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The Journal of Maternal-fetal &... Dec 2023To estimate the incremental yield of detecting pathogenic or likely pathogenic diagnostic genetic variants (DGV) by whole exome sequencing (WES) over standard karyotype... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To estimate the incremental yield of detecting pathogenic or likely pathogenic diagnostic genetic variants (DGV) by whole exome sequencing (WES) over standard karyotype and chromosomal microarray (CMA) analyses in fetuses with isolated increased nuchal translucency (NT) and normal fetal anatomy at the time of 11-14 weeks scan.
MATERIALS AND METHODS
Medline and Embase databases were searched. Inclusion criteria were fetuses with NT >95 percentile, normal karyotype and CMA and no associated structural anomalies at the time of the 11-14 weeks scan. The primary outcome was to estimate the incremental yield of detecting pathogenic or likely pathogenic genetic variants by WES over standard karyotype and CMA analyses in fetuses with isolated increased nuchal translucency. The secondary outcomes were the detection of a genetic variant of unknown significance. Sub-analysis according to different NT cutoffs (between 3.0 and 5.5 mm and > 5.5 mm) and considering fetuses with isolated NT in which fetal anatomy was confirmed to be normal at the anomaly scan were also performed. Random effects model meta-analyses of proportion were used to analyze the data.
RESULTS
Eight articles (324 fetuses) were included in the systematic review. Of the fetuses with negative standard karyotype and CMA analysis, the 8.07% (95% CI 5.4-11.3) had pathogenic or likely pathogenic genetic variants detected exclusively by WES. When stratifying the analysis according to NT cutoffs, genetic anomalies detected exclusively at WES analysis were found in 44.70% (95% CI 26.8-63.4) of fetuses with NT between 3.0 mm and 5.5 mm and 55.3% (95% CI 36.6-73.2) in those fetuses with NT >5.5 mm and positive WES results. The 7.84% (95% CI 1.6-18.2) had variants of unknown significance identified by WES. When considering fetuses with isolated increased NT and normal fetal anatomy at the anomaly scan, the rate of pathogenic or likely pathogenic genetic variants detected by WES was 3.87% (95% CI 1.6-7.1), while variants of unknown significance were detected in 4.27% (95% CI 2.2-7.0) of cases.
CONCLUSIONS
Pathogenic and likely pathogenic genetic variants detected by WES are present in a significant proportion of fetuses with increased NT but normal standard karyotype and CMA analysis, also when no anomalies are detected at the anomaly scan. Further large studies sharing objective protocols of imaging assessment are needed to confirm these findings and to elucidate which gene panels should be assessed in fetuses with isolated increased NT to rule out associated genetic anomalies, which may potentially impact post-natal outcomes.
Topics: Pregnancy; Female; Humans; Nuchal Translucency Measurement; Exome Sequencing; Fetus; Karyotyping; Karyotype; Prenatal Diagnosis
PubMed: 37019452
DOI: 10.1080/14767058.2023.2193285 -
Archives of Academic Emergency Medicine 2020The emergence and fast spread of 2019 novel coronavirus (2019-nCoV) threatens the world as a new public health crisis. This study aimed to clarify the impact of novel... (Review)
Review
INTRODUCTION
The emergence and fast spread of 2019 novel coronavirus (2019-nCoV) threatens the world as a new public health crisis. This study aimed to clarify the impact of novel coronavirus disease (COVID-19) on pregnant patients and maternal and neonatal outcomes.
METHODS
A comprehensive literature search was conducted in databases including PubMed, Scopus, Embase, ProQuest, and Science Direct. All studies including original data; case reports, case series, descriptive and observational studies, and randomized controlled trials were searched from December 2019 until 19 March 2020.
RESULTS
The search identified 1472 results and 939 abstracts were screened. 928 articles were excluded because studies did not include pregnant women. Full texts of eleven relevant studies were reviewed and finally nine studies were included in this study. The characteristics of 89 pregnant women and their neonates were studied. Results revealed that low-grade fever and cough were the principal symptoms in all patients. The main reported laboratory findings were lymphopenia, elevated C-Reactive Protein (CRP), Amino alanine transferase (ALT), and Aspartate amino transferase (AST). In all symptomatic cases, chest Computerized Tomography (CT) scans were abnormal. Fetal distress, premature rupture of membranes and preterm labor were the main prenatal complications. Two women needed intensive care unit admission and mechanical ventilation, one of whom developed multi-organ dysfunction and was on Extracorporeal Membrane Oxygenation (ECMO). No case of maternal death was reported up to the time the studies were published. 79 mothers delivered their babies by cesarean section and five women had a vaginal delivery. No fetal infection through intrauterine vertical transmission was reported.
