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Acta Obstetricia Et Gynecologica... Dec 2023The association between extreme birth spacing and adverse outcomes is controversial, and available evidence is fragmented into different classifications of birth spacing. (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
The association between extreme birth spacing and adverse outcomes is controversial, and available evidence is fragmented into different classifications of birth spacing.
MATERIAL AND METHODS
We conducted a systematic review of observational studies to evaluate the association between birth spacing (i.e., interpregnancy interval and interoutcome interval) and adverse outcomes (i.e., pregnancy complications, adverse birth outcomes). Pooled odds ratios (ORs) with 95% confidence intervals (CI) were calculated using a random-effects model, and the dose-response relationships were evaluated using generalized least squares trend estimation.
RESULTS
A total of 129 studies involving 46 874 843 pregnancies were included. In the general population, compared with an interpregnancy interval of 18-23 months, extreme intervals (<6 months and ≥ 60 months) were associated with an increased risk of adverse outcomes, including preterm birth, small for gestational age, low birthweight, fetal death, birth defects, early neonatal death, and premature rupture of fetal membranes (pooled OR range: 1.08-1.56; p < 0.05). The dose-response analyses further confirmed these J-shaped relationships (p < 0.001-0.009). Long interpregnancy interval was only associated with an increased risk of preeclampsia and gestational diabetes (p < 0.005 and p < 0.001, respectively). Similar associations were observed between interoutcome interval and risk of low birthweight and preterm birth (p < 0.001). Moreover, interoutcome interval of ≥60 months was associated with an increased risk of cesarean delivery (pooled OR 1.72, 95% CI 1.04-2.83). For pregnancies following preterm births, an interpregnancy interval of 9 months was not associated with an increased risk of preterm birth, according to dose-response analyses (p = 0.008). Based on limited evidence, we did not observe significant associations between interpregnancy interval or interoutcome interval after pregnancy losses and risk of small for gestational age, fetal death, miscarriage, or preeclampsia (pooled OR range: 0.76-1.21; p > 0.05).
CONCLUSIONS
Extreme birth spacing has extensive adverse effects on maternal and infant health. In the general population, interpregnancy interval of 18-23 months may be associated with potential benefits for both mothers and infants. For women with previous preterm birth, the optimal birth spacing may be 9 months.
Topics: Pregnancy; Infant; Infant, Newborn; Humans; Female; Pregnancy Outcome; Premature Birth; Birth Intervals; Pre-Eclampsia; Birth Weight; Abortion, Spontaneous; Pregnancy Complications; Fetal Growth Retardation; Mothers; Fetal Death
PubMed: 37675816
DOI: 10.1111/aogs.14648 -
Quintessence International (Berlin,... Mar 2016The correlation between periodontal status and systemic conditions, among them pregnancy, is widely described in the scientific literature. The aim of the present... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The correlation between periodontal status and systemic conditions, among them pregnancy, is widely described in the scientific literature. The aim of the present systematic review of the literature was to evaluate periodontal diseases as an independent risk factor for adverse pregnancy outcomes.
DATA
Case-control studies reporting pregnancy outcomes and periodontal status of the subjects were included. Risk of bias evaluation was performed using a tool developed by the Cochrane Bias Methods Group. After risk of bias evaluation of included studies, a meta-analysis was performed computing the Risk Ratio (RR) for each pregnancy outcome.
SOURCES
Electronic databases (MedLine, Embase, Cochrane Central) were searched after preparation of an appropriate search string.
STUDY SELECTION
The search resulted in 422 entries that were screened. After application of inclusion and exclusion criteria, a total of 22 studies were included in the review accounting for a total of 17,053 subjects. The computed RR for periodontitis was 1.61 for preterm birth evaluated in 16 studies (P < .001), 1.65 for low birthweight evaluated in 10 studies (P < .001), and 3.44 for preterm low birthweight evaluated in four studies.
CONCLUSION
The present systematic review reported a low but existing association between periodontitis and adverse pregnancy outcomes. This assumption is the result of proper corrections of biased methodologies and of heterogeneity of studies. (.
Topics: Female; Humans; Infant, Low Birth Weight; Infant, Newborn; Periodontitis; Pregnancy; Pregnancy Outcome; Premature Birth; Risk Factors
PubMed: 26504910
DOI: 10.3290/j.qi.a34980 -
BMC Pregnancy and Childbirth Jun 2023The aim of this study was to evaluate the pregnancy feasibility of women with mild pulmonary hypertension according to pregnancy outcomes. (Meta-Analysis)
Meta-Analysis
BACKGROUND
The aim of this study was to evaluate the pregnancy feasibility of women with mild pulmonary hypertension according to pregnancy outcomes.
