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European Journal of Obstetrics,... Apr 2022As the number of overweight and obese women seeking assisted reproductive care increases, interest in understanding the effects of excess weight on fertility is also... (Meta-Analysis)
Meta-Analysis Review
As the number of overweight and obese women seeking assisted reproductive care increases, interest in understanding the effects of excess weight on fertility is also increasing. Therefore, a systematic review and meta-analysis were performed to evaluate the associations of overweight and obesity with assisted reproductive technology outcomes. The following databases were searched through March 2019: MEDLINE (PubMed), Embase, Scopus, Lilacs, Web of Science, Clinical Trials and SciELO. The keywords used were obesity, overweight and assisted reproduction, as well as similar terms. Articles were selected based on titles and abstracts. Potentially relevant studies were evaluated for inclusion by two reviewers. Subsequently, quality was assessed using the Newcastle-Ottawa Quality Assessment Scale. The meta-analysis was performed using a random-effects model. Sensitivity analyses were performed to investigate sources of heterogeneity, as recommended by the Cochrane Collaboration. In total, 53 studies with 1,445,406 treatment cycles were included. When analysing one cycle per patient, being overweight or obese was found to have a weak negative impact on clinical pregnancy, livebirth and miscarriage rates; number of mature oocytes; duration of ovarian stimulation; and gonadotropin dosage used among the exposed women. Therefore, an increased body mass index is associated with weak adverse outcomes among women undergoing in-vitro fertilization or intracytoplasmic sperm injection. This study searched a greater number of research databases and analysed a greater number of studies with good methodological quality and low or moderate heterogeneity, including a greater number of assisted reproduction treatment cycles, than other studies conducted to date. Nevertheless, more robust studies on the subject are needed to elucidate other aspects related to exposure and outcomes.
Topics: Female; Fertilization in Vitro; Humans; Live Birth; Obesity; Overweight; Pregnancy; Pregnancy Rate; Sperm Injections, Intracytoplasmic
PubMed: 35183001
DOI: 10.1016/j.ejogrb.2022.01.019 -
Obesity Reviews : An Official Journal... Jul 2015Previous reviews of childhood obesity prevention have focused largely on schools and findings have been inconsistent. Funded by the US Agency for Healthcare Research and... (Meta-Analysis)
Meta-Analysis Review
Previous reviews of childhood obesity prevention have focused largely on schools and findings have been inconsistent. Funded by the US Agency for Healthcare Research and Quality (AHRQ) and the National Institutes of Health, we systematically evaluated the effectiveness of childhood obesity prevention programmes conducted in high-income countries and implemented in various settings. We searched MEDLINE®, Embase, PsycINFO, CINAHL®, ClinicalTrials.gov and the Cochrane Library from inception through 22 April 2013 for relevant studies, including randomized controlled trials, quasi-experimental studies and natural experiments, targeting diet, physical activity or both, and conducted in children aged 2-18 in high-income countries. Two reviewers independently abstracted the data. The strength of evidence (SOE) supporting interventions was graded for each study setting (e.g. home, school). Meta-analyses were performed on studies judged sufficiently similar and appropriate to pool using random effect models. This paper reported our findings on various adiposity-related outcomes. We identified 147 articles (139 intervention studies) of which 115 studies were primarily school based, although other settings could have been involved. Most were conducted in the United States and within the past decade. SOE was high for physical activity-only interventions delivered in schools with home involvement or combined diet-physical activity interventions delivered in schools with both home and community components. SOE was moderate for school-based interventions targeting either diet or physical activity, combined interventions delivered in schools with home or community components or combined interventions delivered in the community with a school component. SOE was low for combined interventions in childcare or home settings. Evidence was insufficient for other interventions. In conclusion, at least moderately strong evidence supports the effectiveness of school-based interventions for preventing childhood obesity. More research is needed to evaluate programmes in other settings or of other design types, especially environmental, policy and consumer health informatics-oriented interventions.
Topics: Behavior Therapy; Child; Diet, Reducing; Evidence-Based Practice; Exercise; Feeding Behavior; Humans; Motivation; Pediatric Obesity; Program Development; Public Health; United States; Weight Reduction Programs
PubMed: 25893796
DOI: 10.1111/obr.12277 -
PloS One 2017Advanced maternal age (AMA; ≥35 years) is an increasing trend and is reported to be associated with various pregnancy complications. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Advanced maternal age (AMA; ≥35 years) is an increasing trend and is reported to be associated with various pregnancy complications.
OBJECTIVE
To determine the risk of stillbirth and other adverse pregnancy outcomes in women of AMA.
