-
American Journal of Obstetrics and... Aug 2023This study aimed to describe the characteristics of fetal demise after SARS-CoV-2 infections and clarify whether it is associated with clinical severity, placental... (Review)
Review
OBJECTIVE
This study aimed to describe the characteristics of fetal demise after SARS-CoV-2 infections and clarify whether it is associated with clinical severity, placental lesions, or malformations or due to actual fetal infections.
DATA SOURCES
PubMed and Web of Science databases were searched between December 1, 2019, and April 30, 2022.
STUDY ELIGIBILITY CRITERIA
Cohort, cross-sectional, and case-control studies and case series or case reports describing stillbirths or late miscarriages (ie, pregnancy loss occurring between 14 and 22 weeks of gestation, before and after the onset of labor) from mothers with SARS-CoV-2 infection during pregnancy (demonstrated by at least 1 positive real-time reverse transcription-polymerase chain reaction from nasopharyngeal swabs and/or SARS-CoV-2 placental infection). No language restriction was applied; cases with other causes possibly explaining the fetal demise were excluded.
METHODS
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-analysis Of Observational Studies in Epidemiology guidelines were followed. The quality of the case series and case reports was evaluated using the specific Mayo Clinic Evidence-Based Practice Center tool. Maternal and clinical fetal data and placental and fetal virology and histology findings were collected. Data were summarized with descriptive statistics using the World Health Organization criteria to classify disease severity and fetal-neonatal infections.
RESULTS
Data from 184 mothers and 190 fetuses were analyzed. No clear link to maternal clinical severity or fetal malformation was evident. Approximately 78% of fetal demise cases occurred during the second and third trimesters of pregnancy, approximately 6 to 13 days after the diagnosis of SARS-CoV-2 infection or the onset of symptoms. Most placentas (88%) were positive for SARS-CoV-2 or presented the histologic features of placentitis (massive fibrin deposition and chronic intervillositis) previously observed in transplacentally transmitted infections (85%-91%). Of note, 11 fetuses (5.8%) had a confirmed in utero transmitted SARS-CoV-2 infection, and 114 fetuses (60%) had a possible in utero transmitted SARS-CoV-2 infection.
CONCLUSION
The synthesis of available data showed that fetal demise generally occurs a few days after the infection with histologic placental inflammatory lesions associated with transplacental SARS-CoV-2 transmission and eventually causing placental insufficiency.
Topics: Female; Humans; Infant, Newborn; Pregnancy; Abortion, Spontaneous; COVID-19; Cross-Sectional Studies; Fetal Death; Infectious Disease Transmission, Vertical; Placenta; Pregnancy Complications, Infectious; SARS-CoV-2; Stillbirth
PubMed: 36706855
DOI: 10.1016/j.ajog.2023.01.019 -
Reproductive Toxicology (Elmsford, N.Y.) Sep 2023There is emerging evidence suggesting that folate status during pregnancy may play a role in fetal programming of metabolic disease. Therefore, this systematic review... (Review)
Review
There is emerging evidence suggesting that folate status during pregnancy may play a role in fetal programming of metabolic disease. Therefore, this systematic review aims to summarize and systematize the current evidence surrounding the relationship between maternal folate status during pregnancy and offspring metabolic programming, focusing on both animal and human studies. PubMed, Web of Science and Scopus databases were searched in order to identify studies conducted on pregnant women or in animals studying the association between maternal folate exposure and at least one metabolic syndrome outcome in offspring after birth (weight, blood pressure, glucose regulation parameters, triglycerides and high-density lipoprotein cholesterol (HDL-C) levels). The quality of included studies was assessed using SYRCLE Risk of Bias Tools for animal studies and NHLBI Study Quality Assessment Tools for observational studies and randomized controlled trials. Among the 10 "good" or "fair" studies that investigated excessive folate exposure during the perigestational period, 7 animal studies and 1 human study reported a positive association with development of metabolic outcomes in offspring. On the other hand, 6 of the 7 "good" or "fair" included human studies compared adequate versus low folate exposure, showing a lack of association (n = 3) or a protective effect (n = 3) regarding offspring's dysmetabolism. In conclusion, there is strong evidence from animal trials suggesting that excessive folate intake in early phases of development programs for metabolic dysfunction. While human evidence regarding excessive maternal folate exposure is currently scarce, human studies suggest that folate adequacy in pregnancy is not detrimental for metabolic function of the offspring.
