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Biological Trace Element Research Nov 2023Observational studies suggest that the potential role of magnesium remains controversial in gestational diabetes mellitus (GDM). This meta-analysis aims to consolidate... (Meta-Analysis)
Meta-Analysis Review
Observational studies suggest that the potential role of magnesium remains controversial in gestational diabetes mellitus (GDM). This meta-analysis aims to consolidate the available information from observational studies that have focused on the relationship between magnesium levels and GDM. A systematic and comprehensive literature search was conducted in PubMed, Embase, Web of Science, CNKI, and Wanfang databases. Data were extracted independently by two investigators. Standardized mean differences (SMD) and 95% confidence intervals (CIs) were used to summarize the circulating magnesium levels (CI). This meta-analysis included a total of 17 studies involving 2858 participants including 1404 GDM cases and 1454 healthy controls, which showed that magnesium levels were significantly lower in GDM compared to healthy controls (SMD: - 0.35; 95% CI: - 0.62, - 0.07, P = 0.013). Likewise, the same phenomenon was observed in the third trimester (SMD = - 1.07; 95% CI: - 1.84 to - 0.29, P = 0.007). Other subgroup analyses revealed that this trend of decreasing magnesium concentration was only observed in Europeans (SMD = - 0.64; 95% CI: - 0.90, - 0.38, P < 0.0001). This meta-analysis revealed that serum magnesium levels were lower in patients with GDM than in healthy pregnant women, and this discrepancy was most pronounced in European populations and during the third trimester. Nevertheless, current evidence suggests that circulating magnesium deficiency is associated with gestational diabetes; the challenge for the future is to further elucidate the possible benefits of preventing gestational diabetes through magnesium supplementation.
Topics: Pregnancy; Female; Humans; Diabetes, Gestational; Magnesium; Pregnancy Trimester, Third; Databases, Factual; Observational Studies as Topic
PubMed: 36790586
DOI: 10.1007/s12011-023-03591-6 -
Ultrasound in Obstetrics & Gynecology :... Apr 2024The finding of an abdominal cyst during pregnancy has an estimated prevalence of 1 in 1000 pregnancies, mostly in second and third trimester. The detection of a fetal... (Review)
Review
OBJECTIVES
The finding of an abdominal cyst during pregnancy has an estimated prevalence of 1 in 1000 pregnancies, mostly in second and third trimester. The detection of a fetal abdominal cyst during the first trimester scan is a rare event, whose natural history and prognosis are often unknown and unpredictable as these anomalies can be related to various underlying conditions and originate from different structures. The aim of this study is to evaluate the outcome of fetal abdominal cysts detected in the first trimester in order to understand their possible clinical significance and to offer the proper management according to the available data.
METHODS
We present a case report of a first trimester fetal abdominal cyst detected with subsequent diagnosis of congenital multiple arthrogryposis and we performed a systematic review of the literature to identify the incidence and the outcomes of similar cases. The systematic literature review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and registered with PROSPERO (CRD42023491729).
RESULTS
A total of 60 cases of first trimester abdominal cysts were included. Of these, 35% were associated with concurrent or late onset structural anomalies, as in our case report, and 65% were isolated. In pregnancies with isolated fetal abdominal cysts, 56% had a completely normal outcome.
CONCLUSIONS
The finding of an abdominal cyst during the first trimester of pregnancy is in most cases an isolated event with a moderate to good prognosis but it could also be an early sign of other associated abnormalities, including arthrogryposis. Increased ultrasound surveillance and additional genetic testing to rule out possible associated anomalies are pivotal to assess the risk of adverse pregnancy outcomes and to provide appropriate counselling to the patient. This article is protected by copyright. All rights reserved.
PubMed: 38642342
DOI: 10.1002/uog.27663 -
AJOG Global Reports Aug 2023This study evaluated the correlation between maternal hepcidin and other biomarkers of iron status, markers of inflammation, and maternal body weight during pregnancy,... (Review)
Review
Hepcidin across pregnancy and its correlation with maternal markers of iron and inflammation, maternal body weight outcomes, and offspring neurodevelopmental outcomes: a systematic review and meta-analysis.
