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European Journal of Obstetrics,... Dec 2023To investigate differences between gut microbiota diversity and composition of healthy pregnant women and women with pre-eclampsia (PE). (Meta-Analysis)
Meta-Analysis Review
AIM
To investigate differences between gut microbiota diversity and composition of healthy pregnant women and women with pre-eclampsia (PE).
METHODS AND RESULTS
This is a systematic review and meta-analysis of the literature, in which the terms "pre-eclampsia", "gastrointestinal microbiome" and "pregnant women" were used to search MEDLINE (PubMed), BVS (LILACS and others), Embase (Elsevier) and Cochrane Library, including observational studies and case-control that investigated changes in the gut microbiota during pregnancy. Six studies were included, with 479 pregnant women. A significantly lower gut microbiota alpha diversity measured as the Shannon index was found in pregnant women with PE in comparison with healthy controls (SMD: -0.47; 95 %IC: -0.77 to -0.18; P = 0.02; I = 0 %; three studies, 179 participants), while no significant differences were found in the relative abundance of Bacteroidetes, Firmicutes, Actinobacteria, and Proteobacteria, despite significant differences reported in the individual studies.
CONCLUSION
Pregnant women with PE have lower gut microbiome diversity, however, there is insufficient evidence to determine whether there are changes in gut microbiota composition.
SIGNIFICANCE AND IMPACT OF THE STUDY
The gut microbiota can be a new treatment target to try to prevent changes in maternal bacterial proportions, aiming to reduce complications during pregnancy.
Topics: Pregnancy; Humans; Female; Gastrointestinal Microbiome; Pre-Eclampsia; Observational Studies as Topic
PubMed: 37826991
DOI: 10.1016/j.ejogrb.2023.10.003 -
Annals of Nutrition & Metabolism 2013Vitamin D may protect from pre-eclampsia through influences on immune modulation and vascular function. To evaluate the role of vitamin D in the development of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND/AIMS
Vitamin D may protect from pre-eclampsia through influences on immune modulation and vascular function. To evaluate the role of vitamin D in the development of pre-eclampsia, we conducted a systematic review and meta-analysis including novel data from 2 large-scale epidemiological studies.
METHODS
PubMed, EMBASE and the Cochrane Central Register of Controlled Trials were searched for prospective observational studies of association between vitamin D supplementation or status (measured by maternal 25-hydroxyvitamin D, 25(OH)D) with a subsequent risk of pre-eclampsia, or randomised controlled trials using vitamin D supplementation to prevent pre-eclampsia. The Hungarian Case-Control Surveillance of Congenital Abnormalities (HCCSCA) and the Avon Longitudinal Study of Parents and Children (ALSPAC) were included in meta-analyses with published studies.
RESULTS
Mothers receiving vitamin D supplementation earlier in pregnancy had lower odds of pre-eclampsia [pooled odds ratios (OR) 0.81 and 95% confidence interval (CI) 0.75-0.87, p = 2.4 × 10(-8), 2 studies] in the meta-analysis of published studies with HCCSCA. The meta-analysis of published studies with ALSPAC suggested an association between higher serum 25(OH)D levels and a reduced risk of pre-eclampsia (pooled OR 0.52 and 95% CI 0.30-0.89, p = 0.02, 6 studies). Randomised trials of supplementation were suggestive of protective association (pooled OR 0.66 and 95% CI 0.52-0.83, p = 0.001, 4 studies).
CONCLUSIONS
This study suggests that low maternal serum 25(OH)D concentrations increase pre-eclampsia risk and that vitamin D supplementation lowers this risk. The quality of evidence is insufficient to determine a causal association, which highlights the need for adequately powered clinical trials.
Topics: Dietary Supplements; Female; Humans; Nutritional Status; Observational Studies as Topic; Pre-Eclampsia; Pregnancy; Randomized Controlled Trials as Topic; Risk Factors; Vitamin D
PubMed: 24603503
DOI: 10.1159/000358338 -
International Journal of Gynaecology... Apr 2023Evidence has shown significant benefits of aspirin for preventing pre-eclampsia. (Review)
Review
BACKGROUND
Evidence has shown significant benefits of aspirin for preventing pre-eclampsia.
