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Best Practice & Research. Clinical... Jan 2021Advanced maternal age is becoming an increasingly relevant issue in high-income developed countries. Lower fertility, greater need for assisted reproductive therapy, and... (Review)
Review
Advanced maternal age is becoming an increasingly relevant issue in high-income developed countries. Lower fertility, greater need for assisted reproductive therapy, and an increase in comorbidities, such as hypertension and diabetes, are some of the reasons for the rise in adverse maternal and fetal outcomes. This chapter reviews and summarizes the recent publications on the impact of advanced maternal age on pregnancy outcomes.
Topics: Female; Fertility; Humans; Maternal Age; Pregnancy; Pregnancy Outcome; Reproductive Techniques, Assisted
PubMed: 32773291
DOI: 10.1016/j.bpobgyn.2020.06.006 -
Social Science & Medicine (1982) Feb 2009Immigrant mothers in developed countries often experience worse pregnancy outcomes than native women. Several epidemiological studies have described the pregnancy... (Review)
Review
Immigrant mothers in developed countries often experience worse pregnancy outcomes than native women. Several epidemiological studies have described the pregnancy outcome of immigrant women in European receiving countries, with conflicting results. The present systematic review makes a quantitative synthesis of available evidence on the association between pregnancy outcomes and integration policies. We reviewed all epidemiological studies comparing the pregnancy outcome of native versus immigrant women in European countries from 1966 to 2004 and retained 65 for analysis, from 12 host countries. Overall, as compared to native women, immigrant women showed a clear disadvantage for all the outcomes considered: 43% higher risk of low birth weight, 24% of pre-term delivery, 50% of perinatal mortality, and 61% of congenital malformations. The risks were clearly and significantly reduced in countries with a strong integration policy. This trend was maintained even after adjustment for age at delivery and parity. On the basis of an analysis of naturalisation rates, five countries in our sample could be categorised as having a strong policies promoting the integration of immigrant communities. The mechanisms through which integration policies may be protective include the increased participation of immigrant communities in the life of the receiving society, and the decreased stress and discrimination they may face. The results of this study highlight a serious problem of equity in perinatal health across European countries. Immigrant women clearly need targeted attention to improve the health of their newborn, but a deep societal change is also necessary to integrate and respect immigrant communities in receiving societies.
Topics: Cross-Cultural Comparison; Emigrants and Immigrants; Emigration and Immigration; Europe; Female; Health Status Disparities; Humans; Pregnancy; Pregnancy Complications; Pregnancy Outcome
PubMed: 19042065
DOI: 10.1016/j.socscimed.2008.10.018 -
African Journal of Reproductive Health May 2023Extremely low-frequency electromagnetic radiation (ELF-EMF) are generated by electrical devices and power systems (1 to 300 Hz). Although several studies have... (Meta-Analysis)
Meta-Analysis Review
Extremely low-frequency electromagnetic radiation (ELF-EMF) are generated by electrical devices and power systems (1 to 300 Hz). Although several studies have demonstrated that ELF-EMF may beassociated with an increased risk of adverse pregnancy outcomes, other studies have shown no evidence of associations. This meta-analysis was conducted to assess the effect of extremely low frequency electromagnetic radiation on pregnancy outcomes. The following electronic bibliographic databases were searched to identify relevant studies: PubMed, Web Of Science, Cochrane library, Embase, EBSCO. In addition, the manual retrieval of relevant references was conducted as a supplement. Select all eligible studies published from Database construction library to March 10, 2021. Search type for queue research on influence of electromagnetic field radiation on pregnancy results. Data were screened and extracted independently by two researchers. Review Manager 5.3 software was used for the meta-analysis. There was no significant increase in the risk of miscarriage, stillbirth, birth defects and preterm delivery in the pregnant women who lived near the electromagnetic fields compared with the control group. Conclusions: No correlation has been found between maternal ELF-EMF exposure and miscarriage, stillbirth, neonatal birth defects and preterm delivery, while the effects on small gestational age and low birth weight are still uncertain. Related research with high-quality large samples and different regions are still needed for further verification.
Topics: Infant, Newborn; Pregnancy; Humans; Female; Stillbirth; Premature Birth; Abortion, Spontaneous; Pregnancy Outcome; Electromagnetic Radiation
PubMed: 37584934
DOI: 10.29063/ajrh2023/v27i5.9 -
BMJ Open Feb 2022To measure pregnancy outcome following attendance at a recurrent miscarriage service and identify factors that influence outcome. (Observational Study)
Observational Study
OBJECTIVES
To measure pregnancy outcome following attendance at a recurrent miscarriage service and identify factors that influence outcome.
DESIGN
Prospective, observational electronic cohort study.
SETTING
Participants attending a specialist recurrent miscarriage clinic, with a history of two or more pregnancy losses. 857 new patients attended over a 30-month period and were invited to participate. Participant data were recorded on a bespoke study database, 'Tommy's Net'.