OBJECTIVE
This study evaluated the correlation between maternal hepcidin and other biomarkers of iron status, markers of inflammation, and maternal body weight during pregnancy, as well as neurodevelopment in the offspring.
DATA SOURCES
PubMed, Web of Science, Scopus, and Embase were searched from inception until March 2022.
STUDY ELIGIBILITY CRITERIA
Studies conducted among pregnant women without apparent pregnancy complications were included. Eligible studies reported correlation coefficients between maternal hepcidin and any outcomes of maternal biomarkers of iron status or inflammatory load during pregnancy, prenatal maternal body weight, and offspring neurodevelopment. Studies without correlation data were eligible if they quantitatively reported volumes of both maternal hepcidin and any marker of iron status and/or inflammatory load during gestation.
METHODS
Pooled correlation coefficients between maternal hepcidin and outcomes of interest were calculated using the Fisher -to-Z transformation. Both fixed-effects and DerSimonian and Laird random-effects models were used to calculate pooled correlation coefficient. When meta-analysis was not feasible, results were descriptively synthesized.
RESULTS
Forty-six studies with 6624 participants were eligible. Hepcidin was significantly correlated with hemoglobin in the third trimester (=0.21; 95% confidence interval, 0.1-0.32); ferritin in the first (=0.31; 95% confidence interval, 0.01-0.61) and third trimester (=0.35; 95% confidence interval, 0.23-0.48); soluble transferrin receptor in the second trimester (=-0.27; 95% confidence interval, -0.4 to -0.14); total iron-binding capacity in the second trimester (=0.37; 95% confidence interval, 0.24-0.50); and serum iron in the third trimester (=0.11; 95% confidence interval, 0.02-0.19). Hepcidin was significantly correlated with the inflammatory marker interleukin-6 in the third trimester (=0.26; 95% confidence interval, 0.17-0.34) and C-reactive protein in the second (=0.16; 95% confidence interval, 0.03-0.30) and third trimester (=0.28; 95% confidence interval, 0.04-0.52). Four out of 5 studies reported weak-to-moderate positive correlation between hepcidin and body mass index. Hepcidin levels varied across body mass index categories. No single study reported the relationship between maternal hepcidin and neurodevelopment in offspring.
CONCLUSION
Hepcidin weakly to moderately correlates with biomarkers of iron and inflammation in pregnancy.
PubMed: 37645642
DOI: 10.1016/j.xagr.2023.100222 -
Reproductive Biology and Endocrinology... Mar 2024Pregnancy is characterized by profound circulatory changes and compensatory adjustments in the renin-angiotensin-aldosterone system (RAAS). Differences in regulatory... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Pregnancy is characterized by profound circulatory changes and compensatory adjustments in the renin-angiotensin-aldosterone system (RAAS). Differences in regulatory response may antedate or accompany vascular complicated pregnancy. We performed a systematic review and meta-analysis to delineate the trajectory of active plasma renin concentration (APRC) in healthy pregnancy and compare this to complicated pregnancy.
METHODS
We performed a systematic review and meta-analysis on APRC during normotensive and hypertensive pregnancies, using PubMed (NCBI) and Embase (Ovid) databases. We included only studies reporting measurements during pregnancy together with a nonpregnant reference group measurement. Risk of bias was assessed with QUIPS. Ratio of the mean (ROM) and 95% confidence intervals (CI) of APRC values between pregnant and nonpregnant women were estimated for predefined intervals of gestational age using a random-effects model. Meta-regression was used to analyze APRC over time.
RESULTS
In total, we included 18 studies. As compared to nonpregnant, APRC significantly increased as early as the first weeks of healthy pregnancy and stayed increased throughout the whole pregnancy (ROM 2.77; 95% CI 2.26-3.39). APRC in hypertensive complicated pregnancy was not significantly different from nonpregnancy (ROM 1.32; 95% CI 0.97-1.80).
CONCLUSION
Healthy pregnancy is accompanied by a profound rise in APRC in the first trimester that is maintained until term. In hypertensive complicated pregnancy, this increase in APRC is not observed.
