scholarly journals Adverse pregnancy outcomes in women with diabetes-related microvascular disease and risks of disease progression in pregnancy: A systematic review and meta-analysis

PLoS Medicine ◽  
2021 ◽  
Vol 18 (11) ◽  
pp. e1003856
Author(s):  
Sophie Relph ◽  
Trusha Patel ◽  
Louisa Delaney ◽  
Soha Sobhy ◽  
Shakila Thangaratinam
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Preterm Birth ◽  
Pregnant Women ◽  
Pregnancy Outcomes ◽  
Meta Analysis ◽  
Microvascular Disease ◽  
Adverse Pregnancy ◽  
In Pregnancy

Background The rise in the global prevalence of diabetes, particularly among younger people, has led to an increase in the number of pregnant women with preexisting diabetes, many of whom have diabetes-related microvascular complications. We aimed to estimate the magnitude of the risks of adverse pregnancy outcomes or disease progression in this population. Methods and findings We undertook a systematic review and meta-analysis on maternal and perinatal complications in women with type 1 or 2 diabetic microvascular disease and the risk factors for worsening of microvascular disease in pregnancy using a prospective protocol (PROSPERO CRD42017076647). We searched major databases (January 1990 to July 2021) for relevant cohort studies. Study quality was assessed using the Newcastle–Ottawa Scale. We summarized the findings as odds ratios (ORs) with 95% confidence intervals (CIs) using random effects meta-analysis. We included 56 cohort studies involving 12,819 pregnant women with diabetes; 40 from Europe and 9 from North America. Pregnant women with diabetic nephropathy were at greater risk of preeclampsia (OR 10.76, CI 6.43 to 17.99, p < 0.001), early (<34 weeks) (OR 6.90, 95% CI 3.38 to 14.06, p < 0.001) and any preterm birth (OR 4.48, CI 3.40 to 5.92, p < 0.001), and cesarean section (OR 3.04, CI 1.24 to 7.47, p = 0.015); their babies were at increased risk of perinatal death (OR 2.26, CI 1.07 to 4.75, p = 0.032), congenital abnormality (OR 2.71, CI 1.58 to 4.66, p < 0.001), small for gestational age (OR 16.89, CI 7.07 to 40.37, p < 0.001), and admission to neonatal unit (OR 2.59, CI 1.72 to 3.90, p < 0.001) than those without nephropathy. Diabetic retinopathy was associated with any preterm birth (OR 1.67, CI 1.27 to 2.20, p < 0.001) and preeclampsia (OR 2.20, CI 1.57 to 3.10, p < 0.001) but not other complications. The risks of onset or worsening of retinopathy were increased in women who were nulliparous (OR 1.75, 95% CI 1.28 to 2.40, p < 0.001), smokers (OR 2.31, 95% CI 1.25 to 4.27, p = 0.008), with existing proliferative disease (OR 2.12, 95% CI 1.11 to 4.04, p = 0.022), and longer duration of diabetes (weighted mean difference: 4.51 years, 95% CI 2.26 to 6.76, p < 0.001) than those without the risk factors. The main limitations of this analysis are the heterogeneity of definition of retinopathy and nephropathy and the inclusion of women both with type 1 and type 2 diabetes. Conclusions In pregnant women with diabetes, presence of nephropathy and/or retinopathy appear to further increase the risks of maternal complications.

scholarly journals Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis

BMJ ◽  
2020 ◽  
pp. m3320 ◽  
Author(s):  
John Allotey ◽  
Elena Stallings ◽  
Mercedes Bonet ◽  
Magnus Yap ◽  
Shaunak Chatterjee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Intensive Care ◽  
Preterm Birth ◽  
Confidence Interval ◽  
Pregnant Women ◽  
Meta Analysis ◽  
Clinical Manifestations ◽  
Perinatal Outcomes ◽  
In Pregnancy

