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Current Hypertension Reports Jul 2024Machine learning (ML) approaches are an emerging alternative for healthcare risk prediction. We aimed to synthesise the literature on ML and classical regression studies... (Review)
Review
PURPOSE OF REVIEW
Machine learning (ML) approaches are an emerging alternative for healthcare risk prediction. We aimed to synthesise the literature on ML and classical regression studies exploring potential prognostic factors and to compare prediction performance for pre-eclampsia.
RECENT FINDINGS
From 9382 studies retrieved, 82 were included. Sixty-six publications exclusively reported eighty-four classical regression models to predict variable timing of onset of pre-eclampsia. Another six publications reported purely ML algorithms, whilst another 10 publications reported ML algorithms and classical regression models in the same sample with 8 of 10 findings that ML algorithms outperformed classical regression models. The most frequent prognostic factors were age, pre-pregnancy body mass index, chronic medical conditions, parity, prior history of pre-eclampsia, mean arterial pressure, uterine artery pulsatility index, placental growth factor, and pregnancy-associated plasma protein A. Top performing ML algorithms were random forest (area under the curve (AUC) = 0.94, 95% confidence interval (CI) 0.91-0.96) and extreme gradient boosting (AUC = 0.92, 95% CI 0.90-0.94). The competing risk model had similar performance (AUC = 0.92, 95% CI 0.91-0.92) compared with a neural network. Calibration performance was not reported in the majority of publications. ML algorithms had better performance compared to classical regression models in pre-eclampsia prediction. Random forest and boosting-type algorithms had the best prediction performance. Further research should focus on comparing ML algorithms to classical regression models using the same samples and evaluation metrics to gain insight into their performance. External validation of ML algorithms is warranted to gain insights into their generalisability.
Topics: Humans; Pre-Eclampsia; Pregnancy; Female; Machine Learning; Algorithms; Prognosis; Regression Analysis; Risk Assessment; Risk Factors; Predictive Value of Tests
PubMed: 38806766
DOI: 10.1007/s11906-024-01297-1 -
Epidemiologia (Basel, Switzerland) Apr 2024Several adverse maternal outcomes have been linked to the excessive consumption of caffeine during pregnancy. Tea is an important source of caffeine. Hypertensive... (Review)
Review
Several adverse maternal outcomes have been linked to the excessive consumption of caffeine during pregnancy. Tea is an important source of caffeine. Hypertensive disorders of pregnancy (HDP) are common pregnancy complications with unfavorable maternal and fetal complications. This study aimed to investigate the relationship between antenatal tea drinking and HDP using a meta-analysis of available evidence. We systematically retrieved eligible studies before computing the pooled odds ratio (OR) and 95% confidence interval (CI) of HDP for women who reported the highest versus the lowest frequencies of antenatal tea drinking. We used the statistic to measure heterogeneity across studies and the test for funnel plot asymmetry to evaluate publication bias. The results showed that the highest frequencies of antenatal tea drinking were associated with increased odds of HDP (pooled OR = 1.16, 95% CI: 1.01, 1.33). We identified no signs of heterogeneity across studies ( = 0.0% and p-heterogeneity = 0.498) or publication bias (z = 0.791 and p-publication bias = 0.429). When the outcome was limited to (pre-)eclampsia, the association became statistically non-significant (pooled OR = 1.28, 95% CI: 0.86, 1.89, = 0.0%, and p-heterogeneity = 0.751). In conclusion, our results indicated that the highest frequency of antenatal tea drinking was positively associated with HDP. Pregnant women should be advised against excessive tea consumption. Still, future prospective cohort studies, considering the effects of different tea types and caffeine content, are needed to confirm our conclusions.
PubMed: 38804341
DOI: 10.3390/epidemiologia5020014 -
Obstetrics & Gynecology Science May 2024This study aimed to summarize the current knowledge on the benefits of in vitro fertilization/intracytoplasmic sperm injection with preimplantation genetic testing for...
This study aimed to summarize the current knowledge on the benefits of in vitro fertilization/intracytoplasmic sperm injection with preimplantation genetic testing for aneuploidy (PGT-A) and to discuss the role of PGT-A in patients of different ages undergoing assisted reproduction. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 checklist. Registration number: CRD42022354697. Studies were identified by searching the PubMed, Cochrane Library, Google Scholar, Scopus, Embase, and ClinicalTrials databases. Seven meta-analyses were performed with additional stratification of age and prognosis of the women studied. Clinical pregnancy rate per embryo transfer in patients aged >35 years was higher in the PGT-A group (P=0.0002) than in controls. Live birth rate (LBR) per embryo transfer in women 35 years old or younger (P=0.002) was higher in the PGT-A group. The LBR per patient in women aged >35 years was higher in the PGT-A group (P=0.004). The effects of PGT-A on LBR in patients with poor prognosis showed a statistically significant increase (P=0.003). There was no significant difference in the rate between the two groups. PGT-A is effective and can be recommended for patients aged >35 years undergoing assisted reproduction to improve their reproductive outcomes. Moreover, our study showed the possible benefits of PGT-A in patients with a poor prognosis. Overall, our findings suggest that PGT-A is a valuable tool for improving the reproductive outcomes of assisted reproductive procedures in older women and those with a history of pregnancy complications.
