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PloS One 2024Stress during pregnancy is detrimental to maternal health, pregnancy and birth outcomes and various preventive relaxation interventions have been developed. This... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Stress during pregnancy is detrimental to maternal health, pregnancy and birth outcomes and various preventive relaxation interventions have been developed. This systematic review and meta-analysis aimed to evaluate their effectiveness in terms of maternal mental health, pregnancy and birth outcomes.
METHOD
The protocol for this review is published on PROSPERO with registration number CRD42020187443. A systematic search of major databases was conducted. Primary outcomes were maternal mental health problems (stress, anxiety, depression), and pregnancy (gestational age, labour duration, delivery mode) and birth outcomes (birth weight, Apgar score, preterm birth). Randomized controlled trials or quasi-experimental studies were eligible. Meta-analyses using a random-effects model was conducted for outcomes with sufficient data. For other outcomes a narrative review was undertaken.
RESULT
We reviewed 32 studies comprising 3,979 pregnant women aged 18 to 40 years. Relaxation interventions included yoga, music, Benson relaxation, progressive muscle relaxation (PMR), deep breathing relaxation (BR), guided imagery, mindfulness and hypnosis. Intervention duration ranged from brief experiment (~10 minutes) to 6 months of daily relaxation. Meta-analyses showed relaxation therapy reduced maternal stress (-4.1 points; 95% Confidence Interval (CI): -7.4, -0.9; 9 trials; 1113 participants), anxiety (-5.04 points; 95% CI: -8.2, -1.9; 10 trials; 1965 participants) and depressive symptoms (-2.3 points; 95% CI: -3.4, -1.3; 7 trials; 733 participants). Relaxation has also increased offspring birth weight (80 g, 95% CI: 1, 157; 8 trials; 1239 participants), explained by PMR (165g, 95% CI: 100, 231; 4 trials; 587 participants) in sub-group analysis. In five trials evaluating maternal physiological responses, relaxation therapy optimized blood pressure, heart rate and respiratory rate. Four trials showed relaxation therapy reduced duration of labour. Apgar score only improved significantly in two of six trials. One of three trials showed a significant increase in birth length, and one of three trials showed a significant increase in gestational age. Two of six trials examining delivery mode showed significantly increased spontaneous vaginal delivery and decreased instrumental delivery or cesarean section following a relaxation intervention.
DISCUSSION
We found consistent evidence for beneficial effects of relaxation interventions in reducing maternal stress, improving mental health, and some evidence for improved maternal physiological outcomes. In addition, we found a positive effect of relaxation interventions on birth weight and inconsistent effects on other pregnancy or birth outcomes. High quality adequately powered trials are needed to examine impacts of relaxation interventions on newborns and offspring health outcomes.
CONCLUSION
In addition to benefits for mothers, relaxation interventions provided during pregnancy improved birth weight and hold some promise for improving newborn outcomes; therefore, this approach strongly merits further research.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Cesarean Section; Maternal Health; Mental Health; Birth Weight; Premature Birth; Labor, Obstetric
PubMed: 38271440
DOI: 10.1371/journal.pone.0278432 -
Reproductive Health Jan 2024Assisted Reproductive Technology utilizes human sperm, eggs, or embryos in vitro to produce pregnancy. However, there is no evidence of the acceptance of these... (Meta-Analysis)
Meta-Analysis Review
Attitude towards assisted reproductive technology: acceptance of donors eggs, sperms, and embryos as treatment of human infertility: a systematic review and meta-analysis.
INTRODUCTION
Assisted Reproductive Technology utilizes human sperm, eggs, or embryos in vitro to produce pregnancy. However, there is no evidence of the acceptance of these technologies by the community.
OBJECTIVE
This study aimed to determine the pooled prevalence of positive attitudes toward the acceptance of donor eggs, embryos, and sperm.
METHODS
The protocol was registered in PROSPERO (number: CRD42022348036). The Condition, Context and Population (CoCoPop) protocol of the systematic review was used to address the relevant questions regarding the objective of the study. Data were extracted into Excel and pooled estimates were calculated using STATA Version 16.
