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PloS One 2023The purpose of this meta-analysis was to assess the safety of the anti-thyroid drugs (ATDs) propylthiouracil (PTU) and methimazole (MMI) in the treatment of... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The purpose of this meta-analysis was to assess the safety of the anti-thyroid drugs (ATDs) propylthiouracil (PTU) and methimazole (MMI) in the treatment of hyperthyroidism during pregnancy.
METHOD
From inception until June 2, 2022, all available studies were searched in PubMed, Web of Science, Cochrane, EBSCO, Embase, Scopus, and CNKI.
RESULT
Thirteen articles satisfying the inclusion criteria were examined. Our meta-analysis indicated that pregnant women treated with MMI had a higher risk of congenital anomalies than those treated with PTU (OR 0.80, 95%CI 0.69-0.92, P = 0.002, I2 = 41.9%). Shifting between MMI and PTU during pregnancy did not reduce the risk of birth defects compared to PTU alone (OR 1.18, CI 1.00 to 1.40, P = 0.061, I2 = 0.0%). There were no statistically significant differences in hepatotoxicity (OR 1.54, 95%CI 0.77-3.09, P = 0.221, I2 = 0.0%) or miscarriage (OR 0.89, 95%CI 0.72-1.11, P = 0.310, I2 = 0.0%) between PTU and MMI exposure.
CONCLUSION
The study confirmed propylthiouracil is a safer alternative to methimazole for treating hyperthyroidism in pregnant women, and it is appropriate to treat maternal thyroid disease with PTU during the first trimester of pregnancy. However, it is not clear whether switching between propylthiouracil and methimazole is a better option than treating PTU alone during pregnancy. Further studies on this matter may be needed to develop new evidence-based guidelines for the treatment of pregnant women with hyperthyroidism.
Topics: Female; Pregnancy; Humans; Methimazole; Propylthiouracil; Antithyroid Agents; Hyperthyroidism; Abortion, Spontaneous; Pregnancy Complications
PubMed: 37205692
DOI: 10.1371/journal.pone.0286097 -
Frontiers in Immunology 2022Recurrent spontaneous abortion (RSA) is defined as two or more pregnancy loss, affecting the happiness index of fertility couples. The mechanisms involved in the...
Recurrent spontaneous abortion (RSA) is defined as two or more pregnancy loss, affecting the happiness index of fertility couples. The mechanisms involved in the occurrence of RSA are not clear to date. The primary problem for the maternal immune system is how to establish and maintain the immune tolerance to the semi-allogeneic fetuses. During the pregnancy, decidual macrophages mainly play an important role in the immunologic dialogue. The purpose of this study is to explore decidual macrophages, and to understand whether there is a connection between these cells and RSA by analyzing their phenotypes and functions. Pubmed, Web of Science and Embase were searched. The eligibility criterion for this review was evaluating the literature about the pregnancy and macrophages. Any disagreement between the authors was resolved upon discussion and if required by the judgment of the corresponding author. We summarized the latest views on the phenotype, function and dysfunction of decidual macrophages to illuminate its relationship with RSA.
Topics: Pregnancy; Humans; Female; Decidua; Abortion, Habitual; Macrophages; Abortion, Induced
PubMed: 36569856
DOI: 10.3389/fimmu.2022.994888 -
Fertility and Sterility Aug 2023The evidence on the association between diet and miscarriage risk is scant and conflicting. (Meta-Analysis)
Meta-Analysis Review
IMPORTANCE
The evidence on the association between diet and miscarriage risk is scant and conflicting.
OBJECTIVE
To summarize the evidence on the association between periconceptual diet and miscarriage risk in healthy women of reproductive age.
DATA SOURCES
Electronic databases were searched from inception to August 2022 without restriction of regions, publication types, or languages.
STUDY SELECTION AND SYNTHESIS
Experimental or observational studies were considered for inclusion. The population was healthy women of reproductive age. Exposure was periconception diet. Study quality was assessed using the modified Newcastle-Ottawa Scale. Summary effect sizes (odds ratio [OR] with 95% confidence interval [CI]) were calculated for each food category.
MAIN OUTCOMES
Miscarriage rate (as defined by primary studies).
