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Iranian Journal of Nursing and... 2022Perineal trauma is a common problem seen after vaginal delivery, which has negative effects on different aspects of women's lives. Poor skin elasticity has been... (Review)
Review
BACKGROUND
Perineal trauma is a common problem seen after vaginal delivery, which has negative effects on different aspects of women's lives. Poor skin elasticity has been introduced as a predictor of perineal trauma, and the appearance of striae gravidarum is associated with poor skin elasticity. This review aimed to determine the association between perineal trauma and striae gravidarum through a systematic review and meta-analysis.
MATERIALS AND METHODS
We searched with MeSH terms ("Perineum" AND "Lacerations" OR "Rupture" AND "Striae Distensae") and their equivalents in databases PubMed, Scopus, Science direct, Web of Science, ProQuest, Scientific Information Database (SID), Magiran, and Google Scholar search engine without time and language restrictions from the beginning of May until the beginning of September 2020. After reviewing the inclusion and exclusion criteria, and quality evaluation, ten articles were included in the systematic review, and we analyzed data of 6 articles using Stata ver 11.2.
RESULTS
The results indicated that the rate and severity of perineal trauma were directly related to the severity of striae gravidarum (OR = 8.28, 95%CI = 2.49-27.54, I = 86.64%).
CONCLUSIONS
Based on the research results, the probability of perineal trauma was higher in individuals with moderate to severe striae than those with mild or without striae; therefore, we suggest evaluating striae score in the third trimester of pregnancy as a simple and noninvasive method to predict the risk of perineal trauma during childbirth. For reducing perineal injuries in women at risk, some supportive measures such as episiotomy and perineal massage are recommended.
PubMed: 36524142
DOI: 10.4103/ijnmr.IJNMR_379_20 -
Advances in Nutrition (Bethesda, Md.) Dec 2022We studied associations between prenatal and early postnatal choline intake, brain development, and neurocognitive function of children. We conducted a systematic review... (Meta-Analysis)
Meta-Analysis
We studied associations between prenatal and early postnatal choline intake, brain development, and neurocognitive function of children. We conducted a systematic review followed by a meta-analysis and critical appraisal of human studies published from 1997 to 2021. Thirty publications were identified. The meta-analysis included 5 of 7 case-control studies studying neural tube defects (NTDs) in relation to maternal choline intakes/circulating concentrations. Low maternal choline intake/circulating concentrations were associated with a higher OR for NTDs among 1131 mothers of newborns with NTDs and 4439 control mothers (pooled estimate = 1.36; 95% CI: 1.11, 1.67). The 95% prediction intervals were 0.78, 2.36. Findings and critical evaluation of 10 publications with interventional designs showed that higher maternal choline intakes during the second half of pregnancy and early postnatal period (550 mg up to 1 g/d on top of the diet) or a child intake of 513 to 625 mg/d from supplements were safe and likely to demonstrate favorable effects on several domains of child neurocognition, such as memory, attention, and visuospatial learning versus the comparators. Findings from observational studies (n = 13) partly supported the association between maternal choline intake/serum concentrations and child neurocognition, but there was low confidence in the use of plasma choline concentrations as a choline intake marker. In conclusion, low maternal choline intakes were associated with a higher OR for NTDs. The risk could be up to 2.36-fold in some populations. Despite limitations of available trials and observational studies, higher maternal choline intake was likely to be associated with better child neurocognition/neurodevelopment. The results should be used to guide choline intake recommendations in pregnancy and lactation, especially because most young women are not achieving the reference intake of choline. This meta-analysis is registered at PROSPERO as CRD42021233790.