RESULTS
The pooled prevalence of positive attitudes toward accepting donor eggs, embryos, and sperms was 38.63%, 33.20%, and 31.34%, respectively. Subgroup analysis revealed that the pooled prevalence of positive attitudes toward accepting donor eggs was high in non-Asian countries (47.78%) and among infertile men (38.60%). Similarly, the pooled prevalence of positive attitudes toward accepting donor eggs was high in non-Asian countries (47.78%) and among infertile men (28.67%). However, the pooled prevalence of positive attitudes toward accepting donor sperm was high in non-Asian countries (37.6%) and among infertile women (28.19%).
CONCLUSION
The pooled estimate of the prevalence of positive attitudes toward accepting donor eggs was higher than the prevalence of positive attitudes toward accepting donor embryos and sperm. Infertile men and non-Asian countries have a higher prevalence of positive attitudes toward accepting eggs and embryos, whereas non-Asian countries and infertile women present a higher prevalence of positive attitudes toward accepting donor sperm. Therefore, regulatory bodies and policymakers should modify their rules and regulations to ensure the availability of minimum standards for the ethical and safe practice of donor conception as a treatment for infertility at national and international levels.
Topics: Female; Pregnancy; Humans; Male; Infertility, Female; Semen; Reproduction; Reproductive Techniques, Assisted; Spermatozoa
PubMed: 38263119
DOI: 10.1186/s12978-024-01741-0 -
JMIR MHealth and UHealth Jan 2024The increasing incidence of gestational diabetes mellitus (GDM) is a global health problem that is more likely to occur in pregnant women with overweight or obesity.... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The increasing incidence of gestational diabetes mellitus (GDM) is a global health problem that is more likely to occur in pregnant women with overweight or obesity. Adhering to a healthy lifestyle is associated with a reduced risk of GDM. With the development of IT, mobile health (mHealth) interventions have become widely available in health care. However, there are no definitive conclusions on the effectiveness of mHealth-based lifestyle interventions in preventing GDM.
OBJECTIVE
This study aims to evaluate the impact of mHealth-based lifestyle interventions on GDM and other pregnancy outcomes in pregnant women with overweight or obesity.
METHODS
A systematic literature search was conducted in 5 English databases (MEDLINE, Embase, Web of Science, CENTRAL, and CINAHL) and 4 Chinese databases (CBM, CNKI, Vip, and Wanfang) to identify randomized controlled trials (RCTs) on the effectiveness of mHealth-based interventions for GDM from inception to January 10, 2023. In total, 2 authors independently screened the studies and extracted the data. The quality of the included studies was examined using the Cochrane risk-of-bias tool. Data synthesis was conducted using Review Manager (version 5.4; The Cochrane Collaboration).
RESULTS
A total of 16 RCTs with 7351 participants were included in this study. The included studies were published between 2014 and 2021 and were conducted in China, the United States, Australia, New Zealand, the United Kingdom, Ireland, and Norway. The sample sizes of the studies ranged from 75 to 2202, and the duration of the mHealth-based lifestyle interventions ranged from 4 to 28 weeks. Compared with usual care, mHealth-based lifestyle interventions significantly reduced the incidence of GDM (odds ratio [OR] 0.74, 95% CI 0.56-0.96; P=.03; I=65%), preterm birth (OR 0.65, 95% CI 0.48-0.87; P=.004; I=25%), macrosomia (OR 0.59, 95% CI 0.40-0.87; P=.008; I=59%), and gestational weight gain (mean difference=-1.12 kg, 95% CI -1.44 to -0.80; P<.001; I=43%). The subgroup analysis showed that interventions delivered via apps (OR 0.55, 95% CI 0.37-0.83; P=.004; I=44%), provided by obstetricians (OR 0.69, 95% CI 0.51-0.93; P=.02; I=60%), and targeted at Asian populations (OR 0.44, 95% CI 0.34-0.58; P<.001; I=0%) and that used the International Association of Diabetes and Pregnancy Study Groups diagnostic criteria (OR 0.58, 95% CI 0.39-0.86; P=.007; I=69%) showed a statistically significant reduction in the risk of GDM.
CONCLUSIONS
mHealth-based lifestyle interventions had a favorable impact on the prevention of GDM in pregnant women with overweight and obesity. Future studies need to further explore the potential of mHealth-based interventions for GDM through better design and more rigorous large-scale RCTs.
