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Fertility and Sterility Oct 2021To investigate whether preimplantation genetic testing (PGT) increases the risk of adverse obstetric and neonatal outcomes. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To investigate whether preimplantation genetic testing (PGT) increases the risk of adverse obstetric and neonatal outcomes.
DESIGN
Systematic review and meta-analysis.
SETTING
Not applicable.
PATIENT(S)
Pregnancies achieved after PGT or in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI).
INTERVENTION(S)
Systematic search of databases until December 2020 with cross-checking of references from relevant articles in English.
MAIN OUTCOME MEASURE(S)
Obstetric and neonatal outcomes after PGT and IVF/ICSI, including mean birth weight, low birth weight, very low birth weight (VLBW), mean gestational age at birth, preterm birth, very preterm birth, birth defects, intrauterine growth retardation (IUGR), sex ratio, cesarean section, hypertensive disorders of pregnancy, gestational diabetes mellitus, placenta disorder (placenta previa, placenta abruption, placenta accreta), and preterm premature rupture of membranes.
RESULT(S)
Ultimately, a total of 785,445 participants were enrolled in this meta-analysis, and these participants were divided into a PGT group (n = 54,294) and an IVF/ICSI group (n = 731,151). The PGT pregnancies had lower rates of low birth weight (risk ratio [RR] 0.85, 95% confidence interval [CI] 0.75 to 0.98), VLBW (RR 0.52, 95% CI 0.33 to 0.81), and very preterm births (RR 0.55, 95% CI 0.42 to 0.70) than those of IVF/ICSI pregnancies. However, the PGT group had a higher rate of the obstetric outcome of hypertensive disorders of pregnancy (RR 1.30, 95% CI 1.08 to 1.57). The PGT did not increase the risk of other adverse obstetric and neonatal outcomes, such as those associated with mean birth weight, mean gestational age at birth, birth defects, IUGR, sex ratio, cesarean section, gestational diabetes mellitus, placental disorder (placenta previa, placenta abruption, placenta accreta), or preterm premature rupture of membranes. We performed subgroup analysis with only blastocyst biopsies and found that PGT with blastocyst biopsies was associated with a lower rate of VLBW (RR 0.55, 95% CI 0.31 to 0.95). The PGT with blastocyst biopsies did not increase the risk of other adverse obstetric and neonatal outcomes. Additionally, we performed subgroup analysis with only frozen-thawed embryo transfer cycles, and we found that PGT pregnancies were associated with a lower rate of VLBW (RR 0.55, 95% CI 0.31 to 0.97), a lower rate of cesarean birth (RR 0.90, 95% CI 0.82 to 0.99), a higher rate of preterm birth (RR 1.10, 95% CI 1.02 to 1.18), and a higher rate of IUGR (RR 1.21, 95% CI 1.06 to 1.38) than those of IVF/ICSI pregnancies. The PGT with frozen-thawed embryo transfer did not increase the risk of other adverse obstetric and neonatal outcomes.
CONCLUSION(S)
The pooled analysis suggested that PGT did not increase the risk of adverse obstetric outcomes. The association between PGT and a higher risk of IUGR requires further investigation.
Topics: Birth Weight; Female; Fertilization in Vitro; Genetic Testing; Gestational Age; Humans; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Infertility; Male; Predictive Value of Tests; Pregnancy; Pregnancy Complications; Preimplantation Diagnosis; Risk Assessment; Risk Factors; Treatment Outcome
PubMed: 34373103
DOI: 10.1016/j.fertnstert.2021.06.040 -
Frontiers in Global Women's Health 2023The World Health Organization (WHO) recommends treatment and management of gestational diabetes (GD) through lifestyle changes, including diet and exercise, and... (Review)
Review
INTRODUCTION
The World Health Organization (WHO) recommends treatment and management of gestational diabetes (GD) through lifestyle changes, including diet and exercise, and self-monitoring blood glucose (SMBG) to inform timely treatment decisions. To expand the evidence base of WHO's guideline on self-care interventions, we conducted a systematic review of SMBG among pregnant individuals with GD.