Abstract Objective To determine the clinical manifestations, risk factors, and maternal and perinatal outcomes in pregnant and recently pregnant women with suspected or confirmed coronavirus disease 2019 (covid-19). Design Living systematic review and meta-analysis. Data sources Medline, Embase, Cochrane database, WHO COVID-19 database, China National Knowledge Infrastructure (CNKI), and Wanfang databases from 1 December 2019 to 26 June 2020, along with preprint servers, social media, and reference lists. Study selection Cohort studies reporting the rates, clinical manifestations (symptoms, laboratory and radiological findings), risk factors, and maternal and perinatal outcomes in pregnant and recently pregnant women with suspected or confirmed covid-19. Data extraction At least two researchers independently extracted the data and assessed study quality. Random effects meta-analysis was performed, with estimates pooled as odds ratios and proportions with 95% confidence intervals. All analyses will be updated regularly. Results 77 studies were included. Overall, 10% (95% confidence interval 7% to14%; 28 studies, 11 432 women) of pregnant and recently pregnant women attending or admitted to hospital for any reason were diagnosed as having suspected or confirmed covid-19. The most common clinical manifestations of covid-19 in pregnancy were fever (40%) and cough (39%). Compared with non-pregnant women of reproductive age, pregnant and recently pregnant women with covid-19 were less likely to report symptoms of fever (odds ratio 0.43, 95% confidence interval 0.22 to 0.85; I 2 =74%; 5 studies; 80 521 women) and myalgia (0.48, 0.45 to 0.51; I 2 =0%; 3 studies; 80 409 women) and were more likely to need admission to an intensive care unit (1.62, 1.33 to 1.96; I 2 =0%) and invasive ventilation (1.88, 1.36 to 2.60; I 2 =0%; 4 studies, 91 606 women). 73 pregnant women (0.1%, 26 studies, 11 580 women) with confirmed covid-19 died from any cause. Increased maternal age (1.78, 1.25 to 2.55; I 2 =9%; 4 studies; 1058 women), high body mass index (2.38, 1.67 to 3.39; I 2 =0%; 3 studies; 877 women), chronic hypertension (2.0, 1.14 to 3.48; I 2 =0%; 2 studies; 858 women), and pre-existing diabetes (2.51, 1.31 to 4.80; I 2 =12%; 2 studies; 858 women) were associated with severe covid-19 in pregnancy. Pre-existing maternal comorbidity was a risk factor for admission to an intensive care unit (4.21, 1.06 to 16.72; I 2 =0%; 2 studies; 320 women) and invasive ventilation (4.48, 1.40 to 14.37; I 2 =0%; 2 studies; 313 women). Spontaneous preterm birth rate was 6% (95% confidence interval 3% to 9%; I 2 =55%; 10 studies; 870 women) in women with covid-19. The odds of any preterm birth (3.01, 95% confidence interval 1.16 to 7.85; I 2 =1%; 2 studies; 339 women) was high in pregnant women with covid-19 compared with those without the disease. A quarter of all neonates born to mothers with covid-19 were admitted to the neonatal unit (25%) and were at increased risk of admission (odds ratio 3.13, 95% confidence interval 2.05 to 4.78, I 2 =not estimable; 1 study, 1121 neonates) than those born to mothers without covid-19. Conclusion Pregnant and recently pregnant women are less likely to manifest covid-19 related symptoms of fever and myalgia than non-pregnant women of reproductive age and are potentially more likely to need intensive care treatment for covid-19. Pre-existing comorbidities, high maternal age, and high body mass index seem to be risk factors for severe covid-19. Preterm birth rates are high in pregnant women with covid-19 than in pregnant women without the disease. Systematic review registration PROSPERO CRD42020178076. Readers’ note This article is a living systematic review that will be updated to reflect emerging evidence. Updates may occur for up to two years from the date of original publication.

scholarly journals Differences in pregnancy and perinatal outcomes among symptomatic versus asymptomatic COVID-19-infected pregnant women: a systematic review and meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Durray Shahwar A. Khan ◽  
La-Raib Hamid ◽  
Anna Ali ◽  
Rehana A. Salam ◽  
Nadeem Zuberi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Pregnant Women ◽  
Low Birthweight ◽  
Meta Analysis ◽  
Perinatal Outcomes ◽  
Respiratory Disorder ◽  
Significant Difference ◽  
The Mean ◽  
In Pregnancy