TRIAL REGISTRATION
PROSPERO International Prospective Register of Systematic Reviews CRD42021286995; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=286995.
Topics: Female; Humans; Pregnancy; Diabetes, Gestational; Life Style; Obesity; Overweight; Pregnant Women; Telemedicine
PubMed: 38231555
DOI: 10.2196/49373 -
BMC Pregnancy and Childbirth Jan 2024Recent reviews have reported inconclusive results regarding the usefulness of consuming dates (Phoenix dactylifera L. fruit) in the peripartum period. Hence, this... (Meta-Analysis)
Meta-Analysis
Is oral consumption of dates (Phoenix dactylifera L. fruit) in the peripartum period effective and safe integrative care to facilitate childbirth and improve perinatal outcomes: a comprehensive revised systematic review and dose-response meta-analysis.
BACKGROUND
Recent reviews have reported inconclusive results regarding the usefulness of consuming dates (Phoenix dactylifera L. fruit) in the peripartum period. Hence, this updated systematic review with meta-analysis sought to investigate the efficacy and safety of this integrated intervention in facilitating childbirth and improving perinatal outcomes.
METHODS
Eight data sources were searched comprehensively from their inception until April 30, 2023. Parallel-group randomized and non-randomized controlled trials published in any language were included if conducted during peripartum (i.e., third trimester of pregnancy, late pregnancy, labor, or postpartum) to assess standard care plus oral consumption of dates versus standard care alone or combined with other alternative interventions. The Cochrane Collaboration's Risk of Bias (RoB) assessment tools and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) were employed to evaluate the potential RoB and the overall quality of the evidence, respectively. Sufficient data were pooled by a random-effect approach utilizing Stata software.
RESULTS
Of 2,460 records in the initial search, 48 studies reported in 55 publications were included. Data were insufficient for meta-analysis regarding fetal, neonatal, or infant outcomes; nonetheless, most outcomes were not substantially different between dates consumer and standard care groups. However, meta-analyses revealed that dates consumption in late pregnancy significantly shortened the length of gestation and labor, except for the second labor stage; declined the need for labor induction; accelerated spontaneity of delivery; raised cervical dilatation (CD) upon admission, Bishop score, and frequency of spontaneous vaginal delivery. The dates intake in labor also significantly reduced labor duration, except for the third labor stage, and increased CD two hours post-intervention. Moreover, the intervention during postpartum significantly boosted the breast milk quantity and reduced post-delivery hemorrhage. Likewise, dates supplementation in the third trimester of pregnancy significantly increased maternal hemoglobin levels. The overall evidence quality was also unacceptable, and RoB was high in most studies. Furthermore, the intervention's safety was recorded only in four trials.
CONCLUSION
More well-designed investigations are required to robustly support consuming dates during peripartum as effective and safe integrated care.
TRIAL REGISTRATION
PROSPERO Registration No: CRD42023399626.
Topics: Female; Humans; Infant, Newborn; Pregnancy; Fruit; Labor, Obstetric; Parturition; Peripartum Period; Phoeniceae; Infant
PubMed: 38166785
DOI: 10.1186/s12884-023-06196-y -
Annals of Internal Medicine Jan 2024Severe maternal morbidity and mortality are worse in the United States than in all similar countries, with the greatest effect on Black women. Emerging research suggests... (Review)
Review
BACKGROUND
Severe maternal morbidity and mortality are worse in the United States than in all similar countries, with the greatest effect on Black women. Emerging research suggests that disrespectful care during childbirth contributes to this problem.
PURPOSE
To conduct a systematic review on definitions and valid measurements of respectful maternity care (RMC), its effectiveness for improving maternal and infant health outcomes for those who are pregnant and postpartum, and strategies for implementation.
DATA SOURCES
Systematic searches of Ovid Medline, CINAHL, Embase, Cochrane Central Register of Controlled Trials, PsycInfo, and SocINDEX for English-language studies (inception to July 2023).
STUDY SELECTION
Randomized controlled trials and nonrandomized studies of interventions of RMC versus usual care for effectiveness studies; additional qualitative and noncomparative validation studies for definitions and measurement studies.
