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PloS One 2023Preeclampsia is a serious condition that is linked to poor perinatal outcomes. In Ethiopia, the overall prevalence of preeclampsia and its associated factors is... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Preeclampsia is a serious condition that is linked to poor perinatal outcomes. In Ethiopia, the overall prevalence of preeclampsia and its associated factors is uncertain. Therefore, the purpose of this review was to find the prevalence of pre-eclampsia and its determinants in Ethiopia.
METHODS
To find primary studies, PubMed, Google Scholar, HINAR, Scopus, the Web of Sciences, and grey literature searches were used between January 1, 2013, and January 1, 2023, in Ethiopia. A Microsoft Excel sheet was used to extract data. The pooled prevalence of pre-eclampsia was predicted using a random-effect model.
RESULTS
Twenty-nine studies were included. The pooled prevalence of pre-eclampsia was 11.51% (95% CI: 8.41, 14.61). Age > 35 years old (AOR = 2.34, 95%CI, 1.74-2.94; p-value = 0.64), housewife (AOR = 2.76, 95%CI, 1.2-4.32; p-value = 0.37), previous history of pre-eclampsia (AOR = 4.02, 95%CI, 2.91-5.55; p-value = 0.09), family history of hypertension (OR = 1.84, 95%CI, 1.39-2.3; p-value = 0.4), history of chronic hypertension (AOR = 2.44, 95%CI, 1.8-3.08; p-value = 0.67), history of multiple pregnancies (AOR = 1.45, 95%CI, 1.09-1.8; p-value = 0.38), and alcohol intake during pregnancy (AOR = 1.53, 95%CI, 1.03-2.04; p-value = 0.03) were the determinants of pre-eclampsia.
CONCLUSIONS
When compared to previous studies, the overall pooled prevalence of pre-eclampsia was high. Pre-eclampsia is associated with maternal age >35 years, being a housewife, having a history of preeclampsia, having a history of chronic hypertension, having a family history of hypertension, having diabetes mellitus, drinking alcohol during pregnancy, and having multiple pregnancies.
Topics: Pregnancy; Female; Humans; Adult; Pre-Eclampsia; Ethiopia; Risk Factors; Maternal Age; Hypertension; Prevalence
PubMed: 37963147
DOI: 10.1371/journal.pone.0287038 -
Journal of Research in Medical Sciences... 2023Researchers have shown that diet is associated with hypertensive disorders of pregnancy, and there are some reports of performed meta-analyses on observational studies.... (Review)
Review
BACKGROUND
Researchers have shown that diet is associated with hypertensive disorders of pregnancy, and there are some reports of performed meta-analyses on observational studies. However, very few randomized-controlled trials have systematically summarized. Thus, we reviewed and meta-analyzed the effects of nutritional interventions on risks of gestational hypertension (GH) or/and preeclampsia (PE).
MATERIALS AND METHODS
A systematic search was performed using Medline, Cochrane library, Google Scholar, ISI Web of Science, Scopus, and ProQuest to find randomized clinical trials assessing the effect of nutritional interventions on incidences of GH or/and PE compared to control or placebo interventions.
RESULTS
After considering duplicates, 1066 articles were screened from the database searches. Full-text articles were retrieved for 116 records, while 87 did not have the inclusion criteria and were later omitted. Twenty-nine studies were eligible, but 8 studies were not included in the meta-analysis due to insufficient data. Finally, seven studies were included in qualitative analysis. Furthermore, 7 studies (693 in intervention vs. 721 in control) were pooled for managed nutritional interventions, three (1255 vs. 1257) for a Mediterranean-style diet, and 4 (409 vs. 312) for sodium restricted. Our results revealed that managed nutritional programs were effective in reducing the incidence of GH (odds ratio [OR] = 0.37; 95% confidence interval [CI] = 0.15, 0.92); = 66.9%; = 0.010), but not for PE (OR = 0.50; 95% CI = 0.23, 1.07); = 58.9%; = 0.032. The Mediterranean-style diets in three trials (1255 vs. 1257) did not reduce the risk of PE (OR = 1.10; 95% CI = 0.71, 1.70); = 2.3%; = 0.359). Likewise, sodium-restricted interventions in four trials (409 vs. 312) did not decrease total risk of GH (OR = 0.99; 95% CI = 0.68, 1.45); = 0%; = 0.520). Meta-regression did not indicate any significant association between maternal age, body mass index, gestational weight gain, and start time of all interventions with the incidence of GH or/and PE ( > 0.05).