OBJECTIVES
The objective of this study was to systematically review recommendations from clinical practice guidelines and other recommendation documents on aspirin for the prevention of pre-eclampsia.
SEARCH STRATEGY
Ten databases were searched for statements from December 1, 2013, to January 1, 2022.
SELECTION CRITERIA
Without language restrictions, the most recent version of documents was considered.
DATA COLLECTION AND ANALYSIS
Two authors independently extracted recommendations. Guideline quality was assessed using a modified AGREE-II instrument and the AGREE-REX tool.
MAIN RESULTS
Out of 48 statements on the prevention of pre-eclampsia, 46 had recommendations on use of aspirin. Of them, 39 were supported by evidence from systematic reviews or randomized controlled trials. Three statements reported aspirin's significant reductions in preterm pre-eclampsia and one in perinatal death. Concerning quality, 41% of statements were rated as high quality in all domains of the AGREE-II tool, 15% were rated high quality in all domains of the AGREE-REX tool, and 11% were rated high quality in all domains on both tools.
CONCLUSIONS
While 96% of statements advocated for use of aspirin, only 9% reported a significant reduction in preterm pre-eclampsia or perinatal death. Based on the AGREE tools, future statements could use methodological improvement.
Topics: Pregnancy; Female; Infant, Newborn; Humans; Aspirin; Pre-Eclampsia; Perinatal Death
PubMed: 36129381
DOI: 10.1002/ijgo.14471 -
Journal of Clinical Periodontology Dec 2010This review evaluates the possible relationship between periodontal disease and pre-eclampsia, a major pregnancy complication. A generalized inflammatory response plays... (Review)
Review
AIM
This review evaluates the possible relationship between periodontal disease and pre-eclampsia, a major pregnancy complication. A generalized inflammatory response plays an important role in the pathogenesis of pre-eclampsia. Because periodontal disease is a low-grade inflammatory state, periodontal disease might contribute to the pathogenesis of pre-eclampsia.
MAIN FINDINGS AND CONCLUSION
A literature search of PubMed, EMBASE and CINAHL until August 2010 revealed 12 eligible observational studies and three randomized-controlled trials (RCTs). It appeared difficult to compare these studies, due to variations in definitions of periodontal disease and pre-eclampsia, timing of periodontal examination and inadequate control for confounding factors. Eight observational studies reported a positive association, while four studies found no association. None of the RTCs reported reductions in pre-eclamptic rate after periodontal therapy during pregnancy. Therefore, it is questionable whether periodontal disease plays a causal role in the pathogenesis of pre-eclampsia. The observed association in eight observational studies might be the result of induction of periodontal disease due to the pre-eclamptic state or it may be an epiphenomenon of an exaggerated inflammatory response to pregnancy. Larger RCTs with pre-eclampsia as the primary outcome and pathophysiological studies are required to explore causality and to dissect biological mechanisms involved.
Topics: Causality; Female; Humans; Periodontal Diseases; Pre-Eclampsia; Pregnancy; Randomized Controlled Trials as Topic; Research Design; Risk Factors
PubMed: 21070324
DOI: 10.1111/j.1600-051X.2010.01636.x -
BMJ Clinical Evidence Aug 2008Pre-eclampsia (raised blood pressure and proteinuria) complicates 2-8% of pregnancies, and raises morbidity and mortality in the mother and child. Pre-eclampsia is more... (Review)
Review
INTRODUCTION
Pre-eclampsia (raised blood pressure and proteinuria) complicates 2-8% of pregnancies, and raises morbidity and mortality in the mother and child. Pre-eclampsia is more common in women with multiple pregnancy and in those who have conditions associates with microvascular disease.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of preventive interventions in women at risk of pre-eclampsia? What are the effects of interventions in women who develop mild-moderate hypertension during pregnancy? What are the effects of interventions in women who develop severe pre-eclampsia or very high blood pressure during pregnancy? What is the best choice of anticonvulsant for women with eclampsia? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2007 (BMJ Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 53 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: anticonvulsants, antihypertensive drugs, antioxidants, antiplatelet drugs, atenolol, bed rest, hospital admission or day care, calcium supplementation, choice of analgesia during labour, early delivery (interventionist care), evening primrose oil, fish oil, glyceryl trinitrate, magnesium supplementation, plasma volume expansion, and salt restriction.
