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BMC Medicine Sep 2014Dietary factors have been suggested to play a role in the prevention of hypertensive disorders of pregnancy (HDP), including gestational hypertension and pre-eclampsia,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Dietary factors have been suggested to play a role in the prevention of hypertensive disorders of pregnancy (HDP), including gestational hypertension and pre-eclampsia, but inconsistent findings have been reported. A systematic review and meta-analyses were performed to synthesize evidence from observational studies of reproductive-aged women on the association between dietary factors and HDP.
METHODS
MEDLINE and EMBASE were searched to identify studies published until the end of May 2014. Studies were included if they were observational studies of reproductive-age women and reported results on dietary factors (energy, nutrients, foods or overall dietary patterns, alone or in combination with dietary supplements) and gestational hypertension and/or pre-eclampsia. Studies were excluded if they reported on supplements not in combination with dietary intake, or examined a biomarker of dietary intake. Random effects meta-analyses were performed on calculated weighted mean differences (WMD) of dietary intake between cases and non-cases, and effect estimates were pooled.
RESULTS
In total, 23 cohort and 15 case-control studies were identified for systematic review, of which 16 could be included in the meta-analyses. Based on meta-analyses of cohort studies, unadjusted energy intake was higher for pre-eclampsia cases (WMD 46 kcal/day, 95% confidence interval (CI) -13.80 to 106.23; I 2 = 23.9%, P = 0.26), although this was not statistically significant. Unadjusted intakes of magnesium (WMD 8 mg/day, 95% CI -13.99 to -1.38; I 2 = 0.0%, P = 0.41) and calcium (WMD 44 mg/day, 95% CI -84.31 to -3.62, I 2 = 51.1%, P = 0.03) were lower for the HDP cases, compared with pregnant women without HDP. Higher calcium intake consistently showed lower odds for HDP after adjustment for confounding factors (OR = 0.76, 95% CI 0.57 to 1.01, I 2 = 0.0%, P = 0.79). A few studies examining foods and dietary patterns suggested a beneficial effect of a diet rich in fruit and vegetables on pre-eclampsia, although not all the results were statistically significant.
CONCLUSIONS
Based on a limited number of studies, higher total energy and lower magnesium and calcium intake measured during pregnancy were identified as related to HDP. Further prospective studies are required to provide an evidence base for development of preventive health strategies, particularly focusing on dietary factors during pre-pregnancy and early pregnancy.
Topics: Adult; Diet; Dietary Supplements; Female; Humans; Hypertension, Pregnancy-Induced; Observational Studies as Topic; Pre-Eclampsia; Pregnancy
PubMed: 25241701
DOI: 10.1186/s12916-014-0157-7 -
Journal of Human Hypertension Mar 2023Arterial hypertension is a major public health issue. Non-pharmacological approaches like Mindfulness-Based Stress Reduction (MBSR) might be a promising addition to... (Meta-Analysis)
Meta-Analysis Review
Arterial hypertension is a major public health issue. Non-pharmacological approaches like Mindfulness-Based Stress Reduction (MBSR) might be a promising addition to conventional therapy. This systematic review and meta-analysis aim to evaluate the effects of MBSR on systolic (SBP) and diastolic blood pressure (DBP) among individuals with prehypertension or hypertension. We searched Medline/PubMed, Scopus and the Cochrane Central Register of Controlled Trials (CENTRAL) for randomized controlled trials (RCTs) from their inception until August 1st 2021. RCTs were included that compared MBSR to any control intervention in participants with diagnosed prehypertension (120-139/80-89 mmHg) or hypertension (≥140/≥90 mmHg). Mean differences (MD) and 95% confidence intervals (CI) were calculated. Risk of Bias was assessed using the Cochrane tool. Seven RCTs with 429 participants were included. Very low quality of evidence was found for positive effects of MBSR on SBP (MD = -11.26 mmHg, 95%CI = -20.24 to -2.29, p = 0.01) but no evidence for effects on DBP levels (MD = -3.62 mmHg, 95%CI = -8.52 to 1.29, p = 0.15) compared to waitlist control. Compared to active control, very low quality of evidence was found for positive effects on DBP (MD = -5.51 mmHg, 95%CI = -10.93 to -0.09, p = 0.05) but no effects on SBP levels (MD = -4.33 mmHg, 95%CI = -12.04 to 3.38, p = 0.27). Overall, the studies showed a high degree of heterogeneity. The effects found were robust against selection, detection, and attrition bias. Only one RCT reported safety data. MBSR may be an option for lowering blood pressure in people with prehypertension to hypertension. More and larger high-quality studies are needed to substantiate our findings.