DATA EXTRACTION
Dual data abstraction and quality assessment using established methods, with resolution of disagreements through consensus.
DATA SYNTHESIS
Thirty-seven studies were included across all questions, of which 1 provided insufficient evidence on the effectiveness of RMC to improve maternal outcomes and none studied RMC to improve infant outcomes. To define RMC, authors identified 12 RMC frameworks, from which 2 main concepts were identified: and frameworks. Disrespect and abuse components focused on recognizing birth mistreatment; rights-based frameworks incorporated aspects of reproductive justice, human rights, and antiracism. Five overlapping framework themes include freedom from abuse, consent, privacy, dignity, communication, safety, and justice. Twelve tools to measure RMC were validated in 24 studies on content validity, construct validity, and internal consistency, but lack of a gold standard limited evaluation of criterion validity. Three tools specific for RMC had at least 1 study demonstrating consistency internally and with an intended construct relevant to U.S. settings, but no single tool stands out as the best measure of RMC.
LIMITATIONS
No studies evaluated other health outcomes or RMC implementation strategies. The lack of definition and gold standard limit evaluation of RMC tools.
CONCLUSION
Frameworks for RMC are well described but vary in their definitions. Tools to measure RMC demonstrate consistency but lack a gold standard, requiring further evaluation before implementation in U.S. settings. Evidence is lacking on the effectiveness of implementing RMC to improve any maternal or infant health outcome.
PRIMARY FUNDING SOURCE
Agency for Healthcare Research and Quality. (PROSPERO: CRD42023394769).
Topics: Infant; Pregnancy; Female; Humans; Maternal Health Services; Respect; Obstetrics; Delivery, Obstetric; Postpartum Period; Quality of Health Care
PubMed: 38163377
DOI: 10.7326/M23-2676 -
International Journal of Fertility &... Nov 2023Recurrent miscarriage (RM) is a condition defined as having three or more consecutive pregnancy losses before the 20 weeks of pregnancy. The present study was undertaken...
Recurrent miscarriage (RM) is a condition defined as having three or more consecutive pregnancy losses before the 20 weeks of pregnancy. The present study was undertaken to investigate association of rs2275913 polymorphism with RM. To this end, we searched the international databases (Web of Science, PubMed, Embase, and Scopus) and extracted studies investigating the association of rs2275913 polymorphism with RM using the appropriate keywords. The collected data were analyzed with the random-effects model and STATA (version 14). A total of five studies met the eligibility criteria, and total sample size was 998 subjects. Mean age of the cases and controls were 31.41 ± 4.16 and 30.56 ± 3.5 years, respectively. Our results disclosed a significant relationship of the rs2275913 AA genotype [odds ratio (OR)=1.68; 95% confidence interval (CI)=1.16- 2.43; I2=19; P=0.294) with RM. There was no statistically significant correlation between rs2275913 GG genotype (OR=1.04; 95% CI=0.64-1.7; I=59.5; P=0.042) and GA genotype (OR=0.85; 95% CI=0.65-1.1; I=19.1; P=0.293) with RM. Our findings revealed that the rs2275913 polymorphism is associated with RM, and the AA genotype of this polymorphism increased possibility of being involved in RM.
PubMed: 38041453
DOI: 10.22074/ijfs.2023.546127.1248 -
PloS One 2023Homebirth preference is the intention/plan to give birth outside health facilities with the help of unskilled birth attendants. The preference to give birth at home... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Homebirth preference is the intention/plan to give birth outside health facilities with the help of unskilled birth attendants. The preference to give birth at home without a skilled birth attendant leads to care-seeking delays, intrapartum mortality, multiple stillbirths, and postpartum morbidities and mortality. Therefore, this study aimed to estimate the pooled prevalence of homebirth preference and associated factors among pregnant women in Ethiopia.
METHODS
Search of Google Scholar, Medline, PubMed, Cochrane Library and Web of Science were done for this study from 20th August 2022 to 6th November 2022. For data extraction and analysis, the standardized data extraction checklist and Stata version 14 were used respectively. Sentence as "Cochrane Q test statistics and I2 statistics were used to check heterogeneity of the studies. The pooled prevalence of homebirth preference was estimated using a random-effects model. The association between homebirth preference and independent variables was determined using an odd ratio with a 95% confidence interval. A funnel plot and Egger's test were used to assess publication bias.
