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Journal of Obstetrics and Gynaecology :... Dec 2023Previous studies evaluating the relationship between blood manganese (Mn) level and gestational diabetes mellitus (GDM) in pregnant women showed inconsistent results. A... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Previous studies evaluating the relationship between blood manganese (Mn) level and gestational diabetes mellitus (GDM) in pregnant women showed inconsistent results. A systematic review and meta-analysis was therefore performed to investigate the above association.
METHODS
Relevant observational studies were obtained by search of electronic databases including Medline, Embase, Cochrane Library and Web of Science from database inception to 10 March 2023. Two authors independently performed database search, literature identification and data extraction. A randomised-effects model was selected to pool the data by incorporating the influence of potential heterogeneity. Subgroup analysis was performed to evaluate the influence of study characteristics on the results of the meta-analysis.
RESULTS
Six datasets from five observational studies, involving 91,249 pregnant women were included in the meta-analysis. Among the participants, 3597 (3.9%) were diagnosed as GDM. Overall, pooled results showed that a high blood level of Mn was associated with a higher risk of GDM (compared between women with highest versus lowest category blood Mn, odds ratio: 1.31, 95% confidence interval: 1.19-1.44, < .001) with no significant heterogeneity ( for Cochrane -test = 0.93, = 0%). Subgroup analyses according to study design, mean maternal age, matrix or methods for measuring blood Mn, and the incidence of GDM also showed consistent results ( for subgroup difference all >.05).
CONCLUSIONS
Results of the meta-analysis suggest that a high blood Mn level may be a risk factor of GDM in pregnant women. Studies are needed to determine the underlying mechanisms, and to investigate if the relationship between blood Mn level and GDM is dose-dependent.
Topics: Pregnancy; Female; Humans; Diabetes, Gestational; Manganese; Risk Factors; Maternal Age; Odds Ratio
PubMed: 37921106
DOI: 10.1080/01443615.2023.2266646 -
Contraception and Reproductive Medicine Nov 2023Unintended pregnancy is a leading cause of maternal mortality associated with abortion, inadequate contraceptive use, contraceptive failure, and contraceptive... (Review)
Review
INTRODUCTION
Unintended pregnancy is a leading cause of maternal mortality associated with abortion, inadequate contraceptive use, contraceptive failure, and contraceptive discontinuation in low- and middle-income countries. Most unintended pregnancies occur in regions with limited availability of maternal health services, resulting in a significant number of maternal deaths. Therefore, this review aimed to assess the overall prevalence of unintended pregnancy among women using contraceptives in low- and middle-income countries.
METHOD
PubMed, Science Direct, Google Scholar, Scopus, and the Ethiopian University Online Library were searched. Data were extracted using Microsoft Excel and analyzed using STATA statistical software (version 14). Publication bias was checked using forest plot, Begg rank test, and Egger regression test. To check for heterogeneity, I was calculated and an overall estimation analysis was performed. Subgroup analysis was conducted by study setting, study design, and publication. The Joanna Briggs Institute quality assessment tool was used to assess the quality of each study. We performed a one-time sensitivity analysis.
RESULTS
Of the 1304 articles retrieved, 23 studies (involving 40,338 subjects) met the eligibility criteria and were included in this study. The pooled prevalence of unintended pregnancy among women using contraceptives in low- and middle-income countries was 44.68% (95% CI: 35.16-54.20; I2 = 99.7%, P < 0.001). Based on subgroup analysis, the pooled prevalence of unintended events was 43.58% (CI: 32.99, 54.173) and 49.93% (CI: 28.298, 71.555) for cross-sectional and cohort studies, respectively. Based on the study design, it was 34.47% (CI: 27.012, 41.933) for community studies and 55.85% (CI: 33.364, 78.339) for institutional studies.
CONCLUSION
The overall prevalence of unintended pregnancy was high among women using contraceptives in low- and middle-income countries. Therefore, it is better to pay attention to prevention strategies for unintended pregnancy, such as information and education accessibility and contraceptive utilization.
PubMed: 37993927
DOI: 10.1186/s40834-023-00255-7 -
BMC Pregnancy and Childbirth Oct 2023Skin-to-skin contact between mother and infant after birth is recommended to promote breastfeeding and maternal-infant bonding. However, its impact on the incidence of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Skin-to-skin contact between mother and infant after birth is recommended to promote breastfeeding and maternal-infant bonding. However, its impact on the incidence of neonatal hypoglycaemia is unknown. We conducted a systematic review and meta-analysis to assess this.