SEARCH STRATEGY
Embase, Medline (Ovid), Cochrane Database of Systematic Reviews, ClinicalTrials.gov, LILACS and conference proceedings were searched from ≥2000.
SELECTION CRITERIA
Cohort and case-control studies reporting data on one or more co-primary outcomes (stillbirth or fetal growth restriction (FGR)) and/or secondary outcomes in mothers ≥35 years and <35 years.
DATA COLLECTION AND ANALYSIS
The effect of age on pregnancy outcome was investigated by random effects meta-analysis and meta-regression. Stillbirth rates were correlated to rates of maternal diabetes, obesity, hypertension and use of assisted reproductive therapies (ART).
MAIN RESULTS
Out of 1940 identified titles; 63 cohort studies and 12 case-control studies were included in the meta-analysis. AMA increased the risk of stillbirth (OR 1.75, 95%CI 1.62 to 1.89) with a population attributable risk of 4.7%. Similar trends were seen for risks of FGR, neonatal death, NICU unit admission restriction and GDM. The relationship between AMA and stillbirth was not related to maternal morbidity or ART.
CONCLUSIONS
Stillbirth risk increases with increasing maternal age. This is not wholly explained by maternal co-morbidities and use of ART. We propose that placental dysfunction may mediate adverse pregnancy outcome in AMA. Further prospective studies are needed to directly test this hypothesis.
Topics: Adult; Diabetes, Gestational; Female; Humans; Infant, Newborn; Maternal Age; Middle Aged; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Stillbirth
PubMed: 29040334
DOI: 10.1371/journal.pone.0186287 -
Obesity Reviews : An Official Journal... Feb 2021Excessive access to fast-food restaurants (FFRs) in the neighbourhood is thought to be a risk factor for childhood obesity by discouraging healthful dietary behaviours... (Meta-Analysis)
Meta-Analysis
Excessive access to fast-food restaurants (FFRs) in the neighbourhood is thought to be a risk factor for childhood obesity by discouraging healthful dietary behaviours while encouraging the exposure to unhealthful food venues and hence the compensatory intake of unhealthy food option. A literature search was conducted in the PubMed, Web of Science, and Embase for articles published until 1 January 2019 that analysed the association between access to FFRs and weight-related behaviours and outcomes among children aged younger than 18. Sixteen cohort studies and 71 cross-sectional studies conducted in 14 countries were identified. While higher FFR access was not associated with weight-related behaviours (eg, dietary quality score and frequency of food consumption) in most studies, it was commonly associated with more fast-food consumption. Despite that, insignificant results were observed for all meta-analyses conducted by different measures of FFR access in the neighbourhood and weight-related outcomes, although 17 of 39 studies reported positive associations when using overweight/obesity as the outcome. This systematic review and meta-analysis revealed a rather mixed relationship between FFR access and weight-related behaviours/outcomes among children and adolescents.
Topics: Adolescent; Child; Cross-Sectional Studies; Fast Foods; Humans; Overweight; Pediatric Obesity; Restaurants
PubMed: 31507064
DOI: 10.1111/obr.12944 -
Obesity Reviews : An Official Journal... Apr 2018This review examined evidence of the association between maternal pre-pregnancy overweight/obesity status and child neurodevelopmental outcomes. PubMed and PsycINFO... (Meta-Analysis)
Meta-Analysis
This review examined evidence of the association between maternal pre-pregnancy overweight/obesity status and child neurodevelopmental outcomes. PubMed and PsycINFO databases were systematically searched for empirical studies published before April 2017 using keywords related to prenatal obesity and children's neurodevelopment. Of 1483 identified papers, 41 were included in the systematic review, and 32 articles representing 36 cohorts were included in the meta-analysis. Findings indicated that compared with children of normal weight mothers, children whose mothers were overweight or obese prior to pregnancy were at increased risk for compromised neurodevelopmental outcomes (overweight: OR = 1.17, 95% CI [1.11, 1.24], I = 65.51; obese: OR = 1.51; 95% CI [1.35, 1.69], I = 79.63). Pre-pregnancy obesity increased the risk of attention deficit-hyperactivity disorder (OR = 1.62; 95% CI [1.23, 2.14], I = 70.15), autism spectrum disorder (OR = 1.36; 95% CI [1.08, 1.70], I = 60.52), developmental delay (OR = 1.58; 95% CI [1.39, 1.79], I = 75.77) and emotional/behavioural problems (OR = 1.42; 95% CI [1.26, 1.59], I = 87.74). Given the current obesity prevalence among young adults and women of childbearing age, this association between maternal obesity during pregnancy and atypical child neurodevelopment represents a potentially high public health burden.
