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International Journal of Molecular... Mar 2024This systematic review delves into the connections between microRNAs and preterm labor, with a focus on identifying diagnostic and prognostic markers for this crucial... (Review)
Review
This systematic review delves into the connections between microRNAs and preterm labor, with a focus on identifying diagnostic and prognostic markers for this crucial pregnancy complication. Covering studies disseminated from 2018 to 2023, the review integrates discoveries from diverse pregnancy-related scenarios, encompassing gestational diabetes, hypertensive disorders and pregnancy loss. Through meticulous search strategies and rigorous quality assessments, 47 relevant studies were incorporated. The synthesis highlights the transformative potential of microRNAs as valuable diagnostic tools, offering promising avenues for early intervention. Notably, specific miRNAs demonstrate robust predictive capabilities. In conclusion, this comprehensive analysis lays the foundation for subsequent research, intervention strategies and improved outcomes in the realm of preterm labor.
Topics: Female; Pregnancy; Infant, Newborn; Humans; Obstetric Labor, Premature; Abortion, Spontaneous; Diabetes, Gestational; Hypertension
PubMed: 38612564
DOI: 10.3390/ijms25073755 -
Current Opinion in Obstetrics &... Jun 2024To examine impact of vaginal dysbiosis (VD), including bacterial vaginosis (BV) and aerobic vaginitis (AV) on reproductive outcomes of in vitro fertilization (IVF)... (Meta-Analysis)
Meta-Analysis
PURPOSE OF REVIEW
To examine impact of vaginal dysbiosis (VD), including bacterial vaginosis (BV) and aerobic vaginitis (AV) on reproductive outcomes of in vitro fertilization (IVF) patients.
RECENT FINDINGS
BV-bacteria (e.g. Gardnerella ) and AV-bacteria (e.g. Streptococci and Enterococci ) have been identified in the endometrium. However, there is inconclusive evidence whether IVF patients with VD have lower success rates.
SUMMARY
The present systematic review and meta-analysis of PubMed/Medline, until December 2023 included 25 studies, involving 6835 IVF patients. Overall VD was defined as an approximation of community state type IV, including BV and AV-type dysbiosis based on either molecular or microscopy methods. Outcomes were live birth rate (LBR), early pregnancy loss (EPL), clinical pregnancy rate (CPR), and biochemical pregnancy rate (BPR).Vaginal dysbiosis prevalence was 19% [1271/6835, 95% confidence interval (CI) 18-20%]. Six studies examined AV-type dysbiosis with a prevalence of 4% (26/628, 95% CI 3-6%). Vaginal dysbiosis correlates with a higher EPL [relative risk (RR) = 1.49, 95% CI 1.15-1.94] and lower CPR (RR = 0.82, 95% CI 0.70-0.95). No statistically significant impact of VD, BV, or AV was found on LBR and BPR.Thus, the association between VD and reproductive outcome remains puzzling as it is difficult to explain how VD impacts CPR and EPL but not LBR and BPR.
Topics: Humans; Female; Dysbiosis; Pregnancy; Fertilization in Vitro; Vaginosis, Bacterial; Vagina; Pregnancy Rate; Abortion, Spontaneous; Pregnancy Outcome; Vaginitis; Live Birth
PubMed: 38597377
DOI: 10.1097/GCO.0000000000000953 -
BMC Pregnancy and Childbirth Apr 2024Endometriosis frequently results in pain and infertility. While conservative surgery offers some relief, it often falls short of ensuring satisfactory pregnancy... (Meta-Analysis)
Meta-Analysis
Systematic review and meta-analysis on the effect of adjuvant gonadotropin-releasing hormone agonist (GnRH-a) on pregnancy outcomes in women with endometriosis following conservative surgery.