Topics: Humans; Prehypertension; Mindfulness; Hypertension; Blood Pressure; Hypotension
PubMed: 36216879
DOI: 10.1038/s41371-022-00764-z -
Journal of Obstetrics and Gynaecology :... Aug 2012The association between lead and hypertension in adults was first identified in the early 1980's and it has since been proposed that lead may also have a role in... (Review)
Review
The association between lead and hypertension in adults was first identified in the early 1980's and it has since been proposed that lead may also have a role in gestational hypertension (GH). This systematic review investigates whether lead may be associated with the development of GH or pre-eclampsia. MEDLINE, Embase and Web of Science were searched from inception to August 2011, using the terms: blood lead levels, pregnancy, pregnancy induced hypertension, gestational hypertension and pre-eclampsia. Nine papers were found. Positive associations between lead and GH or pre-eclampsia were found in six studies. The development of GH or pre-eclampsia may serve as a signal to assess blood lead concentrations in pregnant women, as even low lead concentrations have been shown to negatively impact the neurodevelopment and cognitive abilities of children. Adequate calcium intake throughout the pregnancy and lactation period may assist with reducing lead exposure levels.
Topics: Female; Humans; Lead Poisoning; Pre-Eclampsia; Pregnancy
PubMed: 22779950
DOI: 10.3109/01443615.2012.693987 -
Pregnancy Hypertension Mar 2023Pregnant people with chronic hypertension, pre-existing diabetes or both are at high risk of developing cardiovascular disease. Lifestyle interventions play an important...
BACKGROUND
Pregnant people with chronic hypertension, pre-existing diabetes or both are at high risk of developing cardiovascular disease. Lifestyle interventions play an important role in disease management in non-pregnant populations.
AIM
To review the existing evidence of randomised controlled trials (RCTs) that examine lifestyle interventions in pregnant people with chronic hypertension and/or pre-existing diabetes.
METHODS
A systematic review and narrative synthesis was conducted. Five electronic databases were searched from inception to April 2021 for RCTs evaluating antenatal lifestyle interventions in people with chronic hypertension and/or pre-existing diabetes with outcomes to include weight or blood pressure change.
RESULTS
Nine randomised controlled trials including 7438 pregnant women were eligible. Eight studies were mixed pregnant populations that included women with chronic hypertension and/or pre-existing diabetes. One study included only pregnant women with pre-existing diabetes. Intervention characteristics and procedures varied and targeted diet, physical activity and/or gestational weight. All studies reported weight and one study reported blood pressure change. Outcome data were frequently unavailable for the subset of women of interest, including subgroup data on important pregnancy and birth complications. Eligibility criteria were often ambiguous and baseline data on chronic hypertension was often omitted.
CONCLUSION
A lack of primary interventional trials examining the effect of lifestyle interventions on weight and blood pressure outcomes in pregnant populations with chronic hypertension and/or pre-existing diabetes was evident. Lifestyle modification has the potential to alter disease progression. Future trials should address the ambiguity and frequent exclusion of these important populations.