Topics: Adult; Body Mass Index; Child; Child Development; Child, Preschool; Female; Humans; Infant, Newborn; Mothers; Neurodevelopmental Disorders; Obesity; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects; Risk Factors
PubMed: 29164765
DOI: 10.1111/obr.12643 -
Gut Microbes 2021Early life, including the establishment of the intestinal microbiome, represents a critical window of growth and development. Postnatal factors affecting the microbiome,... (Meta-Analysis)
Meta-Analysis
Early life, including the establishment of the intestinal microbiome, represents a critical window of growth and development. Postnatal factors affecting the microbiome, including mode of delivery, feeding type, and antibiotic exposure have been widely investigated, but questions remain regarding the influence of exposures on infant gut microbiome assembly. This systematic review aimed to synthesize evidence on exposures before birth, which affect the early intestinal microbiome. Five databases were searched in August 2019 for studies exploring pre-pregnancy or pregnancy 'exposure' data in relation to the infant microbiome. Of 1,441 publications identified, 76 were included. Factors reported influencing microbiome composition and diversity included maternal antibiotic and probiotic uses, dietary intake, pre-pregnancy body mass index (BMI), gestational weight gain (GWG), diabetes, mood, and others. Eleven studies contributed to three meta-analyses quantifying associations between maternal intrapartum antibiotic exposure (IAP), BMI and GWG, and infant microbiome alpha diversity (Shannon Index). IAP, maternal overweight/obesity and excessive GWG were all associated with reduced diversity. Most studies were observational, few included early recruitment or longitudinal follow-up, and the timing, frequency, and methodologies related to stool sampling and analysis were variable. Standardization and collaboration are imperative to enhance understanding in this complex and rapidly evolving area.
Topics: Adult; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Body Mass Index; Child, Preschool; Female; Gastrointestinal Microbiome; Humans; Infant; Infant, Newborn; Male; Maternal Exposure; Pregnancy; Pregnancy Complications, Infectious; Young Adult
PubMed: 33978558
DOI: 10.1080/19490976.2021.1897210 -
Risks associated with obesity in pregnancy, for the mother and baby: a systematic review of reviews.Obesity Reviews : An Official Journal... Aug 2015Maternal obesity is linked with adverse outcomes for mothers and babies. To get an overview of risks related to obesity in pregnant women, a systematic review of reviews... (Review)
Review
Maternal obesity is linked with adverse outcomes for mothers and babies. To get an overview of risks related to obesity in pregnant women, a systematic review of reviews was conducted. For inclusion, reviews had to compare pregnant women of healthy weight with women with obesity, and measure a health outcome for mother and/or baby. Authors conducted full-text screening, quality assurance using the AMSTAR tool and data extraction steps in pairs. Narrative analysis of the 22 reviews included show gestational diabetes, pre-eclampsia, gestational hypertension, depression, instrumental and caesarean birth, and surgical site infection to be more likely to occur in pregnant women with obesity compared with women with a healthy weight. Maternal obesity is also linked to greater risk of preterm birth, large-for-gestational-age babies, foetal defects, congenital anomalies and perinatal death. Furthermore, breastfeeding initiation rates are lower and there is greater risk of early breastfeeding cessation in women with obesity compared with healthy weight women. These adverse outcomes may result in longer duration of hospital stay, with concomitant resource implications. It is crucial to reduce the burden of adverse maternal and foetal/child outcomes caused by maternal obesity. Women with obesity need support to lose weight before they conceive, and to minimize their weight gain in pregnancy.
Topics: Adult; Breast Feeding; Cesarean Section; Depression; Directive Counseling; Female; Health Knowledge, Attitudes, Practice; Humans; Infant, Low Birth Weight; Infant, Newborn; Male; Molecular Sequence Data; Mothers; Obesity; Perinatal Mortality; Pre-Eclampsia; Preconception Care; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Premature Birth; Risk Factors; Social Support; Weight Gain; Weight Reduction Programs
PubMed: 26016557
DOI: 10.1111/obr.12288 -
Translational Psychiatry Jan 2021Inflammation is increasingly recognized as a cause or consequence of common problems of humanity including obesity, stress, depression, pollution and disease states such...
