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Suker A, Li Y, Robson D, Marren A. Australasian Recurrent Pregnancy Loss Clinical Management Guideline 2024 Part I. Aust N Z J Obstet Gynaecol 2024. [PMID: 38934264 DOI: 10.1111/ajo.13821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 04/03/2024] [Indexed: 06/28/2024]
Abstract
Guidelines for the investigation and management of recurrent pregnancy loss (RPL) have been developed in Europe, USA and UK, but there is currently no Australasian guideline. The Australasian Certificate of Reproductive Endocrinology and Infertility Consensus Expert Panel on Trial Evidence group has prepared a two-part guideline to provide guidance on the management of RPL. In Part I chromosomal, anatomical, and endocrine factors are outlined along with relevant recommendations for clinical management, levels of evidence and grades of consensus. In Part II thrombophilia, autoimmune factors, infective, inflammatory, and endometrial causes, environmental and lifestyle factors, male factor and unexplained causes will be outlined.
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Affiliation(s)
- Adriana Suker
- Department of Obstetrics & Gynaecology, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Ying Li
- Department of Reproductive Endocrinology & Infertility, Royal Prince Alfred Hospital, Women & Babies, Sydney, New South Wales, Australia
| | - Danielle Robson
- Department of Reproductive Endocrinology & Infertility, Royal Prince Alfred Hospital, Women & Babies, Sydney, New South Wales, Australia
| | - Anthony Marren
- Department of Reproductive Endocrinology & Infertility, Royal Prince Alfred Hospital, Women & Babies, Sydney, New South Wales, Australia
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Sekar S, Fernando S, Budithi S. Association between polycystic ovarian syndrome and incompetent uterine cervix: A systematic review and meta-analysis. J Gynecol Obstet Hum Reprod 2024; 53:102763. [PMID: 38432628 DOI: 10.1016/j.jogoh.2024.102763] [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: 06/12/2023] [Revised: 02/03/2024] [Accepted: 02/29/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE We aimed to determine the association between polycystic ovarian syndrome (PCOS) and cervical incompetence (CI). We hypothesise that insulin resistance induces a glucose metabolism disorder that could potentially cause cervical incompetence, resulting in an adverse outcome. DESIGN We conducted a systematic review and meta-analysis of observational studies to summarise the evidence regarding the strength of the association of occurrence of CI in a PCOS pregnant woman compared to a non-PCOS pregnant woman. We defined PCOS as the presence of two of the three Rotterdam criteria, and a combination of clinical symptoms and ultrasound findings were used to diagnose CI. METHOD This review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) reporting standards and the PROSPERO registration. We systematically searched PubMed, Embase and Cochrane databases to identify observational studies up to December 2022. We included studies in English which compared the PCOS and non-PCOS pregnant women who were diagnosed using Rotterdam criteria and subsequently developed CI in the same pregnancy. We excluded the studies which did not report CI as an outcome. Two reviewers independently screened studies, extracted data, and assessed the risk of bias (JBI critical appraisal tools). In the meta-analysis, effect estimates were pooled using the random effects model, and heterogeneity was measured using I2 statistics. RESULTS We identified 23 articles, of which 19 were screened, and three studies were included in the meta-analysis. Three observational studies reported the data of 3845 pregnant women with PCOS and 9449 pregnant women without PCOS. One hundred and forty-one (3.7 %) pregnant women with PCOS developed CI compared to 58 (0.6 %) non-PCOS pregnant women [Risk ratio: 5.3; 95 % confidence interval: 1.9-14.6; I2: 89 %]. Of the three studies included, two had a low risk of bias, and one had a moderate risk of bias. CONCLUSION The findings of the review suggested higher risk of CI in a pregnant woman with PCOS compared to pregnant women without PCOS. These findings highlight the necessity of establishing guidelines for early identification of CI in PCOS pregnant mothers to prevent adverse maternal and neonatal outcomes following preterm labour.
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Affiliation(s)
- Sindhu Sekar
- Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board, Wrexham LL13 7TD, United Kingdom.
| | - Sujeewa Fernando
- Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board, Wrexham LL13 7TD, United Kingdom
| | - Srividhya Budithi
- Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board, Wrexham LL13 7TD, United Kingdom
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Potdar N, Iyasere C. Early pregnancy complications including recurrent pregnancy loss and obesity. Best Pract Res Clin Obstet Gynaecol 2023; 90:102372. [PMID: 37451193 DOI: 10.1016/j.bpobgyn.2023.102372] [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: 05/08/2023] [Revised: 05/31/2023] [Accepted: 06/05/2023] [Indexed: 07/18/2023]
Abstract
This review on early pregnancy complications and obesity will focus on the known pregnancy complications such as miscarriage (whether spontaneous or after fertility treatment), polycystic ovaries and risk of miscarriage, recurrent pregnancy loss, ectopic pregnancy, hyperemesis gravidarum and birth defects. Evidence will be assessed and mechanistic pathways for the outcomes will be described. We know that obesity is now a pandemic and has an impact on early pregnancy complications. The evidence has been summarised to provide the reader with a comprehensive overview and advice for pregnant women with obesity in early pregnancy.