SETTING
Following PRISMA guidelines, we searched PubMed, CINAHL, LILACS, and EMBASE for publications through November 2020 comparing SMBG with clinic-based monitoring during antenatal care (ANC) globally.
PRIMARY AND SECONDARY OUTCOME MEASURES
We extracted data using standardized forms and summarized maternal and newborn findings using random effects meta-analysis in GRADE evidence tables. We also reviewed studies on values, preferences, and costs of SMBG.
RESULTS
We identified 6 studies examining SMBG compared to routine ANC care, 5 studies on values and preferences, and 1 study on costs. Nearly all were conducted in Europe and North America. Moderate-certainty evidence from 3 randomized controlled trials (RCTs) showed that SMBG as part of a package of interventions for GD treatment was associated with lower rates of preeclampsia, lower mean birthweight, fewer infants born large for gestational age, fewer infants with macrosomia, and lower rates of shoulder dystocia. There was no difference between groups in self-efficacy, preterm birth, C-section, mental health, stillbirth, or respiratory distress. No studies measured placenta previa, long-term complications, device-related issues, or social harms. Most end-users supported SMBG, motivated by health benefits, convenience, ease of use, and increased confidence. Health workers acknowledged SMBG's convenience but were wary of technical problems. One study found SMBG by pregnant individuals with insulin-dependent diabetes was associated with decreased costs for hospital admission and length of stay.
CONCLUSION
SMBG during pregnancy is feasible and acceptable, and when combined in a package of GD interventions, is generally associated with improved maternal and neonatal health outcomes. However, research from resource-limited settings is needed.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42021233862.
PubMed: 37293246
DOI: 10.3389/fgwh.2023.1006041 -
Tropical Medicine & International... Jun 2013(i) To estimate the prevalence burden of placenta praevia in each world region, and (ii) to investigate potential sources of heterogeneity. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
(i) To estimate the prevalence burden of placenta praevia in each world region, and (ii) to investigate potential sources of heterogeneity.
METHODS
Systematic review of the literature and random-effects meta-analysis. Potential sources of heterogeneity were investigated using meta-regression.
RESULTS
The overall prevalence of placenta praevia was 5.2 per 1000 pregnancies (95% CI: 4.5-5.9). However, there was evidence of regional variation (P = 0.0001); prevalence was highest among Asian studies (12.2 per 1000 pregnancies; 95% CI: 9.5-15.2) and lower among studies from Europe (3.6 per 1000 pregnancies; 95% CI: 2.8-4.6), North America (2.9 per 1000 pregnancies; 95% CI: 2.3-3.5) and Sub-Saharan Africa (2.7 per 1000 pregnancies; 95% CI: 0.3-11.0). The prevalence of major placenta praevia was 4.3 per 1000 pregnancies (95% CI: 3.3-5.4).
CONCLUSION
The prevalence of placenta praevia is low at around 5 per 1000 pregnancies. There is some evidence suggestive of regional variation in its prevalence, but it is not possible to determine from existing data whether this is due to true ethnic differences or other unknown factor(s).
Topics: Africa South of the Sahara; Asia; Europe; Female; Humans; Maternal Welfare; North America; Placenta Previa; Postpartum Hemorrhage; Pregnancy; Prevalence; Regression Analysis; Reproductive Health
PubMed: 23551357
DOI: 10.1111/tmi.12100 -
International Journal of Reproductive... Nov 2023Pregnancy with assisted reproductive technology (ART) is accompanied by fetal and maternal outcomes. This systematic review aimed to assess the relationship between... (Review)
Review
Pregnancy with assisted reproductive technology (ART) is accompanied by fetal and maternal outcomes. This systematic review aimed to assess the relationship between ART and maternal outcomes. In this systematic review, the electronic databases, including PubMed, MEDLINE, Web of Science, Scopus, Science Direct, Cochrane Library, Google Scholar, Magiran, Irandoc, and Scientific Information Database were searched for maternal outcomes reported from 2010-2021. The Newcastle-Ottawa Scale for cohort studies was used to assess the methodological quality of studies. A total of 3362 studies were identified by searching the databases. After screening abstracts and full-text reviews, 19 studies assessing the singleton pregnancy-related complications of in vitro fertilization/intracytoplasmic sperm injection were included in the study. The results demonstrated that singleton pregnancies conceived through ART had higher risks of pregnancy-related complications and adverse maternal outcomes, such as vaginal bleeding, cesarean section, hypertension induced by pregnancy, pre-eclampsia, placenta previa, and premature membrane rupture than those conceived naturally. In conclusion, an increased risk of adverse obstetric outcomes was observed in singleton pregnancies conceived by ART. Therefore, obstetricians should consider these pregnancies as high-risk cases and should pay special attention to their pregnancy process.
