Neonatal outcome and adaption after in utero exposure to antidepressants: A systematic review and meta‐analysis

Abstract Background Early exposure to estrogen-like compounds has been implicated in the etiology of testicular cancer, but individual level epidemiologic data addressing this hypothesis are scarce. The synthetic estrogen diethylstilbestrol (DES) was administered during pregnancy from 1948 to 1971, but sequelae of in utero exposure have been more extensively characterized in females than in males. Methods By systematic review, we sought to identify all epidemiologic research relating testicular cancer to a history of in utero exposure to diethylstilbestrol. Identified studies were critically appraised to assemble a set of nonredundant data in which any in utero exposure to DES was compared between men with incident testicular cancer and cancer-free men. These data were synthesized using random effects meta-analysis to estimate the summary association between in utero DES exposure and testicular cancer. Results By meta-analysis of data from the six qualifying studies, the summary odds ratio estimate of the in utero DES-testicular cancer association was 2.98 (95% confidence interval = 1.15 to 7.67). Conclusions Results of this comprehensive meta-analysis accord with a threefold increase in testicular cancer risk among men who were exposed in utero to DES, implicating early hormonal exposures in etiology of testicular cancer. Because use of DES ceased in 1971, this work may provide the most comprehensive estimate of this association that will be made.

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Neonatal Withdrawal Syndrome following Late in utero Exposure to Selective Serotonin Reuptake Inhibitors: A Systematic Review and Meta-Analysis of Observational Studies

Psychotherapy and Psychosomatics ◽

10.1159/000516031 ◽

2021 ◽

pp. 1-9

Author(s):

Jianjun Wang ◽

Fiammetta Cosci

Keyword(s):

Systematic Review ◽

Withdrawal Syndrome ◽

Serotonin Reuptake ◽

Observational Studies ◽

Meta Analysis ◽

In Utero ◽

Selective Serotonin ◽

In Utero Exposure ◽

Withdrawal Signs ◽

Neonatal Withdrawal

Introduction: A clear picture of neonatal withdrawal signs due to in utero selective serotonin reuptake inhibitor (SSRI) exposure and its consequences is still missing. Objective: A systematic review and a meta-analysis were performed to provide an overview of neonatal withdrawal signs following late in utero exposure to SSRIs and to quantify the corresponding risks. Methods: MEDLINE, Web of Science, and Embase were searched from inception to January 2021. The Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines were followed. English-language observational studies reporting on acute postpartum outcomes following late in utero exposure to SSRIs or SSRIs/venlafaxine were evaluated. Results: Of 2,269 citations reviewed, 79 studies were assessed for eligibility; 13 were included in the qualitative analysis of the literature, which allowed us to identify 26 signs. A meta-analysis was run separately for studies on SSRI exposure (n = 3) and those on SSRI/venlafaxine exposure (n = 6). Hypoglycemia was identified as a withdrawal sign based on the SSRI studies. Tremors, hypotonia, tachycardia, rapid breathing, respiratory distress, and hypertonia were identified as withdrawal signs based on the SSRI/venlafaxine studies. Conclusions: The present work provides a framework for the identification of neonatal SSRI withdrawal syndrome. Tapering and discontinuation of antidepressant drugs before and during the early phase of pregnancy are worth attempting to prevent the occurrence of this syndrome.

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Erratum to: Pregnancy Outcomes Following In Utero Exposure to Lamotrigine: A Systematic Review and Meta-Analysis

CNS Drugs ◽

10.1007/s40263-017-0439-7 ◽

2017 ◽

Vol 31 (6) ◽

pp. 451-451 ◽

Cited By ~ 2

Author(s):

Gali Pariente ◽

Tom Leibson ◽

Talya Shulman ◽

Thomasin Adams-Webber ◽

Eran Barzilay ◽

...

Keyword(s):

Systematic Review ◽

Pregnancy Outcomes ◽

Meta Analysis ◽

In Utero ◽

In Utero Exposure

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Pregnancy Outcomes Following In Utero Exposure to Lamotrigine: A Systematic Review and Meta-Analysis

CNS Drugs ◽

10.1007/s40263-017-0433-0 ◽

2017 ◽

Vol 31 (6) ◽

pp. 439-450 ◽

Cited By ~ 21

Author(s):

Gali Pariente ◽

Tom Leibson ◽

Talya Shulman ◽

Thomasin Adams-Webber ◽

Eran Barzilay ◽

...