CONCLUSIONS
Available data showed that pregnant patients in late pregnancy had clinical manifestations similar to non-pregnant adults. It appears that the risk of fetal distress, preterm delivery and prelabor rupture of membranes (PROM) rises with the onset of COVID-19 in the third trimester of pregnancy. There is also no evidence of intrauterine and transplacental transmission of COVID-19 to the fetus in the third trimester of pregnancies.
PubMed: 32440660
DOI: No ID Found -
Revista Brasileira de Ginecologia E... Jun 2023To review the literature and synthesize evidence on pathophysiological interactions attributed to the simultaneous occurrence of COVID-19 and preeclampsia.
OBJECTIVE
To review the literature and synthesize evidence on pathophysiological interactions attributed to the simultaneous occurrence of COVID-19 and preeclampsia.
METHODS
A systematic review was conducted from November (2021) to January (2022) to retrieve observational studies published on the PubMed, LILACS, SciELO Brazil and Google Scholar databases. The search was based on the descriptors [(eclampsia OR preeclampsia) AND (COVID-19)]. Quantitative studies that pointed to pathophysiological interactions were included. Literature reviews, studies with HIV participants, or with clinical approach only were excluded. The selection of studies was standardized and the evaluation was performed by pairs of researchers.
RESULTS
In this review, 155 publications were retrieved; 16 met the inclusion criteria. In summary, the physiological expression of angiotensin-converting enzyme-2 (ACE-2) receptors is physiologically increased in pregnant women, especially at the placental site. Studies suggest that the coronavirus binds to ACE-2 to enter the human cell, causing deregulation of the renin-angiotensin-aldosterone system and in the ratio between angiotensin-II and angiotensin-1-7, inducing manifestations suggestive of preeclampsia. Furthermore, the cytokine storm leads to endothelial dysfunction, vasculopathy and thrombus formation, also present in preeclampsia.
CONCLUSION
The studies retrieved in this review suggest that there is a possible overlap of pathophysiological interactions between COVID-19 and preeclampsia, which mainly involve ACE-2 and endothelial dysfunction. Given that preeclampsia courses with progressive clinical and laboratory alterations, a highly quality prenatal care may be able to detect specific clinical and laboratory parameters to differentiate a true preeclampsia superimposed by covid-19, as well as cases with hypertensive manifestations resulting from viral infection.
Topics: Pregnancy; Female; Humans; Pre-Eclampsia; Placenta; COVID-19; Renin-Angiotensin System; Hypertension
PubMed: 37494578
DOI: 10.1055/s-0043-1770091 -
Ecotoxicology and Environmental Safety Jul 2024Fetal overgrowth has detrimental effects on both the mother and the fetus. The global issue of ambient air pollution has been found to contribute to fetal overgrowth... (Review)
Review
OBJECTIVES
Fetal overgrowth has detrimental effects on both the mother and the fetus. The global issue of ambient air pollution has been found to contribute to fetal overgrowth through various pathways. This study aimed to identify the association between prenatal exposure to ambient air pollution and the risk of fetal overgrowth.
METHODS
We identified articles between January 2013 and February 2024 by searching the Web of Sciences(WoS), PubMed, Proquest, Scopus, and Google Scholar databases. Quality assessment was performed using the Newcastle Ottawa scale. This review was provided based on the PRISMA guideline and registered with PROSPERO, "CRD42023488936".
RESULTS
The search generated 1719 studies, of which 22 cohort studies were included involving 3,480,041 participants. Results on the effects of air pollutants on fetal overgrowth are inconsistent because they vary in population and geographic region. But in general, the results indicate that prenatal exposure to air pollutants, specifically PM, NO, and SO, is linked to a higher likelihood of fetal overgrowth(macrosomia and large for gestational age). Nevertheless, the relationship between CO and O pollution and fetal overgrowth remains uncertain. Furthermore, PM has a limited effect on fetal overgrowth. It is essential to consider the time that reproductive-age women are exposed to air pollution. Exposure to air pollutants before conception and throughout pregnancy has a substantial impact on the fetus's vulnerability to overgrowth.
