Investigation of Some Modifiable Risk Factors That Lead to Congenital Anomalies: A Review Article

2020 ◽  
Author(s):  
Fatemeh Abdi ◽  
Mahdieh Mehrvar ◽  
Sima Valizadeh ◽  
Mahta Mazaheri
Keyword(s):  
Risk Factors ◽  
Environmental Factors ◽  
Congenital Anomalies ◽  
Meta Analysis ◽  
First Trimester ◽  
Modifiable Risk Factors ◽  
Inborn Errors ◽  
Topical Retinoids ◽  
Increased Risk ◽  
Adverse Pregnancy

Background: Congenital anomalies are inborn errors of development. Genetic and environmental factors are known causes of congenital anomalies. Environmental factors are modifiable risk factors. This review focuses on modifiable risk factors for birth defects. There is a strong link between alcohol use and an increased risk of congenital anomalies. Marijuana can be expected to cause fetal growth restriction; smoking before conception, even with cessation in the first trimester, may also pose a risk for gastroschisis. Benzodiazepines during the first trimester were associated with Dandy–Walker malformation ,anophthalmia or microphthalmia  and esophageal atresia. While oral retinoids are absolutely contraindicated, topical retinoids, should conservatively be avoided during pregnancy but  if  were used by accident, the existing data can reduce the anxiety of happening adverse pregnancy outcomes. Antihypertensives such as labetalol, methyldopa and extended release nifedipine are relatively safe choices. Antiemeticssuch as doxylamine-pyridoxine and metoclopramide may have potential teratogenicity in first trimester. Ondansetron use was not significantly associated with major congenital anomalies but recent meta-analysis suggested more concern.  An antiepileptic such as valproate poses the highest risk among antiepileptic drugs, whereas the prevalence of congenital anomalies is the lowest with lamotrigine, levetiracetam, and oxcarbazepine. Education and counseling to women who are planning to become pregnant can reduce the risk of congenital anolamies.  

A systematic review of modifiable risk factors in the progression of multiple sclerosis

2017 ◽  
Vol 23 (4) ◽  
pp. 525-533 ◽  
Author(s):  
Susanne Hempel ◽  
Glenn D Graham ◽  
Ning Fu ◽  
Elena Estrada ◽  
Annie Y Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multiple Sclerosis ◽  
Vitamin D ◽  
Meta Analysis ◽  
Clinical Manifestations ◽  
Rapid Decline ◽  
Modifiable Risk Factors ◽  
Presenting Symptoms ◽  
Increased Risk ◽  
Vitamin D Levels

Background: The presenting symptoms and rate of progression of multiple sclerosis (MS) are very heterogeneous. The diverse clinical manifestations and the clinical course of the disease may vary with modifiable risk factors. Objective: To systematically review modifiable risk factors and exposures associated with MS progression. Methods: We searched six databases till March 2015, reference-mined reviews, and consulted with experts (PROSPERO 2015:CRD42015016461). Two reviewers screened and extracted data. We used random meta-analysis models and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) to assess the quality of evidence. Results: In total, 59 studies met inclusion criteria. Lower vitamin D levels were associated with higher Expanded Disability Status Scale (EDSS) scores ( r = −0.22; confidence interval (CI) = −0.32, −0.12; 11 studies; I2 = 66%), smokers had an increased risk of MS progression (hazard ratio (HR) = 1.55; CI = 1.10, 2.19; I2 = 72%; seven studies), and there was no association of MS progression with the use of epidural analgesics during childbirth delivery (three studies). There was insufficient evidence to draw conclusions for 11 risk factors due to conflicting results or use of different predictor and outcome measures. Conclusion: MS progression was consistently associated with low vitamin D levels, and smoking was associated with a more rapid decline in MS disability. Studies used a variety of methods, predictors, and outcomes making it difficult to draw conclusions. Future studies should focus on prospective assessments.

scholarly journals Combining modifiable risk factors and risk of dementia: a systematic review and meta-analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e022846 ◽  
Author(s):  
Ruth Peters ◽  
Andrew Booth ◽  
Kenneth Rockwood ◽  
Jean Peters ◽  
Catherine D’Este ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Risk Factor ◽  
Cognitive Decline ◽  
Full Text ◽  
Meta Analysis ◽  
Modifiable Risk Factors ◽  
Increased Risk ◽  
The Impact