BACKGROUND
Endometriosis frequently results in pain and infertility. While conservative surgery offers some relief, it often falls short of ensuring satisfactory pregnancy outcomes. Adjuvant GnRH-a is administered post-surgery to mitigate recurrence; however, its impact on pregnancy outcomes remains debated. This study endeavors to assess the efficacy of adjuvant GnRH-a in enhancing pregnancy outcomes post-conservative surgery in endometriosis patients.
METHODS
Databases including PubMed, Embase, the Cochrane Library, Medline (Ovid), Web of Science, and Scopus were rigorously searched up to 02 August 2023, without linguistic constraints. Identified articles were screened using strict inclusion and exclusion criteria. Evaluated outcomes encompassed pregnancy rate, live birth rate, miscarriage rate, ectopic pregnancy rate, multiple pregnancy rate, mean postoperative pregnancy interval, recurrence rate, and adverse reaction rate. The Cochrane risk of bias tool and the Jadad score evaluated the included studies' quality. Subgroup and sensitivity analysis were implemented to analyze the pooled results. A meta-analysis model expressed results as standardized mean difference (SMD) and Risk ratio (RR).
RESULTS
A total of 17 studies about 2485 patients were assimilated. Meta-analysis revealed that post-surgery, the GnRH-a cohort experienced a marginally elevated pregnancy rate (RR = 1.20, 95% CI = 1.02-1.41; P = 0.03) and a reduced mean time to conceive (RR = -1.17, 95% CI = -1.70- -0.64; P < 0.0001). Contrarily, other evaluated outcomes did not exhibit notable statistical differences.
CONCLUSIONS
Incorporating adjuvant GnRH-a following conservative surgery may be deemed beneficial for women with endometriosis, especially before Assisted Reproductive Technology (ART). Nonetheless, owing to pronounced heterogeneity, subsequent research is warranted to substantiate these potential advantages conclusively.
REGISTRATION NUMBER
CRD42023448280.
Topics: Pregnancy; Humans; Female; Pregnancy Outcome; Endometriosis; Pregnancy Rate; Pregnancy, Multiple; Gonadotropin-Releasing Hormone
PubMed: 38575880
DOI: 10.1186/s12884-024-06430-1 -
Facts, Views & Vision in ObGyn Mar 2024Congenital uterine anomalies (CUA) can be associated with impairments of early and late pregnancy events.
BACKGROUND
Congenital uterine anomalies (CUA) can be associated with impairments of early and late pregnancy events.
OBJECTIVE
To assess the impact of CUA on reproductive outcomes in pregnancies conceived spontaneously or after assisted reproduction.
MATERIALS AND METHODS
Systematic review and meta-analysis of cohort studies comparing patients with CUA versus women with normal uterus. A structured literature search was performed in leading scientific databases to identify prospective and retrospective studies. The Newcastle-Ottawa scale, adapted to AHRQ standards, was used to assess the risk of bias. Pooled odds ratios (OR) were calculated. Publication bias and statistical heterogeneity were assessed, and meta-regression was used to analyse the heterogeneity.
MAIN OUTCOME MEASURES
Miscarriage, ectopic pregnancy, placental abruption, term, and premature rupture of membranes (PROM), malpresentation at delivery, preterm delivery prior to 37, 34 and 32 weeks, caesarean delivery, intrauterine growth restriction/small for gestational age, foetal mortality and perinatal mortality.
RESULTS
32 studies were included. CUAs increased significantly the risk of first/second trimester miscarriage (OR:1.54;95%CI:1.14-2.07), placental abruption (OR:5.04;3.60-7.04), PROM (OR:1.71;1.34-2.18), foetal malpresentation at delivery (OR:21.04;10.95-40.44), preterm birth (adjusted OR:4.34;3.59-5.21), a caesarean delivery (adjusted OR:7.69;4.17-14.29), intrauterine growth restriction/small for gestational age (adjusted OR:50;6.11-424), foetal mortality (OR:2.07;1.56-2.73) and perinatal mortality (OR:3.28;2.01-5.36).