Abstract Background There is dearth of information on COVID-19’s impact on pregnant women. However, literature reported trends of COVID-19 differ, depending on the presence of clinical features upon presentation. Objective This systematic review aimed to assess differences in risk factors, management, complications, and pregnancy and perinatal outcomes in symptomatic vs. asymptomatic pregnant women with confirmed SARS-CoV-2 infection. Methods A search was run on electronic databases to identify studies reporting COVID-19 in pregnancy. Meta-analysis was performed and odds ratios and mean difference with 95% confidence intervals were calculated using Review Manager 5.4. Review Prospero registration number CRD42020204662. Results We included ten articles reporting data from 3158 pregnancies; with 1900 symptomatic and 1258 asymptomatic pregnant women. There was no significant difference in the mean age, gestational age, and body mass index between the two groups. The meta-analysis suggested that pregnant women who were obese (OR:1.37;95%CI:1.15 to 1.62), hypertensive (OR:2.07;95%CI:1.38 to 3.10) or had a respiratory disorder (OR:1.64;95%CI:1.25 to 2.16), were more likely to be symptomatic when infected with SARS-CoV-2. Pregnant women with Black (OR:1.48;95%CI:1.19 to 1.85) or Asian (OR:1.64;95%CI:1.23 to 2.18) ethnicity were more likely to be symptomatic while those with White ethnicity (OR:0.63;95%CI:0.52 to 0.76) were more likely to be asymptomatic. Cesarean-section delivery (OR:1.40;95%CI:1.17 to 1.67) was more likely amongst symptomatic pregnant women. The mean birthweight(g) (MD:240.51;95%CI:188.42 to 293.51), was significantly lower, while the odds of low birthweight (OR:1.85;95%CI:1.06 to 3.24) and preterm birth (< 37 weeks) (OR:2.10;95%CI:1.04 to 4.23) was higher amongst symptomatic pregnant women. Symptomatic pregnant women had a greater requirement for maternal ICU admission (OR:13.25;95%CI:5.60 to 31.34) and mechanical ventilation (OR:15.56;95%CI:2.96 to 81.70) while their neonates had a higher likelihood for Neonatal Intensive Care Unit admission (OR:1.96;95%CI:1.59 to 2.43). The management strategies in the included studies were poorly discussed, hence could not be analyzed. Conclusion The evidence suggests that the presence of risk factors (co-morbidities and ethnicity) increased the likelihood of pregnant women being symptomatic. Higher odds of complications were also observed amongst symptomatic pregnant women. However, more adequately conducted studies with adjusted analysis and parallel comparison groups are required to reach conclusive findings.

The influence of disease activity on pregnancy outcomes in women with inflammatory bowel disease: A systematic review and meta-analysis

2020 ◽  
Author(s):  
Min-A Kim ◽  
Young-Han Kim ◽  
Jaeyoung Chun ◽  
Hye Sun Lee ◽  
Soo Jung Park ◽  
...  
Keyword(s):  
Systematic Review ◽  
Preterm Birth ◽  
Disease Activity ◽  
Spontaneous Abortion ◽  
Pregnancy Outcomes ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Increased Risk ◽  
Adverse Pregnancy ◽  
The Impact

Abstract Background & Aims Robust evidence regarding the impact of disease activity on pregnancy outcomes in women with IBD is crucial for both clinicians and patients in preparing a birth plan. We sought to perform a systematic review and meta-analysis to assess the pooled influences of disease activity on pregnancy outcomes in women with IBD. Methods We searched MEDLINE, EMBASE, and COCHRANE library to identify articles comparing pregnancy outcomes between active and inactive IBD at the time of conception or during pregnancy. A meta-analysis was performed using a random-effects model to pool estimates and report odds ratios (ORs). Results A total of 28 studies were identified as eligible for the meta-analysis. In women with active IBD, the pooled ORs for low birth weight (LBW), preterm birth, small for gestational age (SGA), spontaneous abortion, and stillbirths were 3.81 (95% confidence interval [CI] 1.81-8.02), 2.42 (95% CI 1.74-3.35), 1.48 (95% CI 1.19-1.85), 1.87 (95% CI 1.17-3.0), and 2.27 (95% CI 1.03-5.04) compared to women with inactive IBD, respectively. In the subgroup analysis based on disease type, women with active ulcerative colitis had an increased risk of LBW, preterm birth, and spontaneous abortion. Women with active Crohn’s disease had a higher risk of preterm birth, SGA, and spontaneous abortion. Conclusions Active IBD during the periconception period and pregnancy is associated with increased risk of adverse pregnancy outcomes. Our data suggest that pregnancy should be planned when the disease is quiescent, and continuous disease control is important even during pregnancy.

