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Journal of Perinatal Medicine Sep 2023Although the vaccination against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS Cov-2) is considered safe during pregnancy, vaccine hesitancy among pregnant women... (Review)
Review
OBJECTIVES
Although the vaccination against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS Cov-2) is considered safe during pregnancy, vaccine hesitancy among pregnant women is high. The results of published observational studies addressing the issue of Covid-19 vaccination's efficacy and safety during pregnancy need to be summarized.
CONTENT
This systematic review compares the incidence of major maternal and neonatal outcomes between SARS Cov-2 vaccinated and unvaccinated pregnant women. The included studies enrolled pregnant women of any age and any trimester. Medline-Pubmed, Scopus, Cochrane Library, and grey literature were searched until the 28th of May 2022, and 2,947 studies were found.
SUMMARY
Seven observational cohort studies, enrolling 67,274 pregnant women, were selected. When comparing vaccinated and unvaccinated pregnant women, SARS Cov-2 vaccines were not associated with major maternal and neonatal adverse events. The rate of SARS Cov-2 infections among vaccinated pregnant women compared to unvaccinated is significantly reduced by 43%.
OUTLOOK
SARS Cov-2 vaccination in pregnant women is effective and safe. The results are promising, but caution is advised due to some limitations: only observational studies addressing this issue were found. Parallelly, the enrolled populations and the intervention (vaccination type and the number of doses) were not homogeneous.
Topics: Pregnancy; Infant, Newborn; Humans; Female; COVID-19; COVID-19 Vaccines; Vaccination; PubMed; SARS-CoV-2; Pregnancy Complications, Infectious
PubMed: 36800343
DOI: 10.1515/jpm-2022-0463 -
The Journal of Maternal-fetal &... Dec 2023This systematic review aimed to understand the impact of advanced maternal age (AMA) on the neonatal morbidity, based on the available scientific evidence. (Review)
Review
OBJECTIVE
This systematic review aimed to understand the impact of advanced maternal age (AMA) on the neonatal morbidity, based on the available scientific evidence.
METHODS
A systematic search was conducted on 22 November 2021, using the PubMed and Scopus databases to identify studies that compared the morbidity of neonates delivered to AMA mothers with that of neonates delivered to non-AMA mothers.
RESULTS
Sixteen studies that evaluated the effect of AMA on the neonatal morbidity were included in this review. Nine of these studies found some association between AMA and increased neonatal morbidity (with two of them only reporting an increase in asymptomatic hypoglycemia, and one only reporting an association in twins), six found no association between AMA and neonatal morbidity and one study found a decrease in morbidity in preterm neonates. The studies that found an increase in overall neonatal morbidity with AMA considered older ages for the definition of AMA, particularly ≥40 and ≥45 years.
CONCLUSION
The current evidence seems to support a lack of association between AMA and the neonatal morbidity of the delivered neonates. However, more studies focusing on the neonatal outcomes of AMA pregnancies are needed to better understand this topic.
Topics: Infant, Newborn; Pregnancy; Female; Humans; Maternal Age; Mothers; Morbidity
PubMed: 38016703
DOI: 10.1080/14767058.2023.2287981 -
BMJ Open Sep 2023We conducted a systematic review to evaluate associations between influenza vaccination during pregnancy and adverse birth outcomes and maternal non-obstetric serious...
OBJECTIVE
We conducted a systematic review to evaluate associations between influenza vaccination during pregnancy and adverse birth outcomes and maternal non-obstetric serious adverse events (SAEs), taking into consideration confounding and temporal biases.
METHODS
Electronic databases (Ovid MEDLINE ALL, Embase Classic+Embase and the Cochrane Central Register of Controlled Trials) were searched to June 2021 for observational studies assessing associations between influenza vaccination during pregnancy and maternal non-obstetric SAEs and adverse birth outcomes, including preterm birth, spontaneous abortion, stillbirth, small-for-gestational-age birth and congenital anomalies. Studies of live attenuated vaccines, single-arm cohort studies and abstract-only publications were excluded. Records were screened using a liberal accelerated approach initially, followed by a dual independent approach for full-text screening, data extraction and risk of bias assessment. Pairwise meta-analyses were conducted, where two or more studies met methodological criteria for inclusion. The Grading of Recommendations, Assessment, Development and Evaluation approach was used to assess evidence certainty.