ObjectiveTo systematically review the literature relating to the impact of multiple co-occurring modifiable risk factors for cognitive decline and dementia.DesignA systematic review and meta-analysis of the literature relating to the impact of co-occurring key risk factors for incident cognitive decline and dementia. All abstracts and full text were screened independently by two reviewers and each article assessed for bias using a standard checklist. A fixed effects meta-analysis was undertaken.Data sourcesDatabases Medline, Embase and PsycINFO were searched from 1999 to 2017.Eligibility criteriaFor inclusion articles were required to report longitudinal data from participants free of cognitive decline at baseline, with formal assessment of cognitive function or dementia during follow-up, and an aim to examine the impact of additive or clustered comorbid risk factor burden in with two or more core modifiable risk factors.ResultsSeventy-nine full-text articles were examined. Twenty-two articles (18 studies) were included reporting data on >40 000 participants. Included studies consistently reported an increased risk associated with greater numbers of intraindividual risk factors or unhealthy behaviours and the opposite for healthy or protective behaviours. A meta-analysis of studies with dementia outcomes resulted in a pooled relative risk for dementia of 1.20 (95% CI 1.04 to 1.39) for one risk factor, 1.65 (95% CI 1.40 to 1.94) for two and 2.21 (95% CI 1.78 to 2.73) for three or more, relative to no risk factors. Limitations include dependence on published results and variations in study outcome, cognitive assessment, length of follow-up and definition of risk factor exposure.ConclusionsThe strength of the reported associations, the consistency across studies and the suggestion of a dose response supports a need to keep modifiable risk factor exposure to a minimum and to avoid exposure to additional modifiable risks. Further research is needed to establish whether particular combinations of risk factors confer greater risk than others.PROSPERO registration number42016052914.

scholarly journals Peranan Faktor Lingkungan dan Kontributor Selama Kehamilan terhadap Hipospadia

e-CliniC ◽  
2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Ester J. Tuju ◽  
Harsali F. Lampus ◽  
Stephanus J. Ch. Tangel
Keyword(s):  
Risk Factors ◽  
Environmental Factors ◽  
Literature Review ◽  
Maternal Age ◽  
Strong Relationship ◽  
First Trimester ◽  
Google Scholar ◽  
Increased Risk ◽  
Review Study ◽  
The Relationship

Abstract: The etiology of hypospadias is not certainly known and is still controversial. Environmental factors and their influence during pregnancy can be risk factors for increased incidence of hypospadias. This study was aimed to obtain the risk factors of hypospadias. This was a literature review study using three databases, as follows: ClinicalKey, PubMed, and Google Scholar. There were 47 literatures in this study. The results showed that from the 47 literatures containing risk factors of hypospadias, 8 literatures reported the relationship between pesticides and hypospadias; 3 literatures reported the relationship between smoking and increased risk of hypospadias; 6 literatures revealed that there was a strong relationship between maternal age and increased risk of hypospadias; 8 literatures showed that low births weight babies were associated with hypospadias and placental insufficiency as its cause; 5 literatures stated that several drugs consumed by pregnant women during the first trimester were related to the increased risk of hypospadias. In conclusion, environmental factors and contributors during pregnancy are the risk factors of hypospadias.Keywords: hypospadias, risk factors, environmental factors, contributors during pregnancy Abstrtrak: Etiologi hipospadia belum diketahui dengan pasti dan masih bersifat kontroversial. Faktor lingkungan serta hal yang berpengaruh selama kehamilan dapat menjadi faktor risiko peningkatan kejadian hipospadia. Penelitian ini bertujuan untuk mengetahui faktor risiko hipospadia. Jenis penelitian ialah literature review dengan menggunakan database ClinicalKey, PubMed, dan Google Scholar. Hasil penelitian mendapatkan bahwa dari 47 literatur yang memuat tentang faktor risiko hipospadia, 8 literatur memuat adanya hubungan antara pestisida dengan hipospadia, 3 literatur memuat bahwa merokok berkaitan dengan peningkatan risiko hipospadia, 6 literatur memuat bahwa usia ibu memiliki hubungan kuat dengan peningkatan risiko hipospadia, 8 literatur memuat bahwa bayi berat lahir rendah berkaitan dengan hipospadia dan insufisiensi plasenta menjadi penyebab terjadinya hal tersebut, 5 literatur memuat bahwa beberapa obat obatan yang dikonsumsi ibu hamil selama trimester pertama berkaitan dengan peningkatan risiko hipospadia. Simpulan penelitian ini ialah faktor lingkungan dan kontributor selama kehamilan merupakan faktor risiko hipospadia.Kata kunci: hipospadia, faktor risiko, factor lingkungan, Kontributor selama kehamilan

scholarly journals Association between Genetic Variants in NOS2 and TNF Genes with Congenital Zika Syndrome and Severe Microcephaly

