1186/s12978-020-01035-1 -
Annals of Palliative Medicine Apr 2022In recent years, the detection rate of pregnancy complicated with hypothyroidism [subclinical hypothyroidism (SCH) during pregnancy] has increased significantly.... (Meta-Analysis)
Meta-Analysis
Systematic review and meta-analysis of the efficacy and pregnancy outcomes of levothyroxine sodium tablet administration in pregnant women complicated with hypothyroidism.
BACKGROUND
In recent years, the detection rate of pregnancy complicated with hypothyroidism [subclinical hypothyroidism (SCH) during pregnancy] has increased significantly. Levothyroxine sodium tablet is the main drug for the treatment of SCH during pregnancy, but its effect on the treatment of SCH during pregnancy and the effect of pregnancy outcome are still controversial.
METHODS
PubMed, Web of Science, Medline, and Embase databases were screened to retrieve clinical studies on levothyroxine sodium tablets in the treatment of pregnancy complicated with hypothyroidism from the date of establishment to June 2021. Meta-analysis was performed with RevMan5.3 software. The differences in the incidence of preterm birth, miscarriage, gestational hypertension, postpartum hemorrhage, placental abruption, and abnormal neonatal weight were compared between the observation group and the control group. Heterogeneity of results was assessed with chi-square test and I2 in RevMan5.3 software.
RESULTS
Nine articles with a total of 2,873 pregnant women were included. The Cochrane assessments were all grade B and above, and the Jadad scale scores were all >3 points. The incidences of preterm birth, abortion, postpartum hemorrhage, and low birth weight infants in the pregnant women treated with levothyroxine sodium were lower than those in the control group [odds ratio (OR) =0.42, 0.34, 0.40, and 0.08, respectively; 95% confidence interval (CI): 0.30-0.58, 0.23-0.52, 0.22-0.74, and 0.01-0.51, respectively; Z=5.23, 5.08, 2.97, and 2.70, respectively; P<0.00001, <0.00001, =0.003, and =0.007, respectively].
DISCUSSION
Levothyroxine sodium in the treatment of SCH can significantly reduce the incidence of premature birth, miscarriage, postpartum hemorrhage, and low birth weight infants. Due to the limited number of included studies, it remained to be further verified whether levothyroxine sodium treatment in SCH patients would affect the incidence of gestational hypertension.
Topics: Abortion, Spontaneous; Female; Humans; Hypertension, Pregnancy-Induced; Hypothyroidism; Infant, Newborn; Placenta; Postpartum Hemorrhage; Pregnancy; Pregnancy Outcome; Pregnant Women; Premature Birth; Sodium; Tablets; Thyroxine
PubMed: 35523752
DOI: 10.21037/apm-22-269 -
Environmental Pollution (Barking, Essex... Mar 2024Exposure to toxic metals is a global public health threat. Among other adverse effects, exposure to the heavy metal cadmium has been associated with greater risk of... (Meta-Analysis)
Meta-Analysis Review
Exposure to toxic metals is a global public health threat. Among other adverse effects, exposure to the heavy metal cadmium has been associated with greater risk of cardiovascular disease (CVD). Nonetheless, the shape of the association between cadmium exposure and CVD risk is not clear. This systematic review summarizes data on the association between cadmium exposure and risk of CVD using a dose-response approach. We carried out a literature search in PubMed, Web of Science, and Embase from inception to December 30, 2023. Inclusion criteria were: studies on adult populations, assessment of cadmium exposure, risk of overall CVD and main CVD subgroups as endpoints, and observational study design (cohort, cross-sectional, or case-control). We retrieved 26 eligible studies published during 2005-2023, measuring cadmium exposure mainly in urine and whole blood. In a dose-response meta-analysis using the one-stage method within a random-effects model, we observed a positive association between cadmium exposure and risk of overall CVD. When using whole blood cadmium as a biomarker, the association with overall CVD risk was linear, yielding a risk ratio (RR) of 2.58 (95 % confidence interval-CI 1.78-3.74) at 1 μg/L. When using urinary cadmium as a biomarker, the association was linear until 0.5 μg/g creatinine (RR = 2.79, 95 % CI 1.26-6.16), after which risk plateaued. We found similar patterns of association of cadmium exposure with overall CVD mortality and risks of heart failure, coronary heart disease, and overall stroke, whereas for ischemic stroke there was a positive association with mortality only. Overall, our results suggest that cadmium exposure, whether measured in urine or whole blood, is associated with increased CVD risk, further highlighting the importance of reducing environmental pollution from this heavy metal.