CONCLUSIONS
Fetal overgrowth has implications for the health of both mother and fetus. fetal overgrowth can cause cardiovascular diseases, obesity, type 2 diabetes, and other diseases in adulthood, so it is considered an important issue for the health of the future generation. Contrary to popular belief that air pollution leads to intrauterine growth restriction and low birth weight, this study highlights that one of the adverse consequences of air pollution is macrosomia or LGA during pregnancy. Therefore governments must focus on implementing initiatives that aim to reduce pregnant women's exposure to ambient air pollution to ensure the health of future generations.
Topics: Pregnancy; Humans; Female; Air Pollution; Air Pollutants; Prenatal Exposure Delayed Effects; Maternal Exposure; Cohort Studies; Fetal Development; Particulate Matter
PubMed: 38823346
DOI: 10.1016/j.ecoenv.2024.116526 -
Complementary Therapies in Medicine Aug 2021This study aims to investigate the effects of prenatal music therapy on fetal and neonatal status. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
This study aims to investigate the effects of prenatal music therapy on fetal and neonatal status.
DESIGN AND SETTING
A systematic review and meta-analysis of randomized controlled trials.
INTERVENTIONS
Ovid MEDLINE, Embase, Web of Science, Cochrane Library, and Chinese Biomedical Literature Database were searched for studies investigating the effects of prenatal music therapy. Two independent investigators carried out the literature selection, data analysis, and evidence quality assessment. Eligible studies were qualitatively described and synthesized using meta-analyses.
MAIN OUTCOME MEASURES
The outcomes included fetal or neonatal status.
RESULTS
After screening the 821 records yielded by the systematic search, we identified nine eligible studies involving 1419 pregnant women. Eight studies were included in the meta-analysis, and three outcomes were synthesized. Compared with no music therapy, prenatal music therapy did not change fetal heart rate (mean difference [95 % CI]: -0.28 [-3.75-3.20] beat/min, P = 0.88, moderate quality), number of fetal movements (mean difference [95 % CI]: 0.50 [-0.79-1.78] time/min, P = 0.45, low quality), or number of accelerations (mean difference [95 % CI]: 0.16 [-0.87-1.19] time/min, P = 0.76, low quality). This result did not change when two studies with a high risk of bias were excluded. Subgroup analysis showed that prenatal music therapy did not change fetal heart rate, number of fetal movements, or number of accelerations in different intervention phases.
CONCLUSIONS
Prenatal music therapy might not change fetal and neonatal status. However, more systematic strategies of prenatal music therapy deserve further exploration.
Topics: Female; Humans; Infant, Newborn; Music; Music Therapy; Pregnancy; Prenatal Care
PubMed: 34175408
DOI: 10.1016/j.ctim.2021.102756 -
Obstetrics and Gynecology Mar 2024To identify the social-structural determinants of health risk factors associated with maternal morbidity and mortality in the United States during the prenatal and...
OBJECTIVE
To identify the social-structural determinants of health risk factors associated with maternal morbidity and mortality in the United States during the prenatal and postpartum periods.
DATA SOURCES
We searched MEDLINE, CINAHL, and Social Sciences Citation Index through November 2022 for eligible studies that examined exposures related to social and structural determinants of health and at least one health or health care-related outcome for pregnant and birthing people.
METHODS OF STUDY SELECTION
After screening 8,378 unique references, 118 studies met inclusion criteria.
TABULATION, INTEGRATION, AND RESULTS
We grouped studies by social and structural determinants of health domains and maternal outcomes. We used alluvial graphs to summarize results and provide additional descriptions of direction of association between potential risk exposures and outcomes. Studies broadly covered risk factors including identity and discrimination, socioeconomic, violence, trauma, psychological stress, structural or institutional, rural or urban, environment, comorbidities, hospital, and health care use. However, these risk factors represent only a subset of potential social and structural determinants of interest. We found an unexpectedly large volume of research on violence and trauma relative to other potential exposures of interest. Outcome domains included maternal mortality, severe maternal morbidity, hypertensive disorders, gestational diabetes, cardiac and metabolic disorders, weathering depression, other mental health or substance use disorders, and cost per health care use outcomes. Patterns between risk factors and outcomes were highly mixed. Depression and other mental health outcomes represented a large proportion of medical outcomes. Risk of bias was high, and rarely did studies report the excess risk attributable to a specific exposure.