METHODS
Published randomised control trials (RCTs), quasi-RCTs, non-randomised studies of interventions, cohort, or case-control studies with an intervention of skin-to-skin care compared to other treatment were included without language or date restrictions. The primary outcome was neonatal hypoglycaemia (study-defined). We searched 4 databases and 4 trial registries from inception to May 12, 2023. Quality of studies was assessed using Cochrane Risk of Bias 1 or Effective Public Health Practice Project Quality Assessment tools. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results were synthesised using RevMan 5.4.1 or STATA and analysed using random-effects meta-analyses where possible, otherwise with direction of findings tables. This review was registered prospectively on PROSPERO (CRD42022328322).
RESULTS
This review included 84,900 participants in 108 studies, comprising 65 RCTs, 16 quasi-RCTs, seven non-randomised studies of intervention, eight prospective cohort studies, nine retrospective cohort studies and three case-control studies. Evidence suggests skin-to-skin contact may result in a large reduction in the incidence of neonatal hypoglycaemia (7 RCTs/quasi-RCTs, 922 infants, RR 0.29 (0.13, 0.66), p < 0.0001, I = 47%). Skin-to-skin contact may reduce the incidence of admission to special care or neonatal intensive care nurseries for hypoglycaemia (1 observational study, 816 infants, OR 0.50 (0.25-1.00), p = 0.050), but the evidence is very uncertain. Skin-to-skin contact may reduce duration of initial hospital stay after birth (31 RCTs, 3437 infants, MD -2.37 (-3.66, -1.08) days, p = 0.0003, I = 90%, p for Egger's test = 0.02), and increase exclusive breastmilk feeding from birth to discharge (1 observational study, 1250 infants, RR 4.30 (3.19, 5.81), p < 0.0001), but the evidence is very uncertain.
CONCLUSION
Skin-to-skin contact may lead to a large reduction in the incidence of neonatal hypoglycaemia. This, along with other established benefits, supports the practice of skin-to-skin contact for all infants and especially those at risk of hypoglycaemia.
Topics: Infant, Newborn; Infant; Female; Humans; Breast Feeding; Mothers; Fetal Diseases; Hypoglycemia; Case-Control Studies; Observational Studies as Topic
PubMed: 37865757
DOI: 10.1186/s12884-023-06057-8 -
Journal of Pregnancy 2023Urinary tract infection (UTI) remains the most common bacterial infection that affects millions of people around the world, especially pregnant women (PW) and people... (Meta-Analysis)
Meta-Analysis Review
Urinary tract infection (UTI) remains the most common bacterial infection that affects millions of people around the world, especially pregnant women (PW) and people with diabetes mellitus (DM). This systematic review and meta-analysis was aimed at finding the pooled prevalence of UTI and its associated risk factors among PW and DM patients. Scientific articles written in English were recovered from PubMed, ScienceDirect, Web of Science, Google Scholar, Cochrane Library, Google Engine, and University Library Databases. "Prevalence," "urinary tract infection," "associated factors," "pregnant women," "diabetic patients," and "Ethiopia" were search terms used for this study. For critical appraisal, PRISMA-2009 was applied. Heterogeneity and publication bias were evaluated using Cochran's , inverse variance (), and funnel plot asymmetry tests. A random effect model was used to calculate the pooled prevalence of UTI and its associated factors among both patients, along with the parallel odds ratio (OR) and 95% confidence interval (CI). For this meta-analysis, a total of 7271 participants were included in the 25 eligible studies. The pooled prevalence of UTI in Ethiopia among both patients was 14.50% (95% CI: 13.02, 15.97), of which 14.21% (95% CI: 12.18, 16.25) and 14.75% (95% CI: 12.58, 16.92) were cases of DM and PW, respectively. According to the subgroup analysis, the highest prevalence was observed in the Oromia region (19.84%) and in studies conducted from 2018 to 2022 (14.68%). Being female (AOR: 0.88, and 95% CI: 0.11, 1.65, = 0.01) and having an income level ≤ 500ETB (AOR: 4.46, and 95% CI: -1.19, 10.12, = 0.03) were risk factors significantly associated with UTI among patients with DM and PW, respectively. Furthermore, a history of catheterization (AOR = 5.58 and 95% CI: 1.35, 9.81, < 0.01), urinary tract infection (AOR: 3.52, and 95% CI: 1.96, 5.08, < 0.01), and symptomatic patients (AOR: 2.32, and 95% CI: 0.57, 4.06, < 0.01) were significantly associated with UTI in both patients. Early diagnosis and appropriate medication are necessary for the treatment of UTI in patients with DM and PW.