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Affiliation(s)
- Neelam Potdar
- Department of Reproductive Medicine, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, LE1 5WW, UK; Department of Health Sciences, University of Leicester, UK.
| | - Cecilia Iyasere
- Department of Reproductive Medicine, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, LE1 5WW, UK; Department of Health Sciences, University of Leicester, UK
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Firoz T, Pineles B, Navrange N, Grimshaw A, Oladapo O, Chou D. Non-communicable diseases and maternal health: a scoping review. BMC Pregnancy Childbirth 2022; 22:787. [PMID: 36273124 PMCID: PMC9587654 DOI: 10.1186/s12884-022-05047-6] [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: 03/05/2022] [Accepted: 09/05/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Non-communicable diseases [NCDs] are leading causes of ill health among women of reproductive age and an increasingly important cause of maternal morbidity and mortality worldwide. Reliable data on NCDs is necessary for accurate measurement and response. However, inconsistent definitions of NCDs make reliable data collection challenging. We aimed to map the current global literature to understand how NCDs are defined, operationalized and discussed during pregnancy, childbirth and the postnatal period. METHODS: For this scoping review, we conducted a comprehensive global literature search for NCDs and maternal health covering the years 2000 to 2020 in eleven electronic databases, five regional WHO databases and an exhaustive grey literature search without language restrictions. We used a charting approach to synthesize and interpret the data. RESULTS: Only seven of the 172 included sources defined NCDs. NCDs are often defined as chronic but with varying temporality. There is a broad spectrum of conditions that is included under NCDs including pregnancy-specific conditions and infectious diseases. The most commonly included conditions are hypertension, diabetes, epilepsy, asthma, mental health conditions and malignancy. Most publications are from academic institutions in high-income countries [HICs] and focus on the pre-conception period and pregnancy. Publications from HICs discuss NCDs in the context of pre-conception care, medications, contraception, health disparities and quality of care. In contrast, publications focused on low- and middle-income countries discuss NCDs in the context of NCD prevention. They take a life cycle approach and advocate for integration of NCD and maternal health services. CONCLUSION Standardising the definition and improving the articulation of care for NCDs in the maternal health setting would help to improve data collection and facilitate monitoring. It would inform the development of improved care for NCDs at the intersection with maternal health as well as through a woman's life course. Such an approach could lead to significant policy and programmatic changes with the potential corresponding impact on resource allocation.
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Affiliation(s)
- Tabassum Firoz
- Yale New Haven Health, Bridgeport Hospital, Bridgeport, CT, USA
| | - Beth Pineles
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | | | - Alyssa Grimshaw
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, USA
| | | | - Doris Chou
- World Health Organization, Geneva, Switzerland.
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Pregnancy Loss. PHYSICIAN ASSISTANT CLINICS 2022. [DOI: 10.1016/j.cpha.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Abstract
Importance Recurrent spontaneous abortion (RSA) is a distressing condition experienced by approximately 1% of women trying to conceive. However, the treatment of RSA is a challenge both for clinicians and patients. Objective The aim of this review is to discuss the medical and surgical approach to the management of RSA, including those caused by anatomical, genetic, male, infectious, endocrine, and immune factors. Evidence Acquisition A literature search using MeSH terms for each topic was undertaken using PubMed, supplemented by hand searching for additional references. Retrieved articles were reviewed, synthesized, and summarized. Results Available treatments target hypothetical risk factors for RSA, although the effectiveness of many treatment options is controversial. Intervention should depend on the benefit-to-risk ratio of the proposed treatment. Conclusions and Relevance The etiology of RSA is heterogeneous, and patients often lack specific clinical manifestations, which has hindered the progress in predicting and preventing RSA to some extent. Despite intensive workup, at least 50% of couples do not have a clear underlying pathology. In addition, an evidence-based treatment is not available in most patients even if abnormal test results are present. Many new treatment directions are also still actively exploring; empirical and combined multiple treatments are still the main methods. Target Audience Obstetricians and gynecologists, family physicians. Learning Objectives After completing this activity, the learner should be better able to describe common risk factors for RSA; formulate individualized treatment plans to improve pregnancy outcomes; and propose supportive treatment recommendations for patients with unclear causes.
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Shields R, Khan O, Lim Choi Keung S, Hawkes AJ, Barry A, Devall AJ, Quinn SD, Keay SD, Arvanitis TN, Bick D, Quenby S. Quantitative assessment of pregnancy outcome following recurrent miscarriage clinic care: a prospective cohort study. BMJ Open 2022; 12:e052661. [PMID: 35110317 PMCID: PMC8811565 DOI: 10.1136/bmjopen-2021-052661] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To measure pregnancy outcome following attendance at a recurrent miscarriage service and identify factors that influence outcome. DESIGN Prospective, observational electronic cohort study. SETTING Participants attending a specialist recurrent miscarriage clinic, with a history of two or more pregnancy losses. 857 new patients attended over a 30-month period and were invited to participate. Participant data were recorded on a bespoke study database, 'Tommy's Net'. PARTICIPANTS 777 women consented to participate (90.7% of new patients). 639 (82%) women continued within the cohort, and 138 were lost to follow-up. Mean age of active participants was 34 years for women and 37 years for partners, with a mean of 3.5 (1-19) previous pregnancy losses. Rates of obesity (maternal: 23.8%, paternal: 22.4%), smoking (maternal:7.4%, paternal: 19.4%) and alcohol consumption (maternal: 50%, paternal: 79.2%) were high and 55% of participants were not taking folic acid. OUTCOME MEASURES Biannual collection of pregnancy outcomes, either through prompted self-reporting, or existing hospital systems. RESULTS 639 (82%) women were followed up. 404 (83.4%) reported conception and 106 (16.6%) reported no pregnancy, at least 6 months following registration. Of those that conceived, 72.8% (294/404) had a viable pregnancy. Maternal smoking and body mass index (BMI) over 30 were significantly higher in those who did not conceive (p=0.001) CONCLUSIONS: Tommy's Net provides a secure electronic repository on data for couples with recurrent pregnancy loss and associated outcomes. The study identified that subfertility, as well as repeated miscarriage, maternal BMI and smoking status, contributed to failure to achieve live birth. Study findings may enable comparison of clinic outcomes and inform the development of a personalised holistic care package.