CONCLUSIONS
CUA increases the risk of complications during pregnancy, delivery, and postpartum. Complications most frequent in CUA patients were preterm delivery, foetal malpresentation, and caesarean delivery.
WHAT IS NEW?
Bicornuate uterus was associated with the highest number of adverse outcomes, followed by didelphys, subseptate and septate uterus.
PubMed: 38551471
DOI: 10.52054/FVVO.16.1.004 -
Journal of Clinical Medicine Mar 2024(1) : Current evidence indicates that women with polycystic ovarian syndrome (PCOS) undergoing in vitro fertilization (IVF) have an increased likelihood of adverse... (Review)
Review
(1) : Current evidence indicates that women with polycystic ovarian syndrome (PCOS) undergoing in vitro fertilization (IVF) have an increased likelihood of adverse pregnancy outcomes. The objective of this systematic review was to clarify the role of a PCOS-related high body mass index (BMI) in these unfavourable pregnancy outcomes. (2) : A comprehensive search of electronic databases was conducted to identify studies investigating the impact of high BMI on pregnancy outcomes in women with PCOS undergoing IVF. RevMan software (v5.4) was used to calculate the odds ratio (OR) and 95% confidence interval (CI). (3) : Nineteen eligible studies ( = 7680) were identified, including 16 retrospective cohort studies ( = 6934), two prospective cohort studies ( = 525), and one cross-sectional study ( = 221). Pooled analysis showed significantly higher odds of clinical pregnancy (OR, 1.16 [95% CI, 1.04-1.29]; z = 2.73; = 0.006; I = 30%) and livebirths (OR, 1.88 [95% CI, 1.56-2.27]; z = 6.54; < 0.0001; I = 55%) in women with PCOS with a normal versus a high BMI. Meta-analysis showed significantly increased odds of miscarriages in women with PCOS with a high versus a normal BMI (OR, 0.76 [95% CI, 0.60-0.95]; z = 2.42; = 0.02; I = 53%). Pooled analysis of three studies ( = 993) showed significantly higher ORs of gestational diabetes mellitus (OR 3.96 [95% CI 1.62-9.68]; z = 3.01; = 0.003; I = 58%) and gestational hypertension (OR 2.16 [95% CI 1.32-3.54]; z = 3.05; = 0.002; I = 68%) in women with PCOS with a high versus a normal BMI. Meta-analysis of three studies reported significantly greater odds of a caesarean section for women with PCOS with a high versus a normal BMI (OR 0.45 [95% CI 0.29-0.69]; z = 3.66; = 0.0003; I = 0%). (4) : The increased likelihood of adverse pregnancy outcomes observed in women with PCOS undergoing IVF seems to be attributable to a PCOS-related high BMI.
PubMed: 38541804
DOI: 10.3390/jcm13061578 -
BMC Pregnancy and Childbirth Mar 2024Pregnancy is one of the most remarkable experiences in a woman's life. Prenatal depression, characterized by stress and worry associated with pregnancy, can reach severe... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Pregnancy is one of the most remarkable experiences in a woman's life. Prenatal depression, characterized by stress and worry associated with pregnancy, can reach severe levels. On a global scale, mental and addictive disorders affect more than one billion people, causing 19% of years lived with disability. It is estimated that 25-35% of pregnant women experience depressive symptoms, with 20% meeting the diagnostic criteria for major depression.
METHODS
A systematic review and meta-analysis were conducted to examine depression during pregnancy in Ethiopia. The search was conducted from March 1-31, 2023. Data extraction used Microsoft Excel, and analysis was performed using STATA version 17. The New Castle-Ottawa Scale quality assessment tool was employed to evaluate the methodological quality of included studies. The Cochrane Q test and I2 statistics were used to assess heterogeneity. A weighted inverse variance random-effects model estimated the pooled level of antenatal depression (APD). Publication bias was detected using a funnel plot and Begg's and Egger's tests.