Inflammation is increasingly recognized as a cause or consequence of common problems of humanity including obesity, stress, depression, pollution and disease states such as autoimmunity, asthma, and infection. Maternal immune activation (MIA), triggered by both acute and systemic chronic inflammation, is hypothesized to be one of the mechanisms implicated in the pathogenesis of neurodevelopmental disorders (NDD). Although there is substantial preclinical evidence to support the MIA hypothesis, the human evidence is disparate. We performed a systematic review on human studies examining associations between maternal inflammatory states and offspring NDDs (autism spectrum disorder- ASD, attention deficit hyperactivity disorder-ADHD, Tourette syndrome-TS). 32 meta-analyses and 26 additional individual studies were identified. Maternal states associated with ASD include obesity, gestational diabetes mellitus, pre-eclampsia, pollution, stress, depression, autoimmune diseases, and infection. Maternal states associated with ADHD include obesity, pre-eclampsia, smoking, low socioeconomic status (SES), stress, autoimmune disease, and asthma. Maternal states associated with TS include low SES, depression, and autoimmune diseases. Diverse maternal inflammatory states in pregnancy are associated with common offspring NDDs. Given the increased prevalence of NDDs, there is urgent need to explore relative and cumulative maternal risk factors and disease mechanisms. Defining preventable risk factors in high-risk pregnancies could mitigate the expression and severity of NDDs.
Topics: Attention Deficit Disorder with Hyperactivity; Autism Spectrum Disorder; Female; Humans; Inflammation; Neurodevelopmental Disorders; Pregnancy; Prenatal Exposure Delayed Effects; Risk Factors
PubMed: 33479207
DOI: 10.1038/s41398-021-01198-w -
Nutrients Jun 2022Several institutions propose responsive feeding (RF) as the caregivers' relational standard when nurturing a child, from breast/formula feeding onwards. Previous... (Meta-Analysis)
Meta-Analysis Review
Several institutions propose responsive feeding (RF) as the caregivers' relational standard when nurturing a child, from breast/formula feeding onwards. Previous systematic reviews (SRs) on caregivers' feeding practices (CFPs) have included studies on populations from countries with different cultures, rates of malnutrition, and incomes, whereas this SR compares different CFPs only in healthy children (4-24 months) from industrialized countries. Clinical questions were about the influence of different CFPs on several important outcomes, namely growth, overweight/obesity, risk of choking, dental caries, type 2 diabetes (DM2), and hypertension. The literature review does not support any Baby Led Weaning's or Baby-Led Introduction to SolidS' (BLISS) positive influence on children's weight-length gain, nor their preventive effect on future overweight/obesity. RF-CFPs can result in adequate weight gain and a lower incidence of overweight/obesity during the first two years of life, whereas restrictive styles and coercive styles, two kinds of non-RF in CF, can have a negative effect, favoring excess weight and lower weight, respectively. Choking risk: failure to supervise a child's meals by an adult represents the most important risk factor; no cause-effect relation between BLW/BLISS/RF/NRCF and choking could be found. Risks of DM2, hypertension, and caries: different CFPs cannot be considered as a risky or preventive factor for developing these conditions later in life.
Topics: Airway Obstruction; Caregivers; Child; Dental Caries; Diabetes Mellitus, Type 2; Feeding Behavior; Humans; Hypertension; Infant; Infant Nutritional Physiological Phenomena; Noncommunicable Diseases; Obesity; Overweight; Weight Gain
PubMed: 35807827
DOI: 10.3390/nu14132646 -
Journal of Public Health (Oxford,... Sep 2016Maternal obesity is emerging as a public health problem, recently highlighted together with maternal under-nutrition as a 'double burden', especially in African... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Maternal obesity is emerging as a public health problem, recently highlighted together with maternal under-nutrition as a 'double burden', especially in African countries undergoing social and economic transition. This systematic review was conducted to investigate the current evidence on maternal obesity in Africa.
METHODS
MEDLINE, EMBASE, Scopus, CINAHL and PsycINFO were searched (up to August 2014) and identified 29 studies. Prevalence, associations with socio-demographic factors, labour, child and maternal consequences of maternal obesity were assessed. Pooled risk ratios comparing obese and non-obese groups were calculated.
RESULTS
Prevalence of maternal obesity across Africa ranged from 6.5 to 50.7%, with older and multiparous mothers more likely to be obese. Obese mothers had increased risks of adverse labour, child and maternal outcomes. However, non-obese mothers were more likely to have low-birthweight babies. The differences in measurement and timing of assessment of maternal obesity were found across studies. No studies were identified either on the knowledge or attitudes of pregnant women towards maternal obesity; or on interventions for obese pregnant women.
CONCLUSIONS
These results show that Africa's levels of maternal obesity are already having significant adverse effects. Culturally adaptable/sensitive interventions should be developed while monitoring to avoid undesired side effects.
Topics: Africa; Age Factors; Female; Humans; Mothers; Obesity; Parity; Prevalence; Risk Factors
PubMed: 26487702
DOI: 10.1093/pubmed/fdv138