RESULTS
Of 9443 records screened, 63 studies were included. Twenty-nine studies (24 cohort and 5 case-control) evaluated seasonal influenza vaccination (trivalent and/or quadrivalent) versus no vaccination and were the focus of our prioritised syntheses; 34 studies of pandemic vaccines (2009 A/H1N1 and others), combinations of pandemic and seasonal vaccines, and seasonal versus seasonal vaccines were also reviewed. Control for confounding and temporal biases was inconsistent across studies, limiting pooling of data. Meta-analyses for preterm birth, spontaneous abortion and small-for-gestational-age birth demonstrated no significant associations with seasonal influenza vaccination. Immortal time bias was observed in a sensitivity analysis of meta-analysing risk-based preterm birth data. In descriptive summaries for stillbirth, congenital anomalies and maternal non-obstetric SAEs, no significant association with increased risk was found in any studies. All evidence was of very low certainty.
CONCLUSIONS
Evidence of very low certainty suggests that seasonal influenza vaccination during pregnancy is not associated with adverse birth outcomes or maternal non-obstetric SAEs. Appropriate control of confounding and temporal biases in future studies would improve the evidence base.
Topics: Infant, Newborn; Female; Pregnancy; Humans; Abortion, Spontaneous; Stillbirth; Influenza A Virus, H1N1 Subtype; Influenza, Human; Premature Birth
PubMed: 37673449
DOI: 10.1136/bmjopen-2022-066182 -
BMC Pregnancy and Childbirth Nov 2023To quantify the extent of incompleteness and misclassification of maternal and pregnancy related deaths, and to identify general and context-specific factors associated... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To quantify the extent of incompleteness and misclassification of maternal and pregnancy related deaths, and to identify general and context-specific factors associated with incompleteness and/or misclassification of maternal death data.
METHODS
We conducted a systematic review of incompleteness and/or misclassification of maternal and pregnancy-related deaths. We conducted a narrative synthesis to identify methods used to capture and classify maternal deaths, as well as general and context specific factors affecting the completeness and misclassification of maternal death recording. We conducted a meta-analysis of proportions to obtain estimates of incompleteness and misclassification of maternal death recording, overall and disaggregated by income and surveillance system types.
FINDINGS
Of 2872 title-abstracts identified, 29 were eligible for inclusions in the qualitative synthesis, and 20 in the meta-analysis. Included studies relied principally on record linkage and review for identifying deaths, and on review of medical records and verbal autopsies to correctly classify cause of death. Deaths to women towards the extremes of the reproductive age range, those not classified by a medical examiner or a coroner, and those from minority ethnic groups in their setting were more likely misclassified or unrecorded. In the meta-analysis, we found maternal death recording to be incomplete by 34% (95% CI: 28-48), with 60% sensitivity (95% CI: 31-81.). Overall, we found maternal mortality was under-estimated by 39% (95% CI: 30-48) due to incompleteness and/or misclassification. Reporting of deaths away from the intrapartum, due to indirect causes or occurring at home were less complete than their counterparts. There was substantial between and within group variability across most results.
CONCLUSION
Maternal deaths were under-estimated in almost all contexts, but the extent varied across settings. Countries should aim towards establishing Civil Registration and Vital Statistics systems where they are not instituted. Efforts to improve the completeness and accuracy of maternal cause of death recording, such as Confidential Enquiries into Maternal Deaths, are needed even where CRVS is considered to be well-functioning.
Topics: Pregnancy; Humans; Female; Maternal Death; Maternal Mortality; Reproduction; Family; Ethnicity; Cause of Death
PubMed: 37968585
DOI: 10.1186/s12884-023-06077-4 -
Advances in Nutrition (Bethesda, Md.) Feb 2024The Mediterranean diet is a global, well-known healthy dietary pattern. This review aims to synthesize the existing evidence on the relationship between the maternal... (Meta-Analysis)
Meta-Analysis Review
The Mediterranean diet is a global, well-known healthy dietary pattern. This review aims to synthesize the existing evidence on the relationship between the maternal Mediterranean diet during pregnancy and perinatal outcomes, including randomized controlled trials (RCTs) and cohort studies. PubMed, Web of Science, and the Cochrane Library were searched from inception to 10 March, 2023, supplemented by manual screening. A random-effect model was used to estimate pooled sizes with 95% confidence intervals (CIs) for specific outcomes of interest. Data from 5 RCTs and 18 cohort studies with 107,355 pregnant participants were synthesized. In RCTs, it was observed that the maternal Mediterranean diet significantly reduced the incidence of gestational diabetes mellitus [odds ratio (OR), 0.56; 95% CI: 0.34, 0.93], as well as small for gestational age (0.55; 95% CI: 0.35, 0.88). In cohort studies, the highest adherence score to the maternal Mediterranean diet was inversely associated with a lower risk of various adverse pregnancy outcomes, including gestational diabetes mellitus (OR, 0.82; 95% CI: 0.67, 1.00), pregnancy-induced hypertension (0.73; 95% CI: 0.60, 0.89), pre-eclampsia (0.77; 95% CI: 0.64, 0.93), preterm delivery (0.67; 95% CI: 0.49, 0.91), low birth weight (0.70; 95% CI: 0.64, 0.78), intrauterine growth restriction (0.46; 95% CI: 0.23, 0.91), and increased gestational age at delivery (weighted mean difference, 0.11 wk; 95% CI: 0.03, 0.20). Meta-regression analyses did not identify the adjustment for confounders and geographical location as predictive factors for heterogeneity. The results suggest that adherence to the Mediterranean diet during pregnancy appears to be beneficial for perinatal outcomes. Future, larger, and higher-quality RCTs and cohort studies are warranted to confirm the present findings. PROSPERO registration no.: CRD42023406317.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Diabetes, Gestational; Diet, Mediterranean; Pregnancy Outcome; Infant, Low Birth Weight; Pre-Eclampsia; Fetal Growth Retardation