RESULTS
Out of 350 studies searched, 18 were included in the analysis. The overall pooled prevalence of depression in Ethiopia was 27.85% (95% CI: 23.75-31.96). Harari region reported the highest prevalence (37.44%), while Amhara region had the lowest (23.10%). Factors significantly associated with depression included unplanned pregnancies, low social support, low income, previous history of depression, intimate partner violence, and history of abortion.
CONCLUSION
This systematic review and meta-analysis demonstrate that approximately one-quarter of pregnant women in Ethiopia experience depression during pregnancy. Unplanned pregnancy, low social support, low income, previous history of depression, history of abortion, and intimate partner violence are determinants of depression. To address this high prevalence, the Ethiopian government and stakeholders should develop policies that incorporate counseling during pregnancy follow-ups. Improving the quality of life for pregnant women is crucial for the well-being of families, communities, and the nation as a whole.
Topics: Female; Pregnancy; Humans; Ethiopia; Depression; Quality of Life; Pregnant Women; Abortion, Spontaneous; Prevalence
PubMed: 38532382
DOI: 10.1186/s12884-024-06409-y -
Immunity, Inflammation and Disease Mar 2024This systematic review and meta-analysis aimed to evaluate the diagnostic value of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
This systematic review and meta-analysis aimed to evaluate the diagnostic value of the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in women with a history of abortion (missed and threatened) and recurrent pregnancy loss (RPL) in comparison with healthy pregnancies.
METHODS
Electronic databases including MEDLINE, Scopus, Web of Science, Embase, and Cochrane Library were searched for NLR and PLR in women who experienced early pregnancy loss up to January 1, 2023 with a combination of proper keywords. Meta-analysis was done for comparison with three or more studies and summary estimates were measured.
RESULTS
A total of 390 citations were retrieved initially, and after screening, 16 articles were deemed eligible for the final review. Among these, 14 studies underwent meta-analysis. The meta-analysis revealed that the standard mean of the NLR was significantly higher in abortion cases compared to the control group. However, there was no significant difference in the PLR between the pregnancy loss group and the control group.
CONCLUSION
NLR was significantly higher among RPL patients compared to the control group, according to these data, NLR may be capable of being used in the diagnosis of RPL as an easy, cheap, and accessible modality. Further studies, which take these variables into account, will need to be undertaken to determine the diagnostic value of NLR and PLR in early pregnancy loss.
Topics: Pregnancy; Humans; Female; Neutrophils; Blood Platelets; Lymphocytes; Abortion, Habitual; Databases, Factual
PubMed: 38506423
DOI: 10.1002/iid3.1210 -
Scientific Reports Mar 2024The effect of weight loss before in vitro fertilization (IVF) procedures on pregnancy outcomes in women with overweight or obesity and infertility remains controversial.... (Meta-Analysis)
Meta-Analysis
The effect of weight loss before in vitro fertilization (IVF) procedures on pregnancy outcomes in women with overweight or obesity and infertility remains controversial. In this systematic review and meta-analysis, we investigated whether weight loss before IVF in these women affected the IVF results and reproductive outcomes. PubMed, Embase, and the Cochrane Library databases were searched from the inception dates until December 2022, using combinations of relevant keywords. Only six randomized controlled trials, including 1627 women with obesity or overweight, were analyzed. The weight change in the intensive care group, compared to the control group who underwent IVF without weight loss was - 4.62 kg (mean difference; 95% confidence interval [CI] - 8.10, - 1.14). Weight loss before IVF did not significantly increase the live birth rate in women with obesity or overweight and infertility (odds ratio, 1.38; 95% CI 0.88, 2.10). The clinical pregnancy, miscarriage, ongoing pregnancy, and ectopic pregnancy rates did not differ between the weight loss and control groups before IVF. This meta-analysis demonstrated that even significant weight loss before IVF in women with obesity or overweight and infertility did not improve the live birth, clinical pregnancy, ongoing pregnancy, or ectopic pregnancy rates. PROSPERO Registration Number: CRD42023455800.
