Association of serum PAPP-A levels in first trimester with small for gestational age and adverse pregnancy outcomes: systematic review and meta-analysis

Abstract Background Levothyroxine replacement therapy may decrease the risk of adverse pregnancy outcomes among women with subclinical hypothyroidism (SCH). The aim of this study is to conduct a systematic review and meta-analysis to examine the risk of adverse pregnancy, perinatal, and early childhood outcomes among women with SCH treated with levothyroxine. Methods A systematic literature search was conducted using Ovid-Medline, Ovid-EMBASE, Pubmed (non-Medline), Ebsco-CINAHL Plus with full text and Cochrane Library databases. Randomized controlled studies (RCTs) and observational studies examining the association between treatment of SCH during pregnancy and our outcomes of interest were included. Studies that compared levothyroxine treatment versus no treatment were eligible for inclusion. Data from included studies were extracted and quality assessment was performed by two independent reviewers. Results Seven RCTs and six observational studies met our inclusion criteria. A total of 7342 individuals were included in these studies. RCTs demonstrated several sources of bias, with lack of blinding of the participants or research personnel; only one study was fully blinded. In the observational studies, there was moderate to serious risk of bias due to lack of adjustment for certain confounding variables, participant selection, and selective reporting of results. Pooled analyses showed decreased risk of pregnancy loss (RR: 0.79; 95% CI: 0.67 to 0.93) and neonatal death (RR: 0.35; 95% CI: 0.17 to 0.72) associated with levothyroxine treatment during pregnancy among women with SCH. There were no associations between levothyroxine treatment and outcomes during labour and delivery, or cognitive status in children at 3 or 5 years of age. Conclusion Treatment of SCH with levothyroxine during pregnancy is associated with decreased risks of pregnancy loss and neonatal death. Given the paucity of available data and heterogeneity of included studies, additional studies are needed to address the benefits of levothyroxine use among pregnant women with SCH.

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Maternal blood biomarkers and adverse pregnancy outcomes: a systematic review and meta-analysis

Critical Reviews in Toxicology ◽

10.1080/10408444.2019.1629873 ◽

2019 ◽

Vol 49 (6) ◽

pp. 461-478 ◽

Cited By ~ 5

Author(s):

J. Gomes ◽

F. Au ◽

A. Basak ◽

S. Cakmak ◽

R. Vincent ◽

...

Keyword(s):

Systematic Review ◽

Pregnancy Outcomes ◽

Meta Analysis ◽

Maternal Blood ◽

Adverse Pregnancy Outcomes ◽

Blood Biomarkers ◽

Adverse Pregnancy

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Ultrasound Assessment of Twin Reversed Arterial Perfusion Sequence for the Prediction of Adverse Pregnancy Outcomes in the First Trimester

10.21203/rs.3.rs-142998/v1 ◽

2021 ◽

Author(s):

Ying Tang ◽

Yan Zeng ◽

Taizhu Yang ◽

Pan Yang ◽

Shan Bao ◽

...

Keyword(s):

Gestational Age ◽

Pregnancy Outcomes ◽

First Trimester ◽

Adverse Pregnancy Outcomes ◽

University Hospital ◽

Intrauterine Death ◽

Crown Rump Length ◽

Arterial Perfusion ◽

Adverse Pregnancy ◽

Twin Reversed Arterial Perfusion

Abstract ObjectivesTo investigate twin reversed arterial perfusion (TRAP) sequence for the prediction of TRAP-related adverse pregnancy outcomes at the gestational age of 11-14 weeks. MethodsPregnant women in the first trimester diagnosed with TRAP were recruited at West China Second University Hospital from January 2015 to June 2018. Systematic screening for the pump twin’s crown-rump length (CRL) and acardiac twin’s upper pole-rump length (URL) was conducted using ultrasonic detection. The (CRL-URL)/CRL and URL/CRL ratios were used to assess the pregnancy outcomes for the pump twin. ResultsTwenty-one pregnant women aged 21–39 years with a gestation of 11-14 weeks were recruited. TRAP was diagnosed on average (± standard deviation [SD]) at pregnancy week 13.1 ± 0.18. The pump twins’ mean (± SD) CRL was 6.65 ± 1.1 cm. The incidence of intrauterine death for the pump twins was 19.0% (n=4), the miscarriage rate was 14.3% (n=3), and the live birth rate was 66.7% (n=14). The (CRL-URL)/CRL ratios between the non-survival (intrauterine death and miscarriage) and survival groups significantly differed (0.33 ± 0.08 vs. 0.58 ± 0.08, p < 0.05). Similarly, the URL/CRL ratios between the non-survival and survival groups significantly differed (0.67 ± 0.08 vs. 0.42 ± 0.08, p < 0.05). ConclusionsThe (CRL-URL)/CRL and URL/CRL ratios were valuable indicators for determining pregnancy outcomes of pump twins with TRAP at an early gestational age.

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Association between neighbourhood deprivation, fetal growth, small-for-gestational age and preterm birth: a population-based prospective cohort study

BMJ Open ◽

10.1136/bmjopen-2021-049075 ◽

2021 ◽

Vol 11 (11) ◽

pp. e049075

Author(s):

Dionne V Gootjes ◽

Anke G Posthumus ◽

Vincent W V Jaddoe ◽

Eric A P Steegers

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Preterm Birth ◽

Fetal Growth ◽

Gestational Age ◽

Pregnancy Outcomes ◽

First Trimester ◽

Adverse Pregnancy Outcomes ◽

Neighbourhood Deprivation ◽

Adverse Pregnancy

ObjectiveTo study the associations between neighbourhood deprivation and fetal growth, including growth in the first trimester, and adverse pregnancy outcomes.DesignProspective cohort study.SettingThe Netherlands, Rotterdam.Participants8617 live singleton births from the Generation R cohort study.ExpositionLiving in a deprived neighbourhood.Main outcome measuresFetal growth trajectories of head circumference, weight and length.Secondary outcomes measuresSmall-for-gestational age (SGA) and preterm birth (PTB).ResultsNeighbourhood deprivation was not associated with first trimester growth. However, a higher neighbourhood status score (less deprivation) was associated with increased fetal growth in the second and third trimesters (eg, estimated fetal weight; adjusted regression coefficient 0.04, 95% CI 0.02 to 0.06). Less deprivation was also associated with decreased odds of SGA (adjusted OR 0.91, 95% CI 0.86 to 0.97, p=0.01) and PTB (adjusted OR 0.89, 95% CI 0.82 to 0.96, p=0.01).ConclusionsWe found an association between neighbourhood deprivation and fetal growth in the second and third trimester pregnancy, but not with first trimester growth. Less neighbourhood deprivation is associated with lower odds of adverse pregnancy outcomes. The associations remained after adjustment for individual-level risk factors. This supports the hypothesis that living in a deprived neighbourhood acts as an independent risk factor for fetal growth and adverse pregnancy outcomes, above and beyond individual risk factors.

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