CONCLUSION
Limited depth and quality of available research within each risk factor hindered our ability to understand underlying pathways, including risk factor interdependence. Although recently published literature showed a definite trend toward improved rigor, future research should emphasize techniques that improve the ability to estimate causal effects. In the longer term, the field could advance through data sets designed to fully ascertain data required to robustly examine racism and other social and structural determinants of health, their intersections, and feedback loops with other biological and medical risk factors.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, CRD42022300617.
Topics: Pregnancy; Female; Humans; Diabetes, Gestational; Mental Health; Postpartum Period; Maternal Mortality; Violence
PubMed: 38128105
DOI: 10.1097/AOG.0000000000005489 -
International Journal of Environmental... Apr 2024Daily, the number of women who die around the world reaches an average of 800; these deaths are a result of obstetric complications in pregnancy and childbirth, and 99%... (Review)
Review
Daily, the number of women who die around the world reaches an average of 800; these deaths are a result of obstetric complications in pregnancy and childbirth, and 99% of these deaths occur in low- and middle-income countries. This review probes the use of antenatal care (ANC) and skilled birth delivery (SBD) services in sub-Saharan Africa (SSA) and highlights research gaps using Arksey and O'Malley's methodological approach. The screening of abstracts and full text was carried out by two independent authors who ensured the eligibility of data extraction from the included articles. An exploration of the data was undertaken with descriptive analyses. In total, 350 potentially eligible articles were screened, and 137 studies were included for data extraction and analysis. From the 137 included studies, the majority were from Ethiopia ( = 40, 29.2%), followed by Nigeria ( = 30, 21.9%). Most of the studies were published between 2019 and 2023 ( = 84, 61%). Significant trends and challenges with ANC and SBD services emerged from the studies. It is revealed that there are wide gaps in the utilization of ANC and SBD services. Policy attention, intervention strategies to improve access, resources, rural-urban disparity, and women's literacy are recommended to improve the utilization of ANC and SBD services in SSA countries.
Topics: Humans; Prenatal Care; Africa South of the Sahara; Female; Pregnancy; Delivery, Obstetric; Patient Acceptance of Health Care
PubMed: 38673351
DOI: 10.3390/ijerph21040440 -
Heliyon Jan 2022This study aimed to estimate the pooled prevalence and factors associated with postpartum modern contraceptive use in Ethiopia. (Review)
Review
OBJECTIVE
This study aimed to estimate the pooled prevalence and factors associated with postpartum modern contraceptive use in Ethiopia.
DESIGN
Systematic Reviews and Meta-Analysis.
METHOD
PubMed, MEDLINE, EMBASE, Hinari, Google Scholar, direct Google search, African Journal Online (AJOL), an online repository, and gray kinds of literature were used for searching. This meta-analysis included eighteen cross-sectional studies. The quality appraisal criterion of the Joanna Briggs Institute (JBI) was employed to critically appraise papers. The I2 statistics were used to test heterogeneity and subgroup analysis was computed with the evidence of heterogeneity. The Egger test with funnel plot was used to investigate publication bias. The "generate" command in STATA was used to calculate the logarithm and standard error of the odds ratio (OR) for each included study. Then odds ratio (OR) with a 95% confidence interval (CI) was presented.
RESULT
Eighteen studies were included in the systematic review and meta-analysis. The pooled prevalence of modern postpartum family planning utilization among postnatal women in Ethiopia was 45.44% (95%CI: 31.47, 59.42).Prenatal family planning counseling (AOR = 3.80; 95%CI: 2.70, 5.34), postnatal care utilization (AOR = 3.07; 95%CI: 1.39, 6.77), spouse communication on family planning (AOR = 1.86; 95%CI:1.36,2.54), resumption of menses (AOR = 4.20; 95%CI: 2.95, 5.99), and resumption of sexual activity (AOR = 3.98; 95%CI: 2.34, 6.79) were associated factors to uptake modern postpartum family planning among postnatal women.
CONCLUSION
The pooled prevalence of postpartum modern contraceptive use was low. The most common factors significantly associated with postpartum modern contraceptive use were prenatal family planning counseling, postnatal care utilization, spouse communication on family planning, resumption of menses, and resumption of sexual activity were the commonest factors significantly associated with postpartum modern contraceptive use.