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Affiliation(s)
- Rebecca Shields
- Division of Reproductive Health, University of Warwick, Coventry, UK
- Tommy's National Centre for Miscarriage Research, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Omar Khan
- Institute of Digital Healthcare, University of Warwick, Coventry, UK
| | | | - Amelia Jane Hawkes
- Division of Reproductive Health, University of Warwick, Coventry, UK
- Tommy's National Centre for Miscarriage Research, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Aisling Barry
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Adam J Devall
- Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Stephen D Quinn
- 5. Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, Imperial College London, London, UK
| | - Stephen D Keay
- Centre for Reproductive Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | | | - Debra Bick
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Siobhan Quenby
- Tommy's National Centre for Miscarriage Research, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Institute of Early Life, University of Warwick, Coventry, UK
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Hong L, Zhu YC, Liu S, Wu T, Li Y, Ye L, Diao L, Zeng Y. Multi-omics reveals a relationship between endometrial amino acid metabolism and autophagy in women with recurrent miscarriage†. Biol Reprod 2021; 105:393-402. [PMID: 34050352 DOI: 10.1093/biolre/ioab101] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 04/29/2021] [Accepted: 05/18/2021] [Indexed: 12/28/2022] Open
Abstract
Deterioration of the endometrial environment is an essential cause of recurrent miscarriage (RM). However, current studies in terms of endometrial amino acid metabolic characterization and autophagy are still inadequate. We tried to (1) identify the alternation in metabolite profiles in the RM endometrium; (2) investigate the expression of autophagy-related proteins in RM; and (3) elucidate the association between amino acid metabolism and autophagy in RM. Our results showed that glutamine metabolites were up-regulated in the endometrium of RM women. The levels of autophagy-associated proteins, LC3B, ATG12, and Beclin-1, were significantly higher in RM. Hemostasis, autophagy and IFNα signaling were the top three differentially activated signaling pathways between women with RM and normal pregnancy. Interestingly the expression of AMPK and GCN2 was significantly up-regulated in the endometrium of women with RM, and the same expression trend was also observed in the human endometrial stromal cells cultured in glutamine deprivation medium. Furthermore, inhibition of AMPK decreased the level of GCN2, indicating a positive correlation between GCN2 and AMPK. The expression of GCN2 was consistent with the expression of ATG12 and beclin-1; however, it was opposite to that of p62. Exposure to glutamine deprivation increased the level of LC3B, GCN2, ATG12, and beclin-1. Altogether, these findings suggested significant crosstalk between amino acid metabolism and autophagy. In summary, our data suggested that aberrant crosstalk between amino acid metabolism and autophagy may contribute to the impaired endometrial microenvironment of RM. Our study may provide new insight into the diagnosis of RM due to endometrial factors.
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Affiliation(s)
- Ling Hong
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproductive Medicine and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Yuan Chang Zhu
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproductive Medicine and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Su Liu
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproductive Medicine and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Tonghua Wu
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproductive Medicine and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Yuye Li
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproductive Medicine and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Lijun Ye
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproductive Medicine and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Lianghui Diao
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproductive Medicine and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
| | - Yong Zeng
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-implantation, Shenzhen Zhongshan Institute for Reproductive Medicine and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen, China
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Ng KYB, Cherian G, Kermack AJ, Bailey S, Macklon N, Sunkara SK, Cheong Y. Systematic review and meta-analysis of female lifestyle factors and risk of recurrent pregnancy loss. Sci Rep 2021; 11:7081. [PMID: 33782474 PMCID: PMC8007745 DOI: 10.1038/s41598-021-86445-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 03/08/2021] [Indexed: 01/19/2023] Open
Abstract
It is known that lifestyle factors affect sporadic miscarriage, but the extent of this on RPL (recurrent pregnancy loss) is less well known. A systematic review and meta-analysis was performed to assess the associations between lifestyle factors and RPL. Studies that analysed RPL in the context of BMI, smoking, alcohol and caffeine intake were included. The primary and secondary outcomes were odds of having RPL in the general population and odds of further miscarriage, respectively. Underweight and women with BMI > 25 are at higher odds of RPL in the general population (OR 1.2, 95% CI 1.12-1.28 and OR 1.21, 95% CI 1.06-1.38, respectively). In women with RPL, having BMI > 30 and BMI > 25 has increased odds of further miscarriages (OR 1.77, 95% CI 1.25-2.50 and OR 1.35, 95% CI 1.07-1.72, respectively). The quality of the evidence for our findings was low or very low. Being underweight and BMI > 25 contributes significantly to increased risk of RPL (general population). BMI > 25 or BMI > 30 increases the risk of further miscarriages (RPL population). Larger studies addressing the effects of alcohol, cigarette smoking and caffeine on the risk of RPL with optimisation of BMI in this cohort of women are now needed.