Topics: Pregnancy; Female; Humans; Renin; Pregnancy Complications; Hypertension; Renin-Angiotensin System; Blood Pressure; Aldosterone
PubMed: 38454417
DOI: 10.1186/s12958-024-01200-2 -
The Laryngoscope Mar 2024There are several options for surgical management of subglottic stenosis, including endoscopic and open procedures. However, treatment algorithms, outcomes, and... (Review)
Review
OBJECTIVE
There are several options for surgical management of subglottic stenosis, including endoscopic and open procedures. However, treatment algorithms, outcomes, and anesthetic management of subglottic stenosis during pregnancy are not well described.
DATA SOURCES
MEDLINE, EMBASE, and the Cochrane databases.
REVIEW METHODS
A scoping review of management of subglottic stenosis during pregnancy was performed, and then reported in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria consisted of those with subglottic or tracheal stenosis aged greater than 18 years, those in whom management was performed during pregnancy, and those who reported delivery related outcomes.
RESULTS
After systematic review and detailed search of 330 identified articles, 15 articles met inclusion criteria and were included in the final analysis. All studies were case reports or case series (level 4 evidence). This study identified 27 patients. The median age was 29 and the median gestational age at intervention was 28 weeks. Left lateral positioning and fetal heart rate monitoring were used in nearly every case. The most common intervention performed was endoscopic balloon dilation. In many cases, jet ventilation or transnasal humidified rapid insufflation ventilatory exchange was satisfactory for maintenance of the airway. Three women ultimately required tracheostomy prior to labor and delivery. There was no fetal death or complications reported in these studies, and all but one woman proceeded to deliver at term.
CONCLUSION
Endoscopic balloon dilation during pregnancy is safe and effective, resulting in optimized respiratory outcomes for the mother and safe delivery of the fetus. The third trimester appears to be safe for airway intervention. Laryngoscope, 134:1014-1022, 2024.
Topics: Pregnancy; Humans; Female; Aged; Adult; Infant; Constriction, Pathologic; Endoscopy; Tracheostomy; Tracheal Stenosis; Pregnancy Trimester, Third; Laryngostenosis
PubMed: 37632727
DOI: 10.1002/lary.30994 -
Human Reproduction Open 2024Is exposure to dydrogesterone a risk factor for congenital anomalies when given in the first trimester for recurrent/threatened pregnancy loss or as luteal support in... (Review)
Review
STUDY QUESTION
Is exposure to dydrogesterone a risk factor for congenital anomalies when given in the first trimester for recurrent/threatened pregnancy loss or as luteal support in assisted reproductive technology (ART)?
SUMMARY ANSWER
Dydrogesterone, when given in the first trimester for recurrent/threatened pregnancy loss or as luteal support in ART, is not a relevant additional risk factor for congenital anomalies.
WHAT IS KNOWN ALREADY
Despite large clinical trials and meta-analyses that show no association between dydrogesterone and congenital anomalies, some recently retracted publications have postulated an association with teratogenicity. Dydrogesterone is also often rated as less safe than bioidentical progestins.
STUDY DESIGN SIZE DURATION
A systematic review was conducted according to a pre-specified protocol with searches on Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Clinicaltrials.gov. The search was limited to human studies, with no restrictions on language, geographical region, or date. The search algorithm used a PICO (Population, Intervention, Comparison, Outcome)-style approach combining both simple search terms and medical subject heading terms. As congenital anomalies are mostly reported as secondary outcomes, the search term 'safety' was added.
PARTICIPANTS/MATERIALS SETTING METHODS
Interventional study and observational study (OS) designs were eligible for inclusion. Inclusion criteria were: women >17 years old treated for threatened miscarriage, recurrent pregnancy loss, and/or ART; the use of dydrogesterone in the first trimester compared with placebo, no treatment or other interventions; and reporting of congenital anomalies in newborns or infants ≤12 months old (primary outcome). Two authors (A.K., M.R.N.) independently extracted the following data: general study information, study population details, intervention and comparator(s), and frequencies of congenital anomalies (classification, time of determination, and type). Risk of bias focused on the reporting of congenital malformations and was assessed using the Cochrane Risk of Bias Tool Version 2 or the ROBINS-I tool. The GRADEproGDT platform was used to generate the GRADE summary of findings table.