scholarly journals Burden of Asymptomatic Bacteriuria Amongst Nigerian Pregnant Women: A Protocol for Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Daniel N Onwusulu ◽  
Helen Chioma Okoye ◽  
Emmanuel O Nna ◽  
Samuel Onuka ◽  
Amaka Obiageli Nnamani ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Pregnant Women ◽  
Pregnancy Outcomes ◽  
Meta Analysis ◽  
Asymptomatic Bacteriuria ◽  
Cochrane Library ◽  
Categorical Variables ◽  
Pooled Prevalence ◽  
Associated Risk Factors

Abstract BackgroundAsymptomatic bacteriuria can be a cause of adverse pregnancy and neonatal outcomes if undetected and untreated. Pregnant women are usually routinely screened with urine cultures at antenatal booking. However, the exact burden of asymptomatic bacteriuria in Nigeria is unknown. Our protocol is aimed at determining the pooled prevalence of asymptomatic bacteriuria amongst Nigerian pregnant women as well as the associated risk factors and pregnancy outcomes.MethodsNine databases: PubMed, African Journal Online, Google Scholar, Cochrane Library, CINAHL, Embase, ResearchGate, Scopus, and Web of Science will be searched using a search strategy that is developed by combinations of MeSH terms, keywords, text words, and entry terms. Only observational studies published or retrievable in the English Language will be included. Studies must be conducted in Nigeria. The primary measurable outcome of this study is the prevalence of asymptomatic bacteriuria in pregnant women. Identified studies will be screened, selected, and deduplicated in DistillerSR. Data items will be extracted into predefined forms in the DistillerSR. Reports including Prisma flow chart, quality scores, risk of bias, and study outcomes will be generated in DistillerSR. Extracted data items will be exported into the Comprehensive Meta-analysis Software version 3 for quantitative analysis. Methodological, clinical, and statistical heterogeneity will be assessed for all the studies. Publication bias will be assessed using Funnel plots. There will be a subgroup analysis of pooled prevalence using categorical variables. The primary outcome will be expressed in pooled prevalence, standard error, variance, and 95% CI of variance. Quantitative risk factors and pregnancy outcomes will be used used for meta-regression. The reporting of the systematic review and meta-analysis will be according to PRISMA 2015 Statement.DiscussionThe pooled prevalence of asymptomatic bacteriuria in Nigeria will be examined in relation to associated risk factors and pregnancy outcomes. The study will be published in a peer-reviewed scientific journal.Trial Registration NumberThis protocol is registered with the Prospective Register of Systematic Reviews (PROSPERO) with registration number CRD42020213810

Pregnancy outcomes in women with significant valve disease: a systematic review and meta-analysis

Heart ◽  
2020 ◽  
Vol 106 (7) ◽  
pp. 512-519 ◽  
Author(s):  
Robin Alexandra Ducas ◽  
David A Javier ◽  
Rohan D’Souza ◽  
Candice K Silversides ◽  
Wendy Tsang
Keyword(s):  
Systematic Review ◽  
Heart Disease ◽  
Preterm Birth ◽  
Pregnant Women ◽  
Pulmonary Oedema ◽  
Pregnancy Outcomes ◽  
Neonatal Death ◽  
Meta Analysis ◽  
Mortality Rates ◽  
Fetal Outcomes