PubMed: 38803301
DOI: 10.5468/ogs.24028 -
Experimental and Therapeutic Medicine Jul 2024Pregnancies following previous caesarean section (CS) are associated with higher incidence of infections, postpartum haemorrhage and obstetric complications. The present...
Pregnancies following previous caesarean section (CS) are associated with higher incidence of infections, postpartum haemorrhage and obstetric complications. The present study aimed to explore the effect of previous CS on reproductive, maternal and neonatal outcomes in women who underwent assisted reproductive techniques (ART). A systematic review and meta-analysis were conducted to assess reproductive and pregnancy outcomes following ART in women with and without a previous CS. Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines were followed. Eligible language articles written in English, published up to October 2023, were identified in Medline, Google Scholar and Science Direct databases. The quality of the included studies was assessed using the Newcastle Ottawa Scale. A total of 19 articles, reporting on 13 different outcomes met the inclusion criteria. It was revealed that women with previous CS had 9% lower clinical pregnancy rates, 13% lower live birth rates, 11% lower implantation rates and 28% lower multiple pregnancy rates compared with women who had prior natural vaginal deliveries. Additionally, previous CS was associated with an 8-fold higher risk of difficult embryo transfers. No significant differences were noted in ectopic pregnancy rates, miscarriage rates or biochemical pregnancy rates. The present systematic review and meta-analysis demonstrated that previous CS is associated with decreased prospects of clinical pregnancy, live birth and successful embryo implantation during ART. The findings of the present study underscored the need to counsel women with prior CS regarding its potential impact on ART outcomes.
PubMed: 38800052
DOI: 10.3892/etm.2024.12572 -
PLoS Neglected Tropical Diseases May 2024Toxoplasmosis is a serious endemic zoonotic disease caused by the protozoan parasite Toxoplasma gondii. Toxoplasma infection during pregnancy can result in congenital... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Toxoplasmosis is a serious endemic zoonotic disease caused by the protozoan parasite Toxoplasma gondii. Toxoplasma infection during pregnancy can result in congenital transmission and serious fetal and neonatal complications. This systematic review and meta-analysis aimed to assess the pooled seroprevalence of T. gondii infection and its determinants among pregnant women in African countries.
METHODS
All articles reporting the seroprevalence of toxoplasmosis among pregnant women in African countries and published from 2010 to 2023 were searched using various databases. The pooled prevalence of toxoplasmosis was calculated using a random-effect model. The variation between the included studies was assessed using a funnel plot and I2 heterogeneity statistics. To identify the sources of heterogeneity, sub-group analysis was further conducted by country, diagnostic method, and sub-African region. The association of prevalence rates with the socio-economic level and geoclimatic parameters was also explored.
RESULTS
In total, 29,383 pregnant women from 60 articles were included for analysis. The pooled T. gondii seroprevalence was 42.89% with high heterogeneity (I2 = 99.4%, P < 0.001). Sub-group analysis revealed variation by country (ranging from 2.62% in Namibia to 80.28% in Congo), diagnostic method used (from 8.66% in studies using a rapid diagnostic test to 55.69% in those using an agglutination test), and sub-African region (from 4.14% in regions of Southern Africa to 53.96 in Central Africa). Cat ownership (OR = 1.58) and the consumption of raw meat (OR = 1.50) and raw vegetables (OR = 1.48) had a statistically significant combined effect on T. gondii seroprevalence. No association was found between T. gondii prevalence and the level of income of the country or geoclimatic parameters.
CONCLUSION
The prevalence of toxoplasmosis infection among pregnant women in Africa is high, particularly in Central and Eastern Africa. The determinants of prevalence are multifactorial. Therefore, efforts should be made to increase the awareness of women concerning the risk factors for toxoplasmosis.
Topics: Humans; Female; Seroepidemiologic Studies; Pregnancy; Toxoplasmosis; Toxoplasma; Africa; Pregnancy Complications, Parasitic; Antibodies, Protozoan; Animals; Prevalence; Pregnant Women
PubMed: 38781272
DOI: 10.1371/journal.pntd.0012198 -
BMC Pregnancy and Childbirth May 2024Iron deficiency anemia (IDA) is a global health challenge, especially affecting females and children. We aimed to conduct an umbrella systematic review of available... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Iron deficiency anemia (IDA) is a global health challenge, especially affecting females and children. We aimed to conduct an umbrella systematic review of available evidence on IDA's prevalence in Iranian pregnant women and children.