Topics: Adult; Humans; Cardiovascular Diseases; Cadmium; Cross-Sectional Studies; Metals, Heavy; Biomarkers; Observational Studies as Topic
PubMed: 38295933
DOI: 10.1016/j.envpol.2024.123462 -
BMJ Open Apr 2022To determine the accuracy of metabolomics in predicting hypertensive disorders in pregnancy.
OBJECTIVE
To determine the accuracy of metabolomics in predicting hypertensive disorders in pregnancy.
DESIGN
Systematic review of observational studies.
DATA SOURCES AND STUDY ELIGIBILITY CRITERIA
An electronic literature search was performed in June 2019 and February 2022. Two researchers independently selected studies published between 1998 and 2022 on metabolomic techniques applied to predict the condition; subsequently, they extracted data and performed quality assessment. Discrepancies were dealt with a third reviewer. The primary outcome was pre-eclampsia. Cohort or case-control studies were eligible when maternal samples were taken before diagnosis of the hypertensive disorder.
STUDY APPRAISAL AND SYNTHESIS METHODS
Data on study design, maternal characteristics, how hypertension was diagnosed, metabolomics details and metabolites, and accuracy were independently extracted by two authors.
RESULTS
Among 4613 initially identified studies on metabolomics, 68 were read in full text and 32 articles were included. Studies were excluded due to duplicated data, study design or lack of identification of metabolites. Metabolomics was applied mainly in the second trimester; the most common technique was liquid-chromatography coupled to mass spectrometry. Among the 122 different metabolites found, there were 23 amino acids and 21 fatty acids. Most of the metabolites were involved with ammonia recycling; amino acid metabolism; arachidonic acid metabolism; lipid transport, metabolism and peroxidation; fatty acid metabolism; cell signalling; galactose metabolism; nucleotide sugars metabolism; lactose degradation; and glycerolipid metabolism. Only citrate was a common metabolite for prediction of early-onset and late-onset pre-eclampsia. Vitamin D was the only metabolite in common for pre-eclampsia and gestational hypertension prediction. Meta-analysis was not performed due to lack of appropriate standardised data.
CONCLUSIONS AND IMPLICATIONS
Metabolite signatures may contribute to further insights into the pathogenesis of pre-eclampsia and support screening tests. Nevertheless, it is mandatory to validate such methods in larger studies with a heterogeneous population to ascertain the potential for their use in clinical practice.
PROSPERO REGISTRATION NUMBER
CRD42018097409.
Topics: Case-Control Studies; Female; Humans; Hypertension, Pregnancy-Induced; Mass Spectrometry; Metabolomics; Pre-Eclampsia; Pregnancy
PubMed: 35470187
DOI: 10.1136/bmjopen-2021-054697 -
Bioscience Reports Jan 2020Endocan, a novel protein involved in inflammation and endothelial dysfunction, has been suggested to be related to preeclampsia, although the results of previous studies... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Endocan, a novel protein involved in inflammation and endothelial dysfunction, has been suggested to be related to preeclampsia, although the results of previous studies were not consistent. The aim of the study was to evaluate the potential difference of circulating endocan in women with preeclampsia and those with normal pregnancy.
METHODS
Matched case-control studies evaluating the difference of circulating endocan between women with preeclampsia and those with normal pregnancy were identified via systematic search of PubMed and Embase databases. A random-effect model or a fixed-effect model was used to pool the results according to the heterogeneity. Subgroup analysis was performed to evaluate whether the timing of preeclampsia onset affected the outcome.
RESULTS
Overall, eight matched case-control studies, including 451 women with preeclampsia and 442 women with normal pregnancy were included. Significant heterogeneity was detected among the included studies (P for Cochrane's Q test = 0.006, I2 = 65%). Meta-analysis with a random-effect model showed that women with preeclampsia had significantly higher circulating level of endocan compared with women with normal pregnancy (standardized mean difference = 0.37, 95% confidence interval: 0.13-0.62, P = 0.003). Subsequent subgroup analyses showed that the difference of circulating endocan between women with early onset preeclampsia and those with normal pregnancy was not statistically different from that between women with late-onset preeclampsia and those with normal pregnancy (P for subgroup difference = 0.81).
CONCLUSIONS
Women with preeclampsia have higher circulating endocan than those with normal pregnancy.