Topics: Pregnancy; Female; Humans; Pre-Eclampsia; Diabetes Mellitus; Pregnant Women; Hypertension; Life Style; Randomized Controlled Trials as Topic
PubMed: 36608587
DOI: 10.1016/j.preghy.2022.12.004 -
Environmental Pollution (Barking, Essex... Jan 2023Prenatal exposure to endocrine-disrupting chemicals has been linked to gestational hypertension (GH) and preeclampsia (PE). However, the results were conflicting and... (Meta-Analysis)
Meta-Analysis Review
Prenatal exposure to endocrine-disrupting chemicals has been linked to gestational hypertension (GH) and preeclampsia (PE). However, the results were conflicting and inconclusive. We conducted a systematic review and meta-analysis for an overview of these relationships. We searched PubMed, and Google Scholar for studies investigating bisphenol A, phthalates, and per or poly-fluoroalkyl substances and GH or PE. Pooled odds ratio (OR) with a 95% confidence interval (CI) were calculated for risk estimate using the generic inverse variance method. A total of 14 studies were included in the present analysis. The pooled results demonstrated that perfluorooctanoic acid (PFOA, OR:1.20, 95% CI: 1.04, 1.39), perfluoro octane sulfonic acid (PFOS, (OR:1.23, 95% CI: 1.10, 1.38), and perfluononanoic acid (PFNA, OR:1.20, 95% CI: 1.03, 1.40) were significantly associated with an increased risk of PE. There was no significant association observed with perfluoro hexane sulfonic acid (PFHxS), perfluoro decanoic acid (PFDA), perfluoro heptanoic acid (PFHpA), and perfluoro undecanoic acid (PFUnDA) and PE. For GH, a statistically significant positive association was found with PFOA (OR:1.18, 95% CI: 1.01, 1.39) and PFHxS (OR:1.15, 95% CI: 1.02, 1.29). Among various phthalates analysed only mono-ethyl phthalate (MEP, OR:1.37, 95% CI: 1.11, 1.70) showed an association with GH. From our analysis, bisphenol A exposure during pregnancy did not show a significant association with the risk of PE. Our findings indicated that exposure to PFASs such as PFOA, PFOS, and PFNA during pregnancy is associated with an increased risk of PE and PFOA and PFHxS with GH. We also found that MEP was associated with GH. Most of the results were unstable in sensitivity analysis. Since most of these associations have limited evidence, more research is needed to confirm these findings.
Topics: Female; Pregnancy; Humans; Hypertension, Pregnancy-Induced; Pre-Eclampsia; Environmental Pollutants; Endocrine Disruptors; Sulfonic Acids; Fluorocarbons; Alkanesulfonic Acids
PubMed: 36481468
DOI: 10.1016/j.envpol.2022.120828 -
BMJ Open Sep 2020The purpose of this paper is to perform a systematic review and meta-analysis in order to summarise the prevalence of diabetes and pre-diabetes and their associated risk... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The purpose of this paper is to perform a systematic review and meta-analysis in order to summarise the prevalence of diabetes and pre-diabetes and their associated risk factors in Bangladesh.
DESIGN
Systematic review and meta-analysis.
PARTICIPANTS
General population of Bangladesh.
DATA SOURCES
PubMed, Medline, Embase, Bangladesh Journals Online, Science Direct, Scopus, Cochrane Library and Web of Science were used to search for studies, published between 1st of January 1995 and 31st of August 2019, on the prevalence of diabetes and pre-diabetes and their associated risk factors in Bangladesh. Only articles published in the English language articles were considered. Two authors independently selected studies. The quality of the articles was also assessed.
RESULTS
Out of 996 potentially relevant studies, 26 population-based studies, which together involved a total of 80 775 individuals, were included in the meta-analysis. The pooled prevalence of diabetes in the general population was 7.8% (95% CI: 6.4-9.3). In a sample of 56 452 individuals, the pooled prevalence of pre-diabetes was 10.1% (95% CI: 6.7-14.0; 17 studies). The univariable meta-regression analyses showed that the prevalence of diabetes is associated with the factors: the year of study, age of patients and presence of hypertension. The prevalence of diabetes was significantly higher in urban areas compared with rural areas, while there was no significant gender difference.
CONCLUSIONS
This meta-analysis suggests a relatively high prevalence of pre-diabetes and diabetes in Bangladesh, with a significant difference between rural and urban areas. The main factors of diabetes include urbanisation, increasing age, hypertension and time period. Further research is needed to identify strategies for early detecting, prevention and treatment of people with diabetes in the population.
PROSPERO REGISTRATION NUMBER
CRD42019148205.
Topics: Bangladesh; Diabetes Mellitus; Humans; Hypertension; Prediabetic State; Prevalence
PubMed: 32907898
DOI: 10.1136/bmjopen-2019-036086 -
BJOG : An International Journal of... Mar 2017A preponderance of male fetuses in pregnancies complicated by pre-eclampsia was described over 40 years ago. Since then, however, there has been conflicting evidence in... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
A preponderance of male fetuses in pregnancies complicated by pre-eclampsia was described over 40 years ago. Since then, however, there has been conflicting evidence in the literature, with some studies supporting a male preponderance, some demonstrating no relationship with fetal sex, and others reporting increased risk in pregnancies bearing females.