RESULTS
We included 20 studies (11 cohort and 9 case-control), of which 6 presented data suitable for meta-analysis (2 cohort and 4 case-control, n = 13,183 women). Our primary analyses suggest a reduction in miscarriage odds with high intake of the following food groups: fruit (OR, 0.39; 95% CI, 0.33-0.46), vegetables (OR, 0.59; 95% CI, 0.46-0.76), fruit and vegetables (OR, 0.63; 95% CI, 0.50-0.81), seafood (OR, 0.81; 95% CI, 0.71-0.92), dairy products (OR, 0.63; 95% CI, 0.54-0.73), eggs (OR, 0.81; 95% CI, 0.72-0.90), and cereal (grains) (OR, 0.67; 95% CI, 0.52-0.87). The evidence was uncertain for meat, red meat, white meat, fat and oil, and sugar substitutes. We did not find evidence of an association between adherence to predefined dietary patterns and miscarriage risk. However, a whole diet containing healthy foods as perceived by the trialists, or with a high Dietary Antioxidant Index score (OR, 0.43; 95% CI, 0.20-0.91) may be associated with a reduction in miscarriage risk. In contrast, a diet rich in processed food was demonstrated to be associated with increased miscarriage risk (OR, 1.97; 95% CI, 1.36-3.34).
CONCLUSION AND RELEVANCE
A diet abundant in fruit, vegetables, seafood, dairy, eggs, and grain may be associated with lower miscarriage odds. Further interventional studies are required to accurately assess the effectiveness of periconception dietary modifications on miscarriage risk.
PROSPERO REGISTRATION
CRD42020218133.
Topics: Pregnancy; Female; Humans; Abortion, Spontaneous; Diet; Fruit; Vegetables; Meat
PubMed: 37061157
DOI: 10.1016/j.fertnstert.2023.04.011 -
Gynecologie, Obstetrique, Fertilite &... 2017In spontaneous pregnancies, endometriosis appears to be a risk factor of miscarriage. The aim of this study is to evaluate the association between endometriosis and... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
In spontaneous pregnancies, endometriosis appears to be a risk factor of miscarriage. The aim of this study is to evaluate the association between endometriosis and miscarriage in spontaneous pregnancy.
METHODS
We searched the Cochrane Library, Medline of eligible studies from inception to December 2016, without any restriction. We selected studies that compared endometriosis-affected pregnant women to disease-free pregnant women. To ensure the quality of the methodology, the PRISMA criteria have been met at all stages of the development of this meta-analysis. The primary adverse pregnancy outcomes studied was miscarriage. Three reviewers independently extracted the studies' characteristics and outcome data.
RESULTS
Of 225 identified abstracts, 4 primary studies met our inclusion criteria by comparing spontaneous pregnant patients with endometriosis to disease-free women. Miscarriage rate was higher in the endometriosis group (OR 1.77 [CI 95% 1.13-2.78]).
CONCLUSION
In spontaneous pregnancies, endometriosis appears to be a risk factor of miscarriages (almost 80% increased risk). Further prospective studies are needed to confirm these results in order to establish the exact impact of endometriosis on spontaneous pregnancy course.
Topics: Abortion, Spontaneous; Endometriosis; Female; Humans; MEDLINE; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Risk Factors
PubMed: 28712793
DOI: 10.1016/j.gofs.2017.06.003 -
Human Reproduction Update Mar 2017A short interpregnancy interval (IPI) following a delivery is believed to be associated with adverse outcomes in the next pregnancy. The optimum IPI following... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
A short interpregnancy interval (IPI) following a delivery is believed to be associated with adverse outcomes in the next pregnancy. The optimum IPI following miscarriage is controversial. Based on a single large-scale study in Latin and South America, the World Health Organization recommends delaying pregnancy for 6 months after a miscarriage to achieve optimal outcomes in the next pregnancy.
OBJECTIVE AND RATIONALE
Our aim was to determine if a short IPI (<6 months) following miscarriage is associated with adverse outcomes in the next pregnancy.