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Affiliation(s)
- Ka Ying Bonnie Ng
- School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK
- Department of Obstetrics and Gynaecology, Princess Anne Hospital, Room F86, Level F, Coxford Road, Southampton, SO16 5YA, UK
| | - George Cherian
- Department of Obstetrics and Gynaecology, Princess Anne Hospital, Room F86, Level F, Coxford Road, Southampton, SO16 5YA, UK
| | - Alexandra J Kermack
- School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK
- Department of Obstetrics and Gynaecology, Princess Anne Hospital, Room F86, Level F, Coxford Road, Southampton, SO16 5YA, UK
| | - Sarah Bailey
- Department of Obstetrics and Gynaecology, Princess Anne Hospital, Room F86, Level F, Coxford Road, Southampton, SO16 5YA, UK
| | - Nick Macklon
- Zealand University Hospital, University of Copenhagen, Copenhagen, Denmark
- London Women's Clinic, London, W1G 6AP, UK
| | - Sesh K Sunkara
- Department of Women and Children's Health, Kings College London, Guy's Hospital, 11th Floor, Tower Wing, London, SE1 9RT, UK
| | - Ying Cheong
- School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK.
- Department of Obstetrics and Gynaecology, Princess Anne Hospital, Room F86, Level F, Coxford Road, Southampton, SO16 5YA, UK.
- Complete Fertility Southampton, Princess Anne Hospital, Coxford Road, Southampton, SO16 5YA, UK.
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Hennessy M, Dennehy R, Meaney S, Linehan L, Devane D, Rice R, O'Donoghue K. Clinical practice guidelines for recurrent miscarriage in high-income countries: a systematic review. Reprod Biomed Online 2021; 42:1146-1171. [PMID: 33895080 DOI: 10.1016/j.rbmo.2021.02.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 10/22/2022]
Abstract
Recurrent miscarriage affects 1-2% of women of reproductive age, depending on the definition used. A systematic review was conducted to identify, appraise and describe clinical practice guidelines (CPG) published since 2000 for the investigation, management, and/or follow-up of recurrent miscarriage within high-income countries. Six major databases, eight guideline repositories and the websites of 11 professional organizations were searched to identify potentially eligible studies. The quality of eligible CPG was assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE II) Tool. A narrative synthesis was conducted to describe, compare and contrast the CPG and recommendations therein. Thirty-two CPG were included, from which 373 recommendations concerning first-trimester recurrent miscarriage were identified across four sub-categories: structure of care (42 recommendations, nine CPG), investigations (134 recommendations, 23 CPG), treatment (153 recommendations, 24 CPG), and counselling and supportive care (46 recommendations, nine CPG). Most CPG scored 'poor' on applicability (84%) and editorial independence (69%); and to a lesser extent stakeholder involvement (38%) and rigour of development (31%). Varying levels of consensus were found across CPG, with some conflicting recommendations. Greater efforts are required to improve the quality of evidence underpinning CPG, the rigour of their development and the inclusion of multi-disciplinary perspectives, including those with lived experience of recurrent miscarriage.
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Affiliation(s)
- Marita Hennessy
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork T12 DC4A, Ireland; The Irish Centre for Maternal and Child Health, University College Cork, Cork University Maternity Hospital, Cork T12 DC4A, Ireland; College of Medicine and Health, University College Cork Cork T12 EKDO, Ireland.