PubMed: 38292514
DOI: 10.18502/ijrm.v21i11.14651 -
Fertility and Sterility Dec 2013To perform a systematic review and meta-analysis of obstetric and perinatal complications in singleton pregnancies after the transfer of blastocyst-stage and... (Meta-Analysis)
Meta-Analysis Review
Obstetric and perinatal outcomes in singleton pregnancies resulting from the transfer of blastocyst-stage versus cleavage-stage embryos generated through in vitro fertilization treatment: a systematic review and meta-analysis.
OBJECTIVE
To perform a systematic review and meta-analysis of obstetric and perinatal complications in singleton pregnancies after the transfer of blastocyst-stage and cleavage-stage embryos generated through IVF.
DESIGN
Systematic review.
SETTING
University hospital.
PATIENT(S)
Singleton pregnancies resulting from ET at the blastocyst stage versus those at the cleavage stage.
INTERVENTION(S)
Medline, EMBASE, Cochrane Central Register of Clinical Trials DARE, and CINAHL (1980-2013) were searched. Two independent reviewers extracted data and assessed the methodological quality of the relevant studies using CASP scoring. Risk ratios and risk differences were calculated in Rev Man 5.1.
MAIN OUTCOME MEASURE(S)
Very preterm birth, preterm birth, small for gestational age, low birth weight, very low birth weight, congenital anomalies, perinatal mortality, preeclampsia, and placenta previa.
RESULT(S)
In vitro fertilization pregnancies occurring as a result of ET at the blastocyst stage were associated with a higher relative risk (RR; 95% confidence interval [CI]) of preterm (RR 1.27; 95% CI 1.22-1.31) and very preterm delivery (RR 1.22; 95% CI 1.10-1.35) in comparison with those resulting from the transfer of cleavage-stage embryos. The risk of growth restriction was lower in babies conceived through blastocyst transfer (RR 0.82; 95% CI 0.77-0.88).
CONCLUSION(S)
Data from observational studies show that ET at the blastocyst stage is associated with a higher risk of very preterm delivery. However, we were not able to adjust for confounders. Perinatal outcome data from existing randomized trials are needed to determine the safety of ET at the blastocyst stage compared with the cleavage stage.
Topics: Blastocyst; Cleavage Stage, Ovum; Comorbidity; Embryo Transfer; Female; Fertilization in Vitro; Humans; Incidence; Infant, Low Birth Weight; Infertility, Female; Obstetric Labor Complications; Pregnancy; Pregnancy Outcome; Survival Rate; Treatment Outcome
PubMed: 24083875
DOI: 10.1016/j.fertnstert.2013.08.044 -
BMC Pregnancy and Childbirth Jan 2019Severe obstetric hemorrhage caused by placenta accreta results in significant maternal morbidity and mortality. As a new technology, abdominal aortic balloon occlusion... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Severe obstetric hemorrhage caused by placenta accreta results in significant maternal morbidity and mortality. As a new technology, abdominal aortic balloon occlusion (AABO) is becoming an important treatment for patients with placenta accreta. To evaluate the safety and efficacy of AABO, we conducted a systematic review and meta-analysis of previous studies.