RESULTS
A total of 976 research articles were identified. Seven studies that fulfilled eligibility criteria were included in this systematic review and meta-analysis. The pooled prevalence of homebirth preference in Ethiopia was 39.62% (95% CI 27.98, 51.26). The current meta-analysis revealed that average monthly income <1800 ETB (OR = 2.66, 95% CI 1.44, 4.90) lack of ANC follow-up (OR = 2.57, 95%CI 1.32, 5.01), being multipara (OR = 1.77, 95%CI 1.39, 2.25), poor knowledge about obstetric danger sign (OR = 5.75, 95%CI 1.o2, 32.42), and not discussing the place of delivery with a partner (OR = 5.89 (95%CI 1.1, 31.63) were significantly associated with homebirth preference.
CONCLUSION
This systematic review and meta-analysis examined the substantial prevalence of homebirth preference in Ethiopia which may contribute maternal and child health crisis. The homebirth preference was associated with low average monthly income (<1800 ETB), lack of ANC follow-up, multipara, poor knowledge about obstetric danger signs, and not discussing with their partner the place of delivery. Improving knowledge of pregnant women about the benefit of health facility delivery and obstetric danger signs is necessary to decrease the prevalence of homebirth preference; for these can reduce negative outcomes occurred during delivery.
Topics: Child; Pregnancy; Female; Humans; Pregnant Women; Prevalence; Ethiopia; Parturition; Postpartum Period
PubMed: 37967092
DOI: 10.1371/journal.pone.0291394 -
BMC Pregnancy and Childbirth Oct 2023Postpartum urinary incontinence substantially impacts the psychophysical well-being of women. The influencing factors contributing to postpartum urinary incontinence... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Postpartum urinary incontinence substantially impacts the psychophysical well-being of women. The influencing factors contributing to postpartum urinary incontinence remain a subject of contention in clinical investigation. By elucidating the factors contributing to postpartum urinary incontinence, more efficacious interventions for laboring women can be devised. Consequently, this review endeavored to scrutinize the repercussions of maternal postpartum urinary incontinence to furnish empirical references for the clinical advancement of preventive strategies.
METHOD
The investigation employed bibliographic databases: Embase, PubMed, Web of Science, Cochrane Library, CBM, VIP, CNKI, and Wan Fang Data for article retrieval. A comprehensive consideration of all study designs was undertaken during the examination of the effects of postpartum urinary incontinence. The temporal limitation was set at all articles prior to February 2023. Studies incorporated laboring mothers experiencing normative labor and parturition. A total of 28,303 women were encompassed in the reviewed investigations.
RESULTS
A total of 5,915 putative citations were identified, from which 32 articles were selected for evaluating the effects of postpartum urinary incontinence. Meta-analyses revealed that the incidence of postpartum urinary incontinence was 26% [95%CI: (21% ~ 30%)]. Twelve pivotal variables were identified to influence postpartum urinary incontinence: cesarean delivery, vaginal delivery, age ≥ 35 years, multiparty (number of deliveries ≥ 2), neonatal weight > 4 kg, perineal dystonia, antecedents of urological incontinence-related pathology, maternal pre-conception BMI ≥ 24 kg/m^2, perineal laceration, instrumental parturition, historical pelvic surgical procedures, and protracted second stage of labor. Among these, cesarean delivery was identified as a protective factor against postpartum urinary incontinence.
CONCLUSION
The study corroborated that anamnestic factors pertinent to urinary incontinence, vaginal parturitions, and neonates with a weight exceeding 4 kg serve as significant risk factors for postpartum urinary incontinence. Cesarean delivery emerged as a protective factor against postpartum urinary incontinence. Based on the prevalence of postpartum urinary incontinence, proactive intervention is requisite to mitigate the risk of postpartum urinary incontinence in postpartum women possessing these risk factors.
TRIAL REGISTRATION
CRD42023412096.
