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Karimi A, Sayehmiri K, Vaismoradi M, Dianatinasab M, Daliri S. Vaginal bleeding in pregnancy and adverse clinical outcomes: a systematic review and meta-analysis. J OBSTET GYNAECOL 2024; 44:2288224. [PMID: 38305047 DOI: 10.1080/01443615.2023.2288224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 11/20/2023] [Indexed: 02/03/2024]
Abstract
Background: Vaginal bleeding during pregnancy has been recognised as a significant risk factor for adverse pregnancy outcomes. This study aimed to investigate the association between vaginal bleeding during the first trimester of pregnancy and clinical adverse effects using a systematic review and meta-analysis.Methods: Databases of Scopus, Web of Science, PubMed (including Medline), Cochrane Library and Science Direct were searched until June of 2023. Data analysis using statistical test fixed- and random-effects models in the meta-analysis, Cochran and meta-regression. The quality of the eligible studies was assessed by using the Newcastle-Ottawa Scale checklist (NOS).Results: A total of 46 relevant studies, with a sample size of 1,554,141 were entered into the meta-analysis. Vaginal bleeding during the first trimester of pregnancy increases the risk of preterm birth (OR: 1.8, CI 95%: 1.6-2.0), low birth weight (LBW; OR: 2.0, CI 95%: 1.5-2.6), premature rupture of membranes (PROMs; OR: 2.3, CI 95%: 1.8-3.0), abortion (OR: 4.3, CI 95%: 2.0-9.0), stillbirth (OR: 2.5, CI 95%: 1.2-5.0), placental abruption (OR: 2.2, CI 95%: 1.4-3.3) and placenta previa (OR: 1.9, CI 95%: 1.5-2.4).Conclusions: Vaginal bleeding in the first trimester of pregnancy is associated with preterm birth, LBW, PROMs, miscarriage, stillbirth, placental abruption and placenta previa. Therefore, physicians or midwives need to be aware of the possibility of these consequences and manage them when they occur.
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Affiliation(s)
- Arezoo Karimi
- Department of Epidemiology, School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Kourosh Sayehmiri
- Prevention Center of Social-Mental injuries, Ilam University of Medical Sciences, Ilam, Iran
| | | | - Mostafa Dianatinasab
- Department of Complex Genetics and Epidemiology, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Salman Daliri
- Clinical Research Development Unit, Imam Hossein Hospital, Shahroud University of Medical Sciences, Shahroud, Iran
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Schuster HJ, Breedveld AC, Matamoros SPF, van Eekelen R, Painter RC, Kok M, Hajenius PJ, Savelkoul PHM, van Egmond M, van Houdt R. The interrelation between microbial immunoglobulin coating, vaginal microbiota, ethnicity, and preterm birth. MICROBIOME 2024; 12:99. [PMID: 38802950 PMCID: PMC11131309 DOI: 10.1186/s40168-024-01787-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/01/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Vaginal microbiota composition is associated with spontaneous preterm birth (sPTB), depending on ethnicity. Host-microbiota interactions are thought to play an important underlying role in this association between ethnicity, vaginal microbiota and sPTB. METHODS In a prospective cohort of nulliparous pregnant women, we assessed vaginal microbiota composition, vaginal immunoglobulins (Igs), and local inflammatory markers. We performed a nested case-control study with 19 sPTB cases, matched based on ethnicity and midwifery practice to 19 term controls. RESULTS Of the 294 included participants, 23 pregnancies ended in sPTB. We demonstrated that Lactobacillus iners-dominated microbiota, diverse microbiota, and ethnicity were all independently associated with sPTB. Microbial Ig coating was associated with both microbiota composition and ethnicity, but a direct association with sPTB was lacking. Microbial IgA and IgG coating were lowest in diverse microbiota, especially in women of any ethnic minority. When correcting for microbiota composition, increased microbial Ig coating correlated with increased inflammation. CONCLUSION In these nulliparous pregnant women, vaginal microbiota composition is strongly associated with sPTB. Our results support that vaginal mucosal Igs might play a pivotal role in microbiota composition, microbiota-related inflammation, and vaginal community disparity within and between ethnicities. This study provides insight in host-microbe interaction, suggesting that vaginal mucosal Igs play an immunomodulatory role similar to that in the intestinal tract. Video Abstract.
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Affiliation(s)
- H J Schuster
- Amsterdam UMC location Vrije Universiteit Amsterdam, Medical Microbiology and Infection Control, Boelelaan 1117, Amsterdam, The Netherlands.
- Amsterdam institute for Immunology and Infectious Diseases, Amsterdam, The Netherlands.
- Amsterdam UMC location University of Amsterdam, Obstetrics and Gynecology, Meibergdreef 9, Amsterdam, The Netherlands.