Topics: Pregnancy; Female; Humans; Overweight; Fertilization in Vitro; Infertility; Pregnancy Rate; Live Birth; Obesity; Weight Loss; Pregnancy, Ectopic
PubMed: 38486057
DOI: 10.1038/s41598-024-56818-4 -
Human Reproduction Open 2024Does sperm cryopreservation serve as a feasible and effective method for preserving fertility in adult male patients with cancer? (Review)
Review
STUDY QUESTION
Does sperm cryopreservation serve as a feasible and effective method for preserving fertility in adult male patients with cancer?
SUMMARY ANSWER
Sperm cryopreservation is an effective fertility preservation method and may benefit patients with cancer.
WHAT IS KNOWN ALREADY
Sperm cryopreservation is the only way to efficiently preserve male fertility. It is an important procedure in ART. Recently, due to remarkable advances in cancer treatment, an increasing number of studies have reported the outcomes of sperm cryopreservation in patients with cancer.
STUDY DESIGN SIZE DURATION
We conducted an extensive literature search for relevant studies published through to 31 December 2021, in the following databases: CENTRAL, CNKI, Cochrane Systematic Reviews, EMBASE, MEDLINE, PUBMED, and Web of Science. The search terms used were '(cryopreservation OR freeze OR freezing OR banking OR cryostorage OR storage) AND (sperm OR semen OR spermatozoon) AND (cancer OR tumor OR malignancy OR neoplasm)'.
PARTICIPANTS/MATERIALS SETTING METHODS
We included all studies that reported offering or attempting to cryopreserve sperm before or during cancer treatment in male patients considered at risk of treatment-related fertility impairment. We evaluated the eligibility of all data in each study. The major exclusion criteria were as follows: non-cancer patients; pediatric and adolescent cancer patients; not reporting the use of cryopreserved sperm; use of fresh semen for ART; not reporting the number of patients with cancer offered sperm cryopreservation or attempting to do so before or during treatment; using an experimental fertility preservation technique such as preservation of testicular tissue or spermatogonial stem cells; duplicate data; abstracts, case report, comments, reviews, or editorials; insufficient data reported. The quality of the included studies was assessed using the Newcastle-Ottawa scale and the Methodological Index for Non-Randomized Studies.
MAIN RESULTS AND THE ROLE OF CHANCE
This meta-analysis included 69 non-randomized studies, with 32 234 patients referred for sperm analysis and 23 178 patients cryopreserving at least one sperm sample. The pooled failed-to-cryopreserve rate was 10% (95% CI, 8-12%), and the sperm disposal and sperm use rates were 23% (95% CI, 16-30%) and 9% (95% CI, 8-10%), respectively. The pregnancy, miscarriage, and delivery rates were 28% (95% CI, 22-33%), 13% (95% CI, 10-17%), and 20% (95% CI, 15-25%), respectively. Subgroup analysis showed higher pregnancy and delivery rates, as well as a lower failed-to-cryopreserve rate, in recent studies compared to those released a decade ago. The studies from Asia reported higher sperm disposal and pregnancy rates than in other continents. Our analysis showed clinical pregnancy rates per cycle of 34% (27-41%), 24% (14-35%), and 9% (5-15%) and delivery rates per cycle of 23% (17-30%), 18% (11-26%), and 5% (1-9%) for ICSI, IVF, and IUI, respectively.
LIMITATIONS REASONS FOR CAUTION
As with all meta-analyses, some limitations should be considered. The first limitation of our study is that the data span 36 years. During this time, the World Health Organization has revised its sperm analysis standards, and other important changes have been made. There is also a limitation in that the outcome does not analyze the correlation between the type of cancer and sperm quality. Many of the earlier studies were limited by small sample sizes and a lack of control groups. Furthermore, almost all studies did not consider the severity of the disease, which could potentially have a substantial impact on the results. Consequently, further research should evaluate the effect of the type of cancer and, in particular, the severity of the condition on sperm quality in order to draw more precise conclusions. Similarly, it is inappropriate that most studies failed to differentiate between patients with different types of tumors and instead drew generalized conclusions that are presumed to apply to all patients with cancer. In the present analysis, we did not have in-depth information on patients' disease, and although extensive efforts were made to conduct a thorough systematic review and meta-analysis of the outcomes for patients with various types of tumors, the results must be acknowledged as being subject to bias. However, the use of average results obtained in each study, without the patient-level data, might also represent a source of bias.