Topics: Pregnancy; Humans; Child; Infant, Newborn; Female; Choline; Dietary Supplements; Vitamins; Diet; Neural Tube Defects; Brain; Child Development
PubMed: 36041182
DOI: 10.1093/advances/nmac082 -
The Cochrane Database of Systematic... Mar 2017Down's syndrome occurs when a person has three copies of chromosome 21 (or the specific area of chromosome 21 implicated in causing Down's syndrome) rather than two. It... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Down's syndrome occurs when a person has three copies of chromosome 21 (or the specific area of chromosome 21 implicated in causing Down's syndrome) rather than two. It is the commonest congenital cause of mental disability. Non-invasive screening based on biochemical analysis of maternal serum or urine, or fetal ultrasound measurements, allows estimates of the risk of a pregnancy being affected and provides information to guide decisions about definitive testing. Before agreeing to screening tests, parents need to be fully informed about the risks, benefits and possible consequences of such a test. This includes subsequent choices for further tests they may face, and the implications of both false positive (i.e. invasive diagnostic testing, and the possibility that a miscarried fetus may be chromosomally normal) and false negative screening tests (i.e. a fetus with Down's syndrome will be missed). The decisions that may be faced by expectant parents inevitably engender a high level of anxiety at all stages of the screening process, and the outcomes of screening can be associated with considerable physical and psychological morbidity. No screening test can predict the severity of problems a person with Down's syndrome will have.
OBJECTIVES
To estimate and compare the accuracy of first and second trimester serum markers with and without first trimester ultrasound markers for the detection of Down's syndrome in the antenatal period, as combinations of markers.
SEARCH METHODS
We conducted a sensitive and comprehensive literature search of MEDLINE (1980 to 25 August 2011), Embase (1980 to 25 August 2011), BIOSIS via EDINA (1985 to 25 August 2011), CINAHL via OVID (1982 to 25 August 2011), the Database of Abstracts of Reviews of Effectiveness (the Cochrane Library 25 August 2011), MEDION (25 August 2011), the Database of Systematic Reviews and Meta-Analyses in Laboratory Medicine (25 August 2011), the National Research Register (Archived 2007), and Health Services Research Projects in Progress database (25 August 2011). We did not apply a diagnostic test search filter. We did forward citation searching in ISI citation indices, Google Scholar and PubMed 'related articles'. We also searched reference lists of retrieved articles SELECTION CRITERIA: Studies evaluating tests of combining first and second trimester maternal serum markers in women up to 24 weeks of gestation for Down's syndrome, with or without first trimester ultrasound markers, compared with a reference standard, either chromosomal verification or macroscopic postnatal inspection.
DATA COLLECTION AND ANALYSIS
Data were extracted as test positive/test negative results for Down's and non-Down's pregnancies allowing estimation of detection rates (sensitivity) and false positive rates (1-specificity). We performed quality assessment according to QUADAS criteria. We used hierarchical summary ROC meta-analytical methods to analyse test performance and compare test accuracy. Analysis of studies allowing direct comparison between tests was undertaken. We investigated the impact of maternal age on test performance in subgroup analyses.
MAIN RESULTS
Twenty-two studies (reported in 25 publications) involving 228,615 pregnancies (including 1067 with Down's syndrome) were included. Studies were generally high quality, although differential verification was common with invasive testing of only high risk pregnancies. Ten studies made direct comparisons between tests. Thirty-two different test combinations were evaluated formed from combinations of eight different tests and maternal age; first trimester nuchal translucency (NT) and the serum markers AFP, uE3, total hCG, free βhCG, Inhibin A, PAPP-A and ADAM 12. We looked at tests combining first and second trimester markers with or without ultrasound as complete tests, and we also examined stepwise and contingent strategies.Meta-analysis of the six most frequently evaluated test combinations showed that a test strategy involving maternal age and a combination of first trimester NT and PAPP-A, and second trimester total hCG, uE3, AFP and Inhibin A significantly outperformed other test combinations that involved only one serum marker or NT in the first trimester, detecting about nine out of every 10 Down's syndrome pregnancies at a 5% false positive rate. However, the evidence was limited in terms of the number of studies evaluating this strategy, and we therefore cannot recommend one single screening strategy.
AUTHORS' CONCLUSIONS
Tests involving first trimester ultrasound with first and second trimester serum markers in combination with maternal age are significantly better than those without ultrasound, or those evaluating first trimester ultrasound in combination with second trimester serum markers, without first trimester serum markers. We cannot make recommendations about a specific strategy on the basis of the small number of studies available.