Topics: Adult; Female; Humans; Pregnancy; Delivery, Obstetric; Parturition; Postpartum Period; Prevalence; Urinary Incontinence
PubMed: 37898733
DOI: 10.1186/s12884-023-06059-6 -
PloS One 2023Women classified as 'high risk' or 'complicated' in pregnancy and childbirth have increased difficulty in accessing humanised care/humanisation in childbirth due to...
Midwives', obstetricians', and nurses' perspectives of humanised care during pregnancy and childbirth for women classified as high risk in high income countries: A mixed methods systematic review.
Women classified as 'high risk' or 'complicated' in pregnancy and childbirth have increased difficulty in accessing humanised care/humanisation in childbirth due to perceptions that this approach rejects the use of intervention and/or technology. Humanised care recognises the psychological and physical needs of women in pregnancy and birth. A mixed methods systematic review using a convergent segregated approach was undertaken using the Joanne Briggs Institute (JBI) methodology. The objective of the review was to identify the presence of humanisation for women with high risk pregnancy and/or childbirth in high income countries. Studies were included if they measured humanisation and/or explored the perspectives of midwives, obstetricians, or nurses on humanisation for women classified as having a high-risk or complicated pregnancy or childbirth in a high income country. Qualitative data were analysed using a meta-aggregative approach and a narrative synthesis was completed for the quantitative data. All studies were assessed for their methodological quality using the MMAT tool. Four databases were searched, and nineteen studies met the inclusion criteria. A total of 1617 participants from nine countries were included. Three qualitative findings were synthesised, and a narrative synthesis of quantitative data was completed. The integration of qualitative and quantitative data identified complimentary findings on: (i) the importance of developing a harmonised relationship with women; (ii) increased time counselling women on their choices; and (iii) fear of professional reputational damage if caring outside of protocols. Negotiating with women outside of protocols may have a wider impact on the professional than first thought. Understanding how healthcare professionals individualise care for women at risk in labour requires further investigation.
Topics: Pregnancy; Female; Humans; Midwifery; Obstetricians; Developed Countries; Delivery, Obstetric; Nurses; Qualitative Research
PubMed: 37878625
DOI: 10.1371/journal.pone.0293007 -
Women and Birth : Journal of the... Feb 2024Spontaneous vaginal birth (SVB) rates for nulliparous women are declining internationally. (Review)
Review
PROBLEM
Spontaneous vaginal birth (SVB) rates for nulliparous women are declining internationally.
BACKGROUND
There is inadequate understanding of factors affecting this trend overall and limited large-scale responses to improve women's opportunity to birth spontaneously.
AIM
To undertake a descriptive systematic review identifying factors associated with spontaneous vaginal birth at term, in nulliparous women with a singleton pregnancy.
METHODS
Quantitative studies of all designs, of nulliparous women with a singleton pregnancy and cephalic presentation, who experienced a SVB at term were included. Nine databases were searched (inception to October 2022). Two reviewers undertook quality appraisal; Randomised Controlled Trials (RCTs) with high risk of bias (ROB 2.0) and other designs with (QATSDD) scoring ≤ 50% were excluded.
FINDINGS
Data were abstracted from 90 studies (32 RCTs, 39 cohort, 9 cross-sectional, 4 prevalence, 5 case control, 1 quasi-experimental). SVB rates varied (13%-99%). Modifiable factors associated with SVB included addressing fear of childbirth, low impact antenatal exercise, maternal positioning during second-stage labour and midwifery led care. Complexities arising during pregnancy and regional analgesia were shown to decrease SVB and other interventions, such as routine induction of labour were equivocal.
DISCUSSION
Antenatal preparation (low impact exercise, childbirth education, addressing fear of childbirth) may increase SVB, as does midwifery continuity-of-care. Intrapartum strategies to optimise labour progression emerged as promising areas for further research.
CONCLUSION
Declining SVB rates may be improved through multi-factorial approaches inclusive of maternal, fetal and clinical care domains. However, the variability of SVB rates testifies to the complexity of the issue.
Topics: Female; Humans; Pregnancy; Delivery, Obstetric; Labor, Obstetric; Midwifery; Parity; Parturition
PubMed: 37704535
DOI: 10.1016/j.wombi.2023.08.009