Topics: Humans; Female; Pregnancy; Male; Pregnant Women; Urinary Tract Infections; Risk Factors; Ethiopia; Diabetes Mellitus; Prevalence
PubMed: 37545868
DOI: 10.1155/2023/8365867 -
Scientific Reports Oct 2023Multiple evidence indicates that perinatal factors make impact on immune development and affect offspring allergic rhinitis (AR) risk. In this systematic review and... (Meta-Analysis)
Meta-Analysis
Multiple evidence indicates that perinatal factors make impact on immune development and affect offspring allergic rhinitis (AR) risk. In this systematic review and meta-analysis, we examined available published studies to clarify the relationship between cesarean section (C-section) and offspring AR in children. To explore the relationship between C-section, especially the special attention was paid to different cesarean delivery mode, and the risk of AR in children. Articles were searched using PubMed, Web of Science, EMBASE, Cochrane Library, China knowledge Network, Wanfang, and China Science and Technology Journal databases. A meta-analysis of 22 studies published before August 1, 2022, which included 1,464,868 participants, was conducted for statistical analysis with RevMan5.4. The correlation strength between C-section and offspring AR was determined by combining odds ratio (OR) and 95% confidence interval (95% CI). Meta-regression and subgroup analyses were used to explore potential sources of heterogeneity. Publication bias was detected using the funnel chart and Egger tests. Meta-analysis revealed that there was a significant correlation between C-section and children AR (OR = 1.19, 95% CI: 1.12-1.27, P < 0.001), especially C-section with a family history of allergy (OR = 1.82, 95% CI: 1.36-2.43, P < 0.001). Moreover, elective C-section (without genital tract microbe exposure) had the higher risk of offspring AR (OR = 1.24, 95% CI: 1.05-1.46, P = 0.010) compared with the whole study. Meta-regression demonstrated that sample size explained 38.0% of the variability between studies, and year of publication explained 18.8%. Delivery by C-section, particularly elective C-section and C-section with a family history of allergy can increase the risk of AR in children.
Topics: Child; Female; Humans; Pregnancy; Cesarean Section; Odds Ratio; Rhinitis, Allergic
PubMed: 37884557
DOI: 10.1038/s41598-023-44932-8 -
Medicine Oct 2023Being overweight or obese is closely related to adverse pregnancy outcomes and harms both pregnant women and neonates, increasing complications during pregnancy and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Being overweight or obese is closely related to adverse pregnancy outcomes and harms both pregnant women and neonates, increasing complications during pregnancy and leading to adverse pregnancy outcomes. Consequently, a meta-analysis was done to investigate exercise therapy impact on the complications and outcomes of pregnant women who are obese or overweight.
MATERIALS AND METHODS
The computer system searched PubMed, Cochrane Library, Wanfang, EMBASE, and CNKI databases. The search duration extended from the database establishment until October 2022. A thorough search was carried out for pertinent studies investigating exercise therapy impact on pregnancy complications and outcomes in obese or overweight pregnant women. The heterogeneity test was carried out using Cochrane Q and Chi-square tests. The combined findings from the meta-analysis were examined for reliability and robustness using sensitivity and publication bias analyses. All statistics used RevMan 5.3 software.
RESULTS
This meta-analysis included data from 8026 patients from 22 randomized controlled trials. The results demonstrated that exercise therapy might successfully decrease the incidence of gestational diabetes mellitus (GDM) (odds ratio [OR] = 0.85, 95% confidence interval [CI]: 0.74-0.96, P = .01) and macrosomia (OR = 0.78, 95% CI: 0.68-0.89, P < .001), and control weight gain during pregnancy (SMD = -0.2, 95% CI: -0.31 to -0.08, P < .001).
CONCLUSIONS
Exercise therapy can control weight gain during pregnancy, lower the incidence of GDM and the macrosomia rate, and improve adverse pregnancy outcomes.
Topics: Infant, Newborn; Female; Humans; Pregnancy; Overweight; Pregnancy Outcome; Pregnant Women; Fetal Macrosomia; Reproducibility of Results; Exercise; Obesity; Weight Gain; Diabetes, Gestational; Pregnancy Complications; Exercise Therapy
PubMed: 37800765
DOI: 10.1097/MD.0000000000034804 -
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 -
BMJ Open Nov 2023This study aims to estimate the prevalence of neural tube defects (NTDs) and to identify potential risk factors in the Ethiopian context. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
This study aims to estimate the prevalence of neural tube defects (NTDs) and to identify potential risk factors in the Ethiopian context.