PubMed: 35036604
DOI: 10.1016/j.heliyon.2021.e08712 -
Acta Obstetricia Et Gynecologica... Apr 2023Patient-reported measures (PRMs) are becoming popular as they might influence clinical decisions, help to deliver patient-centered care, and improve health care quality.... (Review)
Review
INTRODUCTION
Patient-reported measures (PRMs) are becoming popular as they might influence clinical decisions, help to deliver patient-centered care, and improve health care quality. However, the limited knowledge and consensus about the acceptability of implementing PRMs in maternity care hinder their widespread use in clinical practice, and evidence-based recommendations are lacking. This systematic review aims to synthesize available evidence on the acceptability of implementing PRMs in routine maternity care.
MATERIAL AND METHODS
Literature on the implementation of PRMs in maternity care was electronically searched in six databases (PsycARTICLES, PubMed, Scopus, Web of Science, Cochrane Database of Systematic Reviews, and CINAHL), screened and selected for the topic of "acceptability". Theoretical Framework of Acceptability was used as the basic framework guiding data analysis and synthesis. Evidence was thematically analyzed and synthesized. Mixed Method Appraisal Tool and GRADE-CERQual approach were used to assess the quality of studies and evaluate the confidence in the review findings.
RESULTS
Overall, 4971 articles were screened. From 24 studies, we identified five themes regarding the acceptability of implementing PRMs in routine maternity care: (1) user's action and behavior, (2) stakeholders' attitudes, (3) perceived benefits, (4) perceived challenges and risks, and (5) stakeholders' preferences and suggestions on implementation. While pregnant and postpartum women, health professionals and other stakeholders involved in maternity care were generally positive about the implementation of PRMs in routine care and recognized the potential benefits (eg health improvement, women empowerment, care and services improvement and healthcare system advancement), they pointed out possible challenges and risks in answering PRMs questions, responding to answers, and setting up integrated information systems as well as suggested solutions in the aspects of PRMs data collection, follow-up care, and system-level management. The confidence in the review findings was moderate due to methodological limitations of included studies.
CONCLUSIONS
Available empirical evidence suggested that the use of PRMs in routine maternity care is acceptable among stakeholders involved in maternity care and the potential benefits of its integration in routine clinical practice to healthcare improvement has been recognized. However, possible challenges in data collection, follow-up care arrangement and system-level integration should be appropriately addressed.
Topics: Pregnancy; Humans; Female; Maternal Health Services; Prenatal Care; Delivery of Health Care; Patient Reported Outcome Measures
PubMed: 36647292
DOI: 10.1111/aogs.14506 -
Current Environmental Health Reports Dec 2022Exposure to endocrine disrupting chemicals through personal care products (PCPs) is widespread and may disrupt hormone-sensitive endpoints, such as timing of puberty.... (Review)
Review
PURPOSE OF REVIEW
Exposure to endocrine disrupting chemicals through personal care products (PCPs) is widespread and may disrupt hormone-sensitive endpoints, such as timing of puberty. Given the well-documented (and ongoing) decline in age at menarche in many populations, we conducted a systematic review of the epidemiological literature on exposure to chemicals commonly found in PCPs (including certain phthalates, phenols, and parabens) in relation to girls' pubertal development.
RECENT FINDINGS
The preponderance of research on this topic has examined phthalate exposures with the strongest evidence indicating that prenatal monoethyl phthalate (MEP) concentrations may be associated with slightly earlier timing of puberty, including age at menarche. Findings examining peri-pubertal phthalate exposures and pubertal outcomes were less consistent as were studies of prenatal and peri-pubertal phenol exposures. Very few studies had examined parabens in relation to girls' pubertal development. Common study limitations included potential exposure misclassification related to use of spot samples and/or mistimed biomarker assessment with respect to the outcomes. The role of body size as a mediator in these relationships remains unresolved. Overall, evidence of associations between chemical exposures in PCPs and girls' pubertal development was conflicting. When associations were observed, effect sizes were small. Nevertheless, given the many environmental, social, and behavioral factors in the modern environment that may act synergistically to accelerate timing of puberty, even marginal changes may be cause for concern, with implications for cancer risk, mental health, and cardiometabolic disease in later life.
Topics: Humans; Parabens; Phenols; Cosmetics
PubMed: 35867279
DOI: 10.1007/s40572-022-00366-4