CONCLUSION
The present meta-analysis showed that Mediterranean-style diets and sodium-restriction interventions did not decrease the incidence of GH or/and PE in healthy pregnancies; however, managed nutritional programs reduced the risk of GH, the total incidence of GH and PE, but not PE.
PubMed: 37213454
DOI: 10.4103/jrms.jrms_89_22 -
The Journal of Maternal-fetal &... Dec 2023L-Arginine (L-Arg)/Nitric Oxide (NO) system is involved in the pathophysiology of relevant Obstetric conditions. This review aims at summarizing the effects of L-Arg... (Review)
Review
BACKGROUND/AIM OF THE STUDY
L-Arginine (L-Arg)/Nitric Oxide (NO) system is involved in the pathophysiology of relevant Obstetric conditions. This review aims at summarizing the effects of L-Arg supplementation in pregnancy looking at safety and efficacy.
METHODS
We conducted a systematic review of the literature utilizing PubMed for studies published from inception to September 2022. The search included human and animal studies where L-Arg was supplemented pre-conceptionally or during pregnancy, by either oral or intravenous route. The main perinatal outcomes were focused.
RESULTS
Among 1028 publications, 51 studies were eligible for inclusion, 25 were performed in women, and the remnant in animals. Compared to controls/placebo, the supplementation with L-Arg reduced the development of pre-eclampsia (four studies), decreased blood pressure, and reduced the need for antihypertensive drugs in women with Hypertensive Disorders of Pregnancy (HDP, eight studies). In women carrying growth retarded fetuses, L-Arg improved fetoplacental circulation, birth weight and neonatal outcomes (five studies), while in the case of threatened preterm birth, L-Arg reduced uterine contractions (two studies). In several animal species, L-Arg supplementation in pregnancy improved reproductive performance by increasing the litter number and size. Moreover, in pre-eclamptic and metabolic syndrome experimental models, maternal hypertension and fetal growth were improved.
CONCLUSION
L-Arg displays biological activities in pregnancies complicated by HDP and growth restriction, both in women and animal models. L-Arg administration is safe and could be a candidate as an intervention beneficial to maternal and fetal outcomes, at least in moderate clinical disorders.
Topics: Pregnancy; Animals; Infant, Newborn; Female; Humans; Premature Birth; Dietary Supplements; Pre-Eclampsia; Fetus; Arginine
PubMed: 37258415
DOI: 10.1080/14767058.2023.2217465 -
BJOG : An International Journal of... May 2023Several human randomised controlled trials (RCTs) are investigating the effects of statins on pre-eclampsia (PE) and fetal growth restriction (FGR). This cross-species... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Several human randomised controlled trials (RCTs) are investigating the effects of statins on pre-eclampsia (PE) and fetal growth restriction (FGR). This cross-species meta-analysis summarises the preclinical evidence of statin use for PE and FGR.
OBJECTIVES
Evaluate the effects of statins on maternal blood pressure (MBP) and birthweight (BW) in pregnancies complicated by PE or FGR.
SEARCH STRATEGY
PubMed and Embase.com were searched on 10 May 2022 using 'statins' and 'pregnancy'.
SELECTION CRITERIA
We included RCTs and cohorts with matched control groups as well as animal studies.
DATA COLLECTION AND ANALYSIS
The main outcomes were MBP in mmHg and BW in grams. The standardised mean difference (SMD) with a 95% confidence interval (CI) was calculated. Subgroup analyses on species, statin, dose, timing and route of administration were performed if subgroups included at least three studies.
MAIN RESULTS
Our data included one human and 12 animal studies. Prenatal administration of statins significantly reduced MBP during pregnancy (SMD -2.49 mmHg [95% CI -4.26 to -0.71], p = 0.01). There was no significant effect of statins on BW (SMD 0.69 [95% CI -0.65 to 2.03], p = 0.28). Our subgroup analyses showed no effect on MBP of different doses, species or route of administration.
CONCLUSIONS
Our cross-species meta-analyses demonstrate that statins only reduce maternal blood pressure in rodent pregnancies complicated by pre-eclampsia or fetal growth restriction and have no effect on birthweight across species. The broad confidence intervals, inconsistent direction of the observed effects across the studies and large risk of bias lead us to conclude that a solid base for further human RCTs is lacking.