Topics: Animals; Pregnancy; Humans; Female; Folic Acid; Maternal Exposure
PubMed: 37442213
DOI: 10.1016/j.reprotox.2023.108439 -
Scandinavian Journal of Surgery : SJS :... Sep 2023Non-obstetric surgery is fairly common in pregnant women. We performed a systematic review to update data on non-obstetric surgery in pregnant women. The aim of this... (Review)
Review
BACKGROUND AND OBJECTIVE
Non-obstetric surgery is fairly common in pregnant women. We performed a systematic review to update data on non-obstetric surgery in pregnant women. The aim of this review was to evaluate the effects of non-obstetric surgery during pregnancy on pregnancy, fetal and maternal outcomes.
METHODS
A systematic literature search of MEDLINE and Scopus was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search span was from January 2000 to November 2022. Thirty-six studies matched the inclusion criteria, and 24 publications were identified through reference mining; 60 studies were included in this review. Outcome measures were miscarriage, stillbirth, preterm birth, low birth weight, low Apgar score, and infant and maternal morbidity and mortality rates.
RESULTS
We obtained data for 80,205 women who underwent non-obstetric surgery and data for 16,655,486 women who did not undergo surgery during pregnancy. Prevalence of non-obstetric surgery was between 0.23% and 0.74% (median 0.37%). Appendectomy was the most common procedure with median prevalence of 0.10%. Near half (43%) of the procedures were performed during the second trimester, 32% during the first trimester, and 25% during the third trimester. Half of surgeries were scheduled, and half were emergent. Laparoscopic and open techniques were used equally for abdominal cavity. Women who underwent non-obstetric surgery during pregnancy had increased rate of stillbirth (odds ratio (OR) 2.0) and preterm birth (OR 2.1) compared to women without surgery. Surgery during pregnancy did not increase rate of miscarriage (OR 1.1), low 5 min Apgar scores (OR 1.1), the fetus being small for gestational age (OR 1.1) or congenital anomalies (OR 1.0).
CONCLUSIONS
The prevalence of non-obstetric surgery has decreased during last decades, but still two out of 1000 pregnant women have scheduled surgery during pregnancy. Surgery during pregnancy increases the risk of stillbirth, and preterm birth. For abdominal cavity surgery, both laparoscopic and open approaches are feasible.
Topics: Infant; Pregnancy; Infant, Newborn; Female; Humans; Pregnancy Outcome; Premature Birth; Stillbirth; Abortion, Spontaneous; Fetus
PubMed: 37329286
DOI: 10.1177/14574969231175569 -
BMC Pregnancy and Childbirth Nov 2023To quantify the extent of incompleteness and misclassification of maternal and pregnancy related deaths, and to identify general and context-specific factors associated... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To quantify the extent of incompleteness and misclassification of maternal and pregnancy related deaths, and to identify general and context-specific factors associated with incompleteness and/or misclassification of maternal death data.
METHODS
We conducted a systematic review of incompleteness and/or misclassification of maternal and pregnancy-related deaths. We conducted a narrative synthesis to identify methods used to capture and classify maternal deaths, as well as general and context specific factors affecting the completeness and misclassification of maternal death recording. We conducted a meta-analysis of proportions to obtain estimates of incompleteness and misclassification of maternal death recording, overall and disaggregated by income and surveillance system types.
FINDINGS
Of 2872 title-abstracts identified, 29 were eligible for inclusions in the qualitative synthesis, and 20 in the meta-analysis. Included studies relied principally on record linkage and review for identifying deaths, and on review of medical records and verbal autopsies to correctly classify cause of death. Deaths to women towards the extremes of the reproductive age range, those not classified by a medical examiner or a coroner, and those from minority ethnic groups in their setting were more likely misclassified or unrecorded. In the meta-analysis, we found maternal death recording to be incomplete by 34% (95% CI: 28-48), with 60% sensitivity (95% CI: 31-81.). Overall, we found maternal mortality was under-estimated by 39% (95% CI: 30-48) due to incompleteness and/or misclassification. Reporting of deaths away from the intrapartum, due to indirect causes or occurring at home were less complete than their counterparts. There was substantial between and within group variability across most results.