| | - Rebecca Dennehy
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork T12 DC4A, Ireland; The Irish Centre for Maternal and Child Health, University College Cork, Cork University Maternity Hospital, Cork T12 DC4A, Ireland; College of Medicine and Health, University College Cork Cork T12 EKDO, Ireland
| | - Sarah Meaney
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork T12 DC4A, Ireland; The Irish Centre for Maternal and Child Health, University College Cork, Cork University Maternity Hospital, Cork T12 DC4A, Ireland; College of Medicine and Health, University College Cork Cork T12 EKDO, Ireland; National Perinatal Epidemiology Centre, University College Cork, Cork University Maternity Hospital Cork T12 DC4A, Ireland
| | - Laura Linehan
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork T12 DC4A, Ireland; The Irish Centre for Maternal and Child Health, University College Cork, Cork University Maternity Hospital, Cork T12 DC4A, Ireland; College of Medicine and Health, University College Cork Cork T12 EKDO, Ireland
| | - Declan Devane
- The Irish Centre for Maternal and Child Health, University College Cork, Cork University Maternity Hospital, Cork T12 DC4A, Ireland; School of Nursing and Midwifery, National University of Ireland, Galway, Galway H91 E3YV, Ireland; Evidence Synthesis Ireland, National University of Ireland, Galway, Galway H91 E3YV, Ireland
| | - Rachel Rice
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork T12 DC4A, Ireland; School of Applied Social Studies, University College Cork, Cork T12 D726, Ireland
| | - Keelin O'Donoghue
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork T12 DC4A, Ireland; The Irish Centre for Maternal and Child Health, University College Cork, Cork University Maternity Hospital, Cork T12 DC4A, Ireland; College of Medicine and Health, University College Cork Cork T12 EKDO, Ireland
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Hennessy M, Dennehy R, Meaney S, Devane D, O'Donoghue K. A protocol for a systematic review of clinical practice guidelines for recurrent miscarriage. HRB Open Res 2020; 3:12. [PMID: 33005862 PMCID: PMC7477641 DOI: 10.12688/hrbopenres.13024.3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 12/12/2022] Open
Abstract
Recurrent miscarriage (RM) was recently re-defined by the European Society of Human Reproduction and Embryology (ESHRE) as the loss of two or more consecutive pregnancies. Before this, and indeed still in some countries, RM was defined as three or more consecutive pregnancy losses. While the incidence of RM depends on the definition employed and population studied, it is generally accepted to affect 1-6% of women of reproductive age. Clinical practice guidelines (CPGs) for RM have been published by some professional organisations. While there are CPGs on miscarriage in Ireland, there are none concerning RM specifically. The aim of this systematic review is to identify, appraise and describe published CPGs for the management, investigation and/or follow-up of RM within high-income countries. Electronic databases (MEDLINE (Ovid
®; 1946), Embase
® (Elsevier; 1980), CINAHL Complete (EBSCOhost; 1994), Web of Science™ (Thomson Reuters), Scopus (Elsevier; 2004), and Open Grey (INIST-CNRS; 2011)), selected guideline repositories, and the websites of professional societies will be searched to identify CPGs, published within the last 20 years, for potential inclusion. Two reviewers will review abstracts and full texts independently against the eligibility criteria. Characteristics and recommendations of included CPGs will be extracted by one reviewer and double-checked by another. Two reviewers will use the Appraisal of Guidelines for Research and Evaluation version 2 (AGREE II) instrument independently to assess the quality of the included CPGs. Narrative synthesis will be conducted to appraise and compare CPGs and their recommendations or guidance therein. The identification, appraisal and description of published CPGs in other high-income countries will be a valuable first step in informing efforts to promote the optimisation and standardisation of RM care.
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Affiliation(s)
- Marita Hennessy
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland.,The Irish Centre for Maternal and Child Health, University College Cork, Cork University Maternity Hospital, Cork, Ireland.,College of Medicine and Health, University College Cork, Cork, Ireland
| | - Rebecca Dennehy
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland.,The Irish Centre for Maternal and Child Health, University College Cork, Cork University Maternity Hospital, Cork, Ireland.,College of Medicine and Health, University College Cork, Cork, Ireland
| | - Sarah Meaney
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland.,The Irish Centre for Maternal and Child Health, University College Cork, Cork University Maternity Hospital, Cork, Ireland.,College of Medicine and Health, University College Cork, Cork, Ireland.,National Perinatal Epidemiology Centre, University College Cork, Cork University Maternity Hospital, Cork, Ireland
| | - Declan Devane
- The Irish Centre for Maternal and Child Health, University College Cork, Cork University Maternity Hospital, Cork, Ireland.,School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland.,Evidence Synthesis Ireland, National University of Ireland, Galway, Galway, Ireland
| | - Keelin O'Donoghue
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland.,The Irish Centre for Maternal and Child Health, University College Cork, Cork University Maternity Hospital, Cork, Ireland.,College of Medicine and Health, University College Cork, Cork, Ireland
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Hennessy M, Dennehy R, Meaney S, Devane D, O'Donoghue K. A protocol for a systematic review of clinical practice guidelines for recurrent miscarriage. HRB Open Res 2020; 3:12. [PMID: 33005862 PMCID: PMC7477641 DOI: 10.12688/hrbopenres.13024.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 08/27/2023] Open
Abstract
Recurrent miscarriage (RM) was recently re-defined by the European Society of Human Reproduction and Embryology (ESHRE) as the loss of two or more consecutive pregnancies. Before this, and indeed still in some countries, RM was defined as three or more consecutive pregnancy losses. While the incidence of RM depends on the definition employed and population studied, it is generally accepted to affect 1-6% of women of reproductive age. Clinical practice guidelines (CPGs) for RM have been published by some professional organisations. While there are CPGs on miscarriage in Ireland, there are none concerning RM specifically. The aim of this systematic review is to identify, appraise and describe published CPGs for the management, investigation and/or follow-up of RM within high-income countries. Electronic databases (MEDLINE (Ovid ®; 1946), Embase ® (Elsevier; 1980), CINAHL Complete (EBSCOhost; 1994), Web of Science™ (Thomson Reuters), Scopus (Elsevier; 2004), and Open Grey (INIST-CNRS; 2011)), selected guideline repositories, and the websites of professional societies will be searched to identify CPGs, published within the last 20 years, for potential inclusion. Two reviewers will review abstracts and full texts independently against the eligibility criteria. Characteristics and recommendations of included CPGs will be extracted by one reviewer and double-checked by another. Two reviewers will use the Appraisal of Guidelines for Research and Evaluation version 2 (AGREE II) instrument independently to assess the quality of the included CPGs. Narrative synthesis will be conducted to appraise and compare CPGs and their recommendations or guidance therein. The identification, appraisal and description of published CPGs in other high-income countries will be a valuable first step in informing efforts to promote the optimisation and standardisation of RM care.