PubMed: 38042258
DOI: 10.1016/j.advnut.2023.100159 -
Nutrients Jan 2023Background & aims: Iodine is important for thyroid function during pregnancy to support fetal growth, but studies of maternal iodine status and birth outcomes are... (Meta-Analysis)
Meta-Analysis
Background & aims: Iodine is important for thyroid function during pregnancy to support fetal growth, but studies of maternal iodine status and birth outcomes are conflicting. We aimed to quantify the association between iodine status and birth outcomes, including potential threshold effects using nonlinear dose−response curves. Methods: We systematically searched Medline and Embase to 10 October 2022 for relevant cohort studies. We conducted random-effects meta-analyses of urinary iodine concentration (UIC), iodine:creatinine ratio (I:Cr), and iodide intake for associations with birth weight, birth weight centile, small for gestational age (SGA), preterm delivery, and other birth outcomes. Study quality was assessed using the Newcastle-Ottawa scale. Results: Meta-analyses were conducted on 23 cohorts with 42269 participants. Birth weight was similar between UIC ≥ 150 μg/L and <150 μg/L (difference = 30 g, 95% CI −22 to 83, p = 0.3, n = 13, I2 = 89%) with no evidence of linear trend (4 g per 50 μg/L, −3 to 10, p = 0.2, n = 12, I2 = 80%). I:Cr was similar, but with nonlinear trend suggesting I:Cr up to 200 μg/g associated with increasing birthweight (p = 0.02, n = 5). Birthweight was 2.0 centiles (0.3 to 3.7, p = 0.02, n = 4, I2 = 0%) higher with UIC ≥ 150 μg/g, but not for I:Cr. UIC ≥ 150 μg/L was associated with lower risk of SGA (RR = 0.85, 0.75 to 0.96, p = 0.01, n = 13, I2 = 0%), but not with I:Cr. Conclusions: The main risk of bias was adjustment for confounding, with variation in urine sample collection and exposure definition. There were modest-sized associations between some measures of iodine status, birth weight, birth weight centile, and SGA. In pregnancy, we recommend that future studies report standardised measures of birth weight that take account of gestational age, such as birth weight centile and SGA. Whilst associations were modest-sized, we recommend maintaining iodine sufficiency in the population, especially for women of childbearing age on restricted diets low in iodide.
Topics: Female; Humans; Infant, Newborn; Pregnancy; Birth Weight; Fetal Development; Fetal Growth Retardation; Iodides; Iodine; Parturition; Premature Birth
PubMed: 36678261
DOI: 10.3390/nu15020387 -
International Journal of Environmental... Sep 2022Although numerous studies have found that maternal anxiety is a risk factor for the development of children's problem behaviors, and there is a possible role of genes in... (Meta-Analysis)
Meta-Analysis Review
Although numerous studies have found that maternal anxiety is a risk factor for the development of children's problem behaviors, and there is a possible role of genes in the association between the two. And anxious mothers caring for their children can also affect the development of children's problem behaviors. However, there is also considerable evidence from studies that refute this view. This study used a meta-analysis to explore the relationship between maternal anxiety and preschool children's problem behaviors. Through literature retrieval and selection, in terms of the criteria for inclusion in the meta-analysis, 88 independent effect sizes (34 studies, 295,032 participants) were picked out as meta-analysis units. The test for heterogeneity illustrated that there was significant heterogeneity in 88 independent effect sizes, while the random effects model was an appropriate model for the subsequent meta-analysis. The publication bias test indicated that the impact of publication bias was modest but the major findings remained valid. In addition, in terms of the tentative review analysis and research hypotheses, the random effects model was used as a meta-analysis model. The research revealed that maternal anxiety was significantly positively correlated with preschool children's internalizing problem behaviors, externalizing problem behaviors, and overall problem behaviors. The moderating effect analysis showed that region and gender of the child affected the relationship between maternal anxiety and children's internalizing problem behaviors and externalizing problem behaviors, and region, child's age and gender, mother's age, and education level affected maternal anxiety and preschool children's problems behavioral relationship. Hence, these results affirmed the role of maternal anxiety and emphasized the need to pay attention to the demographic characteristics and cultural background of the subjects during the research process and consider the generalizability of the conclusions under different circumstances.