CONCLUSION
Maternal deaths were under-estimated in almost all contexts, but the extent varied across settings. Countries should aim towards establishing Civil Registration and Vital Statistics systems where they are not instituted. Efforts to improve the completeness and accuracy of maternal cause of death recording, such as Confidential Enquiries into Maternal Deaths, are needed even where CRVS is considered to be well-functioning.
Topics: Pregnancy; Humans; Female; Maternal Death; Maternal Mortality; Reproduction; Family; Ethnicity; Cause of Death
PubMed: 37968585
DOI: 10.1186/s12884-023-06077-4 -
European Child & Adolescent Psychiatry Sep 2023Autism spectrum disorder (ASD) is a disabling neurodevelopmental condition with complex etiology. Emerging evidence has pointed to maternal atopy as a possible risk... (Review)
Review
Autism spectrum disorder (ASD) is a disabling neurodevelopmental condition with complex etiology. Emerging evidence has pointed to maternal atopy as a possible risk factor. It is hypothesized that maternal atopic disease during pregnancy can lead to increased levels of inflammatory cytokines in fetal circulation via placental transfer or increased production. These cytokines can then pass through the immature blood-brain barrier, causing aberrant neurodevelopment via mechanisms including premature microglial activation. The objective of this study is to systematically review observational studies that investigate whether a maternal history of atopic disease (asthma, allergy, or eczema/atopic dermatitis) is associated with a diagnosis of ASD in offspring. A search was conducted in Ovid MEDLINE, PsycINFO, and Embase databases for relevant articles up to November 2021; this was later updated in January 2022. Observational studies published in peer-reviewed journals were included. Data were synthesized and qualitatively analyzed according to the specific atopic condition. Quality assessment was done using the Newcastle-Ottawa Scale. Nine articles were identified, with all including asthma as an exposure, alongside four each for allergy and eczema. Findings were inconsistent regarding the association between a maternal diagnosis of either asthma, allergy, or eczema, and ASD in offspring, with variations in methodology contributing to the inconclusiveness. More consistent associations were demonstrated regarding maternal asthma that was treated or diagnosed during pregnancy. Evidence suggests that symptomatic maternal asthma during pregnancy could be associated with ASD in offspring, underscoring the importance of effective management of atopic conditions during pregnancy. Further research is needed, particularly longitudinal studies that use gold-standard assessment tools and correlate clinical outcomes with laboratory and treatment data.PROSPERO Registration Number and Date: CRD42018116656, 26.11.2018.
PubMed: 37661216
DOI: 10.1007/s00787-023-02285-7 -
BMC Pregnancy and Childbirth Sep 2023There is a dearth of robust evidence regarding the correlation between psoriasis with maternal and neonatal outcomes, making it challenging to establish definitive... (Meta-Analysis)
Meta-Analysis
BACKGROUND
There is a dearth of robust evidence regarding the correlation between psoriasis with maternal and neonatal outcomes, making it challenging to establish definitive recommendations for the management of these patients. This systematic review and meta-analysis aimed to review the evidence with regard to the impact of maternal psoriasis on maternal and neonatal outcomes.
METHODS
Following the PRISMA guideline, a systematic search of English articles using PubMed, Embase, Scopus, ScienceDirect, Web of Science, Google Scholar, and the Cochrane Library was conducted. The search was performed from inception to 22 of May 2022.