Topics: Anticonvulsants; Antihypertensive Agents; Antioxidants; Eclampsia; Female; Humans; Hypertension; Pre-Eclampsia; Pregnancy
PubMed: 19445808
DOI: No ID Found -
PloS One 2021The risk of myocardial infarction (MI) increases during pregnancy, particularly in women with pre-eclampsia. MI is diagnosed by measuring high blood levels of...
BACKGROUND
The risk of myocardial infarction (MI) increases during pregnancy, particularly in women with pre-eclampsia. MI is diagnosed by measuring high blood levels of cardiac-specific troponin (cTn), although this may be elevated in women with pre-eclampsia without MI, which increases diagnostic uncertainty. It is unclear how much cTn is elevated in uncomplicated and complicated pregnancy, which may affect whether the existing reference intervals can be used in pregnant women. Previous reviews have not investigated high-sensitivity troponin in pregnancy, compared to older, less sensitive methods.
METHODS
Electronic searches using the terms "troponin I" or "troponin T", and "pregnancy", "pregnancy complications" or "obstetrics". cTn levels were extracted from studies of women with uncomplicated pregnancies or pre-eclampsia.
RESULTS
The search identified ten studies with 1581 women. Eight studies used contemporary methods that may be too insensitive to use reliably in this clinical setting. Two studies used high-sensitivity assays, with one reporting an elevation in troponin I (TnI) in pre-eclampsia compared to uncomplicated pregnancy, and the other only examining women with pre-eclampsia. Seven studies compared cTn between women with pre-eclampsia or uncomplicated pregnancy using any assay. Seven studies showed elevated TnI in pre-eclampsia compared to uncomplicated pregnancy or non-pregnant women. One study measured troponin T (TnT) in pregnancy but did not examine pre-eclampsia.
CONCLUSION
TnI appears to be elevated in pre-eclampsia, irrespective of methodology, which may reflect the role of cardiac stress in this condition. TnI may be similar in healthy pregnant and non-pregnant women, but we found no literature reporting pregnancy-specific reference intervals using high-sensitivity tests. This limits broader application of cTn in pregnancy. There is a need to define reference intervals for cTn in pregnant women, which should involve serial sampling throughout pregnancy, with careful consideration for gestational age and body mass index, which cause dynamic changes in normal maternal physiology.
Topics: Adult; Biomarkers; Body Mass Index; Diagnostic Tests, Routine; Female; Gestational Age; Humans; Myocardial Infarction; Pre-Eclampsia; Pregnancy; Reference Values; Troponin I; Troponin T; Young Adult
PubMed: 33635922
DOI: 10.1371/journal.pone.0247946 -
Ultrasound in Obstetrics & Gynecology :... Jun 2018To determine the accuracy of ophthalmic artery Doppler in pregnancy for the prediction of pre-eclampsia (PE). (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To determine the accuracy of ophthalmic artery Doppler in pregnancy for the prediction of pre-eclampsia (PE).
METHODS
MEDLINE, EMBASE, CINAHL and The Cochrane Library were searched for relevant citations without language restrictions. Two reviewers independently selected studies that evaluated the accuracy of ophthalmic artery Doppler to predict the development of PE and extracted data to construct 2 × 2 tables. Individual patient data were obtained from the authors if available. A bivariate random-effects model was used for the quantitative synthesis of data. Logistic regression analysis was employed to generate receiver-operating characteristics (ROC) curves and obtain optimal cut-offs for each investigated parameter, and a bivariate analysis was employed using predetermined cut-offs to obtain sensitivity and specificity values and generate summary ROC curves.
