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Environmental Research May 2017Season and vitamin D are indirect and direct correlates of ultraviolet (UV) radiation and are associated with pregnancy outcomes. Further to producing vitamin D, UV has... (Review)
Review
BACKGROUND
Season and vitamin D are indirect and direct correlates of ultraviolet (UV) radiation and are associated with pregnancy outcomes. Further to producing vitamin D, UV has positive effects on cardiovascular and immune health that may support a role for UV directly benefitting pregnancy.
OBJECTIVES
To investigate the effects of UV exposure on pregnancy; specifically fetal growth, preterm birth and hypertensive complications.
METHODS
We conducted a systematic review of Medline, EMBASE, DoPHER, Global Health, ProQuest Public Health, AustHealth Informit, SCOPUS and Google Scholar to identify 537 citations, 8 of which are included in this review. This review was registered on PROSPERO and a. narrative synthesis is presented following PRISMA guidance.
RESULTS
All studies were observational and assessed at high risk of bias. Higher first trimester UV was associated with and improved fetal growth and increased hypertension in pregnancy. Interpretation is limited by study design and quality. Meta-analysis was precluded by the variety of outcomes and methods.
DISCUSSION
The low number of studies and risk of bias limit the validity of any conclusions. Environmental health methodological issues are discussed with consideration given to design and analytical improvements to further address this reproductive environmental health question.
CONCLUSIONS
The evidence for UV having benefits for pregnancy hypertension and fetal growth is limited by the methodological approaches utilized. Future epidemiological efforts should focus on improving the methods of modeling and linking widely available environmental data to reproductive health outcomes.
Topics: Animals; Female; Humans; Pregnancy; Pregnancy Outcome; Ultraviolet Rays
PubMed: 28264782
DOI: 10.1016/j.envres.2017.02.026 -
European Journal of Obstetrics,... Jul 2020A systematic review was conducted to update and provide a comprehensive overview on the psychological effects of antenatal yoga on pregnancy compared to standard... (Review)
Review
OBJECTIVE
A systematic review was conducted to update and provide a comprehensive overview on the psychological effects of antenatal yoga on pregnancy compared to standard prenatal care.
STUDY DESIGN
Four databases were searched using keywords "yoga", "pregnancy", "perinatal care", "prenatal care", "postnatal care", "postpartum period", "peripartum period", "patient outcome assessment", "outcome assessment", "pregnancy outcome", "treatment outcome". Trials were considered if they were randomized controlled trials (RCTs) published from 2011 to 2018 and evaluated an antenatal yoga intervention. All studies were assessed for risk of bias using the Cochrane criteria. Trial characteristics and outcomes were extracted and synthesized descriptively where possible. Due to heterogeneity, meta-analysis was not possible.
RESULTS
Of the 175 non-duplicated studies, 16 met criteria for full-text review. Five RCTs met the inclusion criteria and were included in the systematic review. The findings of the RCTs suggest antenatal yoga may be safe and may effectively decrease stress levels, anxiety scores, depression scores, and pain response as well as increasing maternal immunity and emotional-wellbeing.
CONCLUSION
Yoga appears to be safe and may improve psychological and pregnancy outcomes. However, due to the limited number of studies, more high-quality, large RCTs are needed to draw conclusions about improvement in other pregnancy outcomes.
Topics: Emotions; Female; Humans; Postpartum Period; Pregnancy; Pregnancy Outcome; Prenatal Care; Yoga
PubMed: 32446148
DOI: 10.1016/j.ejogrb.2020.03.044 -
Tropical Medicine & International... Jul 2022Given that women of reproductive age in dengue-endemic areas are at risk of infection, it is necessary to determine whether dengue virus (DENV) infection during... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Given that women of reproductive age in dengue-endemic areas are at risk of infection, it is necessary to determine whether dengue virus (DENV) infection during pregnancy is associated with adverse outcomes. The aim of this systematic review and meta-analysis is to investigate the consequences of DENV infection in pregnancy on various maternal and foetal-neonatal outcomes.