STUDY DESIGN
Systematic review and meta-analysis.
STUDY PARTICIPANTS
A total of 611 064 participants were included in the review obtained from 42 studies.
METHODS
PubMed (Medline), Embase and Cochrane Library databases in combination with other potential sources of literature were systematically searched, whereby studies conducted between January 2010 and December 2022 were targeted in the review process. All observational studies were included and heterogeneity between studies was verified using Cochrane Q test statistics and I test statistics. Small study effects were checked using Egger's statistical test at a 5% significance level.
RESULT
The pooled prevalence of all NTDs per 10 000 births in Ethiopia was 71.48 (95% CI 57.80 to 86.58). The between-study heterogeneity was high (I= 97.49%, p<0.0001). Birth prevalence of spina bifida (33.99 per 10 000) was higher than anencephaly (23.70 per 10 000), and encephalocele (4.22 per 10 000). Unbooked antenatal care (AOR 2.26, 95% CI (1.30 to 3.94)), preconception intake of folic acid (AOR 0.41, 95% CI (0.26 to 0.66)), having chronic medical illness (AOR 2.06, 95% CI (1.42 to 2.99)), drinking alcohol (AOR 2.70, 95% CI (1.89 to 3.85)), smoking cigarette (AOR 2.49, 95% CI (1.51 to 4.11)), chewing khat (AOR 3.30, 95% CI (1.88 to 5.80)), exposure to pesticides (AOR 3.87, 95% CI (2.63 to 5.71)), maternal age ≥35 (AOR 1.90, 95% CI (1.13 to 3.25)), maternal low educational status (AOR 1.60, 95% CI (1.13 to 2.24)), residing in urban areas (AOR 0.75, 95% CI (0.58 to 0.97))and family history of NTDs (AOR 2.51, 95% CI (1.36 to 4.62)) were associated with NTD cases.
CONCLUSION
The prevalence of NTDs in Ethiopia is seven times as high as in other Western countries where prevention measures are put in place. Heredity, maternal and environmental factors are associated with a high prevalence of NTDs. Mandatory fortification of staple food with folic acid should be taken as a priority intervention to curb the burden of NTDs. To smoothen and overlook the pace of implementation of mass fortification, screening, and monitoring surveillance systems should be in place along with awareness-raising measures.
PROSPERO REGISTRATION NUMBER
CRD42023413490.
Topics: Female; Pregnancy; Humans; Prevalence; Ethiopia; Neural Tube Defects; Folic Acid; Risk Factors; Food, Fortified
PubMed: 37940152
DOI: 10.1136/bmjopen-2023-077685 -
Frontiers in Medicine 2023Cadmium (Cd) is a heavy metal associated with several human disorders. Preeclampsia is a major cause of maternal mortality worldwide. The association between maternal Cd...
BACKGROUND
Cadmium (Cd) is a heavy metal associated with several human disorders. Preeclampsia is a major cause of maternal mortality worldwide. The association between maternal Cd exposure and preeclampsia remains elusive.
METHODS
To better understand this relationship, we conducted a systematic review and meta-analysis of eligible studies from five databases (PubMed, Embase, Web of Science, Scopus, and CNKI) from their inception to September 10, 2022. The quality of these studies was evaluated using the Newcastle-Ottawa quality assessment scale (NOS). We use random-effects models to calculate overall standardized mean differences (SMDs) and 95% confidence intervals (CIs). Sensitivity analyses were performed to assess the robustness of our results. We also evaluated publication bias using Egger's and Begg's tests. Additionally, we conducted meta-regression and sub-group analyses to identify potential sources of heterogeneity between studies.
RESULTS
Our analysis included a total of 17 studies with 10,373 participants. We found a significant association between maternal cadmium exposure and the risk of preeclampsia (SMD 0.27, 95% CI 0.09-0.44, < 0.01). No significant publication bias was detected in Begg's or Egger's tests. Meta-regression suggested that geographical location, year of publication, cadmium samples, sample size, and measurement methods did not contribute to heterogeneity between studies.
CONCLUSION
Our findings suggest that maternal blood cadmium levels are associated with an increased risk of preeclampsia. In contrast, the pregnant women's urine or placental levels of cadmium may not suggest preeclamptic risk during pregnancy. Further high-quality clinical studies and animal experiments are needed to understand this association better.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=361291, identifier: CRD42022361291.
PubMed: 38105903
DOI: 10.3389/fmed.2023.1259680 -
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