METHODS
We used a three-check subset including placenta accreta (placenta previa, percreta, increta, etc.), balloon, and aortic (aortas, aorta, etc.) to form a retrieval formula and searched in MEDLINE, EMBASE, the Cochrane Library, clinicaltrials.gov and Web of Science. All articles regarding placenta previa or placenta accreta and including the use of abdominal aortic balloon occlusion were included in our screening. Two researchers selected articles and extracted data independently. Finally, the Newcastle-Ottawa Quality Assessment Scale was used for quality assessments.
RESULTS
We retrieved 776 articles and eventually included 11 clinical studies. Meta-analysis showed that AABO significantly reduced the blood loss volume (MD - 1480 ml, 95% CI -1806 to - 1154 ml, P < 0.001) and blood transfusion volume (MD - 1125 ml, 95% CI -1264 to - 987 ml, P < 0.001). Similarly, obvious reductions in the hysterectomy rate (OR 0.30, 95% CI 0.19 to 0.48, P < 0.001), hospitalization duration (MD - 1.35 days, 95% CI -2.40 to - 0.31 days, P = 0.01), and operative time (MD - 29.23 min, 95% CI -46.04 to - 12.42 min, P < 0.001) were observed in the AABO group.
CONCLUSION
The prophylactic use of AABO in patients with placenta accreta is safe and effective.
Topics: Adult; Aorta, Abdominal; Balloon Occlusion; Blood Loss, Surgical; Blood Transfusion; Female; Humans; Length of Stay; Operative Time; Placenta Accreta; Postpartum Hemorrhage; Pregnancy; Treatment Outcome
PubMed: 30646863
DOI: 10.1186/s12884-019-2175-0 -
NIH Consensus and State-of-the-science...To provide health care providers, patients, and the general public with a responsible assessment of currently available data on cesarean delivery on maternal request.
OBJECTIVE
To provide health care providers, patients, and the general public with a responsible assessment of currently available data on cesarean delivery on maternal request.
PARTICIPANTS
A non-DHHS, nonadvocate 18-member panel representing the fields of obstetrics and gynecology, preventive medicine, biometrics, family planning and reproductive physiology, nurse midwifery, anesthesiology, patient safety, epidemiology, pediatrics, perinatal medicine, urology, urogynecology, general nursing, inner city public health sciences, law, psychiatry, and health services research. In addition, 18 experts from pertinent fields presented data to the panel and conference audience.
EVIDENCE
Presentations by experts and a systematic review of the literature prepared by the RTI International-University of North Carolina Evidence-based Practice Center, through the Agency for Healthcare Research and Quality. Scientific evidence was given precedence over anecdotal experience.
CONFERENCE PROCESS
The panel drafted its statement based on scientific evidence presented in open forum and on published scientific literature. The draft statement was presented on the final day of the conference and circulated to the audience for comment. The panel released a revised statement later that day at http://consensus.nih.gov. This statement is an independent report of the panel and is not a policy statement of the NIH or the Federal Government.
CONCLUSIONS
The incidence of cesarean delivery without medical or obstetric indications is increasing in the United States, and a component of this increase is cesarean delivery on maternal request. Given the tools available, the magnitude of this component is difficult to quantify. There is insufficient evidence to evaluate fully the benefits and risks of cesarean delivery on maternal request as compared to planned vaginal delivery, and more research is needed. Until quality evidence becomes available, any decision to perform a cesarean delivery on maternal request should be carefully individualized and consistent with ethical principles. Given that the risks of placenta previa and accreta rise with each cesarean delivery, cesarean delivery on maternal request is not recommended for women desiring several children. Cesarean delivery on maternal request should not be performed prior to 39 weeks of gestation or without verification of lung maturity, because of the significant danger of neonatal respiratory complications. Maternal request for cesarean delivery should not be motivated by unavailability of effective pain management. Efforts must be made to assure availability of pain management services for all women. NIH or another appropriate Federal agency should establish and maintain a Web site to provide up-to-date information on the benefits and risks of all modes of delivery.
