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PloS One 2022In Ethiopia limited information is available regarding the prevalence and predictors of anemia in pregnancy. This systematic review and meta-analysis estimated the... (Meta-Analysis)
Meta-Analysis
BACKGROUND
In Ethiopia limited information is available regarding the prevalence and predictors of anemia in pregnancy. This systematic review and meta-analysis estimated the pooled prevalence of anemia among pregnant women in Ethiopia and also identified its predictors.
MATERIALS AND METHODS
The published primary studies were searched in the following electronic databases; PubMed/Medline, Google scholars, AJOL, and EMBASE. All primary studies published from 01/01/2010 to 30/05/2020 and written in English language were included without restriction on study setting and design. Critical appraisal of all available articles was done and extracted data was analyzed using STATA software version 14. The pooled prevalence of anemia was presented using a forest plot. The I2 statistical test for heterogeneity, and the Egger's and Begg's tests for publication bias were used. The relative risk was used to assess the association of predictor variables with anemia.
RESULT
After screening 274 articles, sixty studies were included in the analysis. The pooled prevalence of anemia among pregnant women was 26.4(95% CI: 23.1, 29.6). Sub-group analysis showed higher pooled prevalence from community-based studies than institutional-based studies. Factors that were protective against maternal anemia included urban residence, formal education and smaller family size. Short birth interval and not having antenatal care (ANC) are associated with a higher risk of maternal anemia. Women with low dietary diversity [RR: 2.61(95% CI, 1.85, 3.68)], mid-upper arm circumference (MUAC) less than 23 cm [RR: 2.35(95% CI, 1.53, 3.68)] and those not taking iron-folic acid [RR: 1.53(95% CI: 1.30, 1.81)] also had a higher risk of anemia.
CONCLUSION
Almost one in four pregnant women in Ethiopia had anemia. Being literate, living in urban areas with small family size and adequate birth spacing, as well as good dietary diversity are associated with a lower risk of anemia in pregnancy.
REGISTRATION NUMBER
(ID: CRD42020211054).
Topics: Anemia; Ethiopia; Female; Humans; Pregnancy; Pregnant Women; Prenatal Care; Prevalence
PubMed: 35895619
DOI: 10.1371/journal.pone.0267005 -
Midwifery Jun 2023Maternal obesity has been related to adverse maternal and infant outcomes. It is a persistent challenge of midwifery care worldwide and can present clinical challenges... (Review)
Review
OBJECTIVE
Maternal obesity has been related to adverse maternal and infant outcomes. It is a persistent challenge of midwifery care worldwide and can present clinical challenges and complications. This review sought to identify evidence on the practice patterns of midwives related to prenatal care of women with obesity.
METHODS
The databases Academic Search Premier, APA PsycInfo, CINAHL PLUS with Full Text, Health Source: Nursing/Academic Edition, and MEDLINE were searched November 2021. Search terms included weight, obesity, practices, and midwives. Inclusion criteria included quantitative, qualitative, and mixed method studies that addressed practice patterns of midwives related to prenatal care of women with obesity published in peer-reviewed journals, written in English. The recommended Joanna Briggs Institute approach to mixed methods systematic reviews was followed e.g. study selection, critical appraisal, data extraction, and a convergent segregated method of data synthesis and integration.
RESULTS
Seventeen articles from 16 studies were included. The quantitative evidence showed a lack of knowledge, confidence, and support for midwives that would facilitate adequate management of pregnant women with obesity while the qualitative evidence revealed that midwives desire a sensitive approach to discussing obesity and the risks associated with maternal obesity.
DISCUSSION
Quantitative and qualitative literature report consistent individual and system-level barriers to implementing evidence-based practices. Implicit bias training, midwifery curriculum updates, and the use of patient centered care models may help overcome these challenges.