METHODS
This systematic review and meta-analysis compared the differences in maternal and fetal outcomes between mild and moderate-to-severe pulmonary hypertension. Relevant English and Chinese literature were searched in the PubMed, Embase, Cochrane Central Register of Controlled Trials (COCHRANE), CNKI, WanFang Data, and VIP databases between January 1st, 1990 and April 18th, 2023, and the references of the included articles and relevant systematic reviews were reviewed to determine whether studies were missed. The inclusion criteria were randomized controlled and observational studies (including case-control studies and cohort studies) examining maternal and fetal pregnancy outcomes with pulmonary hypertension. Conference abstracts, case reports, case series reports, non-comparative studies, and review articles were excluded.
RESULTS
This meta-analysis included 32 studies. In this study, maternal and fetal outcomes were better in the mild pulmonary hypertension group than in the moderate-to-severe group. Regarding maternal mortality, the mild group was much lower than the moderate to severe group. We found a significant decrease in maternal mortality in the mild group after 2010. However, no significant difference in maternal mortality before and after 2010 was observed in the moderate to severe group. Cardiac complications, ICU admission, neonatal preterm birth, small for gestational age infants, low birth weight infants, neonatal asphyxia, and neonatal mortality were significantly lower in the mild pulmonary hypertension group than in the moderate to severe pulmonary hypertension group. The cesarean section rates of the two groups were similar. However, the vaginal delivery rate in the mild pulmonary hypertension group was significantly higher than that in the moderate to severe pulmonary hypertension group.
CONCLUSIONS
This meta-analysis confirmed that pregnancies with mild pulmonary hypertension had significantly better maternal and fetal outcomes than those with moderate to severe pulmonary hypertension. For patients with mild pulmonary hypertension and good cardiac function, continued pregnancy or even delivery should be considered under multidisciplinary monitoring. However, maternal and fetal complications with moderate to severe pulmonary hypertension significantly increase. Hence, it is essential to evaluate pregnancy risk and terminate it in time.
Topics: Infant; Infant, Newborn; Pregnancy; Humans; Female; Cesarean Section; Hypertension, Pulmonary; Pulmonary Arterial Hypertension; Feasibility Studies; Premature Birth; Pregnancy Outcome
PubMed: 37291508
DOI: 10.1186/s12884-023-05752-w -
Reproductive Toxicology (Elmsford, N.Y.) Aug 2014Studies have suggested that nausea and vomiting of pregnancy (NVP) may confer favorable pregnancy outcome, when compared to women not experiencing NVP. However, this was... (Review)
Review
UNLABELLED
Studies have suggested that nausea and vomiting of pregnancy (NVP) may confer favorable pregnancy outcome, when compared to women not experiencing NVP. However, this was never examined systematically.
METHODS
We systematically reviewed all human studies examining potential effects of NVP on rates of miscarriage, intrauterine growth restriction, congenital malformations, prematurity and developmental achievements.
RESULTS
Our analysis reveals a consistent favorable effect of NVP on rates of miscarriages, congenital malformations, prematurity, and developmental achievements. The effect size was clinically important for miscarriage, malformations and prematurity. In a few studies the protective effects were more prominent in women with moderate-severe NVP than among those with mild or no NVP.
CONCLUSIONS
NVP is associated with favorable fetal outcome, and therefore studies of drug exposure in pregnancy should either match their exposed and control cases for existence and severity of NVP, or adjust for these confounders in their multivariate analysis.
Topics: Female; Fetus; Humans; Nausea; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Vomiting
PubMed: 24893173
DOI: 10.1016/j.reprotox.2014.05.012 -
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 -
Rheumatology (Oxford, England) Apr 2022The aim of this study was to determine the impact of SpA and its treatments on fertility and pregnancy outcomes, as well as the impact of pregnancy on disease activity. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The aim of this study was to determine the impact of SpA and its treatments on fertility and pregnancy outcomes, as well as the impact of pregnancy on disease activity.
METHODS
A systematic review and meta-analyses were performed, including studies in women with SpA [axial (axSpA) and peripheral SpA, including PsA]. The heterogeneity between studies was quantified (I2), and in the case of substantial heterogeneity, the results were reported in a narrative review.