Topics: Cesarean Section; Decision Making; Ethics, Clinical; Female; Humans; Mothers; Needs Assessment; Outcome Assessment, Health Care; Practice Guidelines as Topic; Pregnancy; United States
PubMed: 17308552
DOI: No ID Found -
Fertility and Sterility May 2016To examine whether dichorionic twin pregnancies after assisted reproductive technology (ART) were at higher risk of adverse obstetric outcomes compared with those... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To examine whether dichorionic twin pregnancies after assisted reproductive technology (ART) were at higher risk of adverse obstetric outcomes compared with those conceived naturally.
DESIGN
Meta-analysis.
SETTING
University-affiliated teaching hospital.
PATIENT(S)
Dichorionic twin pregnancies conceived with ART and naturally.
INTERVENTION(S)
Studies comparing obstetric outcomes in dichorionic twin pregnancies conceived by ART and naturally were identified by searching PubMed, Google Scholar, Cochrane Libraries, and Chinese databases through July 2015 with no restrictions. Either a fixed-effects or a random-effects model was used to calculate the overall combined risk estimates. Subgroup analysis was performed to explore potential heterogeneity moderators.
MAIN OUTCOME MEASURE(S)
Maternal complications and adverse pregnancy outcomes.
RESULT(S)
Fifteen cohort studies involving 6,420 dichorionic twins after ART and 13,650 dichorionic twins conceived naturally were included. Most of maternal complications were similar in both groups, but placenta previa (relative risk [RR] = 2.99, 95% confidence interval [CI] 1.51-5.92; I(2) = 0) was significantly more common in the ART group. For neonatal outcomes, the ART group experienced higher risk of preterm birth (RR = 1.13, 95% CI 1.00-1.29; I(2) = 75%), very preterm birth (RR = 1.39, 95% CI 1.07-1.82; I(2) = 71%), low birth weight (RR = 1.11, 95% CI 1.00-1.23; I(2) = 61%), and congenital malformations (RR = 1.26, 95% CI 1.09-1.46; I(2) = 26%). In addition, the ART group had a higher proportion of elective cesarean sections (RR = 1.79, 95% CI 1.49-2.16; I(2) = 60%), but had a similar proportion for emergency cesarean sections. Relevant heterogeneity moderators have been identified by subgroup analysis. No evidence of publication bias was observed.
CONCLUSION(S)
The rates of placenta previa, elective cesarean section, preterm birth, very preterm birth, low birth weight, and congenital malformations were significantly higher in dichorionic twin pregnancies after ART.
Topics: Chorion; Delivery, Obstetric; Female; Humans; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Pregnancy, Twin; Reproductive Techniques, Assisted
PubMed: 26801066
DOI: 10.1016/j.fertnstert.2015.12.131 -
Taiwanese Journal of Obstetrics &... Dec 2015To determine factors associated with late preterm births in an underdeveloped region of China, and search for relevant reports in other underdeveloped regions by a... (Review)
Review
OBJECTIVE
To determine factors associated with late preterm births in an underdeveloped region of China, and search for relevant reports in other underdeveloped regions by a systematic review.
MATERIALS AND METHODS
Data of births occurring between January 2004 and December 2008 from eight hospitals in Western Sichuan Province, China, were analyzed. Late preterm birth was defined as delivery at 34-36 6/7 weeks' gestation. Medline, Cochrane Library, and Google Scholar were searched for studies which reported the risk factors of late preterm births in undeveloped regions until January 31, 2014.
RESULTS
During the study period there were 4711 late preterm births and 54,574 term births. The odds ratios (ORs) for a late preterm birth of mothers < 20 years and ≥ 35 years of age were 3.813 [95% confidence interval (CI): 3.256-4.465] and 1.872 (95% CI: 1.677-2.090), respectively, as compared with an age of 20-34.9 years. Mothers who received prenatal care were less likely (OR = 0.623, 95% CI: 0.582-0.667) and those with a multiple gestation were more likely (OR = 9.346, 95% CI: 7.813, 11.236) to have a late preterm birth. The systematic review found that the incidence of late preterm births ranged from 4.4% to 16%, and the most prominent risk factors were eclampsia, preeclampsia, placenta previa, placental abruption, and twin pregnancy.