METHODS
A systematic literature search was undertaken using PubMed, Google Scholar, and Embase till December 2021. Mantel-Haenszel risk ratios were calculated to report overall effect size using random effect models. The pooled prevalence was computed using the random effect model. All statistical analyses were performed on MedCalc Software.
RESULT
We obtained data from 36 studies involving 39,632 DENV-infected pregnant women. DENV infection in pregnancy was associated with an increased risk of maternal mortality (OR = 4.14 [95% CI, 1.17-14.73]), stillbirth (OR = 2.71 [95% CI, 1.44-5.10]), and neonatal deaths (OR = 3.03 [95% CI, 1.17-7.83]) compared with pregnant women without DENV infection. There was no significant statistical association established between maternal DENV infection and the outcomes of preterm birth, maternal bleeding, low birth weight in neonates, and risk of miscarriage. Pooled prevalences were 14.9% for dengue shock syndrome, 14% for preterm birth, 13.8% for maternal bleeding, 10.1% for low birth weight, 6% for miscarriages, and 5.6% for stillbirth.
CONCLUSION
DENV infection in pregnant women may be associated with adverse outcomes such as maternal mortality, stillbirth, and neonatal mortality. Hence, pregnant women should be considered an at-risk population for dengue management programmes.
Topics: Abortion, Spontaneous; Dengue; Female; Humans; Infant; Infant Mortality; Infant, Newborn; Maternal Mortality; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Premature Birth; Stillbirth
PubMed: 35689528
DOI: 10.1111/tmi.13783 -
Early Human Development Mar 2016To understand what evidence exists with regard to maternal and offspring benefits of aerobic and/or resistance training during pregnancy. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To understand what evidence exists with regard to maternal and offspring benefits of aerobic and/or resistance training during pregnancy.
METHODS
Systematic review of RCTs (published until May 2015) with healthy pregnant women and focusing on the benefits of exercise interventions on maternal health or perinatal outcomes. Studies were ranked as high/low quality, and a level of evidence was established according to the number of high-quality studies and consistency of the results.
RESULTS
61 RCTs were analyzed. The evidence for a benefit of combined exercise [aerobic+resistance (muscle strength)] interventions on maternal cardiorespiratory fitness and prevention of urinary incontinence was strong. A weak or insufficient level of evidence was found for the rest of interventions and outcomes
CONCLUSION
The exercise modality that seems to induce a more favorable effect on maternal health is the combination of aerobic and resistance exercises during pregnancy.
Topics: Female; Humans; Maternal Health; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Resistance Training
PubMed: 26850782
DOI: 10.1016/j.earlhumdev.2016.01.004 -
International Journal of Gynaecology... Oct 2022To evaluate the risk levels for maternal and perinatal complications at > 40, > 45 and > 50 years old compared with younger controls. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To evaluate the risk levels for maternal and perinatal complications at > 40, > 45 and > 50 years old compared with younger controls.
METHODS
Electronic databases were searched from their inception until March 2021. We included studies reporting pregnancy outcome in pregnant women aged 40, 45, and 50 years or older compared with controls at the time of delivery. Case reports and case series were excluded. The primary outcome was the incidence of stillbirth. Meta-analysis was performed using the random effects model of DerSimonian and Laird, to produce summary treatment effects in terms of relative risk (RR) with 95% confidence interval (CI). Heterogeneity was measured using I (Higgins I ). Subgroup analyses in women older than 45 years and in those older than 50 years were performed.
