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BMJ Open Oct 2022The COVID-19 pandemic has led to concerns about potential adverse pregnancy outcomes associated with infection, resulting in intensive research. Numerous studies have...
INTRODUCTION
The COVID-19 pandemic has led to concerns about potential adverse pregnancy outcomes associated with infection, resulting in intensive research. Numerous studies have attempted to examine whether COVID-19 is associated with an increased risk of pregnancy loss. However, studies and reviews to date have drawn differing conclusions. The aim of this systematic review is to provide a summary of all quantitative research on the relationship between pregnancy loss and COVID-19 infection and, if appropriate, to synthesise the evidence into an overall effect estimate.
METHODS AND ANALYSIS
Three publication databases (Embase, PubMed and Cochrane) and four preprint databases (medRxiv, Lancet Preprint, Gates Open Research and Wellcome Open Research) will be searched. Boolean logic will be used to combine terms associated with pregnancy loss and COVID-19. The population of interest are pregnant women. Retrieved results will be assessed in two phases: (1) abstract screening and (2) full text evaluation. All studies which compare pregnancy loss outcomes in women who had COVID-19 versus those who did not quantitatively will be included. Narrative and non-English studies will be excluded. Two reviewers will screen independently, with results compared and discrepancies resolved by the study team. Study quality and risk of bias will be assessed using a quality appraisal tool. Results will be summarised descriptively and where possible synthesised in a meta-analysis.
ETHICS AND DISSEMINATION
This systematic review requires no ethical approval. This review will be published in a peer-reviewed journal and provide an important update in a rapidly evolving field of research.
PROSPERO REGISTRATION NUMBER
CRD42022327437.
Topics: Abortion, Spontaneous; COVID-19; Female; Humans; Meta-Analysis as Topic; Pandemics; Pregnancy; Pregnancy Outcome; Research Design; Stillbirth; Systematic Reviews as Topic
PubMed: 36192094
DOI: 10.1136/bmjopen-2022-065588 -
BMC Pregnancy and Childbirth Jul 2022Adolescent pregnancy is a public health issue with well-defined causes and health risks with social and economic implications. Aim of this review was to examine adverse... (Review)
Review
BACKGROUND
Adolescent pregnancy is a public health issue with well-defined causes and health risks with social and economic implications. Aim of this review was to examine adverse pregnancy outcomes and risk factors associated with adolescent pregnancy in Africa.
METHOD
PubMed Central, Science Direct and JSTOR were the main databases for the literature review. Other online sources and experts were consulted for relevant studies. In all, 11,574 records were identified and 122 were considered as full-text studies for evaluation after thorough screening and removal of duplicates. Finally, 53 studies were included in this review for thematic synthesis.
RESULTS
The 53 studies sampled 263,580 pregnant women, including 46,202 adolescents (< 20 years) and 217,378 adults (> 20 years). Adolescent pregnancy was associated with higher risks of adverse pregnancy outcomes. Factors of poor pregnancy outcomes included low socioeconomic and educational status, poor utilization of antenatal care, risky lifestyles such as alcohol consumption, and unattractive health care factors. Maternal health care utilization was identified as an important factor to improve pregnancy outcomes among adolescents in Africa.
CONCLUSION
To prevent adolescent pregnancy, stakeholders need to help lower socioeconomic inequalities, poor utilization of antenatal care, alcohol consumption, and improve adolescents' health care and their educational status. Issues such as child marriage, abortion, poor health care infrastructure and non-adolescent friendly health facilities need to be addressed.
Topics: Adolescent; Adult; Africa; Child; Female; Humans; Infant, Newborn; Maternal Health Services; Pregnancy; Pregnancy Outcome; Pregnancy in Adolescence; Prenatal Care
PubMed: 35896998
DOI: 10.1186/s12884-022-04821-w -
Kathmandu University Medical Journal...Background Teenage pregnancies constitute a serious health and social problem worldwide. World estimates in 2008 report about 16 million births to adolescent mothers,...