CONCLUSION
A number of factors are associated with late preterm births, and the incidence in underdeveloped regions is high. The inconsistent results between our study and previous reports indicate more attention towards preventing late preterm births in undeveloped regions is needed.
Topics: Adult; China; Cohort Studies; Delivery, Obstetric; Developing Countries; Female; Gestational Age; Humans; Maternal Age; Pregnancy; Pregnancy Complications; Pregnancy, Multiple; Premature Birth; Retrospective Studies; Risk Factors; Young Adult
PubMed: 26700979
DOI: 10.1016/j.tjog.2014.05.011 -
Systematic Reviews Dec 2018Placenta praevia refers to a placenta located in the lower segment of the uterus. This abnormal location predisposes the placenta to abnormal bleeding with an increased... (Meta-Analysis)
Meta-Analysis
Using tocolysis in pregnant women with symptomatic placenta praevia does not significantly improve prenatal, perinatal, neonatal and maternal outcomes: a systematic review and meta-analysis.
BACKGROUND
Placenta praevia refers to a placenta located in the lower segment of the uterus. This abnormal location predisposes the placenta to abnormal bleeding with an increased risk of premature labour. The merits of tocolytic drugs (tocolysis) to calm uterine contractions and prolong pregnancy in women with placenta praevia are uncertain.
OBJECTIVES
The primary objective is to determine the effects of tocolysis versus no tocolysis on pregnancy prolongation. Secondary objectives include to determining the effects of tocolysis versus no tocolysis on gestational age at delivery, maternal hospitalisations, recurrent vaginal bleeding, prematurity, admissions into neonatology, and perinatal deaths.
METHODS
We searched MEDLINE, EMBASE, The Cochrane Central Register of Controlled Trials, reference lists of pertinent articles and trial registries for randomised controlled trials comparing tocolysis to no tocolysis or placebo in patients with placenta praevia. Risk of bias and data extraction was done independently by two reviewers. We pooled data using a random-effects model. We used the GRADE system to assess the certainty of evidence for each outcome.
MAIN RESULTS
There is no significant difference in pregnancy prolongation with the use of tocolysis in cases of placenta praevia (mean difference [MD] 11.51 days; 95% CI, - 1.75, 24.76; 3 trials, 253 participants; low certainty evidence). Tocolysis has no significant effect on gestational age at delivery (MD 0.33 weeks [95% CI - 1.53, 2.19]: 2 trials, 169 participants, moderate certainty evidence), birthweight (MD 0.12 kg [95% CI - 0.26, 0.5 kg]: 2 trials, 169 participants, moderate certainty evidence), risk of premature delivery (risk ratio [RR] 1.04; 95% CI 0.56, 1.94): 2 trials, 169 participants, low certainty evidence), risk of repeat vaginal bleeding (RR 1.05 [95% CI 0.73, 1.51]: 2 trials, 169 participants, moderate certainty evidence). Tocolysis has no significant effect on the risk of perinatal death (risk difference [RD]: 0.00 [95% CI - 0.04, 0.03]: 2 trials, 169 women; low certainty evidence), number of days of maternal hospitalisation (MD 0.60 days [95% CI - 0.79, 1.99]: 1 trial, 109 women; low certainty evidence), risk of fetal admissions into neonatology (RR 1.30 [95% CI 0.80, 2.12]: 1 trial, 109 participants, low certainty evidence) and on the duration of stay in neonatology units (MD 0.70 days [95% CI - 5.26, 6.66]: 1 trial, 109 participants, low certainty evidence).
CONCLUSION
In women with symptomatic placenta praevia, there is no significant effect on pregnancy prolongation with the use of tocolysis. Tocolysis has no significant effect on other prenatal, perinatal, neonatal and maternal outcomes among women with symptomatic placenta praevia.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO CRD42018091513.
Topics: Birth Weight; Female; Gestational Age; Humans; Parturition; Placenta Previa; Pregnancy; Pregnancy Complications; Tocolysis; Tocolytic Agents
PubMed: 30591076
DOI: 10.1186/s13643-018-0923-2