RESULTS
Twenty-seven studies, including 31 090 631 women, were included in the meta-analysis. The overall quality of the included studies was moderate to high. Most of the included studies were retrospective cohort studies (21/27), four were population-based studies, and two were cross-sectional studies. Women aged ≥40 years had significantly higher risk of stillbirth (RR 2.16, 95% CI 1.86-2.51), perinatal mortality, intrauterine growth restriction, neonatal death, admission to neonatal intensive care unit, pre-eclampsia, preterm delivery, cesarean delivery, and maternal mortality compared with women younger than 40 years old (RR 3.18, 95% CI 1.68-5.98). The increased risks for maternal mortality were 42.76 and 11.60 for women older than 50 years and for those older than 45 years, respectively, whereas those for stillbirth were 3.72 and 2.32. The risk of stillbirth and cesarean delivery was significantly higher in women >45 years compared with those aged 40-45 years, and in those aged >50 years compared with those aged 45-50 years. The risk of maternal mortality was significantly higher in women aged >50 years compared with those aged 40-45 (RR 60.40, 95% CI 13.28-274.74).
CONCLUSION
The risk of stillbirth, cesarean delivery, and maternal mortality increases with advancing maternal age. The risk ratios for maternal mortality were 3.18, 11.60, and 42.76 in women older than 40, older than 45, and older than 50 years, respectively. These data should be used when women with advanced maternal age are counseled regarding their risk in pregnancy.
SYSTEMATIC REVIEW REGISTRATION
The review was registered with the PROSPERO International Prospective Register of Systematic Reviews (registration No.: CRD42020208788).
Topics: Adult; Female; Humans; Infant, Newborn; Maternal Age; Middle Aged; Perinatal Death; Pregnancy; Pregnancy Outcome; Premature Birth; Retrospective Studies; Stillbirth
PubMed: 35044694
DOI: 10.1002/ijgo.14100 -
International Journal of Environmental... Jul 2017Climate change will increasingly affect the health of vulnerable populations, including maternal and fetal health. This systematic review aims to identify recent... (Review)
Review
Climate change will increasingly affect the health of vulnerable populations, including maternal and fetal health. This systematic review aims to identify recent literature that investigates increasing heat and extreme temperatures on pregnancy outcomes globally. We identify common research findings in order to create a comprehensive understanding of how immediate effects will be sustained in the next generation. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guide, we systematically reviewed articles from PubMed and Cochrane Reviews. We included articles that identify climate change-related exposures and adverse health effects for pregnant women. There is evidence that temperature extremes adversely impact birth outcomes, including, but not limited to: changes in length of gestation, birth weight, stillbirth, and neonatal stress in unusually hot temperature exposures. The studies included in this review indicate that not only is there a need for further research on the ways that climate change, and heat in particular, may affect maternal health and neonatal outcomes, but that uniform standards for assessing the effects of heat on maternal fetal health also need to be established.
Topics: Climate Change; Female; Hot Temperature; Humans; Maternal Health; Pregnancy; Pregnancy Outcome
PubMed: 28758917
DOI: 10.3390/ijerph14080853 -
Maternal and Child Health Journal Mar 2017Introduction Previous systematic reviews concluded that rigorous research on the relationships between pregnancy intentions and pregnancy outcomes is limited. They... (Meta-Analysis)
Meta-Analysis
Introduction Previous systematic reviews concluded that rigorous research on the relationships between pregnancy intentions and pregnancy outcomes is limited. They further noted that most studies were conducted in high-income countries and had methodological limitations. We aim to assess the current evidence base for the relationship between pregnancy intention and miscarriage, stillbirth, low birthweight (LBW) and neonatal mortality. In March 2015 Embase, PubMed, Scopus and PsychInfo were searched for studies investigating the relationship between pregnancy intention and the outcomes of interest. Methods Studies published since 1975 and in English, French or Spanish were included. Two reviewers screened titles and abstracts, read the full text of identified articles and extracted data. Meta-analyses were conducted where possible. Results Thirty-seven studies assessing the relationships between pregnancy intention and LBW were identified. A meta-analysis of 17 of these studies found that unintended pregnancies are associated with 1.41 times greater odds of having a LBW baby (95%CI 1.31, 1.51). Eight studies looking at miscarriage, stillbirth or neonatal death were found. The limited data concerning pregnancy loss and neonatal mortality precluded meta-analysis but suggest these outcomes may be more common in unintended pregnancies. Discussion While there seems to be an increased risk of adverse pregnancy outcome in unintended pregnancies, there has been little improvement in either the quantity of evidence from low-income countries or in the quality of evidence generally. Longitudinal studies of pregnancy intention and pregnancy outcome, where pregnancy intention is assessed prospectively with a validated measure and where analyses include confounding or mediating factors, are required in both high- and low-income countries.