Topics: Female; Animals; Humans; Pre-Eclampsia; Fetal Growth Retardation; Blood Pressure; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Birth Weight; Fetal Development
PubMed: 36681887
DOI: 10.1111/1471-0528.17393 -
Scientific Reports Feb 2023To quantify the association between maternal uric acid levels and pre-eclampsia risk in a large collection of primigravid women. A case-control study (1365 cases of... (Meta-Analysis)
Meta-Analysis
To quantify the association between maternal uric acid levels and pre-eclampsia risk in a large collection of primigravid women. A case-control study (1365 cases of pre-eclampsia and 1886 normotensive controls) was conducted. Pre-eclampsia was defined as blood pressure ≥ 140/90 mmHg and proteinuria ≥ 300 mg/24 h. Sub-outcome analysis included early, intermediate, and late pre-eclampsia. Multivariable analysis for pre-eclampsia and its sub-outcomes was conducted using binary and multinomial logistic regression, respectively. Additionally, a systematic review and meta-analysis of cohort studies measuring uric acid levels < 20 weeks of gestation was performed to rule out reverse causation. There was a positive linear association between increasing uric acid levels and presence of pre-eclampsia. Adjusted odds ratio of pre-eclampsia was 1.21 (95%CI 1.11-1.33) for every one standard deviation increase in uric acid levels. No differences in the magnitude of association were observed between early and late pre-eclampsia. Three studies with uric acid measured < 20 weeks' gestation were identified, with a pooled OR for pre-eclampsia of 1.46 (95%CI 1.22-1.75) for a top vs. bottom quartile comparison. Maternal uric acid levels are associated with risk of pre-eclampsia. Mendelian randomisation studies would be helpful to further explore the causal role of uric acid in pre-eclampsia.
Topics: Pregnancy; Female; Humans; Pre-Eclampsia; Prospective Studies; Uric Acid; Case-Control Studies; Blood Pressure
PubMed: 36810371
DOI: 10.1038/s41598-023-29651-4 -
Public Health Nov 2021We aimed to quantitatively synthesize the association between maternal exposure to particulate matter (PM; including PM <2.5 μm and PM <10 μm) and hypertensive... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
We aimed to quantitatively synthesize the association between maternal exposure to particulate matter (PM; including PM <2.5 μm and PM <10 μm) and hypertensive disorders in pregnancy (HDP; including gestational hypertension [GH] and pre-eclampsia) and to explore the influence of certain factors on the outcome.
STUDY DESIGN
Meta-analysis was used to quantitatively synthesize the results of similar independent studies.
METHODS
Original documents were identified by searching six electronic bibliographic databases from their inceptions to August 17, 2021. Then we performed meta-analysis to combine the effect estimates if at least three estimates reported the same exposure and outcome and used stratified analysis to evaluate the impact of exposure assessment method, data source, and study area on heterogeneity. In addition, we used the 95% prediction interval to evaluate the potential effects of exposure in random effects meta-analysis.
RESULTS
The overall meta-analysis showed that the risk of HDP was significantly associated with per 5 μg/m increase in PM exposure during T1 and PM exposure during T, with odds ratios [ORs] 1.06 (95% confidence interval [CI]: 1.01-1.12) and 1.04 (95% CI: 1.02-1.07), respectively. The results also showed that PM exposure during T1 and T2 and PM exposure during T1 increased the incidence of GH; the summary ORs were 1.11 (95% CI: 1.01-1.23), 1.16 (95% CI: 1.05-1.29), and 1.04 (95% CI: 1.02-1.07), respectively. Subgroup analyses showed that the pooled effects were generally significant or more apparent in studies using models to assess exposure, studies whose data derived from birth registers, and studies in Europe.
CONCLUSIONS
This meta-analysis showed that PM exposure was associated with increased HDP risks, and the association varied by study area, data source, and exposure assessment method. With the continuous improvement of research design and exposure assessment, future research may find higher risks.
Topics: Agriculture; Air Pollutants; Air Pollution; Environmental Exposure; Female; Humans; Hypertension, Pregnancy-Induced; Maternal Exposure; Particulate Matter; Pregnancy
PubMed: 34653738
DOI: 10.1016/j.puhe.2021.08.013 -
BJOG : An International Journal of... Oct 2022Birthweight (BW) is an important prognostic factor in newborns with congenital heart defects (CHD). (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Birthweight (BW) is an important prognostic factor in newborns with congenital heart defects (CHD).