RESULTS
A total of 87 citations matched the search criteria of which three studies, involving 1119 pregnancies, were included in the analysis. All included studies had clear description of the index and reference tests, avoidance of verification bias and adequate follow-up. Individual patient data were obtained for all three included studies. First diastolic peak velocity of ophthalmic artery Doppler at a cut-off of 23.3 cm/s showed modest sensitivity (61.0%; 95% CI, 44.2-76.1%) and specificity (73.2%; 95% CI, 66.9-78.7%) for the prediction of early-onset PE (area under the ROC curve (AUC), 0.68; 95% CI, 0.61-0.76). The first diastolic peak velocity had a much lower sensitivity (39.0%; 95% CI, 20.6-61.0%), a similar specificity (73.2%; 95% CI, 66.9-78.7%) and a lower AUC (0.58; CI, 0.52-0.65) for the prediction of late-onset PE. The pulsatility index of the ophthalmic artery did not show a clinically useful sensitivity or specificity at any cut-off for early- or late-onset PE. Peak ratio above 0.65 showed a similar diagnostic accuracy to that of the first diastolic peak velocity with an AUC of 0.67 (95% CI, 0.58-0.77) for early-onset PE and 0.57 (95% CI, 0.51-0.63) for late-onset disease.
CONCLUSIONS
Ophthalmic artery Doppler is a simple, accurate and objective technique with a standalone predictive value for the development of early-onset PE equivalent to that of uterine artery Doppler evaluation. The relationship between ophthalmic Doppler indices and PE cannot be a consequence of trophoblast invasion and may be related to maternal hemodynamic adaptation to pregnancy. The findings of this review justify efforts to elucidate the effectiveness and underlying mechanism whereby two seemingly unrelated maternal vessels can be used for the prediction of a disease considered a 'placental disorder'. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
Topics: Female; Humans; Ophthalmic Artery; Pre-Eclampsia; Pregnancy; ROC Curve; Sensitivity and Specificity; Ultrasonography, Prenatal
PubMed: 29330892
DOI: 10.1002/uog.19002 -
International Journal of Epidemiology Dec 2012Pre-eclampsia is thought to have a polygenic basis, but the identification of susceptibility genes and the quantification of associated risks have been elusive owing to... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Pre-eclampsia is thought to have a polygenic basis, but the identification of susceptibility genes and the quantification of associated risks have been elusive owing to lack of replication from published genetic association studies.
OBJECTIVE
To perform a systematic review and meta-analysis of genetic association studies to evaluate the evidence for the associations of various candidate genes with pre-eclampsia.
METHODS
For inclusion, studies had to involve unrelated subjects and examine the associations between pre-eclampsia (excluding publications without a measurement of proteinuria) and any candidate variant. Authors were contacted to obtain unpublished data when necessary. A meta-analysis was conducted for all variants with three or more independent samples available. Summary odds ratios (ORs), 99% confidence intervals (CIs) and P-values were calculated using random effects models.
RESULTS
Data from 192 genetic association studies met the selection criteria and were included in 25 independent meta-analyses. There was some evidence of association for F5 rs6025 (OR = 1.74; 99% CI 1.43-2.12), F2 rs1799963 (OR = 1.72; 99% CI 1.31-2.26), ACE rs4646994 (OR = 1.17; 99% CI 0.99-1.40), AGT rs699 (OR = 1.26; 99% CI 1.00-1.59) and AGTR1 rs5186 (OR = 1.22; 99% CI 0.96-1.56), but only the first two associations reached moderate epidemiological credibility. Possible bias resulting from small study size and poor reporting of individual studies were the most important factors affecting the reported associations.
CONCLUSION
To date, candidate gene studies in pre-eclampsia have not robustly documented any associations with strong epidemiological credibility. Large-scale replication of the most promising associations, exhibited by two genetic variants, and incorporation of agnostic high-throughput data may improve our genetic knowledge base for this complex phenotype.