Topics: Female; Humans; Pregnancy; Midwifery; Obesity; Obesity, Maternal; Prenatal Care; Qualitative Research
PubMed: 36907010
DOI: 10.1016/j.midw.2023.103653 -
Ultrasound in Obstetrics & Gynecology :... Aug 2022To evaluate the incidence of antenatally diagnosed brain injury in twin pregnancy complicated by twin-to-twin transfusion syndrome (TTTS) and to quantify the perinatal... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To evaluate the incidence of antenatally diagnosed brain injury in twin pregnancy complicated by twin-to-twin transfusion syndrome (TTTS) and to quantify the perinatal mortality, morbidity and long-term neurodevelopmental outcome of these fetuses.
METHODS
MEDLINE, EMBASE, ClinicalTrials.gov and The Cochrane Library databases were searched. Inclusion criteria were studies reporting on brain abnormality diagnosed antenatally in twin pregnancies complicated by TTTS. The primary outcome was the incidence of prenatal brain abnormality. The secondary outcomes were intrauterine demise (IUD), neonatal death, termination of pregnancy (TOP) and long-term morbidity. Outcomes were explored in the population of fetuses with antenatal diagnosis of brain abnormality. Subgroup analysis according to the type of treatment, gestational age, Quintero stage at diagnosis and/or treatment, and cotwin death was planned. Meta-analysis of proportions was used to combine data and pooled proportions and their 95% CI were reported.
RESULTS
Thirteen studies including 1573 cases of TTTS and 88 fetuses with an antenatal diagnosis of brain abnormality were included in the systematic review. The meta-analysis included only studies reporting on brain abnormality in twin pregnancy complicated by TTTS cases and treated with laser surgery. Overall, brain injury occurred in 2.2% (52/2410) of fetuses (eight studies). Brain abnormality was reported in 1.03% and 0.82% of recipients and donors, respectively. The most common type of abnormality was ischemic lesions (30.4% (95% CI, 19.1-43.0%)), followed by destructive lesions (23.9% (95% CI, 13.7-35.9%)), ventriculomegaly (19.9% (95% CI, 10.6-31.3%)) and hemorrhagic lesions (15.3% (95% CI, 7.1-25.8%)). Spontaneous IUD occurred in 13.4% (95% CI, 5.1-24.8%) of fetuses, while TOP was chosen by parents in 53.5% (95% CI, 38.9-67.8%) cases. Neonatal death was reported by only three studies, with an incidence of 15.4% (95% CI, 2.8-35.4%). Finally, only two studies reported on composite morbidity, with an overall rate of the outcome of 20.4% (95% CI, 2.5-49.4%) and rates of 29.7% and 20.4% in the recipient and donor fetuses, respectively. Due to the small numbers, only composite morbidity was analyzed and no information on neonatal intensive care unit admission, respiratory distress syndrome or other long-term outcomes, such as neurodevelopmental delay and cerebral palsy, could be retrieved reliably.
CONCLUSIONS
The overall incidence of antenatally diagnosed fetal brain abnormality in twin pregnancy complicated by TTTS treated with laser surgery is around 2% and is mainly ischemic in nature (30.4%). TOP was chosen by parents in more than half of cases (53.5%). No information could be retrieved on morbidity outcomes, highlighting the urgent need for long-term follow-up studies of these children. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
Topics: Brain; Brain Injuries; Child; Female; Fetofetal Transfusion; Gestational Age; Humans; Incidence; Infant, Newborn; Nervous System Malformations; Perinatal Death; Pregnancy; Pregnancy Outcome; Pregnancy, Twin
PubMed: 35233861
DOI: 10.1002/uog.24895 -
AJOG Global Reports Feb 2024This review examined the quantitative relationship between group care and overall maternal satisfaction compared with standard individual care. (Review)
Review
OBJECTIVE
This review examined the quantitative relationship between group care and overall maternal satisfaction compared with standard individual care.
DATA SOURCES
We searched CINAHL, Clinical Trials, The Cochrane Library, PubMed, Scopus, and Web of Science databases from the beginning of 2003 through June 2023.