Background Teenage pregnancies constitute a serious health and social problem worldwide. World estimates in 2008 report about 16 million births to adolescent mothers, most of them occurring in low and middle income countries. Objective To assess pregnancy co-morbidities and outcome of teenage pregnancy. Method A cross-sectional study was conducted at obstetrics and gynecological department of Dhulikhel Hospital. Study was conducted for 18 month period from 1-07-2013 to 30-12-2014. All teenage pregnancy cases admitted at the time of study period were enrolled. Purposive sampling technique was used. Data were collected by face to face interview using clinical Performa and through record file of the patient. Collected data were analyzed in SPSS version 21.0. Result Total of 527 teenage mothers of varying age group (15 to 19 years ) were enrolled in the study. Teenagers who had never been to school were 3.0%; 66.2% of them were from low socioeconomic background , and 58.6% were from rural areas. Pregnancy co-morbidities detected were, Urinary tract infection (UTI) 18.4%, threatened preterm 12.9% followed by ante partum hemorrhage 4.7%. However, other major co-morbidities such as hypertensive disorder, gestational diabetes found to be very less such as, hypertension 0.8% and gestational diabetes found in only one woman. Conclusion Maternal and newborn outcome and co-morbidities among teenage pregnant women found less compare to other studies. Major pregnancy related morbidities such as hypertension, pre-eclampsia and diabetes were found very less. Most common maternal morbidity found was urinary tract infection during pregnancy but statistically not significant. Similarly, newborn mean weight was more than 2.5 kg and neonatal death found very less. However, teenage pregnancy is significantly associated with low economic status, illiteracy status, willingness to marriage by teenagers and ethnicity.
Topics: Adolescent; Adult; Cross-Sectional Studies; Female; Humans; Infant, Newborn; Nepal; Pregnancy; Pregnancy Outcome; Pregnancy in Adolescence; Tertiary Care Centers; Young Adult
PubMed: 33582690
DOI: No ID Found -
Journal of Obstetrics and Gynaecology :... Jan 2020In early pregnancy, miscarriage is the most common complication. The early identification of women at high risk for miscarriage could improve pregnancy outcomes. We...
In early pregnancy, miscarriage is the most common complication. The early identification of women at high risk for miscarriage could improve pregnancy outcomes. We investigated whether the first trimester neutrophil to lymphocyte ratio (NLR) could be used as a prognostic marker for miscarriage, in pregnancies after spontaneous conception. We retrospectively identified 129 pregnant women who had a first trimester full blood count available and known pregnancy outcome. First trimester NLR was calculated for each woman and mean NLR values were compared between women with live births (group 1) with those with miscarriage (group 2). Mean NLR values were not significantly different between the two groups (2.5 ± 1.0 vs. 2.9 ± 1.5, = .167) and were not associated with pregnancy outcomes. However, NLR values >5.8 were exclusively observed in the miscarriage group ( = .028).IMPACT STATEMENT As a marker of inflammation, NLR has been found to be elevated in various diseases and complications that affect pregnancy outcome. Pregnancy complications, such as preeclampsia and gestational diabetes have been associated with an increased NLR, but little is known on their direct causal relationship. So far, there has been no evaluation of maternal NLR in regards to miscarriage in otherwise healthy women. We found that NLR does not differ significantly between pregnant women with live birth and those whose pregnancy ended in miscarriage . However, NLR values >5.8 were solely found in the miscarriage group- an observation that was statistically significant. The above finding supports high NLR values as a potential marker for the identification of the subset of miscarriages in otherwise healthy pregnant women. This may allow personalised approaches to prevent pregnancy loss.