SEARCH METHODS
Studies were retrieved from MEDLINE, Embase and Pubmed, with no time and language restrictions. The search strategy used a combination of Medical Subject Headings terms for miscarriage, IPI and adverse outcomes. Bibliographies of the retrieved articles were also searched by hand. All studies including women with at least one miscarriage, comparing subsequent adverse pregnancy outcomes for IPIs of less than and more than 6 months were included. Two independent reviewers screened titles and abstracts for inclusion. Characteristics of the studies were extracted and quality assessed using Critical Appraisal Skills Programme criteria. A systematic review and meta-analysis were conducted to compare short (<6 months) versus long (>6 months) IPI following miscarriage in terms of risk of further miscarriage, preterm birth, stillbirth, pre-eclampsia and low birthweight babies in the subsequent pregnancy. Review Manager 5.3 was used for conducting meta-analyses.
OUTCOMES
Sixteen studies including 1 043 840 women were included in the systematic review and data from 10 of these were included in one or more meta-analyses (977 972 women). With an IPI of less than 6 months, the overall risk of further miscarriage (Risk ratio (RR) 0.82 95% CI 0.78, 0.86) and preterm delivery (RR 0.79 95% CI 0.75, 0.83) were significantly reduced. The pooled risks of stillbirth (RR 0.88 95% CI 0.76, 1.02); low birthweight (RR 1.05 95% CI 0.48, 2.29) and pre-eclampsia (RR 0.95 95% CI 0.88, 1.02) were not affected by IPI. Similar findings were obtained in subgroup analyses when IPI of <6 months was compared with IPI of 6-12 months and >12 months.
WIDER IMPLICATIONS
This is the first systematic review and meta-analysis providing clear evidence that an IPI of less than 6 months following miscarriage is not associated with adverse outcomes in the next pregnancy. This information may be used to revise current guidance.
Topics: Abortion, Spontaneous; Birth Intervals; Female; Humans; Infant, Low Birth Weight; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Premature Birth; Risk Factors; Time Factors
PubMed: 27864302
DOI: 10.1093/humupd/dmw043 -
Heart (British Cardiac Society) Nov 2013The 2011 American Heart Association guidelines identified pregnancy complications as a risk factor for cardiovascular disease in women. However, miscarriage was not... (Meta-Analysis)
Meta-Analysis Review
CONTEXT
The 2011 American Heart Association guidelines identified pregnancy complications as a risk factor for cardiovascular disease in women. However, miscarriage was not mentioned within the guidelines, and there is no consensus on the association between miscarriage and future risk of cardiovascular disease.
OBJECTIVE
To confirm or refute the association, a meta-analysis of published papers was conducted.
DATA SOURCES
PubMed, Web of Knowledge and Scopus were systematically searched to identify appropriate articles. Reference lists were then hand searched for additional relevant titles.
STUDY SELECTION
To be included, articles had to assess the association between miscarriage and subsequent cardiovascular disease in otherwise healthy women. Only women who had miscarriages were considered exposed. Pooled association measures, using random effects meta-analysis, were calculated for coronary heart disease and cerebrovascular disease. Publication bias and between-study heterogeneity were evaluated.
DATA EXTRACTION
Two authors individually reviewed all studies and extracted data on patient and study characteristics along with cardiovascular outcomes.
RESULTS
10 studies were identified, with 517 504 individuals included in the coronary heart disease meta-analysis and 134 461 individuals in the cerebrovascular disease analysis. A history of miscarriage was associated with a greater odds of developing coronary heart disease, OR (95% CI) =1.45 (1.18 to 1.78), but not with cerebrovascular disease, OR=1.11 (0.72 to 1.69). There was a strong association between recurrent miscarriage and coronary heart disease OR=1.99 (1.13 to 3.50). Evidence was found for moderate between-study heterogeneity and publication bias in the coronary heart disease analysis.
CONCLUSIONS
The meta-analysis indicates that a history of miscarriage or recurrent miscarriage is associated with a greater risk of subsequent coronary heart disease.