ObjectiveTo perform a systematic review and meta-analysis of maternal/fetal outcomes in pregnant women with moderate/severe native valvular heart disease (VHD) from medium/higher Human Development Index (HDI) countries.MethodsOvidSP platform databases were searched (1985-January 2019) to identify studies reporting pregnancy outcomes in women with moderate/severe VHD. The primary maternal outcome was maternal mortality. The primary fetal/neonatal outcome was stillbirth and neonatal death. Pooled incidences and 95% confidence intervals (CI) of maternal/fetal outcomes could only be calculated from studies involving mitral stenosis (MS) or aortic stenosis (AS).ResultsTwelve studies on 646 pregnancies were included. Pregnant women with severe MS had mortality rates of 3% (95% CI, 0% to 6%), pulmonary oedema 37% (23%–51%) and new/recurrent arrhythmias 16% (1%–25%). Their stillbirth, neonatal death and preterm birth rates were 4% (1%–7%), 2% (0%–4%), and 18% (7%–29%), respectively. Women with moderate MS had mortality rates of 1%(0%–2%), pulmonary oedema 18% (2%–33%), new/recurrent arrhythmias 5% (1%–9%), stillbirth 2% (1%–4%) and preterm birth 10%(2%–17%).Pregnant women with severe AS had a risk of mortality of 2% (0%–5%), pulmonary oedema 9% (2%–15%), and new/recurrent arrhythmias 4% (0%–7%). Their stillbirth, neonatal death and preterm birth rates were 2% (0%–5%), 3% (0%–6%) and 14%(4%–24%), respectively. No maternal/neonatal deaths were reported in moderate AS, however women experienced pulmonary oedema (8%; 0%–20%), new/recurrent arrhythmias (2%; 0%–5%), and preterm birth (13%; 6%–20%).ConclusionsWomen with moderate/severe MS and AS are at risk for adverse maternal and fetal/neonatal outcomes. They should receive preconception counseling and pregnancy care by teams with pregnancy and heart disease experience.

scholarly journals Adverse pregnancy outcomes and long-term risk of maternal renal disease: a systematic review and meta-analysis protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e027180 ◽  
Author(s):  
Peter M Barrett ◽  
Fergus P McCarthy ◽  
Karolina Kublickiene ◽  
Marie Evans ◽  
Sarah Cormican ◽  
...  
Keyword(s):  
Systematic Review ◽  
Birth Weight ◽  
Preterm Birth ◽  
Kidney Disease ◽  
Renal Disease ◽  
Pregnancy Outcomes ◽  
Meta Analysis ◽  
Later Life ◽  
Adverse Pregnancy ◽  
Meta Analyses

IntroductionAdverse pregnancy outcomes, such as hypertensive disorders of pregnancy (HDP), gestational diabetes (GDM) and preterm birth have been linked to maternal cardiovascular disease in later life. Pre-eclampsia (PE) is associated with an increased risk of postpartum microalbuminuria, but there is no clear consensus on whether HDP increases the risk of maternal chronic kidney disease (CKD) and end-stage kidney disease (ESKD). Similarly, it is uncertain whether GDM, preterm birth and delivery of low birth-weight infants independently predict the risk of maternal renal disease in later life. The aims of this proposed systematic review and meta-analysis are to summarise the available evidence examining the association between adverse outcomes of pregnancy (HDP, GDM, preterm birth, delivery of low birth-weight infant) and later maternal renal disease and to synthesise the results of relevant studies.Methods and analysisA systematic search of PubMed, EMBASE and Web of Science will be undertaken using a detailed prespecified search strategy. Two authors will independently review the titles and abstracts of all studies, perform data extraction and appraise the quality of included studies using a bias classification tool. Original case–control and cohort studies published in English will be considered for inclusion. Primary outcomes of interest will be CKD and ESKD; secondary outcomes will be hospitalisation for renal disease and deaths from renal disease. Meta-analyses will be performed to calculate the overall pooled estimates using the generic inverse variance method. The systematic review will follow the Meta-analyses Of Observational Studies in Epidemiology guidelines.Ethics and disseminationThis systematic review and meta-analysis will be based on published data, and thus there is no requirement for ethics approval. The results will be shared through publication in a peer reviewed journal and through presentations at academic conferences.PROSPERO registration numberCRD42018110891

scholarly journals Socioeconomic inequalities and adverse pregnancy outcomes in the UK and Republic of Ireland: a systematic review and meta-analysis

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e042753
Author(s):  
Katie Thomson ◽  
Malcolm Moffat ◽  
Oluwatomi Arisa ◽  
Amrita Jesurasa ◽  
Catherine Richmond ◽  
...  
Keyword(s):  
Systematic Review ◽  
Birth Weight ◽  
Preterm Birth ◽  
Pregnancy Outcomes ◽  
Meta Analysis ◽  
Adverse Pregnancy Outcomes ◽  
Individual Level ◽  
Healthy Pregnancy ◽  
Adverse Pregnancy ◽  
The Uk