Topics: Abortion, Spontaneous; Adult; Biomarkers; Female; Humans; Leukocyte Count; Live Birth; Lymphocytes; Neutrophils; Predictive Value of Tests; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Pregnancy Trimester, First; Prognosis; Retrospective Studies; Risk Factors; Young Adult
PubMed: 31609136
DOI: 10.1080/01443615.2019.1606171 -
American Journal of Obstetrics &... Jan 2023This study aimed to investigate the association between early pregnancy with subchorionic hematoma and preterm delivery and other adverse pregnancy outcomes in singleton... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
This study aimed to investigate the association between early pregnancy with subchorionic hematoma and preterm delivery and other adverse pregnancy outcomes in singleton pregnancies.
DATA SOURCES
English studies published from 2000 to July 15, 2022 were retrieved from PubMed, Web of Science, and the Cochrane Library.
STUDY ELIGIBILITY CRITERIA
The inclusion criteria were: singleton pregnancy, subchorionic hematoma, and perinatal outcomes. Studies including multiple pregnancy, basic molecular studies, case reports (series), and conference reviews were excluded.
METHODS
Data analysis was mainly conducted with Review Manager (RevMan) and Stata, and the results were represented with odds ratios and 95% confidence intervals. The methodological quality of the included studies was evaluated by the Cochrane risk assessment scale.
RESULTS
In total, 370 studies were retrieved from the above databases. Our review included 16 studies and divided them into 2 subgroups: natural pregnancy (12 studies) and assisted reproductive pregnancy (4 studies). The relevant characteristics of each study were analyzed in detail. The primary outcome was preterm delivery. The secondary outcomes were miscarriage, fetal growth restriction, cesarean delivery, and preeclampsia. We found that subchorionic hematoma in the first trimester was not significantly associated with preterm delivery (odds ratio, 1.11; 95% confidence interval, 0.82-1.51) or other adverse outcomes in singleton pregnancy. Regression analysis found that the large heterogeneity of the included studies might be related to whether the included study population (early pregnancy with subchorionic hematoma) was complicated with threatened abortion (P<.05). However, no studies caused large heterogeneity according to sensitivity analysis. Finally, 15 studies related to preterm delivery did not have publication bias (Egger test: P=.26). However, subchorionic hematoma in the first trimester was associated with miscarriage in single pregnancies (natural pregnancy: odds ratio, 3.07; 95% confidence interval, 1.98-4.75; assisted reproductive pregnancy: odds ratio, 1.45; 95% confidence interval, 1.1-1.90).
CONCLUSION
In singleton pregnancy, we found no association between subchorionic hematoma in the first trimester and preterm delivery. Although there was a correlation with miscarriage, the possible gestational age of miscarriage was not stated. More studies are needed to further address the herein posed research questions.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Premature Birth; Pregnancy Complications; Pregnancy Outcome; Pregnancy Trimester, First; Abortion, Spontaneous; Hematoma
PubMed: 36328350
DOI: 10.1016/j.ajogmf.2022.100791 -
Pregnancy Hypertension Dec 2023Human chorionic gonadotropin (hCG), a glycoprotein produced in the placenta, is crucial for a healthy pregnancy. We investigated the relationship between hCG levels and... (Meta-Analysis)
Meta-Analysis Review
Human chorionic gonadotropin (hCG), a glycoprotein produced in the placenta, is crucial for a healthy pregnancy. We investigated the relationship between hCG levels and adverse pregnancy outcomes. We conducted a systematic review including studies measuring hCG blood levels in the first or second trimester, reporting on any of the 12 predefined adverse pregnancy outcomes with logistic regression-adjusted association estimates. The primary outcomes were placenta-associated complications, such as miscarriage, preeclampsia, intrauterine growth restriction, and preterm delivery. We searched PubMed, Embase and CINAHL Complete. The hCG levels were analysed as multiple of the median (MoM). Odds ratio (OR) and 95% confidence interval (CI) were used. Risk of bias and the certainty of evidence were assessed using ROBINS-I and GRADE, respectively. Meta-analysis also showed that hCG levels, reported as MoM ≥2/2.31/2.5, might be associated with an increased risk of preeclampsia (OR 2.08, 95% CI 1.26 to 3.44) and preterm delivery (OR 1.29, 95% CI 1.12 to 1.47), but the evidence is very uncertain. High second trimester hCG levels may be associated with preeclampsia and preterm delivery but confidence in evidence is low.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Premature Birth; Pre-Eclampsia; Pregnancy Outcome; Chorionic Gonadotropin; Abortion, Spontaneous; Pregnancy Trimester, Second