Topics: Female; Humans; Intention; Mothers; Pregnancy; Pregnancy Outcome
PubMed: 28093686
DOI: 10.1007/s10995-016-2237-0 -
Occupational and Environmental Medicine Jul 2020This systematic review was conducted to help clarify the effect of lifting at work on pregnancy outcome, by focusing on specific exposure categories. A search in Medline... (Meta-Analysis)
Meta-Analysis
This systematic review was conducted to help clarify the effect of lifting at work on pregnancy outcome, by focusing on specific exposure categories. A search in Medline and Embase identified 51 articles reporting association of spontaneous abortion (SA), preterm delivery (PTD) or small-for-gestational-age (SGA) infant with exposure to occupational lifting. A global validity score was assigned to each study and six potential sources of bias were considered in sensitivity analyses. For each exposure-outcome combination, a summary risk estimate (RE) was obtained from all studies and from a subset of studies with high validity score, this latter summary RE was selected as a final result. Statistical heterogeneity was measured with I and Q tests and the possibility of a publication bias was also assessed. For each meta-analysis, the strength of evidence was established from explicit criteria. Heavy (or ≥10 kg) loads often (or ≥10x/day) lifted were associated with increased risks of SA (summary RE=1.31, 95% CI 1.17 to 1.47) and PTD (summary RE=1.24, 95% CI 1.07 to 1.43), with good strength of evidence. No association was identified with SGA, nor with lower exposure levels and SA or PTD. These results are reassuring for lower levels of exposure; however, observed associations can guide health professionals' recommendations aimed at the prevention of SA and PTD for pregnant women who frequently lift (or ≥10x/day) heavy (or ≥10 kg) loads at work.Résumé.
Topics: Abortion, Spontaneous; Female; Humans; Infant, Newborn; Infant, Small for Gestational Age; Lifting; Occupational Exposure; Pregnancy; Pregnancy Outcome; Premature Birth; Work
PubMed: 32184210
DOI: 10.1136/oemed-2019-106334 -
American Journal of Reproductive... Oct 2021Antiphospholipid antibodies (aPLs) are a group of autoantibodies associated with a variety of pregnancy complications, but the impact of aPL on the outcomes of assisted... (Meta-Analysis)
Meta-Analysis
PROBLEM
Antiphospholipid antibodies (aPLs) are a group of autoantibodies associated with a variety of pregnancy complications, but the impact of aPL on the outcomes of assisted fertility treatment (ART) is controversial. This systematic review and meta-analysis were designed to explore the association between aPL and ART outcomes and to explore in which stages does aPL play a role.
METHOD OF STUDY
PubMed and Cochrane database were systematically retrieved, and odds ratios (ORs) or risk ratios (RRs) with 95% confidence intervals (CIs) were calculated in a random-effect model or fixed-effect model according to the heterogenicity assessed by the Cochran Q and I statistic test. Of 246 records identified by the search, 10 case-control studies and 13 cohort studies that explored the association between aPL and in vitro fertilization (IVF) and/or intracytoplasmic sperm injection (ICSI) were analyzed.