STUDY ELIGIBILITY CRITERIA
We included studies that reported the association between overall maternal satisfaction and centering-based perinatal care where the control group was standard individual care. We included randomized and observational designs.
METHODS
Screening and independent data extraction were carried out by 4 researchers. We extracted data on study characteristics, population, design, intervention characteristics, satisfaction measurement, and outcome. Quality assessment was performed using the Cochrane tools for Clinical Trials (RoB2) and observational studies (ROBINS-I). We summarized the study, intervention, and satisfaction measurement characteristics. We presented the effect estimates of each study descriptively using a forest plot without performing an overall meta-analysis. Meta-analysis could not be performed because of variations in study designs and methods used to measure satisfaction. We presented studies reporting mean values and odds ratios in 2 separate plots. The presentation of studies in forest plots was organized by type of study design.
RESULTS
A total of 7685 women participated in the studies included in the review. We found that most studies (ie, 17/20) report higher satisfaction with group care than standard individual care. Some of the noted results are lower satisfaction with group care in both studies in Sweden and 1 of the 2 studies from Canada. Higher satisfaction was present in 14 of 15 studies reporting CenteringPregnancy, Group Antenatal Care (1 study), and Adapted CenteringPregnancy (1 study). Although indicative of higher maternal satisfaction, the results are often based on statistically insignificant effect estimates with wide confidence intervals derived from small sample sizes.
CONCLUSION
The evidence confirms higher maternal satisfaction with group care than with standard care. This likely reflects group care methodology, which combines clinical assessment, facilitated health promotion discussion, and community-building opportunities. This evidence will be helpful for the implementation of group care globally.
PubMed: 38318267
DOI: 10.1016/j.xagr.2023.100301 -
Journal of Personalized Medicine Aug 2023Coronavirus disease (COVID-19) is a pandemic causing respiratory symptoms, taste alterations, olfactory disturbances, and cutaneous, cardiovascular, and neurological... (Review)
Review
Coronavirus disease (COVID-19) is a pandemic causing respiratory symptoms, taste alterations, olfactory disturbances, and cutaneous, cardiovascular, and neurological manifestations. Recently, research interest has shifted to reproductive health to understand the factors predisposing to COVID-19 infection in pregnancy, the consequences of the infection on the fetus and on the mother, and possible vertical transmission through the placenta. Pregnancy does not increase the risk of SARS-CoV-2 infection, according to studies. However, contrary to non-pregnant women, pregnancy worsens the clinical outcome of COVID-19. Studies investigating the effects of COVID-19 on pregnancy women are heterogeneous, and the results are often conflicting. The goal of the current work was to offer a thorough and up-to-date systematic review of, and meta-analysis on, the impact of COVID-19 on ovarian function, pregnancy, and fetal outcomes. This meta-analysis (PROSPERO n. CRD42023456904) was conducted using the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) protocols. The search for relevant material was conducted using PubMed, Scopus, Cochrane, and Embase databases, through to 15 December 2022. Original articles on fertile pregnant women or women attempting to become pregnant, with an active case of, or history of, SARS-CoV-2 infection were included, and reproductive function was compared to that of uninfected women. The effects of COVID-19 on female reproductive function, particularly ovarian function, the profile of female sex hormones, pregnancy outcomes and fetal outcomes were the focus of our search. Quantitative analysis was performed with Comprehensive Meta-Analysis Software. The standard difference of the mean was calculated for the statistical comparison between cases and controls. Cochran's Q test and heterogeneity (I) indexes were used to assess statistical heterogeneity. Sensitivity analysis and publication bias tests were also performed. Twenty-eight articles met our inclusion criteria, for a total of 27,383 patients pregnant or looking to have offspring, with active or anamnestic COVID-19, and 1,583,772 uninfected control women. Our study revealed that there was no significant difference between COVID-19 patients and the control group in terms of maternal characteristics such as age, body mass index (BMI) and comorbidities that could affect pregnancy and fetal outcomes. The risk of a miscarriage or Cesarean delivery was significantly lower, while the risk of fetal death or premature delivery was significantly higher in COVID-19 patients than in the controls. None of the included studies evaluated hormonal profiles or investigated the presence of infertility. Maternal comorbidities, age, and BMI do not raise the risk of COVID-19. However, pregnant women with COVID-19 had a lower risk of miscarriage and Cesarean delivery, possibly because of better prenatal care and high levels of observation during labor. COVID-19 during pregnancy increases the risk of fetal death and premature delivery.