RESULTS
Of 4397 eligible studies, 21 articles were included, assessing a total of 3566 patients and 3718 pregnancies, compared with 42 264 controls. There is a lack of data on fertility in the literature. We found an increased risk of preterm birth [pooled odds ratio (OR) 1.64 (1.15-2.33), I2 =24% in axSpA and 1.62 (1.23-2.15), I2 =0.0% in PsA], small for gestational age [pooled OR 2.05 (1.09-3.89), I2 =5.8% in axSpA], preeclampsia [pooled OR 1.59 (1.11-2.27], I2 =0% in axSpA] and caesarean section [pooled OR 1.70 (1.44-2.00), I2 =19.9% in axSpA and 1.71 (1.14-2.55), I2 =74.3% in PsA], without any other unfavourable pregnancy outcome. Further analysis showed a significantly higher risk of elective caesarean section [pooled OR 2.64 (1.92-3.62), I2 =0.0% in axSpA and 1.47 [1.15-1.88], I2 =0,0% in PsA), without increased risk of emergency caesarean section in PsA. During pregnancy, there appears to be a tendency for unchanged or worsened disease activity in axSpA and unchanged or improved disease activity in PsA. Both conditions tend to flare in the postpartum period.
CONCLUSION
SpA seems to be associated with an increased risk of preterm birth, small for gestational age, preeclampsia, and caesarean section.
Topics: Cesarean Section; Female; Fertility; Humans; Infant, Newborn; Male; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Premature Birth; Prostate-Specific Antigen; Spondylarthritis
PubMed: 34297033
DOI: 10.1093/rheumatology/keab589 -
Frontiers in Endocrinology 2022Although the overt hyperthyroidism treatment during pregnancy is mandatory, unfortunately, few studies have evaluated the impact of treatment on reducing maternal and... (Meta-Analysis)
Meta-Analysis
CONTEXT
Although the overt hyperthyroidism treatment during pregnancy is mandatory, unfortunately, few studies have evaluated the impact of treatment on reducing maternal and fetal outcomes.
OBJECTIVE
This study aimed to demonstrate whether treatment to control hyperthyroidism manifested during pregnancy can potentially reduce maternal-fetal effects compared with euthyroid pregnancies through a systematic review with meta-analysis.
DATA SOURCE
MEDLINE (PubMed), Embase, Cochrane Library Central, LILACS/BIREME until May 2021.
STUDY SELECTION
Studies that compared, during the gestational period, treated women with hyperthyroidism versus euthyroid women. The following outcomes of this comparison were: pre-eclampsia, abruptio placentae, fetal growth retardation, gestational diabetes, postpartum hemorrhage, low birth weight, stillbirth, spontaneous abortions, premature birth.
DATA EXTRACTION
Two independent reviewers extracted data and performed quality assessments. Dichotomous data were analyzed by calculating risk differences (DR) with fixed and random effect models according to the level of heterogeneity.
DATA SYNTHESIS
Seven cohort studies were included. The results of the meta-analysis indicated that there was a lower incidence of preeclampsia (p=0.01), low birth weight (p=0.03), spontaneous abortion (p<0.00001) and preterm birth (p=0.001) favouring the euthyroid pregnant group when compared to those who treated hyperthyroidism during pregnancy. However, no statistically significant differences were observed in the outcomes: abruptio placentae, fetal growth retardation, gestational diabetes mellitus, postpartum hemorrhage, and stillbirth.
CONCLUSIONS
Our findings demonstrated that treating overt hyperthyroidism in pregnancy is mandatory and appears to reduce some potential maternal-fetal complications, despite there still being a residual risk of negative outcomes.
Topics: Abruptio Placentae; Diabetes, Gestational; Female; Fetal Growth Retardation; Humans; Hyperthyroidism; Infant, Newborn; Postpartum Hemorrhage; Pre-Eclampsia; Pregnancy; Pregnancy Outcome; Premature Birth; Stillbirth
PubMed: 35813653
DOI: 10.3389/fendo.2022.800257 -
Environment International Nov 2021Maternal wildfire exposure (e.g., smoke, stress) has been associated with poor birth outcomes with effects potentially mediated through air pollution and psychosocial... (Review)
Review
BACKGROUND
Maternal wildfire exposure (e.g., smoke, stress) has been associated with poor birth outcomes with effects potentially mediated through air pollution and psychosocial stress. Despite the recent hike in the intensity and frequency of wildfires in some regions of the world, a critical appraisal of the evidence on the association between maternal wildfire exposure and adverse birth outcomes has not yet been undertaken. We conducted a systematic review that evaluated the scientific evidence on the association between wildfire exposure during pregnancy and the risk of adverse birth outcomes.
METHODS
Comprehensive searches in nine bibliographic databases were conducted from database inception up to June 2020. Observational epidemiological studies that evaluated associations between exposure to wildfire during pregnancy and adverse birth outcomes were eligible for inclusion. Studies were assessed using the National Toxicology Program's Office of Health Assessment and Translation (NTP OHAT) risk of bias tool and certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework. Screening of retrieved articles, data extraction, and risk of bias assessment were performed by two independent reviewers. Study results were synthesized descriptively.