RESULTS
The results showed that aPL positive rate was higher in females who failed in IVF/ICSI than those who succeeded in IVF/ICSI (OR: 3.62, 95% CI: 1.95-6.74). This study also indicated that females positive for aPL have a higher miscarriage rate (RR: 1.68, 95% CI: 1.24-2.28) than those negative for aPL, but live birth rate, biochemical pregnancy rate, and clinical pregnancy rate were similar between two groups (RR: 1.01, 95% CI: 0.91-1.12; RR: 1.18, 95% CI: 0.57-2.43 and RR: 0.95, 95% CI: 0.80-1.13).
CONCLUSIONS
There was higher aPL prevalence in females with adverse IVF/ICSI outcomes. It seems that aPL mainly affects the miscarriage rate, but has little effect on live birth rate, biochemical pregnancy rate, and clinical pregnancy rate. Routine detection of aPL before IVF/ICSI treatment is meaningful.
Topics: Adult; Antibodies, Antiphospholipid; Female; Humans; Pregnancy; Pregnancy Outcome; Reproductive Techniques, Assisted
PubMed: 34018271
DOI: 10.1111/aji.13470 -
Human Reproduction Update Jul 2019A worldwide increase in the prevalence of obesity has been observed in the past three decades, particularly in women of reproductive age. Female obesity has been clearly... (Meta-Analysis)
Meta-Analysis
BACKGROUND
A worldwide increase in the prevalence of obesity has been observed in the past three decades, particularly in women of reproductive age. Female obesity has been clearly associated with impaired spontaneous fertility, as well as adverse pregnancy outcomes. Increasing evidence in the literature shows that obesity also contributes to adverse clinical outcomes following in vitro fertilization (IVF) procedures. However, the heterogeneity of the available studies in terms of populations, group definition and outcomes prevents drawing firm conclusions. A previous meta-analysis published in 2011 identified a marginal but significant negative effect of increased female body mass index (BMI) on IVF results, but numerous studies have been published since then, including large cohort studies from national registries, highlighting the need for an updated review and meta-analysis.
OBJECTIVE AND RATIONALE
Our systematic review and meta-analysis of the available literature aims to evaluate the association of female obesity with the probability of live birth following IVF. Subgroup analyses according to ovulatory status, oocyte origin, fresh or frozen-embryo transfer and cycle rank were performed.
SEARCH METHODS
A systematic review was performed using the following key words: ('obesity', 'body mass index', 'live birth', 'IVF', 'ICSI'). Searches were conducted in MEDLINE, EMBASE, Cochrane Library, Eudract and clinicaltrial.gov from 01 January 2007 to 30 November 2017. Study selection was based on title and abstract. Full texts of potentially relevant articles were retrieved and assessed for inclusion by two reviewers. Subsequently, quality was assessed using the Newcastle-Ottawa Quality Assessment Scales for patient selection, comparability and assessment of outcomes. Two independent reviewers carried out study selection and data extraction according to Cochrane methods. Random-effect meta-analysis was performed using Review Manager software on all data (overall analysis), followed by subgroup analyses.
OUTCOMES
A total of 21 studies were included in the meta-analysis. A decreased probability of live birth following IVF was observed in obese (BMI ≥ 30 kg/m2) women when compared with normal weight (BMI 18.5-24.9 kg/m2) women: risk ratio (RR) (95% CI) 0.85 (0.82-0.87). Subgroups analyses demonstrated that prognosis was poorer when obesity was associated with polycystic ovary syndrome, while the oocyte origin (donor or non-donor) did not modify the overall interpretation.
WIDER IMPLICATIONS
Our meta-analysis clearly demonstrates that female obesity negatively and significantly impacts live birth rates following IVF. Whether weight loss can reverse this deleterious effect through lifestyle modifications or bariatric surgery should be further evaluated.
Topics: Birth Rate; Embryo Transfer; Female; Fertilization in Vitro; Humans; Infant, Newborn; Live Birth; Male; Obesity; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Pregnancy Rate
PubMed: 30941397
DOI: 10.1093/humupd/dmz011