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Affiliation(s)
- Marita Hennessy
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
- The Irish Centre for Maternal and Child Health, University College Cork, Cork University Maternity Hospital, Cork, Ireland
- College of Medicine and Health, University College Cork, Cork, Ireland
| | - Rebecca Dennehy
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
- The Irish Centre for Maternal and Child Health, University College Cork, Cork University Maternity Hospital, Cork, Ireland
- College of Medicine and Health, University College Cork, Cork, Ireland
| | - Sarah Meaney
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
- The Irish Centre for Maternal and Child Health, University College Cork, Cork University Maternity Hospital, Cork, Ireland
- College of Medicine and Health, University College Cork, Cork, Ireland
- National Perinatal Epidemiology Centre, University College Cork, Cork University Maternity Hospital, Cork, Ireland
| | - Declan Devane
- The Irish Centre for Maternal and Child Health, University College Cork, Cork University Maternity Hospital, Cork, Ireland
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
- Evidence Synthesis Ireland, National University of Ireland, Galway, Galway, Ireland
| | - Keelin O'Donoghue
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
- The Irish Centre for Maternal and Child Health, University College Cork, Cork University Maternity Hospital, Cork, Ireland
- College of Medicine and Health, University College Cork, Cork, Ireland
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Han Y, Li M, Ma H, Yang H. Cervical insufficiency: a noteworthy disease with controversies. J Perinat Med 2020; 48:648-655. [PMID: 32692707 DOI: 10.1515/jpm-2020-0255] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 06/19/2020] [Indexed: 11/15/2022]
Abstract
Cervical insufficiency (CI) is a mainly disease leading to recurrent abortions and preterm birth which may present in about 1% of obstetric populations. Recurrent pregnancy losses caused by CI incur serious economic burdens on society as well as huge psychological burdens to family members. However, many patients even clinicians in some areas of the world still remain confused about this disease. At the same time, the etiology of CI is still uncertain and it is still a controversial disease in diagnosis and treatment. This article summarizes the potential risk factors associated with CI, which could be worthy of attention and helpful for future research. It also reviews the methods for diagnosis and treatment of CI to better understand this noteworthy disease, as well as presents the related consensus and controversies according to the newly updated guidelines, which has practical significance for conducting more in-depth investigations in the future.
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Affiliation(s)
- Yu Han
- Department of First Clinical Medical College, Shanxi Medical University, Taiyuan, P.R. China
| | - Mengnan Li
- Department of Obstetrics, First Hospital of Shanxi Medical University, Taiyuan, P.R. China
| | - Huijing Ma
- Department of Obstetrics, First Hospital of Shanxi Medical University, Taiyuan, P.R. China
| | - Hailan Yang
- Department of Obstetrics, First Hospital of Shanxi Medical University, Taiyuan, P.R. China
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14
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The Prevalence and Impact of Polycystic Ovary Syndrome in Recurrent Miscarriage: A Retrospective Cohort Study and Meta-Analysis. J Clin Med 2020; 9:jcm9092700. [PMID: 32825545 PMCID: PMC7565166 DOI: 10.3390/jcm9092700] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/14/2020] [Accepted: 08/17/2020] [Indexed: 12/26/2022] Open
Abstract
Background: The use of different definitions and diagnostic approaches of polycystic ovary syndrome (PCOS) and recurrent miscarriage (RM) has led to a wide range of prevalence rates in the literature. Despite the persistent controversy about the factual prevalence of PCOS in RM, a vast number of studies have revealed evidence about their association with each other. The goals of this study were to evaluate the prevalence of polycystic ovarian morphology and PCOS within the RM population, performing meta-analyses with the obtained data from this study, together with previous reports on this topic and evaluating reproductive outcome in women with RM and PCOS. Methods: A retrospective cohort study with 452 women with RM and a meta-analysis were conducted. The main outcome parameter was the prevalence of PCOS in RM patients. Results: In the retrospective study, the prevalence of PCOS in RM was 9.5%. Negative results for the selected risk factors for RM were present in 283 patients (62.6%). From all evaluated possible underlying causes for RM, only the presence of thrombophilic disorders was significantly associated with PCOS (PCOS: 20.9% versus no PCOS: 7.8%, p = 0.010). In the meta-analysis of three studies on PCOS in RM patients, which used the revised Rotterdam criteria for defining PCOS, an estimated pooled prevalence of 14.3% (95% CI: 6.2–24.9) was found. In the retrospective data set, women in the PCOS group revealed significantly higher luteinizing hormone (LH), testosterone, and Anti-Mullerian hormone (AMH) levels than age- and body mass index (BMI)-matched controls with RM negative for the selected risk facotrs (p < 0.05). The rate of further miscarriages was significantly higher in PCOS women than in controls (71.4% versus 53.6%, respectively; p = 0.031). Conclusions: The prevalence of PCOS seems slightly increased in women with RM. Women with PCOS suffering from RM showed a significantly higher risk for further miscarriage and decreased chances of having a life birth of about 18% which did not reach statistical significance. Therefore, we assume that PCOS plays a moderate role in RM.