PubMed: 37951184
DOI: 10.1016/j.preghy.2023.11.003 -
Environmental Science & Technology May 2023Organophosphate flame retardants (OPFRs) are found in various environmental matrixes and human samples. Exposure to OPFRs during gestation may interfere with pregnancy,... (Review)
Review
Organophosphate flame retardants (OPFRs) are found in various environmental matrixes and human samples. Exposure to OPFRs during gestation may interfere with pregnancy, for example, inducing maternal oxidative stress and maternal hypertension during pregnancy, interfering maternal and fetal thyroid hormone secretion and fetal neurodevelopment, and causing fetal metabolic abnormalities. However, the consequences of OPFR exposure on pregnant women, impact on mother-to-child transmission of OPFRs, and harmful effects on fetal and pregnancy outcomes have not been evaluated. This review describes the exposure to OPFRs in pregnant women worldwide, based on metabolites of OPFRs (mOPs) in urine for prenatal exposure and OPFRs in breast milk for postnatal exposure. Predictors of maternal exposure to OPFRs and variability of mOPs in urine have been discussed. Mother-to-child transmission pathways of OPFRs have been scrutinized, considering the levels of OPFRs and their metabolites in amniotic fluid, placenta, deciduae, chorionic villi, and cord blood. The results showed that bis(1,3-dichloro-2-propyl) phosphate (BDCIPP) and diphenyl phosphate (DPHP) were the two predominant mOPs in urine, with detection frequencies of >90%. The estimated daily intake (EDI) indicates low risk when infants are exposed to OPFRs from breast milk. Furthermore, higher exposure levels of OPFRs in pregnant women may increase the risk of adverse pregnancy outcomes and influence the developmental behavior of infants. This review summarizes the knowledge gaps of OPFRs in pregnant women and highlights the crucial steps for assessing health risks in susceptible populations, such as pregnant women and fetuses.
Topics: Infant; Humans; Female; Pregnancy; Organophosphates; Pregnant Women; Flame Retardants; Pregnancy Outcome; Infectious Disease Transmission, Vertical; Phosphates
PubMed: 37079500
DOI: 10.1021/acs.est.2c06503 -
European Journal of Obstetrics,... Apr 2021Does psychosocial intervention affect pregnancy outcomes in women and couples undergoing assisted reproductive technology (ART) treatment?. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Does psychosocial intervention affect pregnancy outcomes in women and couples undergoing assisted reproductive technology (ART) treatment?.
DESIGN
A systematic review and meta-analysis of Randomized Controlled Trials (RCTs) evaluating the efficacy of psychosocial intervention on pregnancy outcomes in women and couples undergoing ART treatment. The primary outcome was Pregnancy Rates. Secondary outcomes were Live Birth Rate (LBR) and Abortion Rate (AR).
MATERIALS AND METHODS
Databases searched were Pubmed, PsycINFO, Embase, CINAHL and The Cochrane Library. 1439 records were screened, 15 were eligible and included in the meta-analyses (N = 2434). Data was extracted using the Covidence software. Effect sizes were reported as relative risks with 95% confidence-intervals and p-values.
RESULTS
A positive association was found between psychosocial intervention and pregnancy rates (RR = 1.12 CI=(1.01;1.24), p = 0.033). Long-duration interventions and mind-body intervention types were found to be associated with increased pregnancy rates (RR 1.21, CI= (1.04;1.43), p = 0.017) and (RR = 1.25, CI= (1.00;1.55), p = 0.046) respectively. Q and Itests suggested no to low heterogeneity. Funnel plots, Trim and Fill analyses and Fail-safe numbers were applied to adjust for possible publication bias.