Topics: Female; Genetic Association Studies; Genetic Predisposition to Disease; Humans; Odds Ratio; Polymorphism, Genetic; Pre-Eclampsia; Pregnancy
PubMed: 23132613
DOI: 10.1093/ije/dys162 -
Reproductive Health Jul 2016Women with a history of pre-eclampsia have a higher risk of developing pre-eclampsia in subsequent pregnancies. However, the role of the inter-pregnancy interval on this... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Women with a history of pre-eclampsia have a higher risk of developing pre-eclampsia in subsequent pregnancies. However, the role of the inter-pregnancy interval on this association is unclear.
OBJECTIVE
To explore the effect of inter-pregnancy interval on the risk of recurrent pre-eclampsia or eclampia.
SEARCH STRATEGY
MEDLINE, EMBASE and LILACS were searched (inception to July 2015).
SELECTION CRITERIA
Cohort studies assessing the risk of recurrent pre-eclampsia in the immediate subsequent pregnancy according to different birth intervals.
DATA COLLECTION AND ANALYSIS
Two reviewers independently performed screening, data extraction, methodological and quality assessment. Meta-analysis of adjusted odds ratios (aOR) with 95 % confidence intervals (CI) was used to measure the association between various interval lengths and recurrent pre-eclampsia or eclampsia.
MAIN RESULTS
We identified 1769 articles and finally included four studies with a total of 77,561 women. The meta-analysis of two studies showed that compared to inter-pregnancy intervals of 2-4 years, the aOR for recurrent pre-eclampsia was 1.01 [95 % CI 0.95 to 1.07, I(2) 0 %] with intervals of less than 2 years and 1.10 [95 % CI 1.02 to 1.19, I(2) 0 %] with intervals longer than 4 years.
CONCLUSION
Compared to inter-pregnancy intervals of 2 to 4 years, shorter intervals are not associated with an increased risk of recurrent pre-eclampsia but longer intervals appear to increase the risk. The results of this review should be interpreted with caution as included studies are observational and thus subject to possible confounding factors.
Topics: Adult; Birth Intervals; Cohort Studies; Databases, Factual; Eclampsia; Electronic Health Records; Evidence-Based Medicine; Female; Humans; Male; Observational Studies as Topic; Pre-Eclampsia; Pregnancy; Recurrence; Risk; Secondary Prevention; Sexual Partners
PubMed: 27430353
DOI: 10.1186/s12978-016-0197-x -
PloS One 2020Prediction models for gestational hypertension and preeclampsia have been developed with data and assumptions from developed countries. Their suitability and application...
INTRODUCTION
Prediction models for gestational hypertension and preeclampsia have been developed with data and assumptions from developed countries. Their suitability and application for low resource settings have not been tested. This review aimed to identify and assess the methodological quality of prediction models for gestational hypertension and pre-eclampsia with reference to their application in low resource settings.
METHODS
Using combinations of keywords for gestational hypertension, preeclampsia and prediction models seven databases were searched to identify prediction models developed with maternal data obtained before 20 weeks of pregnancy and including at least three predictors (Prospero registration CRD 42017078786). Prediction model characteristics and performance measures were extracted using the CHARMS, STROBE and TRIPOD checklists. The National Institute of Health quality assessment tools for observational cohort and cross-sectional studies were used for study quality appraisal.
RESULTS
We retrieved 8,309 articles out of which 40 articles were eligible for review. Seventy-seven percent of all the prediction models combined biomarkers with maternal clinical characteristics. Biomarkers used as predictors in most models were pregnancy associated plasma protein-A (PAPP-A) and placental growth factor (PlGF). Only five studies were conducted in a low-and middle income country.
CONCLUSIONS
Most of the studies evaluated did not completely follow the CHARMS, TRIPOD and STROBE guidelines in prediction model development and reporting. Adherence to these guidelines will improve prediction modelling studies and subsequent application of prediction models in clinical practice. Prediction models using maternal characteristics, with good discrimination and calibration, should be externally validated for use in low and middle income countries where biomarker assays are not routinely available.
Topics: Biomarkers; Cohort Studies; Cross-Sectional Studies; Female; Humans; Hypertension, Pregnancy-Induced; Placenta Growth Factor; Pre-Eclampsia; Pregnancy; Pregnancy-Associated Plasma Protein-A
PubMed: 32315307
DOI: 10.1371/journal.pone.0230955