OBJECTIVES
In this context, we sought to conduct a systematic review and meta-analysis to objectively evaluate the relationship between fetal sex and maternal risk of pre-eclampsia/eclampsia.
SEARCH STRATEGY
Studies from January 1950 to April 2015 were identified from PUBMED and EMBASE.
SELECTION CRITERIA
This systematic review and meta-analysis evaluated 22 articles reporting data on fetal sex and prevalence of pre-eclampsia/eclampsia.
DATA COLLECTION AND ANALYSIS
Data were extracted by two independent reviewers. Pooled estimates of the relative risk (RR) were calculated by random-effects model.
MAIN RESULTS
Male fetus was considered the exposure and prevalence of maternal pre-eclampsia/eclampsia was the outcome of interest. We identified 534 studies through electronic searches and three studies through manual searches. Twenty-two studies fulfilled the inclusion criteria, yielding data on 3 163 735 women. Pooled analyses of these studies showed no association between male fetal sex and maternal risk of pre-eclampsia/eclampsia (RR 1.01; 95% confidence interval, 95% CI 0.97-1.05); however, a subgroup analysis including only studies that evaluated the non-Asian population (n = 2 931 771 women) demonstrated that male fetal sex was associated with increased maternal risk of pre-eclampsia/eclampsia (RR 1.05; 95% CI 1.03-1.06; I = 10%; P = 0.33).
CONCLUSION
Male fetal sex is associated with maternal risk of pre-eclampsia/eclampsia in the non-Asian population.
TWEETABLE ABSTRACT
Fetal sex is associated with maternal risk of pre-eclampsia/eclampsia in the non-Asian population.
Topics: Female; Fetus; Humans; Hypertension, Pregnancy-Induced; Male; Pregnancy; Prevalence; Risk Assessment; Risk Factors; Sex Factors
PubMed: 27315789
DOI: 10.1111/1471-0528.14163 -
BJOG : An International Journal of... Feb 2021Women with a history of hypertensive disorders of pregnancy (HDP) are at increased long-term risk of cardiovascular disease. However, there has been increasing evidence... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Women with a history of hypertensive disorders of pregnancy (HDP) are at increased long-term risk of cardiovascular disease. However, there has been increasing evidence on the same risks in the months following birth.
OBJECTIVES
This review aims to estimate the incidence of hypertension in the first 2 years after HDP.
SEARCH STRATEGY
MEDLINE, Embase and Cochrane databases were systematically searched in October 2019.
SELECTION CRITERIA
Observational studies comparing hypertension rate following HDP and normotensive pregnancies up to 2 years.
DATA COLLECTION AND ANALYSIS
A meta-analysis to calculate the odds ratio (OR) with a 95% confidence interval (CI) and a sub-group analysis excluding women with chronic hypertension were performed.
MAIN RESULTS
Hypertension was diagnosed within the first 2 years following pregnancy in 468/1646 (28.4%) and 584/6395 (9.1%) of the HDP and control groups, respectively (OR 6.28; 95% CI 4.18-9.43; I = 56%). The risk of hypertension in HDP group was significantly higher in the first 6 months following delivery (OR 18.33; 95% CI 1.35-249.48; I = 84%) than at 6-12 months (OR 4.36; 95% CI 2.81-6.76; I = 56%) or between 1-2 years postpartum (OR 7.24; 95% CI 4.44-11.80; I = 9%). A sub-group analysis demonstrated a similar increase in the risk of developing postpartum hypertension after HDP (OR 5.75; 95% CI 3.92-8.44; I = 49%) and pre-eclampsia (OR 6.83; 95% CI 4.25-10.96; I = 53%).
CONCLUSIONS
The augmented risk of hypertension after HDP is highest in the early postpartum period, suggesting that diagnosis and targeted interventions to improve maternal cardiovascular health may need to be commenced in the immediate postpartum period.
TWEETABLE ABSTRACT
The risk of hypertension within 2 years of birth is six-fold higher in women who experienced pre-eclampsia.