RESULT
A significant association was observed between psoriasis and maternal outcomes, including cesarean delivery [OR = 1.25 (95% CI: 1.13-1.30, p-value = 0.001)], (pre)eclampsia [OR = 1.29 (95% CI: 1.15-1.44, p-value = 0.0001)], gestational diabetes [Odds Ratio (OR) = 1.23 (95% Confidence Intervals (CI): 1.15-1.30, p-value = 0.001)], gestational hypertension [OR = 1.31 (95% CI: 1.18-1.45, p-value = 0.001)] and preterm birth [OR = 1.22 (95% CI: 1.10-1.35, p-value = 0.001)]. Also, there was a significant association between psoriasis and neonatal outcomes, including small for gestational age [OR = 1.07 (95% CI: 1.02-1.11, p-value = 0.053)], low birth weight [OR = 1.19 (95% CI: 1.02-1.38, p-value = 0.001)] and stillbirth [OR = 1.27 (95% CI: 1.04-1.55, p-value = 0.023)].
CONCLUSION
Maternal psoriasis could negatively impact maternal and neonatal outcomes. Our results strengthen the importance of close monitoring of the mothers' psoriasis status before and during pregnancy.
Topics: Pregnancy; Female; Infant, Newborn; Humans; Pregnancy Outcome; Premature Birth; Stillbirth; Diabetes, Gestational; Pre-Eclampsia
PubMed: 37777747
DOI: 10.1186/s12884-023-06006-5 -
Trauma, Violence & Abuse Dec 2023Violence against children is a significant problem, particularly during early childhood development. Spanking and other forms of corporal punishment in child-rearing... (Review)
Review
Violence against children is a significant problem, particularly during early childhood development. Spanking and other forms of corporal punishment in child-rearing have been used by families worldwide to correct children's unwanted behaviors. Despite previous studies focusing on the negative consequences of these parental practices, open questions remain. The present study aimed to systematically review the empirical studies published in scientific literature that examined the associations between parenting practices of spanking and corporal punishment of mothers and their children's behaviors and development in early childhood. Search was performed in PubMed, APA PsycNet, Web of Science, SciELO, and LILACS databases using the combination of the following keywords: ((spank OR physical punishment OR physical abuse OR physical maltreatment OR corporal punishment) AND (parenting)) AND (child* development OR child* behavior). The inclusion and exclusion criteria were applied and 34 articles were selected for review. The inclusion criteria were the following: studies that evaluated associations between maternal spanking or corporal punishment practices and behaviors or development of 0-to-6-year-old children; quantitative studies; studies published in English, Spanish, or Portuguese language. The results showed that in 94% of the studies, there were significant associations between maternal spanking and corporal punishment with deteriorated child behavior and development, concurrently or later. In addition, maternal physical practices also acted as mediators or moderator variables in models that explained behavioral and developmental problems in early childhood.
PubMed: 36177799
DOI: 10.1177/15248380221124243 -
The Journal of Maternal-fetal &... Dec 2023Intraplacental choriocarcinoma is a gestational trophoblastic neoplasia located within the placenta. Due to the usual silent presentation, more than half of the cases... (Review)
Review
INTRODUCTION
Intraplacental choriocarcinoma is a gestational trophoblastic neoplasia located within the placenta. Due to the usual silent presentation, more than half of the cases are diagnosed incidentally. It has been demonstrated that this pathology is linked to feto-maternal hemorrhage (FMH), stillbirth, and intrauterine growth restriction. The aim of our review was to establish if there are recurrent signs that might lead to an early diagnosis and better management in cases complicated by FMH.
MATERIALS AND METHODS
We performed a systematic review of the literature from 2000 up to March 2023. The adopted research strategy included the following terms: (gestational choriocarcinoma obstetrics outcome) AND (intraplacental choriocarcinoma) AND (gestational choriocarcinoma). The MEDLINE (PubMed), Google Scholar, and Scopus databases were searched.
RESULTS
The research strategy identified 19 cases of FMH coexisting with intraplacental choriocarcinoma (IC), as described in 17 studies. The perinatal mortality rate was 36.8%. In eight cases, histological diagnosis of IC was made post-delivery. Metastatic lesions were found in 75% (6/8) of described cases. One case of maternal death has been described. Chemotherapy was necessary in seven cases. Sporadical prenatal ultrasound signs were described.
DISCUSSION
The diagnosis of IC is usually delayed, mostly due to aspecific symptoms and signs. Histological analysis of the placenta, when not routinely performed, should be performed when warning symptoms are encountered. The maternal prognosis was good, with a mortality rate of 5.5%. A fertility-sparing approach is always possible even in the presence of metastasis. Chemotherapy seems to be useful in cases of maternal and neonatal metastasis.