Topics: Adult; Biomarkers; Blood Pressure; Case-Control Studies; Female; Humans; Neoplasm Proteins; Pre-Eclampsia; Pregnancy; Proteoglycans; Up-Regulation; Young Adult
PubMed: 31854443
DOI: 10.1042/BSR20193219 -
The Pan African Medical Journal 2022thrombocytopenia is a common hematological disorder during pregnancy next to anemia. Pregnant women with thrombocytopenia have complications of excessive bleeding during... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
thrombocytopenia is a common hematological disorder during pregnancy next to anemia. Pregnant women with thrombocytopenia have complications of excessive bleeding during or after childbirth, cesarean section incision site oozing, stillbirth and neonatal thrombocytopenia. Findings on the magnitude of thrombocytopenia among pregnant women were inconsistent. Therefore, this review aimed to estimate the pooled prevalence of thrombocytopenia among pregnant women in Africa.
METHODS
this systematic review and meta-analysis were performed based on PRISMA guidelines. The databases (PubMed, PubMed Central, Hinari, Science Direct, Pop line, Google Scholar, and African Journals Online) were searched to identify relevant studies. Data were analyzed using STATA 11 statistical software. A random-effect model was fitted to estimate the pooled prevalence of thrombocytopenia. I test statistics were done to test the heterogeneity of included studies. Funnel plots analysis and Egger weighted regression tests were done to detect publication bias.
RESULTS
of the total 1,517 articles retrieved, 15 articles which involved 8,380 pregnant women were eligible for meta-analysis. The overall pooled prevalence of thrombocytopenia among pregnant women in Africa was 10.23% (95% confidence interval (CI): 7.44, 13.02%). Its level of severity showed that, 77.95% (I=43.1%), 15.62% (I=53.4%), and 5.60 (I=0.0%) of pregnant women had mild, moderate and severe thrombocytopenia, respectively. The highest prevalence of thrombocytopenia was occurred in the third trimester of pregnancy (54.05% (95% CI: 29.48, 78.61)).
CONCLUSION
this systematic review and meta-analysis showed that the pooled prevalence of thrombocytopenia among pregnant women in Africa was found to be relatively higher compared with the globe. Therefore, routine screening and follow-up programs are needed to identify pregnant women with thrombocytopenia and provide them with the necessary interventions.
Topics: Africa; Anemia; Cesarean Section; Ethiopia; Female; Humans; Infant, Newborn; Pregnancy; Pregnant Women; Prevalence; Thrombocytopenia
PubMed: 35865846
DOI: 10.11604/pamj.2022.41.334.30175 -
BMC Pregnancy and Childbirth Oct 2023A meta-analysis has compared the pregnancy outcomes between women with and without RA, while the effect of disease severity on pregnancy outcomes within women with RA... (Meta-Analysis)
Meta-Analysis
BACKGROUND
A meta-analysis has compared the pregnancy outcomes between women with and without RA, while the effect of disease severity on pregnancy outcomes within women with RA has not been explored. Therefore, we performed a systematic review and meta-analysis to assess the association between disease activity of RA and pregnancy outcomes.
METHODS
Four English databases (Pubmed, Embase, Cochrane Library, and Web of Science) and three Chinese databases (China National Knowledge Infrastructure [CNKI], VIP, and Wan Fang) was searched for eligible studies up to August 13, 2023. Cochran's Q test and the I statistic were used to assess the heterogeneity of the included studies. The odds ratio (OR) (for counting data) and weighted mean difference (WMD) (for measurement data) were calculated with 95% confidence intervals (95%CIs) using random-effect model (I ≥ 50%) or fixed-effect model (I < 50%). Subgroup analysis based on study design and regions was used to explore the sources of heterogeneity. Sensitivity analysis was performed for all outcomes and the publication bias was assessed using Begg's test.
RESULTS
A total of 41 eligible articles were finally included. RA women had higher odds to suffer from preeclampsia, gestational diabetes, spontaneous abortion, and cesarean delivery (all P < 0.05). The infants born from RA mother showed the higher risk of stillbirth, SGA, LBW, congenital abnormalities, diabetes type 1, and asthma (all P < 0.05). The high disease activity of RA was significantly associated with the higher risk of cesarean delivery (OR: 2.29, 95%CI: 1.02-5.15) and premature delivery (OR: 5.61, 95%CI: 2.20-14.30).
CONCLUSIONS
High disease activity of RA was associated with the high risk of adverse pregnancy outcomes, suggesting that it was important to control disease for RA women with high disease activity who prepared for pregnancy.