PARTICIPANTS
777 women consented to participate (90.7% of new patients). 639 (82%) women continued within the cohort, and 138 were lost to follow-up. Mean age of active participants was 34 years for women and 37 years for partners, with a mean of 3.5 (1-19) previous pregnancy losses. Rates of obesity (maternal: 23.8%, paternal: 22.4%), smoking (maternal:7.4%, paternal: 19.4%) and alcohol consumption (maternal: 50%, paternal: 79.2%) were high and 55% of participants were not taking folic acid.
OUTCOME MEASURES
Biannual collection of pregnancy outcomes, either through prompted self-reporting, or existing hospital systems.
RESULTS
639 (82%) women were followed up. 404 (83.4%) reported conception and 106 (16.6%) reported no pregnancy, at least 6 months following registration. Of those that conceived, 72.8% (294/404) had a viable pregnancy. Maternal smoking and body mass index (BMI) over 30 were significantly higher in those who did not conceive (p=0.001) CONCLUSIONS: Tommy's Net provides a secure electronic repository on data for couples with recurrent pregnancy loss and associated outcomes. The study identified that subfertility, as well as repeated miscarriage, maternal BMI and smoking status, contributed to failure to achieve live birth. Study findings may enable comparison of clinic outcomes and inform the development of a personalised holistic care package.
Topics: Abortion, Habitual; Adult; Cohort Studies; Female; Humans; Live Birth; Pregnancy; Pregnancy Outcome; Prospective Studies
PubMed: 35110317
DOI: 10.1136/bmjopen-2021-052661 -
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 -
Thrombosis and Haemostasis Sep 2016Today, direct oral anticoagulants (DOAC) are widely used alternatives to Vitamin-K antagonists (VKA). Women of reproductive age may become pregnant during...
Today, direct oral anticoagulants (DOAC) are widely used alternatives to Vitamin-K antagonists (VKA). Women of reproductive age may become pregnant during anticoagulation and, while VKA carry an embryotoxic potential, the risk of DOAC embryopathy is unknown. As a result, some patients elect to terminate pregnancy for fear of DOAC embryotoxicity. To assess the risk of DOAC embryopathy, we reviewed cases of DOAC exposure in pregnancy collected from physicians, literature and pharmacovigilance systems of drug authorities and manufacturers. A total of 357 reports including duplicates were available from which 233 unique cases could be identified. Information on pregnancy outcome was available in only 137/233 cases (58.8 %): 67 live births (48.9 %); 31 miscarriages (22.6 %); 39 elective pregnancy terminations (28.5 %). In 93 cases (39.9 %) no outcome data were available (including 3 cases of ongoing pregnancy). Of the 137 pregnancies with reported outcomes, seven showed abnormalities (5.1 %) of which three (2.2 %) could potentially be interpreted as embryopathy: live birth with facial dysmorphism; miscarriage in week 10 with limb abnormality; elective pregnancy termination due to a foetal cardiac defect in a woman who had to terminate a previous pregnancy due to Fallot tetralogy. Within its limitations (small numbers, incomplete outcome data) our results do not indicate that DOAC exposure in pregnancy carries a high risk of embryopathy or that DOAC exposure per se should be used to direct patient counselling towards pregnancy termination. Pregnancy outcome data are inconsistently captured in pharmacovigilance databases indicating the strong need for a more robust system of reporting.
Topics: Abortion, Spontaneous; Anticoagulants; Blood Coagulation; Female; Humans; Live Birth; Pregnancy; Pregnancy Outcome
PubMed: 27384740
DOI: 10.1160/TH16-04-0305 -
Paediatric and Perinatal Epidemiology Oct 1996We present an assessment of studies published in the last decade that consider the relationship of stress and social support to preterm delivery or fetal growth... (Review)
Review
We present an assessment of studies published in the last decade that consider the relationship of stress and social support to preterm delivery or fetal growth retardation. Included in the review are all reports on the direct effects of stressors or psychological distress; the indirect effects of stressors or distress through health behaviours such as smoking; and the direct and buffering effects of social support. Although an important stimulus for recent stress research has been the attempt to explain racial and social class differences in birth outcome, the recent data show that stressful life events during pregnancy, though more common in disadvantaged groups, do not increase the risk of preterm birth. In contrast, intimate social support from a partner or family member appears to improve fetal growth, even for women with little life stress. Questions unanswered by the research to date are whether elevated levels of depressive symptoms affect pregnancy outcome, either directly or by encouraging negative health behaviours, and whether chronic (vs. acute) stressors are harmful. Additional research is also needed to determine whether psychosocial factors interact with specific clinical conditions to promote adverse pregnancy outcomes. Focusing on intimate support and how it benefits pregnancy outcome could lead to the design of more effective interventions.
Topics: Black or African American; Female; Global Health; Health Behavior; Humans; Life Change Events; Pregnancy; Pregnancy Outcome; Research; Social Support; Socioeconomic Factors; Stress, Physiological; Stress, Psychological; United States; White People
PubMed: 8931053
DOI: 10.1111/j.1365-3016.1996.tb00063.x -
Reproductive Toxicology (Elmsford, N.Y.) Aug 2021In contrast to other non-steroidal anti-inflammatory drugs (NSAIDs), naproxen use during pregnancy is not well studied. The objective of this analysis was to assess...