RESULTS
Eight epidemiological studies conducted in four countries and involving 1,702,252 births were included in the review. The exposure to wildfire during pregnancy was assessed in individual studies by measurement of PM (n = 2), PM (n = 1), Total Ozone Mapping Spectrometer (TOMS)aerosol index (n = 1), heat spots (n = 1), and by proximity of maternal residence to wildfire-affected areas (n = 3). There is some evidence indicating that maternal wildfire exposure associates with birth weight reduction (n = 7) and preterm birth (n = 4), particularly when exposure to wildfire smoke occurred in late pregnancy. The association between wildfire exposure and small for gestational age (n = 2) and infant mortality (n = 1) was inconclusive.
CONCLUSION
Current evidence suggests that maternal exposure to wildfire during late pregnancy is linked to reduced birth weight and preterm birth. Well-designed comprehensive studies are needed to better understand the perinatal effects of wildfires.
Topics: Air Pollution; Female; Humans; Infant, Newborn; Infant, Small for Gestational Age; Maternal Exposure; Pregnancy; Pregnancy Outcome; Premature Birth; Wildfires
PubMed: 34030071
DOI: 10.1016/j.envint.2021.106644 -
Prenatal Diagnosis Sep 2021Low fetal fraction (LFF) in prenatal cell-free DNA (cfDNA) testing is an important cause of test failure and no-call results. LFF might reflect early abnormal...
OBJECTIVE
Low fetal fraction (LFF) in prenatal cell-free DNA (cfDNA) testing is an important cause of test failure and no-call results. LFF might reflect early abnormal placentation and therefore be associated with adverse pregnancy outcome. Here, we review the available literature on the relationship between LFF in cfDNA testing and adverse pregnancy outcome.
METHOD
A systematic literature search was conducted in MEDLINE and EMBASE up to November 1, 2020.
RESULTS
Five studies met the criteria for inclusion; all were retrospective observational cohort studies. The cohort sizes ranged from 370 to 6375 pregnancies, with all tests performed in the first trimester or early second trimester. A 4% cutoff for LFF was used in two studies, two studies used the 5th and 25th percentiles, respectively, and one study used a variety of cutoff values for LFF. LFF in prenatal cfDNA testing was observed to be associated with hypertensive disease of pregnancy, small for gestational age neonates, and preterm birth. Conflicting results were found regarding the association between LFF and gestational diabetes mellitus.
CONCLUSIONS
LFF in cfDNA testing is associated with adverse pregnancy outcome,specifically pregnancy-related hypertensive disorders, preterm birth, and impaired fetal growth related to placental dysfunction. Since the available evidence is limited, a large prospective cohort study on the relationship between fetal fraction and pregnancy outcomes is needed.
Topics: Adult; Cell-Free Nucleic Acids; Female; Humans; Noninvasive Prenatal Testing; Pregnancy; Pregnancy Outcome
PubMed: 34350596
DOI: 10.1002/pd.6028 -
Fertility and Sterility Feb 2013To assess current studies on the relationship between cell-derived microparticles (cMP) and recurrent miscarriages (RM) and pre-eclampsia (PE), and review the... (Review)
Review
OBJECTIVE
To assess current studies on the relationship between cell-derived microparticles (cMP) and recurrent miscarriages (RM) and pre-eclampsia (PE), and review the relationships between cMP and inflammatory and clot pathways, antiphospholipid antibodies (aPL), cytokines, and pregnancy complications.
DESIGN
Systematic and comprehensive review of the literature from January 2000 to January 2012.
SETTING
Vall d'Hebron University Hospital.
PATIENT(S)
Women with recurrent miscarriages or PE, healthy nonpregnant women, and healthy pregnant women.
INTERVENTION(S)
None.
MAIN OUTCOME MEASURE(S)
Comparison of cMP numbers and types among groups.
RESULT(S)
Platelet and endothelial cMP are increased in women with normal pregnancies compared with nonpregnant healthy women. Only five case-control studies regarding cMP and RM and 16 on cMP and PE were found to match our objective. Three of five articles referring to RM showed differences in cMP numbering, and 13 of 16 on cMP and PE showed differences in some type of cMP compared with controls.
CONCLUSION(S)
Cell-derived microparticles were raised in normal pregnancy. Recurrent miscarriage seems to be related to endothelial and platelet cell activation and/or consumption. An increase in almost all cMP types was observed in PE. A relationship between cMP and endothelial activation and proinflammatory status seems to exist.
Topics: Abortion, Habitual; Biomarkers; Cell-Derived Microparticles; Comorbidity; Female; Humans; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy Outcome; Prevalence; Risk Factors; Spain
PubMed: 23122952
DOI: 10.1016/j.fertnstert.2012.10.009