Topics: Anxiety; Child; Child Behavior Disorders; Child, Preschool; Female; Humans; Mothers; Problem Behavior
PubMed: 36078827
DOI: 10.3390/ijerph191711106 -
Nutrition & Dietetics: the Journal of... Feb 2022The aim of this systematic review was to examine the literature regarding rural healthcare delivery for women with any type of diabetes in pregnancy, and subsequent... (Review)
Review
AIM
The aim of this systematic review was to examine the literature regarding rural healthcare delivery for women with any type of diabetes in pregnancy, and subsequent maternal and infant outcomes.
METHODS
Eight databases were searched in September 2020, including Medline, EMCare, CINAHL, EMBASE, Maternity and Infant Care, Cochrane, Rural and Remote Health and Aboriginal and Torres Strait Islander Health bibliography. Studies from high-income countries in rural, regional or remote areas with interventions conducted during the antenatal period were included. Intervention details were reported using the template for intervention description and replication template. Two reviewers independently assessed for risk of bias using the RoB2 and ROBINS I tools.
RESULTS
Three articles met the inclusion criteria: two conducted in Australia and one in the United States. A multidisciplinary approach was reported in two of the included studies, which were modified specifically for their respective rural settings. All three studies reported rates of caesarean section, birthweight (grams) and gestational age at birth as maternal and infant outcomes. One study was considered at moderate risk of bias, and two studies were at serious risk of bias.
CONCLUSION
There is a significant gap in research relating to healthcare delivery for women with diabetes in pregnancy in rural areas. This lack of research is concerning given that 19% of individuals in high-income countries reside rurally. Further research is required to understand the implications of healthcare delivery models for diabetes in pregnancy in rural areas.
Topics: Cesarean Section; Delivery of Health Care; Diabetes Mellitus; Female; Humans; Infant; Infant, Newborn; Parturition; Pregnancy; Rural Population
PubMed: 35128769
DOI: 10.1111/1747-0080.12722 -
Frontiers in Endocrinology 2022There is a relative lack of data that systematically investigates the breadth and validity of the association between bariatric surgery and health-related outcomes. We...
BACKGROUND
There is a relative lack of data that systematically investigates the breadth and validity of the association between bariatric surgery and health-related outcomes. We aimed to evaluate the quantity, validity, and credibility of evidence regarding the association between bariatric surgery and health-related outcomes using an umbrella review of meta-analyses.
METHODS
We systematically searched PubMed, Embase, and the Web of Science databases from inception until December 2, 2021, to identify meta-analyses of observational or interventional studies that investigated the association between bariatric surgery and multiple health outcomes. We extracted the summary effect size and 95% confidence interval (CI) data. The Assessment of Multiple Systematic Reviews (AMSTAR-2) and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) guidelines were used for methodological and evidence quality assessments, respectively.
RESULTS
Twenty-eight studies with 82 different health-related outcomes were included in this umbrella review. Beneficial effects of bariatric surgery have been observed in cancer incidence, mortality, cardiovascular risk, polycystic ovary syndrome (PCOS), anxiety symptoms, depressive symptoms, gestational diabetes mellitus, gestational hypertension, large for gestational age (LGA), macrosomia, post-term birth, risk of kidney stones, albuminuria, urinary incontinence, fecal incontinence, Barrett's esophagus, and diabetic retinopathy. However, adverse effects of bariatric surgery were observed for maternal anemia, perinatal mortality, congenital anomalies, preterm birth, neonatal intensive care unit (NICU) admission, intrauterine growth restriction, small for gestational age (SGA), fracture risk, upper limb fracture, suicide, self-harm, and alcohol use disorder (AUD).
CONCLUSIONS
Current evidence suggests that bariatric surgery improves the majority of health-related outcomes; however, caution is advised given it may increase the risk of adverse mental effects, perinatal problems, and fractures.
Topics: Pregnancy; Female; Infant, Newborn; Humans; Premature Birth; Bariatric Surgery; Pregnancy Outcome; Diabetes, Gestational; Hypertension, Pregnancy-Induced; Weight Gain; Fetal Growth Retardation
PubMed: 36387921
DOI: 10.3389/fendo.2022.1016613 -
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