PubMed: 37763105
DOI: 10.3390/jpm13091337 -
Primary Health Care Research &... Feb 2023Appropriate prenatal care (PNC) is essential for improving maternal and infant health; nevertheless, millions of women in low- and middle-income countries (LMICs) do not... (Review)
Review
BACKGROUND
Appropriate prenatal care (PNC) is essential for improving maternal and infant health; nevertheless, millions of women in low- and middle-income countries (LMICs) do not receive it properly. The objective of this review is to identify and summarize the qualitative studies that report on health system-related barriers in PNC management in LMICs.
METHODS
This systematic review was conducted in 2022. A range of electronic databases including PubMed, Web of Knowledge, CINHAL, SCOPUS, Embase, and Science Direct were searched for qualitative studies conducted in LMICs. The reference lists of eligible studies also were hand searched. The studies that reported health system-related barrier of PNC management from the perspectives of PNC stakeholders were considered for inclusion. Study quality assessment was performed applying the Critical Appraisal Skills Programme (CASP) checklist, and thematic analyses performed.
RESULTS
Of the 32 included studies, 25 (78%) were published either in or after 2013. The total population sample included 1677 participants including 629 pregnant women, 122 mothers, 240 healthcare providers, 54 key informed, 164 women of childbearing age, 380 community members, and 88 participants from other groups (such as male partners and relatives). Of 32 studies meeting inclusion criteria, four major themes emerged: (1) healthcare provider-related issues; (2) service delivery issues; (3) inaccessible PNC; and (4) poor PNC infrastructure.
CONCLUSION
This systematic review provided essential findings regarding PNC barriers in LMICs to help inform the development of effective PNC strategies and public policy programs.
Topics: Infant; Female; Pregnancy; Male; Humans; Prenatal Care; Developing Countries; Pregnant Women; Qualitative Research
PubMed: 36843095
DOI: 10.1017/S1463423622000706 -
PloS One 2020Existing systematic reviews of Rh immunoprophylaxis include only data from randomized controlled trials, have dated searches, and some do not report on all domains of...
BACKGROUND
Existing systematic reviews of Rh immunoprophylaxis include only data from randomized controlled trials, have dated searches, and some do not report on all domains of risk of bias or evaluate the certainty of the evidence. Our objective was to perform an updated review, by including new trials, any comparative observational studies, and assessing the certainty of the evidence using the GRADE framework.
METHODS
We searched MEDLINE, Embase and the Cochrane Library from 2000 to November 26, 2019. Relevant websites and bibliographies of systematic reviews and guidelines were searched for studies published before 2000. Outcomes of interest were sensitization and adverse events. Risk of bias was evaluated with the Cochrane tool and ROBINS-I. The certainty of the evidence was performed using the GRADE framework.
RESULTS
Thirteen randomized trials and eight comparative cohort studies were identified, evaluating 12 comparisons. Although there is some evidence of beneficial treatment effects (e.g., at 6-months postpartum, fewer women who received RhIg at delivery compared to no RhIg became sensitized [70 fewer sensitized women per 1,000 (95%CI: 67 to 71 fewer); I2 = 73%]), due to very low certainty of the evidence, the magnitude of the treatment effect may be overestimated. The certainty of the evidence was very low for most outcomes often due to high risk of bias (e.g., randomization method, allocation concealment, selective reporting) and imprecision (i.e., few events and small sample sizes). There is limited evidence on prophylaxis for invasive fetal procedures (e.g. amniocentesis) in the comparative literature, and few studies reported adverse events.