Keyword(s):

Systematic Review ◽

Pregnancy Outcomes ◽

Meta Analysis ◽

In Utero ◽

In Utero Exposure

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Cardiovascular risk factors in offspring exposed to gestational diabetes mellitus in utero: systematic review and meta-analysis

Journal of Developmental Origins of Health and Disease ◽

10.1017/s2040174419000850 ◽

2020 ◽

Vol 11 (6) ◽

pp. 599-616 ◽

Cited By ~ 8

Author(s):

Maleesa M. Pathirana ◽

Zohra S. Lassi ◽

Claire T. Roberts ◽

Prabha H. Andraweera

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Systematic Review ◽

Blood Pressure ◽

Cardiovascular Risk ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Systolic Blood Pressure ◽

Meta Analysis ◽

In Utero

AbstractGestational diabetes mellitus (GDM) is a pregnancy complication that affects one in seven pregnancies. Emerging evidence demonstrates that children born of pregnancies complicated by GDM may be at increased risk of cardiovascular disease (CVD) in adulthood. Therefore, the aim of this study was to determine cardiovascular risk factors in offspring exposed to GDM in utero. PubMed, CINAHL, SCOPUS, and EMBASE databases were searched. Information was extracted on established CVD risk factors including blood pressure, lipids, blood glucose, fasting insulin, body mass index (BMI), and endothelial/microvascular function. The review protocol is registered in PROSPERO (CRD42018094983). Prospective and retrospective studies comparing offspring exposed to GDM compared to controls (non-GDM pregnancies) were considered. We included studies that defined GDM based on the International Association of Diabetes and Pregnancy Study Groups (IADPSG) definition, or prior definitions. The PRISMA guidelines were followed in conducting this systematic review. Methodological quality was assessed using the Newcastle–Ottawa Quality Assessment Scale. Study selection, data extraction, and quality assessment were done by two independent reviewers. The data were pooled using a random-effects model. Of 59 eligible studies, 24 were included in the meta-analysis. Offspring exposed to GDM had higher systolic blood pressure (mean difference (MD): 1.75 mmHg, 95% CI 0.57–2.94; eight studies, 7264 participants), BMI z-score (MD 0.11, 95% CI 0.02–0.20; nine studies, 8759 participants), and glucose (standard MD 0.43, 95% CI 0.08–0.77; 11 studies, 6423 participants) than control participants. In conclusion, offspring exposed to GDM have elevated systolic blood pressure, BMI, and glucose. Those exposed to GDM in utero may benefit from early childhood blood pressure measurements.

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Effect of in utero exposure to HIV and antiretroviral drugs on growth in HIV-exposed uninfected children: a systematic review and meta-analysis protocol

BMJ Open ◽

10.1136/bmjopen-2018-023937 ◽

2019 ◽

Vol 9 (6) ◽

pp. e023937 ◽

Cited By ~ 2

Author(s):

Gabriel L Ekali ◽

Julie Jesson ◽

Pascal B Enok ◽

Valériane Leroy

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

In Utero ◽

Antiretroviral Drugs ◽

Morbidity And Mortality ◽

Cochrane Library ◽

Growth Disorders ◽

Growth Impairment ◽

Hiv Exposed ◽

Exposed Uninfected

IntroductionHIV-exposed uninfected (HEU) children have higher morbidity and mortality compared with HIV unexposed uninfected children. Despite the fact that malnutrition contributes to about half of all infant deaths below 5 years of age in low-income and middle-income countries and that growth impairment has been reported in the HEU population, the spectrum of growth disorders associated with HIV and antiretroviral therapy (ART) exposure during the in utero and perinatal periods is yet to comprehensively summarised among the global HEU population. This protocol for a systematic review and meta-analysis aims to critically synthesise data concerning the prevalence of underweight, stunting and wasting at different ages in the global HEU population.Methods and analysisMedline, EMBASE, Cochrane Library, TOXLINE, WHO Global Index Medicus and the Web of Science will be searched for relevant articles published between 1 January 1989 and 1 December 2017 without language restriction. In addition, conference abstracts and reference lists of eligible papers and relevant review articles will be screened. Authors will screen and select studies, extract data, assess the risk of bias as well as studies individually for heterogeneity. Study-specific estimates will be pooled through a random-effects meta-analysis model for studies that are clinically homogeneous while funnel plots and Egger’s test will be used to detect publication bias. Results will be presented by ART availability period, country income levels and mode of breastfeeding.Ethics and disseminationEthical approval will not be required for this study because it will be based on published data. The final report of this study will be published in a peer-reviewed journal and presented at scientific conferences. This review will summarise the evidence and quantify the problem of growth impairment in HEU infants and so shed more light on our understanding of the higher morbidity and mortality in this growing population.PROSPERO registration numberCRD42018091762.

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