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands.
| | - A C Breedveld
- Amsterdam institute for Immunology and Infectious Diseases, Amsterdam, The Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Molecular Cell Biology and Immunology, Boeleaan 1117, Amsterdam, The Netherlands
| | - S P F Matamoros
- Amsterdam UMC location Vrije Universiteit Amsterdam, Medical Microbiology and Infection Control, Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam institute for Immunology and Infectious Diseases, Amsterdam, The Netherlands
| | - R van Eekelen
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science, Boelelaan 1117, Amsterdam, The Netherlands
| | - R C Painter
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Obstetrics and Gynaecology, Boelelaan 1117, Amsterdam, The Netherlands
| | - M Kok
- Amsterdam UMC location University of Amsterdam, Obstetrics and Gynecology, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - P J Hajenius
- Amsterdam UMC location University of Amsterdam, Obstetrics and Gynecology, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - P H M Savelkoul
- Amsterdam UMC location Vrije Universiteit Amsterdam, Medical Microbiology and Infection Control, Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam institute for Immunology and Infectious Diseases, Amsterdam, The Netherlands
- Maastricht University Medical Center+, Medical Microbiology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht, The Netherlands
| | - M van Egmond
- Amsterdam institute for Immunology and Infectious Diseases, Amsterdam, The Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Molecular Cell Biology and Immunology, Boeleaan 1117, Amsterdam, The Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Surgery, Boelelaan 1117, Amsterdam, The Netherlands
| | - R van Houdt
- Amsterdam UMC location Vrije Universiteit Amsterdam, Medical Microbiology and Infection Control, Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam institute for Immunology and Infectious Diseases, Amsterdam, The Netherlands
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van Beukering MDM, Schuster HJ, Peelen MJCS, Schonewille MEA, Hajenius PJ, Duijnhoven RG, Brand T, Painter RC, Kok M. Working conditions in low risk nulliparous women in The Netherlands: are legislation and guidelines a guarantee for a healthy working environment? A cohort study. Int Arch Occup Environ Health 2022; 95:1305-1315. [PMID: 35708771 PMCID: PMC9273547 DOI: 10.1007/s00420-022-01888-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 05/16/2022] [Indexed: 12/04/2022]
Abstract
Objective Hazardous working conditions increase the risk of adverse pregnancy outcomes. In this study, we examine adherence to legislation and guidelines aimed at improving working conditions in pregnancy. Methods Between 2014 and 2016, we recruited a prospective cohort of low-risk nulliparous pregnant women in paid employment or self-employed in 16 community midwifery practices in The Netherlands. Participants completed two questionnaires concerning demographics, education, general health and working conditions between 10–16 and 20–24 weeks of pregnancy. We calculated the proportion of participants with work-related risk factors not in accordance with legislation and/or guidelines. Results Of 269 participants included, 214 (80%) completed both questionnaires. At 10–16 weeks 110 (41%) participants and at 20–24 weeks 129 (63%) participants continued to work under circumstances that did not meet recommendations. Employers provided mandated information on work adjustment to 37 (15%) participants and 96 (38%) participants received no information about the potential hazards while working with biological and chemical hazards. Participants with lower educational attainment (aOR 2.2 95%CI 1.3–3.9), or employment in healthcare (aOR 4.5, 95%CI 2.2–9.0), education/childcare and social service (aOR 2.6, 95%CI 1.1–6.0 2),, catering (aOR 3.6, 95%CI 1.1–12) and industry, construction and cleaning (aOR 3.3, 95%CI 1.1–10.3) more often continued work which did not meet recommendations. Conclusion There is poor adherence to national legislation and guidelines for safe working in pregnancy in The Netherlands: 50% of the pregnant women worked under hazardous conditions. Given the impact on adverse pregnancy outcomes as well as on the public purse, action to improve compliance must be taken by all stakeholders.
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Affiliation(s)
- Monique D M van Beukering
- Department of Obstetrics and Gynaecology, Location Amsterdam Medical Center, Amsterdam University Medical Centres, P.O. Box 22660, Amsterdam, 1100 DD, The Netherlands.
| | - Heleen J Schuster
- Department of Obstetrics and Gynaecology, Location Amsterdam Medical Center, Amsterdam University Medical Centres, P.O. Box 22660, Amsterdam, 1100 DD, The Netherlands
- Department of Medical Microbiology and Infection Control, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Myrthe J C S Peelen
- Department of Obstetrics and Gynaecology, Location Amsterdam Medical Center, Amsterdam University Medical Centres, P.O. Box 22660, Amsterdam, 1100 DD, The Netherlands
| | - Marit E A Schonewille
- Department of Obstetrics and Gynaecology, Location Amsterdam Medical Center, Amsterdam University Medical Centres, P.O. Box 22660, Amsterdam, 1100 DD, The Netherlands
| | - Petra J Hajenius
- Department of Obstetrics and Gynaecology, Location Amsterdam Medical Center, Amsterdam University Medical Centres, P.O. Box 22660, Amsterdam, 1100 DD, The Netherlands
| | - Ruben G Duijnhoven
- Department of Obstetrics and Gynaecology, Location Amsterdam Medical Center, Amsterdam University Medical Centres, P.O. Box 22660, Amsterdam, 1100 DD, The Netherlands
| | - Teus Brand
- Coronel Institute of Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Rebecca C Painter
- Department of Obstetrics and Gynaecology, Location Amsterdam Medical Center, Amsterdam University Medical Centres, P.O. Box 22660, Amsterdam, 1100 DD, The Netherlands
| | - Marjolein Kok
- Department of Obstetrics and Gynaecology, Location Amsterdam Medical Center, Amsterdam University Medical Centres, P.O. Box 22660, Amsterdam, 1100 DD, The Netherlands
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