OBJECTIVES
To give an overview of the literature on BW z-score in children with isolated CHD.
SEARCH STRATEGY
A systematic search was performed on isolated CHD and BW in PubMed, Embase, Web of Science, COCHRANE Library and Emcare.
SELECTION CRITERIA
Neonates with isolated CHD were included if a BW percentile, BW z-score or % small-or-gestational age (SGA) was reported.
DATA COLLECTION AND ANALYSIS
BW z-score and percentage SGA were pooled with random-effect meta-analysis. Quality and risk of bias were assessed using the modified Newcastle Ottawa Scale.
MAIN RESULTS
Twenty-three articles (27 893 cases) were included. BW z-scores were retrieved from 11 articles, resulting in a pooled z-score of -0.20 (95% CI -0.50 to 0.11). The overall pooled prevalence of SGA <10th percentile was 16.0% (95% CI 11.4-20.5; 14 studies). Subgroup analysis of major CHD showed similar results (BW z-score -0.23 and percentage SGA 16.2%).
CONCLUSIONS
Overall BW in isolated CHD is within range of normality but impaired, with a 1.6-fold higher risk of SGA, irrespective of the type of CHD (major CHD vs all CHD combined). Our findings underline the association between CHD and BW. The use of BW z-scores provides insight into growth of all fetuses with CHD.
TWEETABLE ABSTRACT
Infants with a congenital heart defect (CHD) have a lower birthweight z-score and a higher incidence of small-for-gestational age (<10th percentile). This was encountered both in the major CHD-group as well as in all-CHD combined group analysis. Future research on the association between birthweight and CHD should include all types of CHDs (including mild cardiac defects) and placental-related disease, such as pre-eclampsia. We advocate the use of international standardised fetal growth and birthweight charts in CHD research.
Topics: Birth Weight; Child; Female; Fetal Growth Retardation; Heart Defects, Congenital; Humans; Infant; Infant, Newborn; Infant, Small for Gestational Age; Placenta; Pregnancy
PubMed: 35352871
DOI: 10.1111/1471-0528.17164 -
International Journal of Gynaecology... Oct 2023Protein neutrophil gelatinase-associated lipocalin (NGAL) has been associated with kidney injury and inflammatory conditions. In particular, several studies have found... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Protein neutrophil gelatinase-associated lipocalin (NGAL) has been associated with kidney injury and inflammatory conditions. In particular, several studies have found an association between maternal blood and urine levels and the development of pre-eclampsia.
OBJECTIVES
To examine whether maternal blood and urine levels of NGAL are good predictors of pre-eclampsia.
SEARCH STRATEGY
The authors searched MEDLINE databases via PubMed, Embase, Scopus, Scielo, Google Scholar, PROSPERO International Prospective Register of Systematic Reviews, and the Cochrane Central Register of Controlled Trials.
SELECTION CRITERIA
The authors included case-control observational clinical studies comparing protein levels of NGAL in serum and urine in women with pre-eclampsia with uncomplicated pregnancies. Only studies where the collection of blood or urine was peformed before the occurrence of pre-eclampsia were selected.
DATA COLLECTION AND ANALYSIS
The primary outcome was the difference in NGAL levels in blood or urine between women with and without pre-eclampsia.
RESULTS
Seven studies in total were included: five studies measuring NGAL in blood and two in urine. Regarding the serum studies, 315 patients were included as cases and 540 as controls. Higher NGAL in maternal blood during all three trimesters together was associated with pre-eclampsia; the standardized mean difference was 1.15 ng/mL (95% confidence interval, 0.92-1.39; P < 0.01). Regarding the urine studies, 39 patients were included as cases and 220 as controls. There was no statistically significant difference between patients with pre-eclampsia and controls regarding urine NGAL.
CONCLUSIONS
NGAL in maternal blood is higher in patients who later develop pre-eclampsia compared with controls and could be used as a potential predicting test in the routine clinical setting.