MAIN RESULTS AND THE ROLE OF CHANCE
Of the 897 records retrieved during the literature search, 47 were assessed for eligibility. Nine studies were included in the final analysis: six randomized controlled trials (RCTs) and three OSs. Among the RCTs, three had a low risk and three a high risk of bias. Two of the OSs were considered to have a serious risk of bias and one with critical risk of bias and was excluded for the evidence syntheses. The eight remaining studies included a total of 5070 participants and 2680 live births from 16 countries. In the meta-analysis of RCTs only, the overall risk ratio (RR) was 0.92 [95% CI 0.55; 1.55] with low certainty. When the two OSs were included, the overall RR was 1.11 [95% CI 0.73; 1.68] with low certainty.
LIMITATIONS REASONS FOR CAUTION
The studies included in the analysis do not report congenital anomalies as the primary outcome; reporting of congenital anomalies was often not standardized.
WIDER IMPLICATIONS OF THE FINDINGS
This systematic literature review and meta-analysis provide clear reassurance to both clinicians and patients that dydrogesterone is not associated with congenital anomalies above the rate that might be expected due to environmental and genetic factors. The results of this work represent the highest current level of evidence for the question of congenital anomalies, which removes the existing uncertainty caused by poor quality and retracted studies.
STUDY FUNDING/COMPETING INTERESTS
Editorial support was provided by Highfield Communication Consultancy, Oxford, UK, sponsored by Abbott Products Operations AG, Allschwil, Switzerland. A.K., J.A.G.-V., L.P.S., J.N.v.d.A., and J.F.S. received honoraria from Abbott for preparation and participation in an advisory board. J.A.G.-V. received grants and lecture fees from Merck, Organon, Ferring, Gedeon Richter, and Theramex. M.R.N. has no conflicts of interest. J.N.v.d.A. and J.A.G.-V. have no other conflicts of interest. A.K. received payment from Abbott for a talk at the IVF Worldwide congress on 22 September 2023. J.F.S. has received grants from the National Institutes of Health, royalties/licences from Elsevier and Prescient Medicine (SOLVD Health), consulting fees from Burroughs Wellcome Fund (BWF) and Bayer, honoraria from Magee Women's Research Institute, Wisconsin National Primate Research Centre, University of Kansas and Oakridge National Research Laboratory, Agile, Daiichi Sankyo/American Regent, and Bayer, and travel support to attend meetings for the International Academy of Human Reproduction (IAHR). J.F.S. has patents related to diagnosis and treatment of PCOS and prediction of preterm birth. J.F.S. participates on advisory boards for SOLVD Health, Wisconsin National Primate Research Centre, and FHI360, was the past President board member of the Society for Reproductive Investigation, has a leadership role for the following organizations: Scientific Advisory Board, SOLVD Health, EAB Chair for contraceptive technology initiative, FHI360, EAB member, Wisconsin National Primate Research Centre, Advisory Board for MWRI Summit, Chair of BWF NextGen Pregnancy Research Panel, Medical Executive Committee at the Howard, and Georgeanna Jones Foundation, and is Vice President, IAHR. L.P.S. has received consulting fees from Shield Pharmaceuticals, Scynexis, Organon, Natera, Celula China, AiVF, Agile, Daiichi Sankyo, American Regent, and Medicem, honoraria from Agile, Daiichi Sankyo/American Regent, and Bayer, and travel support from BD Diagnostics. L.P.S. participates on the data safety monitoring board for Astellas and is a Chair of DSMB for fezolinetant. Abbott played no role in the funding of the study or in study design, data collection, data analysis, data interpretation, or writing of the report.
TRIAL REGISTRATION NUMBER
PROSPERO 2022 CRD42022356977.
PubMed: 38344249
DOI: 10.1093/hropen/hoae004 -
The Journal of Maternal-fetal &... Dec 2023Previous studies evaluating the association between circulating neutrophil gelatinase-associated lipocalin (NGAL) and the risk of preeclampsia (PE) showed inconsistent... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Previous studies evaluating the association between circulating neutrophil gelatinase-associated lipocalin (NGAL) and the risk of preeclampsia (PE) showed inconsistent results. A systematic review and meta-analysis was performed to summarize the relationship between circulating NGAL and PE.