CONCLUSION
Serious risk of bias and low to very low certainty of the evidence is found in existing RCTs and comparative observational studies addressing optimal effectiveness of Rh immunoprophylaxis. Guideline development committees should exercise caution when assessing the strength of the recommendations that inform and influence clinical practice in this area.
Topics: Female; GRADE Approach; Humans; Immunologic Factors; Postnatal Care; Pregnancy; Prenatal Care; Randomized Controlled Trials as Topic; Rh Isoimmunization; Rh-Hr Blood-Group System
PubMed: 32913362
DOI: 10.1371/journal.pone.0238844 -
Journal of the International AIDS... Aug 2021Young pregnant and postpartum women living with HIV (WLHIV) are at high risk of poor outcomes in prevention of mother-to-child transmission services. The aim of this... (Review)
Review
INTRODUCTION
Young pregnant and postpartum women living with HIV (WLHIV) are at high risk of poor outcomes in prevention of mother-to-child transmission services. The aim of this systematic review was to collate evidence on strategies to improve retention in antenatal and/or postpartum care in this population. We also conducted a secondary review of strategies to increase attendance at antenatal care (ANC) and/or facility delivery among pregnant adolescents, regardless of HIV status, to identify approaches that could be adapted for adolescents and young WLHIV.
METHODS
Selected databases were searched on 1 December 2020, for studies published between January 2006 and November 2020, with screening and data abstraction by two independent reviewers. We identified papers that reported age-disaggregated results for adolescents and young WLHIV aged <25 years at the full-text review stage. For the secondary search, we included studies among female adolescents aged 10 to 19 years.
RESULTS AND DISCUSSION
Of 37 papers examining approaches to increase retention among pregnant and postpartum WLHIV, only two reported age-disaggregated results: one showed that integrated care during the postpartum period increased retention in HIV care among women aged 18 to 24 years; and another showed that a lay counsellor-led combination intervention did not reduce attrition among women aged 16 to 24 years; one further study noted that age did not modify the effectiveness of a combination intervention. Mobile health technologies, enhanced support, active follow-up and tracing and integrated services were commonly examined as standalone interventions or as part of combination approaches, with mixed evidence for each strategy. Of 10 papers identified in the secondary search, adolescent-focused services and continuity of care with the same provider appeared to be effective in improving attendance at ANC and/or facility delivery, while home visits and group ANC had mixed results.
CONCLUSIONS
This review highlights the lack of evidence regarding effective strategies to improve retention in antenatal and/or postpartum care among adolescents and young WLHIV specifically, as well as a distinct lack of age-disaggregated results in studies examining retention interventions for pregnant WLHIV of all ages. Identifying and prioritizing approaches to improve retention of adolescents and young WLHIV are critical for improving maternal and child health.
Topics: Adolescent; Adult; Female; HIV Infections; Humans; Infectious Disease Transmission, Vertical; Postnatal Care; Pregnancy; Pregnant Women; Prenatal Care; Young Adult
PubMed: 34449121
DOI: 10.1002/jia2.25770 -
Journal of Thrombosis and Haemostasis :... Jul 2020Hemophilia carriers (HCs) face specific psychosocial challenges related to pregnancy, caused by their inherited bleeding disorder. Optimal support from healthcare... (Review)
Review
BACKGROUND
Hemophilia carriers (HCs) face specific psychosocial challenges related to pregnancy, caused by their inherited bleeding disorder. Optimal support from healthcare providers can only be realized by exploring medical and psychological healthcare requirements.
OBJECTIVE
To review all published evidence on the experiences and attitudes of HCs regarding reproductive decision-making, prenatal diagnosis, pregnancy, childbirth, and puerperium to provide an accessible overview of this information for health care providers.
STUDY SELECTION
Cochrane library, PubMed/MEDLINE, EMBASE, CINAHL, and PsycINFO were searched for original qualitative data. Two authors performed study selection, risk-of-bias assessment, data extraction, and data analysis through meta-summary. The extracted themes were discussed within the research team.