In contrast to other non-steroidal anti-inflammatory drugs (NSAIDs), naproxen use during pregnancy is not well studied. The objective of this analysis was to assess negative effects on pregnancy outcomes following naproxen exposure in the first trimester of pregnancy. Out of 121 exposed pregnancies prospectively recorded by two German teratology information services (TIS) 15 ended as spontaneous abortion and ten were electively terminated; in one case for prenatal diagnosis of anencephaly. Four pregnancies were stillborn, in these cases naproxen was discontinued more than two months before the event. Of 95 live-born infants, including three pairs of twins, two were born with major birth defects: one with dysmelia of the left hand and foot and another with a complex congenital heart defect, esophageal atresia with tracheoesophageal fistula, and choanal stenosis. The results of this case series do not suggest that naproxen has a significant teratogenic effect. However, due to the limited cohort size and lack of comparable reference group results should be interpreted with caution and better studied NSAIDs such as ibuprofen should be preferred in the first and second trimester of pregnancy. This work was supported by the German Federal Institute for Drugs and Medical Devices (BfArM).
Topics: Abortion, Spontaneous; Anencephaly; Anti-Inflammatory Agents, Non-Steroidal; Cohort Studies; Female; Germany; Humans; Ibuprofen; Live Birth; Maternal Exposure; Naproxen; Pregnancy; Pregnancy Outcome; Pregnancy Trimester, First; Pregnancy Trimester, Second; Stillbirth
PubMed: 34015472
DOI: 10.1016/j.reprotox.2021.05.006 -
Taiwanese Journal of Obstetrics &... Jan 2022Flood is one of the natural disasters with high prevalence in the world. The aim of this research was to investigate the effect of flood on pregnancy outcome and... (Review)
Review
Flood is one of the natural disasters with high prevalence in the world. The aim of this research was to investigate the effect of flood on pregnancy outcome and pregnancy complication such as preterm birth, LBW, SGA, stillbirth, spontaneous abortion, preeclampsia and eclampsia. This is a systematic review based on the PRISMA model that examines pregnancy disorder, pregnancy complication, and reproductive outcomes in floods. For fulfilling of the objectives of the research, related keywords were identified using Mesh and Emtree databases. Then the search was done in the electronic database of Medline, Web of Science, Embase, scopus until 2021.2.10. The search strategy in the Medline database. Database searches resulted in 823 non-duplicate records. After reading the abstracts, 808 articles were excluded. 15 abstracts were eligible for the study, which their full texts were provided. Finally based on inclusion and exclusion criteria 7 articles were included in this study. After flood, the rate of LBW birth and gestational hypertension increases. However, there is no significant difference in preterm birth rates. Pregnancy complications can be reduced or prevented by starting prenatal care early and also by controlling risk factors such as reducing smoking and alcohol consumption.
Topics: Female; Floods; Humans; Infant, Low Birth Weight; Infant, Newborn; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Premature Birth; Stillbirth
PubMed: 35181015
DOI: 10.1016/j.tjog.2021.11.005 -
Fertility and Sterility Oct 2005To investigate whether the outcome of a pregnancy is related to the time required to achieve that pregnancy (TTP). (Comparative Study)
Comparative Study
OBJECTIVE
To investigate whether the outcome of a pregnancy is related to the time required to achieve that pregnancy (TTP).
DESIGN
The distribution of the TTP for pregnancies ending in multiple birth, early (before week 12) and late (weeks 12-28) miscarriage, stillbirth, and extrauterine pregnancy was compared to that of pregnancies ending in singleton birth. Furthermore, the distribution of the TTP for preterm singleton births was compared to that of full-term singleton births.
SETTING
Sweden.
PATIENT(S)
Information from three previous studies on reproduction was used: Women chosen for exposure to persistent organochlorine pollutants, or exposure as a hairdresser, and their respective controls.
INTERVENTION(S)
None.
MAIN OUTCOME MEASURE(S)
Self-reported pregnancy outcome.
RESULT(S)
An increased TTP (i.e., decreased fecundability) was associated with pregnancies ending in miscarriage (early as well as late) and extrauterine pregnancies. Pregnancies ending in multiple live birth tended to have shorter TTPs than those ending in single live birth. No association between TTP and stillbirths was found. Among women whose pregnancies ended in singleton birth, a prolonged TTP was associated with preterm delivery.
CONCLUSION(S)
The TTP of a pregnancy seemed to be associated with the outcome of that pregnancy. The mechanisms behind this phenomenon are, however, unclear.
Topics: Abortion, Spontaneous; Adolescent; Adult; Female; Humans; Live Birth; Multivariate Analysis; Odds Ratio; Pregnancy; Pregnancy Outcome; Pregnancy, Multiple; Premature Birth; Risk Factors; Stillbirth; Time Factors
PubMed: 16213851
DOI: 10.1016/j.fertnstert.2005.04.030