METHODS
We searched the Web of Science, Science Direct, PubMed, Scopus, and Google Scholar databases for articles published by April 2023. Meta-analyses investigating the status of IDA in Iran were included. The findings of seven meta-analyses comprising 189,627 pregnant women with a mean age of 26 and 5,890 children under six years old were included in this study. The methodological quality of each study was evaluated with the Assessment of Multiple Systematic Reviews (AMSTAR2) instrument.
RESULTS
We estimated the prevalence of IDA at 15.71% in pregnant women and 19.91% in young children. According to our subgroup analysis of pregnant women, IDA's prevalence in urban and rural regions was 16.32% and 12.75%; in the eastern, western, central, southern, and northern regions of Iran, it was estimated at 17.8%, 7.97%, 19.97%, 13.45%, and 17.82%, respectively.
CONCLUSION
IDA is common in young children and pregnant females and is a significant public health concern in Iran. The present umbrella review results estimated that Iran is in the mild level of IDA prevalence based on WHO classification. However, due to sanctions and high inflation in Iran, the prevalence of anemia is expected to increase in recent years. Multi-sectoral efforts are required to improve the iron status of these populations and reduce the burden of IDA in the country.
Topics: Humans; Anemia, Iron-Deficiency; Female; Iran; Pregnancy; Prevalence; Child; Child, Preschool; Infant; Pregnancy Complications, Hematologic; Adult
PubMed: 38778245
DOI: 10.1186/s12884-024-06575-z -
Clinical Nutrition ESPEN Jun 2024Advice to monitor and distribute carbohydrate intake is a key recommendation for treatment of gestational diabetes, but fails to consider circadian regulation of glucose...
BACKGROUND & AIMS
Advice to monitor and distribute carbohydrate intake is a key recommendation for treatment of gestational diabetes, but fails to consider circadian regulation of glucose homeostasis. In the non-pregnant state, glucose responses to a meal at night-time are significantly higher than during the day and are associated with an increased risk of developing type 2 diabetes. However, the impact of night time eating on postprandial glucose in pregnancy is uncertain. Using a systematic approach we explored postprandial glucose responses to dietary intake at night compared to during the day in pregnant women.
METHODS
Searches were conducted in four databases (Ovid MEDLINE, Ovid Embase, CINAHL plus and Scopus), in September 2022 (updated, June 2023). Eligible studies reported on postprandial glucose at a minimum of two times a day, after identical meals or an oral glucose tolerance test, in pregnant women with or without gestational diabetes. Publication bias was assessed using the ROBINS-I tool.
RESULTS
Four eligible studies were retrieved. Two studies reported within group comparison of two timepoints, and observed reduced glucose tolerance in the afternoon compared to the morning in pregnant women, irrespective of diabetes status. The other two studies meeting inclusion criteria did not report time of day comparisons.
CONCLUSION
It is unclear as to whether the higher (and extended) postprandial glucose levels observed at night in non-pregnant populations are observed in pregnancy. Clinical studies are needed to explore the impact of circadian rhythmicity on glucose metabolism during pregnancy, and the implications of current dietary advice on when and what to eat for management of gestational diabetes.
Topics: Humans; Female; Pregnancy; Blood Glucose; Diabetes, Gestational; Postprandial Period; Circadian Rhythm; Glucose Tolerance Test; Time Factors; Pregnant Women; Adult
PubMed: 38777436
DOI: 10.1016/j.clnesp.2024.03.021 -
Heliyon May 2024Zinc is an essential trace element involved in different physiological functions. During pregnancy, it plays a crucial role in healthy embryogenesis. Abortion is the...
INTRODUCTION
Zinc is an essential trace element involved in different physiological functions. During pregnancy, it plays a crucial role in healthy embryogenesis. Abortion is the most severe problem associated with early pregnancy complications. This study aims to compare the levels of Zn in mothers with and without abortion.
METHODS
This study is a systematic review and meta-analysis of studies published between 1980 and 2022 in PubMed, Science Direct, Pro Quest, Wiley, Web of Science, and Scopus databases. The search was conducted using both main and Mesh keywords, specifically targeting terms related to abortion, pregnancy loss, and zinc. Heterogeneity in the studies included in the meta-analysis was evaluated using statistical tests such as the chi-square test, I2, and forest plots. Publication bias was assessed using Begg's and Egger's tests. All analyses were conducted using Stata 15, and statistical significance was considered at p < 0.05.
RESULTS
In general, nine studies were included in this analysis. Based on the results of the meta-analysis, the mean difference in the Zn level between mothers with and without abortion is equal to 193.18 (95 % CI; 107.11 to 279.25, P ≤ 0.001). In other words, the level of Zn in the group of mothers without abortion is 193 units higher than the group of mothers with abortion. The investigation into the comparison of Zn levels in mothers with and without abortion did not reveal any indication of publication bias according to both Begg's test (P-value = 0.858) and Egger's test (P-value = 0.270).