FINDINGS
Fifteen studies with an overall moderate quality were included. The following findings were identified: (a) Quality of life of family members with hemophilia influences reproductive decision-making; (b) Genetic counselling is generally considered useful; (c) The development of a specialized carrier clinic is considered valuable; (d) HCs describe prenatal diagnosis as beneficial yet psychosocially challenging; and (e) noninvasive prenatal diagnosis and preimplantation genetic diagnosis are predominantly considered beneficial. These findings are limited by the overall moderate quality of included studies and the possibly partly outdated results in the current era of hemophilia treatment.
CONCLUSIONS
Available qualitative literature on HCs around pregnancy focuses on genetic counselling and prenatal diagnosis. Future studies are needed on the experiences and needs of HCs through pregnancy and puerperium as well as in light of emerging hemophilia diagnosis and treatment options.
Topics: Attitude; Female; Genetic Counseling; Hemophilia A; Humans; Pregnancy; Qualitative Research; Quality of Life
PubMed: 32271985
DOI: 10.1111/jth.14825 -
BJOG : An International Journal of... Jul 2022Biologic medications, specifically tumour necrosis factor-α (TNF-α) inhibitors, have become increasingly prevalent in the treatment of chronic inflammatory disease... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Biologic medications, specifically tumour necrosis factor-α (TNF-α) inhibitors, have become increasingly prevalent in the treatment of chronic inflammatory disease (CID) in pregnancy.
OBJECTIVE
To determine pregnancy outcomes in women with CID exposed to biologics during pregnancy.
SEARCH STRATEGY
PubMed and EMBASE databases were searched through January 1998-July 2021.
SELECTION CRITERIA
Peer-reviewed, English-language cohort, case-control, cross-sectional studies, and case series that contained original data.
DATA COLLECTION AND ANALYSIS
Two authors independently conducted data extraction. A meta-analysis of proportions using a random-effects model was used to pool outcomes. Linear regression analysis was used to compare the mean of proportions of outcomes across exposure groups using the 'treated' group as the reference category. All studies were evaluated using an appropriate quality assessment tool. The GRADE approach was used to assess the overall certainty of evidence.
MAIN RESULTS
Thirty-five studies, describing 11 172 pregnancies, were eligible for inclusion. Analysis showed pooled proportions for congenital malformations as follows: treated 0.04 (95% CI 0.03-0.04; I = 77) versus disease-matched 0.04 (95% CI 0.03-0.05. I = 86; p = 0.238); preterm delivery treated 0.04 (95% CI 0.10-0.14; I = 88) versus disease-matched 0.10 (95% CI 0.09-0.12; I = 87; p = 0.250); severe neonatal infection: treated 0.05 (95% CI 0.03-0.07; I = 88) versus disease-matched 0.05 (95% CI 0.02-0.07; I = 94; p = 0.970); low birthweight: treated 0.10 (95% CI 0.07-0.12; I = 93) versus disease-matched 0.08 (95% CI 0.07-0.09; I = 0; p = 0.241); pooled miscarriage: treated 0.13 (95% CI 0.10-0.15; I = 77) versus disease-matched 0.08 (95% CI 0.04-0.11; I = 5; p = 0.078); pre-eclampsia; treated 0.01 (95% CI 0.01-0.02; I = 0) versus disease-matched 0.01 (95% CI 0.00-0.01; I = 0; p = 0.193). No statistical differences in proportions were observed. GRADE certainty of findings was low to very low.
CONCLUSION
We demonstrated comparable pregnancy outcomes in pregnancies exposed to biologics, disease-matched controls and CID-free pregnancies using the GRADE approach.
Topics: Biological Products; Cross-Sectional Studies; Female; Humans; Infant, Newborn; Pregnancy; Pregnancy Outcome; Premature Birth; Prenatal Care
PubMed: 35014759
DOI: 10.1111/1471-0528.17093