Topics: Adult; Female; Heart Disease Risk Factors; Humans; Hypertension, Pregnancy-Induced; Incidence; Middle Aged; Observational Studies as Topic; Odds Ratio; Postpartum Period; Pre-Eclampsia; Pregnancy; Puerperal Disorders
PubMed: 32981216
DOI: 10.1111/1471-0528.16545 -
Frontiers in Medicine 2021This study aimed to assess the differences in the average and sectoral peripapillary retinal nerve fiber layer (pRNFL), macular ganglion cell plus inner plexiform layer...
Optical Coherence Tomography Evaluation of Peripapillary and Macular Structure Changes in Pre-perimetric Glaucoma, Early Perimetric Glaucoma, and Ocular Hypertension: A Systematic Review and Meta-Analysis.
This study aimed to assess the differences in the average and sectoral peripapillary retinal nerve fiber layer (pRNFL), macular ganglion cell plus inner plexiform layer (mGCIPL), and macular ganglion cell complex (mGCC) thickness using optical coherence tomography (OCT) in patients with pre-perimetric glaucoma (PPG) compared to those with early perimetric glaucoma (EG) and ocular hypertension (OHT). A comprehensive literature search of the PubMed database, the Cochrane Library, and Embase was performed from inception to March 2021. The weighted mean difference (WMD) with the 95% confidence interval (CI) was pooled for continuous outcomes. Twenty-three cross-sectional studies comprising 2,574 eyes (1,101 PPG eyes, 1,233 EG eyes, and 240 OHT eyes) were included in the systematic review and meta-analysis. The pooled results demonstrated that the average pRNFL (WMD = 8.22, 95% CI = 6.32-10.12, < 0.00001), mGCIPL (WMD = 4.83, 95% CI = 3.43-6.23, < 0.00001), and mGCC (WMD = 7.19, 95% CI = 4.52-9.85, < 0.00001) were significantly thinner in patients with EG than in those with PPG. The sectoral thickness of pRNFL, mGCIPL, and mGCC were also significantly lower in the EG eyes. In addition, the average pRNFL and mGCC were significantly thinner in the PPG eyes than those in the OHT eyes (pRNFL: WMD = -8.57, 95% CI = -9.88 to -7.27, < 0.00001; mGCC: WMD = -3.23, 95% CI = -6.03 to -0.44, = 0.02). Similarly, the sectoral pRNFL and mGCC were also significantly thinner in the PPG eyes than those in the OHT eyes. OCT-based measurements of peripapillary and macular structural alterations can be used to distinguish PPG from EG and OHT, which can help understand the pathophysiology of glaucoma at earlier stages. Studies that employ clock hour classification methods and longitudinal studies are needed to verify our findings. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=239798 CRD42021239798.
PubMed: 34277670
DOI: 10.3389/fmed.2021.696004 -
Birth Defects Research Jan 2019Several studies have reported an association between maternal hypertensive disorders and hypospadias in offspring; however there is still debate on the role of maternal... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Several studies have reported an association between maternal hypertensive disorders and hypospadias in offspring; however there is still debate on the role of maternal hypertension and preeclampsia on this relatively common congenital malformation. Therefore, we conducted a systematic review and meta-analysis to comprehensively evaluate the relationship between these frequent maternal conditions and hypospadias in offspring.
METHODS
Fifteen articles meeting the eligibility criteria were identified in our search and included in the analysis. A meta-analysis was conducted and pooled odds ratio (OR) estimates were calculated separately for hypertension and preeclampsia using meta-analysis. We also conducted several secondary analyses, including (a) studies conducted before versus after January 1, 1998; (b) studies in United States versus other countries; and (c) studies that accounted for ≥3 versus fewer or no potential confounders, among others.
RESULTS
Significant positive associations were observed between hypertension and hypospadias (OR 1.68; 95% CI 1.46-1.93), as well as preeclampsia and hypospadias (OR 2.18; 95% CI 1.63-2.91). The direction and magnitude of effect was comparable for the majority of secondary analyses conducted.
CONCLUSIONS
Our results indicate that maternal hypertensive disorders are positively associated with hypospadias in offspring. Further research is needed to better understand the mechanisms involved, and to ultimately develop public health strategies geared toward prevention of hypospadias.
Topics: Female; Humans; Hypertension; Hypospadias; Male; Maternal Inheritance; Odds Ratio; Pre-Eclampsia; Pregnancy; Prenatal Exposure Delayed Effects; Risk Factors
PubMed: 30411533
DOI: 10.1002/bdr2.1415