Topics: Biomarkers; Chorionic Gonadotropin; Down Syndrome; Estriol; False Positive Reactions; Female; Humans; Inhibins; Maternal Age; Nuchal Translucency Measurement; Pregnancy; Pregnancy Trimester, First; Pregnancy Trimester, Second; Pregnancy-Associated Plasma Protein-A; Sensitivity and Specificity; alpha-Fetoproteins
PubMed: 28295159
DOI: 10.1002/14651858.CD012599 -
Acta Obstetricia Et Gynecologica... Jul 2023According to a precautionary principle, it is recommended that pregnant women and women trying to conceive abstain from alcohol consumption. In this dose-response... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
According to a precautionary principle, it is recommended that pregnant women and women trying to conceive abstain from alcohol consumption. In this dose-response meta-analysis, we aimed to examine the association between alcohol consumption and binge drinking and the risk of miscarriage in the first and second trimesters.
MATERIAL AND METHODS
The literature search was conducted in MEDLINE, Embase and the Cochrane Library in May 2022, without any language, geographic or time limitations. Cohort or case-control studies reporting dose-specific effects adjusting for maternal age and using separate risk assessments for first- and second-trimester miscarriages were included. Study quality was assessed using the Newcastle-Ottawa Scale. This study is registered with PROSPERO, registration number CRD42020221070.
RESULTS
A total of 2124 articles were identified. Five articles met the inclusion criteria. Adjusted data from 153 619 women were included in the first-trimester analysis and data from 458 154 women in the second-trimester analysis. In the first and second trimesters, the risk of miscarriage increased by 7% (odds ratio [OR] 1.07, 95% confidence interval [CI] 0.96-1.20) and 3% (OR 1.03, 95% CI 0.99-1.08) for each additional drink per week, respectively, but not to a statistically significant degree. One article regarding binge drinking and the risk of miscarriage was found, which revealed no association between the variables in either the first or second trimester (OR 0.84 [95% CI 0.62-1.14] and OR 1.04 [95% CI 0.78-1.38]).
CONCLUSIONS
This meta-analysis revealed no dose-dependent association between miscarriage risk and alcohol consumption, but further focused research is recommended. The research gap regarding miscarriage and binge drinking needs further investigation.
Topics: Pregnancy; Female; Humans; Abortion, Spontaneous; Pregnancy Trimester, Second; Binge Drinking; Alcohol Drinking; Maternal Age
PubMed: 37221907
DOI: 10.1111/aogs.14566 -
BMC Pregnancy and Childbirth Dec 2023Back pain during pregnancy is often considered as an unavoidable problem and can reduce the quality of life or disability of pregnant women. The aim of this study is to... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Back pain during pregnancy is often considered as an unavoidable problem and can reduce the quality of life or disability of pregnant women. The aim of this study is to determine the global prevalence of back pain in pregnancy based on a systematic review and meta-analysis.
METHODS
In this study, Researchers systematically searched electronic databases PubMed, Scopus, Web of Science, Embase, ScienceDirect, and Google Scholar search engines for studies until September 2023. To analyze data, the random effects model was used, and the heterogeneity of the studies was checked with the I2 index. Data analysis was performed by software (Version 2 Comprehensive Meta-Analysis).
RESULTS
In the review of 28 studies with a sample size of 12,908 people, the I heterogeneity test showed high heterogeneity (I: 98.4). Based on this, the random effects method was used to analyze the results. Therefore, the meta-analysis reported the global prevalence of back pain at 40.5 (95% CI: 33-48.4) during pregnancy. Also, according to the meta-analysis, the global prevalence of back pain in the first trimester of pregnancy is 28.3 (95%CI: 10.5-57.1), in the second trimester is 36.8 (95%CI: 30.4-43.7) and in the third trimester of pregnancy was reported as 47.8 (95% CI: 37.2-58.6).
CONCLUSION
In this meta-analysis, the overall prevalence of back pain in pregnant women was reported to be significant, so it is necessary for health policymakers to pay more attention to complications during pregnancy, in addition to increasing society's awareness of pregnant mothers, with timely diagnosis and treatment of such disorders, it can lead to improvement; and reduction in Complications caused by pregnancy and becoming more pleasant during pregnancy.
Topics: Pregnancy; Female; Humans; Low Back Pain; Prevalence; Quality of Life; Pregnant Women; Back Pain
PubMed: 38042815
DOI: 10.1186/s12884-023-06151-x -
Ultrasound in Obstetrics & Gynecology :... Dec 2017The aim of this systematic review and meta-analysis was to describe comprehensively the pattern of cardiac remodeling during normotensive human singleton pregnancy and... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The aim of this systematic review and meta-analysis was to describe comprehensively the pattern of cardiac remodeling during normotensive human singleton pregnancy and to compare it with that of pregnancy complicated by hypertension.