Topics: Infant; Pregnancy; Female; Humans; Pregnant Women; Pregnancy Outcome; Stillbirth; Pregnancy Complications; Arthritis, Rheumatoid
PubMed: 37821885
DOI: 10.1186/s12884-023-06033-2 -
PloS One 2022In Ethiopia limited information is available regarding the prevalence and predictors of anemia in pregnancy. This systematic review and meta-analysis estimated the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
In Ethiopia limited information is available regarding the prevalence and predictors of anemia in pregnancy. This systematic review and meta-analysis estimated the pooled prevalence of anemia among pregnant women in Ethiopia and also identified its predictors.
MATERIALS AND METHODS
The published primary studies were searched in the following electronic databases; PubMed/Medline, Google scholars, AJOL, and EMBASE. All primary studies published from 01/01/2010 to 30/05/2020 and written in English language were included without restriction on study setting and design. Critical appraisal of all available articles was done and extracted data was analyzed using STATA software version 14. The pooled prevalence of anemia was presented using a forest plot. The I2 statistical test for heterogeneity, and the Egger's and Begg's tests for publication bias were used. The relative risk was used to assess the association of predictor variables with anemia.
RESULT
After screening 274 articles, sixty studies were included in the analysis. The pooled prevalence of anemia among pregnant women was 26.4(95% CI: 23.1, 29.6). Sub-group analysis showed higher pooled prevalence from community-based studies than institutional-based studies. Factors that were protective against maternal anemia included urban residence, formal education and smaller family size. Short birth interval and not having antenatal care (ANC) are associated with a higher risk of maternal anemia. Women with low dietary diversity [RR: 2.61(95% CI, 1.85, 3.68)], mid-upper arm circumference (MUAC) less than 23 cm [RR: 2.35(95% CI, 1.53, 3.68)] and those not taking iron-folic acid [RR: 1.53(95% CI: 1.30, 1.81)] also had a higher risk of anemia.
CONCLUSION
Almost one in four pregnant women in Ethiopia had anemia. Being literate, living in urban areas with small family size and adequate birth spacing, as well as good dietary diversity are associated with a lower risk of anemia in pregnancy.
REGISTRATION NUMBER
(ID: CRD42020211054).
Topics: Anemia; Ethiopia; Female; Humans; Pregnancy; Pregnant Women; Prenatal Care; Prevalence
PubMed: 35895619
DOI: 10.1371/journal.pone.0267005 -
Oncology and Therapy Jun 2022Based on the available data on ovarian cancer during pregnancy, we performed a review and meta-analysis to evaluate the efficacy and safety of platinum-based... (Review)
Review
INTRODUCTION
Based on the available data on ovarian cancer during pregnancy, we performed a review and meta-analysis to evaluate the efficacy and safety of platinum-based chemotherapy against ovarian cancer during pregnancy.
METHODS
We systematically searched three databases including the PubMed, Embase, and Cochrane Library databases for articles published from January 1986 to December 2020 using the following terms: "ovarian tumors OR ovarian carcinoma OR adnexal masses OR ovarian cancer" AND "pregnancy" AND "chemotherapy." Two authors (Yaping Pei and Yuanfeng Gou) independently searched the literature and extracted data from each eligible study. The outcome measures were overall survival (OS) and progression-free survival (PFS). The OS and PFS of all patients were estimated by Kaplan-Meier survival curves and log-rank tests.
RESULTS
A total of 43 studies including 55 cases of ovarian cancer during pregnancy were selected. Forty-eight patients were comprehensively staged using the International Federation of Gynecology and Obstetrics (FIGO) staging system. Twenty-six of the 48 patients (54.17%) were diagnosed with early-stage disease, while the remaining had advanced stages (II, III, and IV). The mean age at diagnosis was 29.31 years. The majority of patients in this meta-analysis were diagnosed at a mean gestational age of 16.05 weeks. The mean GA at chemotherapy administration was 17.42 weeks. Overall, 55 women gave birth to 56 newborns, including a pair of twins. At the end of follow-up (median 10 months, range 0-73 months), all the children were healthy, except for one child who died 5 days after delivery due to a congenital abnormality. During 2-204 months of follow-up, there were five cases of recurrence, with no evidence of recurrence in the remaining cases. Unfortunately, one patient died 29 months after diagnosis. Neither median overall survival nor median progression-free survival was obtained.
CONCLUSION
Platinum-based chemotherapy may be a good choice for pregnant women with ovarian cancer who want to continue their pregnancy.
PubMed: 34865206
DOI: 10.1007/s40487-021-00179-9