CONCLUSION
the study findings indicate a significant association between lower levels of Zn in mothers with abortion compared to mothers without abortion. This suggests that a higher level of Zn may have a preventive effect on the occurrence of abortion in pregnant women. The data also highlights the positive role of trace metals, particularly Zn, in influencing pregnancy outcomes and suggests that maintaining adequate levels of Zn may reduce the likelihood of abortion occurrence, along with other contributing factors. It is important to note that further research, including prospective cohort and experimental studies, is needed to provide more substantial evidence and strengthen these findings.
PubMed: 38774104
DOI: 10.1016/j.heliyon.2024.e30605 -
International Wound Journal May 2024Caesarean section (C-section) is the most performed major surgery worldwide. About 15% of births are delivered through C-section in Rwanda. The post-caesarean surgical... (Meta-Analysis)
Meta-Analysis
Caesarean section (C-section) is the most performed major surgery worldwide. About 15% of births are delivered through C-section in Rwanda. The post-caesarean surgical section is one of the most frequent complications that follow a C-section. The purpose of this systematic review and meta-analysis is to estimate the pooled prevalence of surgical site infections following caesarean section deliveries in Rwanda. A comprehensive search was conducted across PubMed/MEDLINE, Google Scholar, DOAJ, AJOL and the Cochrane Library to identify primary studies on post-caesarean surgical site infections in Rwanda. Studies meeting predetermined criteria were included, and their quality was assessed using the JBI Critical Appraisal Tools. Heterogeneity was evaluated using I2 statistics, while publication bias was examined via funnel plots and statistical tests. Pooled prevalence was calculated using Jamovi 2.3.28 software, with subgroup analysis conducted to identify sources of heterogeneity. Statistical significance was set at p < 0.05. From 139 articles initially searched from the databases, only 17 studies with 8, 082 individuals were finally included in the systematic review and meta-analysis. Using the random-effects model, the pooled estimate of post C-section SSIs prevalence in Rwanda was 6.85% (95% CI 5.2, 8.5). Subgroup analysis based on publication year, sample size, hospital and study design showed no much difference in SSI prevalence. The current systematic review and meta-analysis indicates that post-caesarean surgical site infections are significant in Rwanda. A collaborative effort is required to lower post-C-section SSIs and provide the best surgical care in the country.
Topics: Humans; Cesarean Section; Surgical Wound Infection; Rwanda; Female; Prevalence; Pregnancy; Adult
PubMed: 38772859
DOI: 10.1111/iwj.14929 -
BMC Public Health May 2024Smokeless tobacco (SLT) poses many negative health impacts. Despite its longstanding presence in societies across the world, the health implications of SLT have only... (Meta-Analysis)
Meta-Analysis
Smokeless tobacco (SLT) poses many negative health impacts. Despite its longstanding presence in societies across the world, the health implications of SLT have only been rigorously studied in recent decades. This systematic review and meta-analysis aimed to consolidate existing research to provide a comprehensive understanding of the global prevalence of SLT use among women of reproductive age. Relevant articles were extracted from databases such as PubMed, EMBASE, Web of Science, and Scopus from their inception until November 11, 2023. Observational studies reporting the number of SLT users among women of reproductive age were included. The quality of the studies was assessed using the Joanna Briggs Institute (JBI) tool. The meta-analysis used a random-effects model to determine SLT prevalence, supported by statistical tools like forest plots, I statistics, and sensitivity analyses to ensure the accuracy and comprehensiveness of the results. All statistical analyses were performed in R version 4.3. From 10 studies involving 2,053,667 participants, a pooled prevalence for SLT use among women of reproductive age was found to be 9.3% (95% CI: 0.038 to 0.21), with significant heterogeneity among studies (I = 100%). Publication bias was suspected among the studies. Sensitivity analysis and subgroup analysis couldn't resolve the heterogeneity. Our analysis shows a significant prevalence of SLT use in women of reproductive age, especially in low socioeconomic and developing countries like India, Pakistan, and Nepal. For women of reproductive age, the use of smokeless tobacco (SLT) can lead to infertility, pregnancy complications, and adverse fetal outcomes, including low birth weight and preterm birth. The results highlight the necessity for specific public health measures and policy changes to decrease SLT consumption among reproductive-age women. Further studies are needed to investigate the reasons behind SLT usage in this group and to assess the impact of intervention strategies, to guide more effective public health initiatives and policies.
Topics: Humans; Tobacco, Smokeless; Female; Tobacco Use; Prevalence; Adult; Pregnancy
PubMed: 38769491
DOI: 10.1186/s12889-024-18840-z