Topics: Pregnancy; Female; Infant, Newborn; Humans; Fetomaternal Transfusion; Placenta; Choriocarcinoma; Placenta Diseases; Prenatal Care
PubMed: 38010764
DOI: 10.1080/14767058.2023.2285238 -
Frontiers in Nutrition 2023Exclusive breastfeeding for 6 months after birth provides infants with the best start for life. A review by Bravi et al. summarized the importance of maternal diet as... (Review)
Review
CONTEXT
Exclusive breastfeeding for 6 months after birth provides infants with the best start for life. A review by Bravi et al. summarized the importance of maternal diet as a determinant of human milk composition based on data up to 2015, but evidence on nutrient intake level was limited.
OBJECTIVE
We updated the review by Bravi et al., critically assessed differences in study designs and sampling methods, and graphically visualized trends and associations.
DATA SOURCES
PubMed was systematically searched for articles published between January 2015 and March 2021.
DATA EXTRACTION
Article screening, selection, and data extraction was done by two independent researchers, including a risk of bias assessment based on 11 criteria. Articles were eligible when including: quantitative information, commonly used effect estimates, healthy mother-infant dyads.
RESULTS
Twenty seven observational and five intervention studies were identified ( = 7,138) and combined with results of Bravi et al. Fatty acids were still the most studied human milk components in relation to maternal diet ( = 17 studies) with maternal fish intake being predominantly positively associated with milk ALA ( = 0.28-0.42), DHA ( = 0.24-0.46), and EPA ( = 0.25-0.28) content. PUFAs from diet were generally positively correlated with their concentrations in milk, while SFA intake was negatively associated with several fatty acids in milk. Studies on associations with maternal diet and milk carbohydrates, proteins, vitamins and minerals were limited in number and varied in methods and results.
CONCLUSION
This updated review shows that evidence on the association between maternal diet and human milk fatty acids is rapidly increasing, but still diversified in methodology and results. Further studies, preferably intervention studies, assessing diet and milk carbohydrates, proteins, vitamins and minerals are needed to be able draw conclusions on the importance of maternal diet for human milk composition as a whole.
PubMed: 38352250
DOI: 10.3389/fnut.2023.1320560 -
Trauma, Violence & Abuse May 2024Emotional and behavioral regulations are crucial for the development of perceptive, responsive, and flexible parenting. Moreover, maternal emotional dysregulation... (Review)
Review
Emotional and behavioral regulations are crucial for the development of perceptive, responsive, and flexible parenting. Moreover, maternal emotional dysregulation constitutes a risk for maltreatment behaviors. The present study aimed to conduct a systematic review of empirical studies on the associations between mothers' emotional and behavioral regulations and parenting practices with their children or adolescents. A systematic review was conducted, including papers that addressed these variables, analyzing the direct effects, and moderation or mediation effects of maternal emotional and behavioral regulation on parenting practices, targeting child and adolescent samples. We identified 35 studies for analysis. Most of the studies (86%) showed significant associations between maternal emotional and behavioral regulation and parenting practices. Mothers' emotional dysregulation was related to a high risk of maltreatment and negative parenting, such as unsupportive reactions and harsh discipline. High maternal emotional dysregulation and negative parenting, in turn, were associated with children's aggressive behaviors. Conversely, when mothers exhibited high emotional regulation, they engaged in more positive and supportive parenting. Additionally, maternal behavioral regulation with inhibitory control and effortful control led to supportive and warm parenting. Individual and contextual factors, such as maternal victimization history and symptoms of inattention and hyperactivity, had effects on maternal emotional dysregulation, which, in turn, impacted their parenting practices. Consequently, emotional and behavioral regulation played a crucial role in mothers' parenting practices with their children and adolescents. The findings of the current review could contribute to planning parenting interventions, including maternal emotional and behavioral regulation skills, aimed at preventing maltreatment of their children.
PubMed: 38804703
DOI: 10.1177/15248380241253036