Topics: Pregnancy; Humans; Female; Lipocalin-2; Pre-Eclampsia; Biomarkers; Acute Kidney Injury; Kidney
PubMed: 37040030
DOI: 10.1002/ijgo.14777 -
Environmental Research Aug 2023Hypertensive disorders of pregnancy (HDP), including gestational hypertension (GH) and preeclampsia (PE), cause significant morbidity and mortality among pregnant women.... (Meta-Analysis)
Meta-Analysis
Hypertensive disorders of pregnancy (HDP), including gestational hypertension (GH) and preeclampsia (PE), cause significant morbidity and mortality among pregnant women. Several environmental toxins, particularly those that affect the normal function of the placenta and the endothelium, are emerging as potential risk factors for HDP. Among them, per- and polyfluoroalkyl substances (PFAS), widely used in a variety of commercial products, have been related to a variety of adverse health effects including HDP. This study was conducted by searching three databases for observational studies reporting associations between PFAS and HDP, all of which were published before December 2022. We used random-effects meta-analysis to calculate pooled risk estimates, and assessing each combination of exposure and outcome for quality and level of evidence. In total, 15 studies were included in the systematic review and meta-analysis. The results from meta-analyses showed that risk of PE was increased with exposure to PFOA (perfluorooctanoic acid) (RR = 1.39, 95% CI = 1.05, 1.85; N = 6 studies; exposure = 1 ln-unit increment; low certainty), PFOS (perfluorooctane sulfonate) (RR = 1.51, 95% CI = 1.23, 1.86; N = 6 studies; exposure = 1 ln-unit increment; moderate certainty), and PFHxS (perfluorohexane sulfonate) (RR = 1.39, 95% CI = 1.10, 1.76; N = 6 studies; exposure = 1 ln-unit increment; low certainty). PFOS was also associated with an increased risk of HDP (RR = 1.39, 95% CI = 1.10, 1.76; exposure = 1 ln-unit increment; low certainty). Exposure to legacy PFAS (PFOA, PFOS, PFHxS) is associated with an increased risk of PE, and PFOS is further associated with HDP. In view of the limitations of meta-analysis and quality of evidence, these findings should be interpreted with caution. Further research is required that assesses exposure to multiple PFAS in diverse and well-powered cohorts.
Topics: Humans; Female; Pregnancy; Hypertension, Pregnancy-Induced; Environmental Pollutants; Pre-Eclampsia; Fluorocarbons; Alkanesulfonic Acids; Hazardous Substances; Observational Studies as Topic
PubMed: 37178750
DOI: 10.1016/j.envres.2023.116064 -
Maternal and Child Health Journal Dec 2022A conflicting body of evidence suggests localized periodontal inflammation spreads systemically during pregnancy inducing adverse pregnancy outcomes. This systematic... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
A conflicting body of evidence suggests localized periodontal inflammation spreads systemically during pregnancy inducing adverse pregnancy outcomes. This systematic review and meta-analysis aim to specifically evaluate the relationship between periodontitis and preeclampsia.
METHODS
Electronic searches were carried out in Medline, Pubmed, Embase, Lilacs, Cochrane Controlled Clinical Trial Register, CINAHL, ClinicalTrials.gov, and Google Scholar with no restrictions on the year of publication. We identified and selected observational case-control and cohort studies that analyzed the association between periodontal disease and preeclampsia. This meta-analysis was conducted following the PRISMA checklist and MOOSE checklist. Pooled odds ratios, mean difference, and 95% confidence intervals were calculated using the random effect model. Heterogeneity was tested with Cochran's Q statistic.
RESULTS
Thirty studies including six cohort- and twenty-four case-control studies were selected. Periodontitis was significantly associated with increased risk for preeclampsia (OR 3.18, 95% CI 2.26 - 4.48, p < 0.00001), especially in a subgroup analysis including cohort studies (OR 4.19, 95% CI 2.23 - 7.87, p < 0.00001). The association was even stronger in a subgroup analysis with lower-middle-income countries (OR 6.70, 95% CI 2.61 - 17.19, p < 0.0001).
CONCLUSIONS
Periodontitis appears as a significant risk factor for preeclampsia, which might be even more pronounced in lower-middle-income countries. Future studies to investigate if maternal amelioration of periodontitis prevents preeclampsia might be warranted.
Topics: Pregnancy; Female; Humans; Pre-Eclampsia; Periodontitis; Pregnancy Outcome; Periodontal Diseases; Odds Ratio
PubMed: 36209308
DOI: 10.1007/s10995-022-03556-6