METHODS
We performed a meta-analysis of the current literature on cardiac remodeling during normotensive and complicated pregnancies. Literature was retrieved from PubMed (NCBI) and EMBASE (Ovid) databases. Included studies needed to report a reference measurement (matched non-pregnant control group, prepregnancy or postpartum) and measurements made during predetermined gestational-age intervals. Mean differences between reference and pregnancy data were calculated using the random-effects model described by DerSimonian and Laird.
RESULTS
Forty-eight studies were included in the meta-analysis, with publication dates ranging from 1977 to 2016. During normotensive pregnancy, most geometric indices started to increase in the second trimester. Left ventricular mass (LVM) increased by 28.36 (95% CI, 19.73-37.00) g (24%), and relative wall thickness (RWT) increased by 0.03 (95% CI, 0.02-0.05) (10%) compared with those in the reference group. During hypertensive pregnancy, LVM and RWT increased more than during normotensive pregnancy (92 (95% CI, 75.46-108.54) g (95%) and 0.14 (95% CI, 0.09-0.19) (56%), respectively).
CONCLUSIONS
During normotensive pregnancy, most cardiac geometric indices change from the second trimester onwards. Both LVM and RWT increase, by 20% and 10%, respectively, consistent with concentric rather than eccentric remodeling. Cardiac adaptation in hypertensive pregnancy deviates from that in healthy pregnancy by a greater change in LVM (95% increase from reference) and RWT (56% increase from reference). Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
Topics: Adaptation, Physiological; Echocardiography; Female; Humans; Hypertension, Pregnancy-Induced; Mothers; Pregnancy; Vascular Resistance; Ventricular Remodeling
PubMed: 28078751
DOI: 10.1002/uog.17410 -
British Medical Bulletin Sep 2023Transient bone osteoporosis (TBO) is characterized by persistent pain, loss of function, no history of trauma and magnetic resonance image (MRI) findings of bone marrow...
INTRODUCTION
Transient bone osteoporosis (TBO) is characterized by persistent pain, loss of function, no history of trauma and magnetic resonance image (MRI) findings of bone marrow edema.
SOURCE OF DATA
PubMed, Google scholar, EMABSE and Web of Science were accessed in February 2023. No time constrains were used for the search.
AREAS OF AGREEMENT
TBO is rare and misunderstood, typically affecting women during the third trimester of pregnancy or middle-aged men, leading to functional disability for 4-8 weeks followed by self-resolution of the symptoms.
AREAS OF CONTROVERSY
Given the limited evidence in the current literature, consensus on optimal management is lacking.
GROWING POINTS
This systematic review investigates current management of TBO.
AREAS TIMELY FOR DEVELOPING RESEARCH
A conservative approach leads to the resolution of symptoms and MRI findings at midterm follow-up. Administration of bisphosphonates might alleviate pain and accelerate both clinical and imaging recovery.
Topics: Male; Middle Aged; Pregnancy; Humans; Female; Osteoporosis; Magnetic Resonance Imaging; Diphosphonates; Bone Marrow Diseases; Edema
PubMed: 37328938
DOI: 10.1093/bmb/ldad012 -
Turkish Neurosurgery 2016Hemodynamic changes during pregnancy may favor the formation and rupture of intracranial aneurysms. Despite this risk, guidelines for managing intracranial aneurysms... (Review)
Review
Hemodynamic changes during pregnancy may favor the formation and rupture of intracranial aneurysms. Despite this risk, guidelines for managing intracranial aneurysms during pregnancy have not been clearly defined. The objective of this review is to describe the treatment options for pregnant women with intracranial aneurysms, and to report the maternal and fetal outcomes associated with different treatment strategies. A search of the literature was conducted using the PubMed database for the period January 1991 through June 2015. Aneurysm characteristics and management, pregnancy management, and maternal and fetal outcomes were evaluated. The most recent search was performed in June 2015. In total, 50 aneurysms (44 patients) were evaluated. Rupture was confirmed upon imaging in 36 aneurysms (72%), and most aneurysms ruptured during the third trimester (77.8%). Coil embolization was associated with a lower complication rate than clipping in patients with ruptured aneurysms (9.5% vs 23.1%). For patients with unruptured aneurysms, surgical management was associated with 31.9% fewer complications compared to no treatment. Most patients underwent Cesarean delivery (84%), and a combined neurosurgical-obstetrical procedure was used for 8 patients with ruptured aneurysms near term. Adverse outcomes were reported in 11.9% of children. Treatment of intracranial aneurysms during pregnancy is safe and effective. Furthermore, we suggest that coil embolization be considered a first line treatment over clipping for surgical management of the pregnant population. Going forward, we encourage the establishment of formal guidelines for managing intracranial aneurysms during pregnancy.