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Sadeghi A, Fadaei R, Moradi N, Fouani FZ, Roozbehkia M, Zandieh Z, Ansaripour S, Vatannejad A, Doustimotlagh AH. Circulating levels of C1q/TNF-α-related protein 6 (CTRP6) in polycystic ovary syndrome. IUBMB Life 2020; 72:1449-1459. [PMID: 32170998 DOI: 10.1002/iub.2272] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 02/10/2020] [Accepted: 02/25/2020] [Indexed: 12/22/2022]
Abstract
Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders affecting females of reproductive age. It has been associated with cardiometabolic disorders including diabetes mellitus and cardiovascular disorders, and increases the risk of developing fecundity pathologies including recurrent pregnancy loss (RPL) and infertility. C1q/tumor necrosis factor-α-related protein-6 (CTRP6) is a novel adipokine involved in glucose and lipid metabolism, host inflammation, and organogenesis. In the present study, we aimed to determine the association of serum CTRP6 levels with some components of metabolic syndrome in PCOS patients (infertile PCOS [inf-PCOS] and PCOS-RPL). This case-control study included 120 PCOS patients (60 inf-PCOS and 60 PCOS-RPL) and 60 healthy controls. Serum high-sensitivity C-reactive protein (hs-CRP) and homocysteine were measured using commercial kits, while adiponectin and CTRP6 levels were assessed using ELISA technique. Inf-PCOS and PCOS-RPL individuals had higher levels of serum CTRP6 than controls (546.15 ± 125.02 ng/ml and 534.04 ± 144.19 ng/ml vs. 440.16 ± 159.24 ng/ml; both p < .001). Moreover, serum adiponectin levels were significantly reduced, while fasting insulin, homeostasis model assessment of insulin resistance, free testosterone, and hs-CRP levels were significantly elevated in PCOS group, when compared with controls. Furthermore, serum CTRP6 positively associated with body mass index in all subjects. It showed an inverse correlation with adiponectin in PCOS group and subgroups. However, it had a direct association with hs-CRP in PCOS group and inf-PCOS subgroup, but not PCOS-RPL subgroup. These findings unravel a probable role of CTRP6 in PCOS pathogenesis, which poses a possibility to be a good diagnostic target. However, further investigation is needed.
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Affiliation(s)
- Asie Sadeghi
- Student Research Committee, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran.,Department of Clinical Biochemistry, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Reza Fadaei
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nariman Moradi
- Cellular and Molecular Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.,Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Fatima Z Fouani
- Department of Cellular and Molecular Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Roozbehkia
- Department of Immunology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Zandieh
- Shahid Akbar Abadi Clinical Research Development Unit (ShACRDU), Iran University of Medical Sciences, Tehran, Iran
| | - Soheila Ansaripour
- Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR, Tehran, Iran
| | - Akram Vatannejad
- Department of Comparative Biosciences, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran.,Student's Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir H Doustimotlagh
- Medicinal Plants Research Center, Yasuj University of Medical Sciences, Yasuj, Iran.,Department of Clinical Biochemistry, Faculty of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran
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Cavalcante MB, Sarno M, Cavalcante CTDMB, Araujo Júnior E, Barini R. Coagulation Biomarkers in Women with Recurrent Miscarriage and Polycystic Ovarian Syndrome: Systematic Review and Meta-Analysis. Geburtshilfe Frauenheilkd 2019; 79:697-704. [PMID: 31303657 PMCID: PMC6620176 DOI: 10.1055/a-0884-3212] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 03/22/2019] [Accepted: 03/26/2019] [Indexed: 12/24/2022] Open
Abstract
Introduction Pregnant women with polycystic ovarian syndrome (PCOS) have high risk of pregnancy loss. Pathophysiological mechanisms appear to be associated with obesity, hormonal factors, or blood clotting disorders. Our aim is to perform a systematic review and meta-analysis on the relationship between coagulation disorders and risk of recurrent miscarriage (RM) in patients with PCOS and to identify coagulation biomarkers for this condition. Material and Methods PubMed and MEDLINE databases were searched for publications in English language. The search terms used included "RM", "polycystic ovary syndrome", "coagulation disorders", and "thrombophilia". Odds ratios (ORs) and 95% confidence intervals (CIs) for miscarriage in different RM groups (with and without PCOS). Results A total of 575 publications including the search terms were identified. Six studies were included for qualitative analysis, and five were included for quantitative analysis (meta-analysis). We found no association between RM and inherited thrombophilias in patients with PCOS: (1) Factor V Leiden (OR, 0.74; 95% CI, 0.38 - 1.45; p = 0.38); (2) C677T methylenetetrahydrofolate reductase polymorphism (MTHFR) (OR, 1.01; 95% CI, 0.64 - 1.59; p = 0.97); and (3) A1297C MTHFR polymorphism (OR, 1.08; 95% CI, 0.62 - 1.89; p = 0.77). Other potential biomarkers were identified, with emphasis on plasminogen activator inhibitor type 1. Conclusion Data available in the current literature revealed that there was no association between RM and inherited thrombophilias in patients with PCOS. RM patients with PCOS have a high risk of thromboembolic events.