CONCLUSIONS
Our findings suggest a positive association between psychosocial interventions, particularly long-duration interventions, and pregnancy rate in infertile women and couples in ART treatment. The findings are in line with findings from other reviews and meta-analyses exploring the same topic. More good quality RCTs need to be performed to increase the quality of guidance for infertile women and couples. The effect of psychosocial interventions on LBR and AR remain to be examined.
Topics: Female; Humans; Infertility, Female; Live Birth; Pregnancy; Pregnancy Outcome; Pregnancy Rate; Psychosocial Intervention; Reproductive Techniques, Assisted
PubMed: 33677371
DOI: 10.1016/j.ejogrb.2021.02.012 -
Thrombosis Research Sep 2019Pregnancy outcomes in women with mechanical heart valves (MHV) remain poor. The thrombogenicity of MHV, the hypercoagulable state of pregnancy and limitations of current... (Review)
Review
Pregnancy outcomes in women with mechanical heart valves (MHV) remain poor. The thrombogenicity of MHV, the hypercoagulable state of pregnancy and limitations of current anticoagulation strategies combine to give a very high risk state. Recent additions to the literature in the form of registry data as well as meta-analyses and systematic reviews have highlighted the risks of thrombotic and haemorrhagic events in mothers and increased fetal complication rates. There remains a lack of consensus about the optimal anticoagulation approach to mitigate the risks to mother and fetus and registry data confirm poor quality of care. Current guidelines recommend the sequential use of heparin and vitamin K antagonists, but low molecular weight heparin is often used throughout the pregnancy, with inadequate monitoring in many instances. There is an urgent need to standardise the management of such women, which should be undertaken in specialist centres, supported by research on optimal anticoagulation regimens and the impact on pregnancy outcomes.
Topics: Female; Heart Valve Prosthesis; Humans; Pregnancy; Pregnancy Outcome
PubMed: 31477226
DOI: 10.1016/S0049-3848(19)30365-2 -
International Journal of Gynaecology... Feb 2022To investigate whether food insecurity is associated with adverse pregnancy outcomes such as miscarriage, stillbirth, and neonatal mortality among women in rural Malawi.
OBJECTIVE
To investigate whether food insecurity is associated with adverse pregnancy outcomes such as miscarriage, stillbirth, and neonatal mortality among women in rural Malawi.
METHODS
We analyzed data from the baseline (July 2014 to February 2015) and follow-up (January 2018 to May 2018) waves of a longitudinal study of reproductive-age women in rural Malawi. We sampled women from villages from the catchment area of a community hospital in rural Lilongwe district of Malawi using stratified cluster sampling. We classified women as food secure or insecure at baseline. Using unadjusted and adjusted log-binomial models, we used baseline data to examine the cross-sectional association between food insecurity and ever experiencing an adverse pregnancy outcome. We used baseline and follow-up data to assess the longitudinal association between food insecurity and experiencing a new adverse pregnancy outcome during follow-up. In a subgroup analysis, we repeated the longitudinal analysis after restricting the sample to women who had no adverse pregnancy outcomes at baseline.
RESULTS
We observed no significant cross-sectional association between baseline food insecurity and ever experiencing an adverse pregnancy outcome (adjusted prevalence ratio: 1.09; 95% confidence interval [CI]: 0.78-1.53). Baseline food insecurity was not associated with experiencing a new adverse pregnancy outcome during follow-up (adjusted risk ratio [aRR]: 1.14, 95% CI: 0.60-2.20) or in the subgroup analysis (aRR: 1.52, 95% CI: 0.78-2.96).
CONCLUSIONS
While food insecurity is a critical issue, in this cohort of rural Malawian women, food insecurity was not associated with adverse pregnancy outcomes.
Topics: Cross-Sectional Studies; Female; Food Insecurity; Humans; Infant, Newborn; Longitudinal Studies; Pregnancy; Pregnancy Outcome; Rural Population
PubMed: 33507564
DOI: 10.1002/ijgo.13630