ObjectiveThere has been an unprecedented rise in infant mortality associated with deprivation in recent years in the United Kingdom (UK) and Republic of Ireland. A healthy pregnancy can have significant impacts on the life chances of children. The objective of this review was to understand the association between individual-level and household-level measures of socioeconomic status and adverse pregnancy outcomes.DesignSystematic review and meta-analysis.Data sourcesNine databases were searched (Medline, Embase, Scopus, ASSIA, CINAHL, PsycINFO, BNI, MIDRIS and Google Scholar) for articles published between 1999 and August 2019. Grey literature searches were also assessed.Study selection criteriaStudies reporting associations between individual-level or household socioeconomic factors on pregnancy outcomes in the UK or Ireland.ResultsAmong the 82 353 search results, 53 821 titles were identified and 35 unique studies met the eligibility criteria. Outcomes reported were neonatal, perinatal and maternal mortality, preterm birth, birth weight and mode of delivery. Pooled effect sizes were calculated using random-effects meta-analysis. There were significantly increased odds of women from lower levels of occupation/social classes compared with the highest level having stillbirth (OR 1.40, 95% CI 1.23 to 1.59, I298.62%), neonatal mortality (OR 1.39, 95% CI 1.22 to 1.57, I297.09%), perinatal mortality (OR 1.39, 95% CI 1.23 to 1.57, I298.69%), preterm birth (OR 1.41, 95% CI 1.33 to 1.50, I270.97%) and low birth weight (OR 1.40, 95% CI 1.19 to 1.61, I299.85%). Limitations relate to available data, unmeasured confounders and the small number of studies for some outcomes.ConclusionsThis review identified consistent evidence that lower occupational status, especially manual occupations and unemployment, were significantly associated with increased risk of multiple adverse pregnancy outcomes. Strategies to improve pregnancy outcomes should incorporate approaches that address wider determinants of health to provide women and families with the best chances of having a healthy pregnancy and baby and to decrease pregnancy-related health inequalities in the general population.PROSPERO registration numberPROSPERO CRD42019140893.

scholarly journals Extreme heat exposure in pregnancy and risk for preterm birth, low birth weight and stillbirths

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Böckmann ◽  
M F Chersich ◽  
M D Pham ◽  
A Areal ◽  
M M Haghighi ◽  
...  
Keyword(s):  
Birth Weight ◽  
Preterm Birth ◽  
Pregnant Women ◽  
Heat Waves ◽  
Meta Analysis ◽  
Extreme Temperature ◽  
Preterm Births ◽  
Heat Adaptation ◽  
Adverse Pregnancy ◽  
In Pregnancy

Abstract Background Exposure to high ambient temperatures during pregnancy may increase the risk of adverse pregnancy outcomes due to physiological and anatomical changes in pregnancy compromising the ability to thermoregulate. Methods A systematic review and meta-analysis of studies that assessed associations between ambient heat, and preterm birth, birth weight and stillbirths. Articles were identified through a search of Medline (PubMed) and Web of Science. Titles and abstracts were screened, eligible studies extracted and risk of bias assessed using the Joanna Briggs Institute appraisal tools. Results 14,880 records were screened and a total of 70 studies included. In 40 of 47 studies, preterm births were more frequent at higher than lower temperatures. In random effects meta-analysis, the odds of a preterm birth rose 1.05-fold per 1 °C increase in temperature (95%CI=1.03, 1.07), and 1.16 fold during heat waves (95%CI=1.10, 1.23). Reduced birth weight associated with higher temperature was found in in 18 of 28 studies, with considerable heterogeneity. Studies on stillbirths (n = 8) all showed temperature-stillbirth associations, with stillbirths increasing 1.05-fold per 1 °C rise in temperature (95%CI=1.01, 1.08). Associations between temperature and outcomes were largest among women in lower socioeconomic groups and at age extremes. The multiple temperature metrics and lag analyses limited comparison between studies and settings. Conclusions As frequency of heat exposures is increasing, prevention for pregnant women during heat waves should become a standard aspect of heat adaptation. Key messages Increase in extreme temperature events may have major implications for child health unless much more is done to provide heat adaptation services for pregnant women. Links between socio-economic status and study outcomes suggest higher vulnerability for already disadvantaged groups.

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