Topics: Abortion, Spontaneous; Coronary Disease; Female; Humans; Risk
PubMed: 23539554
DOI: 10.1136/heartjnl-2012-303237 -
American Journal of Epidemiology Apr 2014We conducted a systematic review and meta-analysis to characterize the relationship between smoking and miscarriage. We searched the PubMed database (1956-August 31,... (Meta-Analysis)
Meta-Analysis Review
We conducted a systematic review and meta-analysis to characterize the relationship between smoking and miscarriage. We searched the PubMed database (1956-August 31, 2011) using keywords and conducted manual reference searches of included articles and reports of the US Surgeon General. The full text of 1,706 articles was reviewed, and 98 articles that examined the association between active or passive smoking and miscarriage were included in the meta-analysis. Data were abstracted by 2 reviewers. Any active smoking was associated with increased risk of miscarriage (summary relative risk ratio = 1.23, 95% confidence interval (CI): 1.16, 1.30; n = 50 studies), and this risk was greater when the smoking exposure was specifically defined as during the pregnancy in which miscarriage risk was measured (summary relative risk ratio = 1.32, 95% CI: 1.21, 1.44; n = 25 studies). The risk of miscarriage increased with the amount smoked (1% increase in relative risk per cigarette smoked per day). Secondhand smoke exposure during pregnancy increased the risk of miscarriage by 11% (95% CI: 0.95, 1.31; n = 17 studies). Biases in study publication, design, and analysis did not significantly affect the results. This finding strengthens the evidence that women should not smoke while pregnant, and all women of reproductive age should be warned that smoking increases the risk of miscarriage.
Topics: Abortion, Spontaneous; Female; Humans; Maternal Exposure; Odds Ratio; Pregnancy; PubMed; Risk; Smoking; Tobacco Smoke Pollution
PubMed: 24518810
DOI: 10.1093/aje/kwt334 -
PloS One 2013To compare the risk of stillbirth and miscarriage in a subsequent pregnancy in women with a previous caesarean or vaginal delivery. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To compare the risk of stillbirth and miscarriage in a subsequent pregnancy in women with a previous caesarean or vaginal delivery.
DESIGN
Systematic review of the published literature including seven databases: CINAHL; the Cochrane library; Embase; Medline; PubMed; SCOPUS and Web of Knowledge from 1945 until November 11(th) 2011, using a detailed search-strategy and cross-checking of reference lists.
STUDY SELECTION
Cohort, case-control and cross-sectional studies examining the association between previous caesarean section and subsequent stillbirth or miscarriage risk. Two assessors screened titles to identify eligible studies, using a standardised data abstraction form and assessed study quality.
DATA SYNTHESIS
11 articles were included for stillbirth, totalling 1,961,829 pregnancies and 7,308 events. Eight eligible articles were included for miscarriage, totalling 147,017 pregnancies and 12,682 events. Pooled estimates across the stillbirth studies were obtained using random-effect models. Among women with a previous caesarean an increase in odds of 1.23 [95% CI 1.08, 1.40] for stillbirth was yielded. Subgroup analyses including unexplained stillbirths yielded an OR of 1.47 [95% CI 1.20, 1.80], an OR of 2.11 [95% CI 1.16, 3.84] for explained stillbirths and an OR of 1.27 [95% CI 0.95, 1.70] for antepartum stillbirths. Only one study reported adjusted estimates in the miscarriage review, therefore results are presented individually.
CONCLUSIONS
Given the recent revision of the National Institute for Health and Clinical Excellence guidelines (NICE), providing women the right to request a caesarean, it is essential to establish whether mode of delivery has an association with subsequent risk of stillbirth or miscarriage. Overall, compared to vaginal delivery, the pooled estimates suggest that caesarean delivery may increase the risk of stillbirth by 23%. Results for the miscarriage review were inconsistent and lack of adjustment for confounding was a major limitation. Higher methodological quality research is required to reliably assess the risk of miscarriage in subsequent pregnancies.
Topics: Abortion, Spontaneous; Adult; Case-Control Studies; Cesarean Section; Cohort Studies; Cross-Sectional Studies; Databases, Bibliographic; Female; Humans; Likelihood Functions; Middle Aged; Pregnancy; Risk Factors; Stillbirth
PubMed: 23372739
DOI: 10.1371/journal.pone.0054588 -
Pituitary Jun 2022To evaluate the association between acromegaly and pregnancy in terms of disease activity, maternal and fetal outcomes. (Meta-Analysis)
Meta-Analysis
PURPOSE
To evaluate the association between acromegaly and pregnancy in terms of disease activity, maternal and fetal outcomes.