METHODS
Studies comparing the circulating NGAL between pregnant women with PE and controls with no PE were found by searching Medline, Web of Science, Cochrane's Library, and Embase. Pooling results was performed using a random-effects model incorporating heterogeneity.
RESULTS
In the study, 1293 women with PE and 1773 healthy pregnant women were enrolled in 18 case-control studies, and the gestational age was matched between cases and controls. Pooled results showed that compared to controls, women with PE had a significantly higher blood level of NGAL (standardized mean difference [SMD]: 0.95, 95% confidence interval [CI]: 0.63-1.28, < .001; = 92%). Subgroup analyses showed consistent results in studies of NGAL measured at the first (SMD: 0.47, 95% CI: 0.15-0.80, = .004), the second (SMD: 0.87, 95% CI: 0.55-1.19, < .001), and the third trimester (SMD: 1.06, 95% CI: 0.63-1.24, < .001) of pregnancy. In addition, women with mild (SMD: 0.78, 95% CI: 0.13-1.44, = .02) and severe PE (SMD: 1.19, 95% CI: 0.40-1.97, = .003) both had higher circulating NGAL as compared to controls.
CONCLUSIONS
High circulating NGAL is associated with PE, which may be independent of the trimesters for blood sampling and the severity of PE.
Topics: Female; Humans; Pregnancy; Biomarkers; Lipocalin-2; Pre-Eclampsia; Pregnancy Trimester, Third; Pregnancy Trimesters
PubMed: 37282560
DOI: 10.1080/14767058.2023.2197100 -
International Journal of Fertility &... Aug 2023Human leukocyte antigen G (HLA-G) levels are among the biomarkers suggested for pre-eclampsia (PE). This study is aimed at determining the possible relationship between...
Human leukocyte antigen G (HLA-G) levels are among the biomarkers suggested for pre-eclampsia (PE). This study is aimed at determining the possible relationship between low soluble HLA-G (sHLA-G) levels in maternal blood at the beginning of pregnancy and subsequent PE. We searched the international scientific databases of Web of Science, Embase, PubMed, Cochrane, and Scopus. We extracted the studies investigating the relationship between the serum levels of HLA-G in the first trimester of pregnancy and the onset of PE using the appropriate keywords. The collected data were analyzed using the random-effects meta-analysis model and STATA (version 14). A total of 5 studies met the eligibility criteria, and the total sample size was 668 subjects. The mean and SD age of case subjects was 31.41 ± 4.16 years, while it was 30.56 ± 3.5 for control subjects. According to the findings, there was an inverse relationship between HLA-G serum level in the first trimester of pregnancy and the subsequent onset of PE, standard mean difference (SMD)=-1.51 [95% confidence interval (CI): -2.26, -0.75, I2=90.8%, P=0.000]. Based on these results, low sHLA-G level in early pregnancy has a positive correlation with subsequent PE, and the significant role of sHLA-G in the early stages of placentation can be proven.
PubMed: 37577904
DOI: 10.22074/ijfs.2023.559787.1349 -
The Science of the Total Environment May 2024Ambient particulate matter (PM) has been recognized as inducing oxidative stress, which could contribute to mitochondrial damage and dysfunction. However, studies... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Ambient particulate matter (PM) has been recognized as inducing oxidative stress, which could contribute to mitochondrial damage and dysfunction. However, studies investigating the association between ambient PM and mitochondria, particularly mitochondrial DNA copy number (mtDNA-CN), have yielded inconsistent results.
METHODS
We conducted comprehensive literature searches to identify observational studies published before July 17, 2023, examining the association between ambient PM exposure and mtDNA-CN. Meta-analysis using random effects model was employed to calculate the pooled effect estimates for general individual exposures, as well as for prenatal exposure with specific trimester. Additionally, the quality and level of evidence for each exposure-outcome pair was evaluated.