Topics: Adult; Aneurysm, Ruptured; Embolization, Therapeutic; Female; Humans; Intracranial Aneurysm; Neurosurgical Procedures; Postoperative Complications; Pregnancy; Pregnancy Complications, Cardiovascular; Treatment Outcome
PubMed: 27400091
DOI: 10.5137/1019-5149.JTN.15773-15.0 -
Journal of Affective Disorders Mar 2016Postpartum depression, now termed perinatal depression by the DSM-5, is a clinically relevant disorder reaching 15% of incidence. Although it is quite frequent and... (Review)
Review
Postpartum depression, now termed perinatal depression by the DSM-5, is a clinically relevant disorder reaching 15% of incidence. Although it is quite frequent and associated with high social dysfunction, only recently its underpinning biological pathways have been explored, while multiple and concomitant risk factors have been identified (e.g. psychosocial stress). Peripartum depression usually has its onset during the third trimester of pregnancy or in the postpartum, being one of the most common medical complications in new mothers. Purpose of the present review is to summarize the state of art of biological biomarkers involved in the pathogenesis of perinatal depression, in view of the fact that suboptimal prenatal milieu can induce permanent damage in subsequent offspring life and have a negative impact on mother-child relationship. Furthermore, parents' biological changes due to medical/psychiatric disorders or stress exposure could influence offspring life: a concept known as 'intergenerational transmission', acting by variations into gametes and the gestational uterine environment. Given the evidence that perinatal mental disorders involve risks for the mother and offspring, the search for reliable biomarkers in high-risk mothers actually represents a medical priority to prevent perinatal depression.
Topics: Biomarkers; Depression, Postpartum; Depressive Disorder, Major; Female; Humans; Pregnancy
PubMed: 26802316
DOI: 10.1016/j.jad.2016.01.027 -
Frontiers in Medicine 2022Studies evaluating the relationship between intrauterine hematoma in the first trimester and prenatal complications are conflicting.
BACKGROUND
Studies evaluating the relationship between intrauterine hematoma in the first trimester and prenatal complications are conflicting.
OBJECTIVES
To evaluate whether intrauterine hematoma identified in the first trimester in women with singleton pregnancies is associated with adverse perinatal outcomes.
SEARCH STRATEGY
A comprehensive literature search of three databases (Embase, PubMed, and Web of Science) was performed up to September 2021.
SELECTION CRITERIA
Cohort and case-control studies that have evaluated the relationship between intrauterine hematoma identified before 14 gestational weeks and the risk of prenatal complications, in women with a singleton pregnancy.
DATA COLLECTION AND ANALYSIS
Two members of our team independently assessed the studies for inclusion, collected the data of interest, and assessed the risk of bias, and calculated pooled odds ratios (ORs) using random-effects models.
MAIN RESULTS
Nine studies, including 1,132 women with intrauterine hematoma and 11,179 controls met the inclusion criteria. Intrauterine hematoma increased the risk of spontaneous abortion [OR 2.15, 95% confidence interval (CI) 1.23-3.75], preterm birth (OR 1.83, 95% CI 1.37-2.43), fetal growth restriction (OR 2.33, 95% CI 1.13-4.83) and placental abruption (OR 3.16, 95% CI 1.23-8.13). No statistically significant association was found between intrauterine hematoma and preeclampsia (OR 1.30, 95% CI 0.87-1.94).
CONCLUSION
Intrauterine hematoma in the first trimester of pregnancy increases the risk of spontaneous abortion, preterm birth, placental abruption, and fetal growth restriction.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO/.
PubMed: 35783643
DOI: 10.3389/fmed.2022.892146