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Affiliation(s)
| | - Manoel Sarno
- Department of Obstetrics and Gynecology, Federal University of Bahia (UFBA), Salvador-BA, Brazil
| | | | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil
| | - Ricardo Barini
- Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP), Campinas-SP, Brazil
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Relation of Pregnancy Loss to Risk of Cardiovascular Disease in Parous Postmenopausal Women (From the Women's Health Initiative). Am J Cardiol 2019; 123:1620-1625. [PMID: 30871746 DOI: 10.1016/j.amjcard.2019.02.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/05/2019] [Accepted: 02/11/2019] [Indexed: 01/06/2023]
Abstract
Women with history of pregnancy loss (PL) have higher burden of cardiovascular disease (CVD) later in life, yet it is unclear whether this is attributable to an association with established CVD risk factors (RFs). We examined whether PL is associated with CVD RFs and biomarkers in parous postmenopausal women in the Women's Health Initiative, and whether the association between PL and CVD RFs accounted for the association between PL and incident CVD. Linear and logistic regressions were used to estimate associations between baseline history of PL and CVD RFs. Cox proportional hazards regression models were used to estimate the associations between baseline history of PL and incident CVD after adjustment for baseline RFs. Of 79,121 women, 27,272 (35%) had experienced PL. History of PL was associated with higher body mass index (p < 0.0001), hypertension (p < 0.0001), diabetes (p = 0.003), depression (p < 0.0001), and lower income (p < 0.0001), physical activity (p = 0.01), poorer diet (p < 0.0001), smoking (p < 0.0001), and alcohol use (p < 0.0001). After adjustment for CVD RFs, PL was significantly associated with incident CVD over mean follow up of 16 years (hazard ratio 1.11, 95% confidence interval 1.06 to 1.16). In conclusion, several CVD RFs are associated with PL, but they do not entirely account for the association between PL and incident CVD.
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Cavalcante MB, Sarno M, Peixoto AB, Araujo Júnior E, Barini R. Obesity and recurrent miscarriage: A systematic review and meta-analysis. J Obstet Gynaecol Res 2018; 45:30-38. [PMID: 30156037 DOI: 10.1111/jog.13799] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 08/06/2018] [Indexed: 01/02/2023]
Abstract
The aim of this study is to perform a systematic review and meta-analysis on the relationship between excess weight and risk of recurrent pregnancy loss (RPL) and to highlight the common immunological mechanisms of these two conditions. The PubMed and MEDLINE databases were searched for publications in English available as of November 2017. The search terms used were 'recurrent pregnancy loss', 'body mass index' (BMI), 'overweight' and 'obesity'. For calculation of the odds ratio (OR) and 95% confidence intervals (CI) for miscarriage in different BMI groups, RevMan software was used (Review Manager, Version 5.3.5 for Windows; The Cochrane Collaboration). In total, 100 publications including the search terms were identified. Six studies were included for qualitative analysis, and two studies were included for quantitative analysis (meta-analysis). The association between excess weight and RPL was significant (OR, 1.34; 95% CI, 1.05-1.70; P = 0.02). The isolated analyses of the groups of obese and overweight women revealed an association only between obesity and RPL (OR, 1.75; 95% CI, 1.24-2.47; P = 0.001). The data available in the current literature revealed that obese women with a history of RPL have a high risk of future pregnancy losses, a risk which was not found among overweight women.
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Affiliation(s)
- Marcelo B Cavalcante
- Department of Obstetrics and Gynecology, Fortaleza University (UNIFOR), Fortaleza, Brazil
| | - Manoel Sarno
- Department of Obstetrics and Gynecology, Federal University of Bahia (UFBA), Salvador, Brazil
| | - Alberto B Peixoto
- Mario Palmério University Hospital, University of Uberaba (UNIUBE), Uberaba, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Ricardo Barini
- Department of Obstetrics and Gynecology, Campinas University (UNICAMP), Campinas, Brazil
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Immunometabolism, pregnancy, and nutrition. Semin Immunopathol 2017; 40:157-174. [PMID: 29071391 DOI: 10.1007/s00281-017-0660-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 10/18/2017] [Indexed: 12/16/2022]
Abstract
The emerging field of immunometabolism has substantially progressed over the last years and provided pivotal insights into distinct metabolic regulators and reprogramming pathways of immune cell populations in various immunological settings. However, insights into immunometabolic reprogramming in the context of reproduction are still enigmatic. During pregnancy, the maternal immune system needs to actively adapt to the presence of the fetal antigens, i.e., by functional modifications of distinct innate immune cell subsets, the generation of regulatory T cells, and the suppression of an anti-fetal effector T cell response. Considering that metabolic pathways have been shown to affect the functional role of such immune cells in a number of settings, we here review the potential role of immunometabolism with regard to the molecular and cellular mechanisms necessary for successful reproduction. Since immunometabolism holds the potential for a therapeutic approach to alter the course of immune diseases, we further highlight how a targeted metabolic reprogramming of immune cells may be triggered by maternal anthropometric or nutritional aspects.
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