METHODS
This systematic review was conducted according to the Joanna Briggs Institute methodology for systematic reviews of etiology and risk. We focused on observational studies that included pregnant women with acromegaly. The outcomes were acromegaly activity, preterm birth, gestational diabetes, hypertension, eclampsia/preeclampsia, miscarriage, perinatal mortality, low birthweight, small for gestational age, and congenital malformations. Embase, Medline, LILACS, and CENTRAL were our source databases. To perform proportional meta-analyses, we used Stata Statistical Software 17.
RESULTS
Nineteen studies were included encompassing a total of 273 pregnancies in 211 women with acromegaly. The overall frequency of control of acromegaly during pregnancy was 62%, and of tumor growth was 9%. No fetal or maternal deaths were reported. The overall frequency of worsening of previous diabetes or development of gestational diabetes was 9%, and of previous hypertension or preeclampsia/eclampsia was 6%. The overall frequency of premature labor was 9% [from 17 studies of 263 pregnancies; 95% confidence interval (CI), 5-13%]; of spontaneous miscarriage was 4% (from 19 studies of 273 pregnancies; 95% CI, 2-11%); of small for gestational age was 5% (from 15 studies of 216 newborns; 95% CI, 3-9%); and of congenital malformations was 1% (from 18 studies of 240 newborns; 95% CI, 0-7%).
CONCLUSION
Pregnancy in women with acromegaly is frequently associated with disease control and is safe in relation to fetal and maternal outcomes, as in women without acromegaly.
Topics: Abortion, Spontaneous; Acromegaly; Diabetes, Gestational; Eclampsia; Female; Humans; Hypertension; Infant, Newborn; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Premature Birth
PubMed: 35098440
DOI: 10.1007/s11102-022-01208-0 -
Journal of Minimally Invasive Gynecology Jun 2022To provide a systematic review of pregnancy outcomes after radiofrequency ablation (RFA) of uterine myomas. (Review)
Review
OBJECTIVE
To provide a systematic review of pregnancy outcomes after radiofrequency ablation (RFA) of uterine myomas.
DATA SOURCES
A literature search was conducted using PubMed, Cochrane Library, Scopus, Web of Science, and Embase, from database inception to October 2021.
METHODS OF STUDY SELECTION
Two reviewers conducted independent literature searches. Studies that met the criteria based on title and abstract underwent full-text review. Publications were included if they reported pregnancies and obstetric outcomes after laparoscopic or transcervical RFA of myomas.
TABULATION, INTEGRATION, AND RESULTS
A total of 405 publications were initially identified and screened, 39 underwent full-text review, and 10 publications were ultimately included. There were 50 pregnancies reported among 923 RFA patients: 40 pregnancies after 559 laparoscopic RFAs and 10 pregnancies after 364 transcervical RFAs. The number of patients from these studies actively trying to conceive after RFA is unknown. Among the RFA patients who conceived, the average age at ablation was 37 years old (range, 27-46 years). Most patients had between 1 and 3 myomas ablated, and myomas size ranged from <2 cm to 12.5 cm. There were 6 spontaneous abortions (12%) and 44 full-term pregnancies (88%), of which 24 were vaginal deliveries and 20 were cesarean deliveries. There were only 2 complications among 44 deliveries: one placenta previa that underwent an uncomplicated cesarean delivery and 1 delayed postpartum hemorrhage with expulsion of a degenerated myoma, with no long-term sequelae. There were no cases of uterine rupture, uterine window, or invasive placentation and no fetal complications. The spontaneous abortion rate was comparable with the general obstetric population.
CONCLUSION
Almost all pregnancies after RFA of myomas were full-term deliveries with no maternal or neonatal complications. These findings add to the literature that radiofrequency myoma ablation may offer a safe and effective alternative to existing treatments for women who desire future fertility.
Topics: Abortion, Spontaneous; Adult; Catheter Ablation; Female; Humans; Infant, Newborn; Leiomyoma; Myoma; Pregnancy; Pregnancy Outcome; Uterine Neoplasms
PubMed: 35123041
DOI: 10.1016/j.jmig.2022.01.015