WIDER IMPLICATIONS OF THE FINDINGS
Sperm cryopreservation is an effective fertility preservation method and may benefit patients with cancer. The observed utilization rate of frozen sperm at 9% may underestimate the actual usage, as the short follow-up period is inadequate for obtaining comprehensive data on the use of frozen sperm in young cancer survivors. ART plays an important role in fertility preservation and the achievement of pregnancy, with this meta-analysis showing that ICSI delivers better clinical outcomes than IVF or IUI in patients with cancer undergoing fertility preservation.
STUDY FUNDING/COMPETING INTERESTS
This work was supported by the National Natural Science Foundation of China (grant no. 82001634, 81960550), and the China Postdoctoral Science Foundation (2019M661521). There are no competing interests to declare.
REGISTRATION NUMBER
CRID 42022314460.
PubMed: 38389980
DOI: 10.1093/hropen/hoae006 -
BMC Pregnancy and Childbirth Feb 2024About 25% of pregnant women experience bleeding in the early stage, and half of them eventually progress to pregnancy loss. Progesterone serves as a useful biomarker to... (Meta-Analysis)
Meta-Analysis
BACKGROUND
About 25% of pregnant women experience bleeding in the early stage, and half of them eventually progress to pregnancy loss. Progesterone serves as a useful biomarker to predict miscarriage in threatened miscarriage, yet its performance is still debated.
AIM
To evaluate the performance of single serum progesterone predicting miscarriage in early pregnant patients with threatened miscarriage.
METHOD
The online database was searched to yield the literature using the terms of 'Abortion', 'Miscarriage', and 'serum Progesterone', including PubMed, Scopus, Embase, Cochrane library, and China national knowledge infrastructure. Receiver operating characteristic (ROC) curve, likelihood ratio (LLR) and diagnostic odds ratio (DOR) and 95% confidence interval (CI) were computed. Publication bias was assessed by the deeks funnel plot asymmetry test. Subgroup analyses were conducted according to the progesterone level (< 12 ng/mL), recruited location and region, progesterone measurement method, exogenous progesterone supplement and follow up.
RESULTS
In total, 12 studies were eligible to be included in this study, with sample sizes ranging from 76 to 1087. The included patients' gestational age was between 4 and 12 weeks. No significant publication bias was detected from all included studies. The threshold of progesterone reported ranged from 8 to 30 ng/ml. The synthesized area under the ROC curve (0.85, 95% CI 0.81 to 0.88), positive LLR (6.2, 4.0 to 9.7) and DOR (18, 12 to 27) of single progesterone measurement distinguishing miscarriage were relatively good in early pregnant patients with threatened miscarriage. When the threshold of < 12 ng/mL was adapted, the progesterone provided a higher area under the ROC curve (0.90 vs. 0.78), positive LLR (8.3 vs. 3.8) and DOR (22 vs.12) than its counterpart (12 to 30 ng/mL).
CONCLUSION
Single progesterone measurement can act as a biomarker of miscarriage in early pregnant patients with threatened miscarriage, and it has a better performance when the concentration is <12 ng/mL.
TRIAL REGISTRATION
PROSPERO (CRD42021255382).
Topics: Pregnancy; Humans; Female; Infant, Newborn; Infant; Progesterone; Abortion, Spontaneous; Abortion, Threatened; Pregnant Women; Biomarkers
PubMed: 38350926
DOI: 10.1186/s12884-024-06303-7