RESULTS
A total of 10 studies were included in the systematic review and meta-analysis. The results indicated that general individual exposure to PM (β = -0.084, 95 % CI: -0.521, 0.353; I = 93 %) and PM (β = 0.035, 95 % CI: -0.129, 0.199; I = 95 %) did not significantly affect mtDNA-CN. Prenatal exposure to PM (β = 0.023, 95 % CI: -0.087, 0.133; I = 0 %) and PM (β = 0.006, 95 % CI: -0.135; 0.147; I = 51 %) were also not significantly associated with mtDNA-CN in offspring. The level of evidence for each tested exposure-outcome pair was assessed as "inadequate."
CONCLUSIONS
The findings of this systematic review and meta-analysis indicate that there is an "inadequate" strength of evidence for the association between general individual or prenatal exposure to ambient PM and mtDNA-CN. Future research necessitates studies with more rigorous design, enhanced control of confounding factors, and improved measures of exposure to substantiate our findings.
Topics: Female; Pregnancy; Humans; Particulate Matter; DNA, Mitochondrial; Air Pollution; DNA Copy Number Variations; Prenatal Exposure Delayed Effects; Mitochondria; Environmental Exposure; Air Pollutants
PubMed: 38442762
DOI: 10.1016/j.scitotenv.2024.171423 -
BMC Pregnancy and Childbirth Oct 2023Early detection, prevention, and management of diseases associated with pregnancy and pregnancy-related conditions depend on the beginning of antenatal care contact in... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Early detection, prevention, and management of diseases associated with pregnancy and pregnancy-related conditions depend on the beginning of antenatal care contact in the first trimester. Across Africa, regional and national differences are observed in the proportion of first-trimester ANC contact and the factors contributing to it. To create a suitable intervention plan, it is crucial to overcome these differences through single standard and uniform guidelines. This can be achieved through meta-analysis and systematic reviews. Therefore, this systematic review aimed to assess the pooled prevalence of first trimester ANC contact and the factors contributing to it in Africa.
METHODS
Observational studies conducted in Africa were retrieved from PubMed, Google Scholar, EMASE, CINHAL, Cochrane Library, Hinari databases and Mednar using combinations of search terms with Boolean operators. The JBI 2020 Critical Appraisal Checklist was used to assess the methodological quality of the studies. To assess publication bias, a funnel plot and Egger's test were used to and I-squared was used to check the heterogeneity of the included studies. Data were extracted using Microsoft Excel and exported to Stata 16 software for analysis.
RESULTS
A total of 86 articles with 224,317 study participants from 19 African countries were included. The overall pooled prevalence of first-trimester ANC contact was 37.15% (95% CI: 33.3-41.0; I = 99.8%). The following factors were found to be significantly associated with first-trimester ANC contact: urban residence (OR = 2.2; 95% CI: 1.5-3.1; I = 98.5%); women under the age of 25 (OR = 1.5; 95% CI: 1.2-1.9; I = 94.1%);, educational status (OR = 1.8; 95% CI: 1.4-2.2; I = 96.1%), primiparity (OR: 1.7; 95% CI: 1.2-2.4: I = 97.4%), having planned pregnancies (OR: 2.1; 95% CI: 1.5-2.7; I = 95.5%) and employed women (OR = 1.7; 95% CI: 1.7-2.1; I = 94.4%).
CONCLUSION
Because so few women in Africa initiate first-trimester ANC contact, it is clear that increasing maternal healthcare service uptake is still a challenge and will require significant effort to scale up the services. When working to improve maternal health in Africa, each nation's government and nongovernmental organizations should prioritize raising women's educational levels and providing pertinent information to rural women, focusing on reducing unintended pregnancies, women who live far from health facilities, women with low socioeconomic statuses, multiparous women and older women.
TRIAL REGISTRATION
PROSPERO International Prospective Register of Systematic reviews (ID: CRD42023401711).
Topics: Pregnancy; Female; Humans; Aged; Prenatal Care; Pregnancy Trimester, First; Prevalence; Africa; Pregnancy Complications; Ethiopia; Observational Studies as Topic
PubMed: 37858033
DOI: 10.1186/s12884-023-06034-1