Viruses ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 325
Author(s):  
Julia A. Gomes ◽  
Eduarda Sgarioni ◽  
Juliano A. Boquett ◽  
Ana Cláudia P. Terças-Trettel ◽  
Juliana H. da Silva ◽  
...  
Keyword(s):  
Risk Factors ◽  
Zika Virus ◽  
Genetic Variants ◽  
Educational Level ◽  
Congenital Anomalies ◽  
Family Income ◽  
First Trimester ◽  
In Utero ◽  
Zikv Infection ◽  
Congenital Zika Syndrome

Zika virus (ZIKV) causes Congenital Zika Syndrome (CZS) in individuals exposed prenatally. Here, we investigated polymorphisms in VEGFA, PTGS2, NOS3, TNF, and NOS2 genes as risk factors to CZS. Forty children with CZS and forty-eight children who were in utero exposed to ZIKV infection, but born without congenital anomalies, were evaluated. Children with CZS were predominantly infected by ZIKV in the first trimester (p < 0.001) and had mothers with lower educational level (p < 0.001) and family income (p < 0.001). We found higher risk of CZS due the allele rs2297518[A] of NOS2 (OR = 2.28, CI 95% 1.17–4.50, p = 0.015). T allele and TT/CT genotypes of the TNF rs1799724 and haplotypes associated with higher expression of TNF were more prevalent in children with CZS and severe microcephaly (p = 0.029, p = 0.041 and p = 0.030, respectively). Our findings showed higher risk of CZS due ZIKV infection in the first trimester and suggested that polymorphisms in NOS2 and TNF genes affect the risk of CZS and severe microcephaly.

scholarly journals Greater cardiorespiratory fitness reduces incidence of atrial fibrillation: a meta-analysis

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
C Verdicchio ◽  
A Elliott ◽  
R Mahajan ◽  
D Linz ◽  
D Lau ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Risk Factor ◽  
Cardiorespiratory Fitness ◽  
Meta Analysis ◽  
Exercise Stress ◽  
Inverse Association ◽  
Exercise Interventions ◽  
Increased Risk ◽  
Statistical Heterogeneity

Abstract Funding Acknowledgements Type of funding sources: None. Introduction  Atrial Fibrillation (AF) is the most common sustained cardiac arrhythmia affecting 1-2% of the global population, with the prevalence of AF increasing dramatically over the past two decades. Although low levels of cardiorespiratory fitness (CRF) and physical activity are predictive of cardiovascular disease onset and mortality, only recently has this emerged as a potential risk factor for AF. Purpose The aim of this meta-analysis was therefore to quantify the relationship between CRF, measured by a symptom limited exercise stress test, and incident AF. We hypothesised that there would be an inverse relationship between CRF and the incidence of AF. Methods The systematic literature review was conducted using PUBMED, MEDLINE and EMBASE databases, with seven studies meeting the inclusion criteria. A random-effects meta-analysis was then used to compare the multivariate risk estimates of the lowest CRF group from each cohort with the group of the highest CRF. Results Data from 206,925 individuals (55.8% males) was used for analysis with a mean age of 55 ± 2.5 years and a mean follow-up period of 10.3 ± 5 years. The total number of AF events across the studies was 19,913. The overall pooled risk of AF in the high-CRF group versus the low-CRF group showed a significant lower risk of incident AF in those with high-CRF (OR: 0.52, 95% CI, 0.44-0.605, p &lt; 0.001). There was evidence of statistical heterogeneity between the studies (I2 = 81%, p &lt; 0.001). AF incidence rates demonstrated an overall decline in rates across the CRF quartiles from low to high. The mean incidence rate for low-CRF was 21 ± 13.4 compared to 6.9 ± 0.7 per 1000 person-years for the high CRF group (p = 0.03). Conclusion There is an inverse association between a lower CRF and an increased risk of AF, with a higher level of CRF protective against AF. This study highlights that low-CRF may be an additional risk factor for AF along with already other established lifestyle-based risk factors such as obesity and hypertension. Exercise interventions should be promoted as a primary prevention strategy in those at risk of developing AF with known risk factors. Future studies are warranted to identify the mechanism(s) through which improved CRF confers a reduction in AF incidence. Abstract Figure. AF risk between high and low-CRF

scholarly journals Platelet function and cardiovascular risk in adult HIV-infected patients on HAART: a protocol for a systematic review and meta-analysis

BMJ Open ◽  
2017 ◽  
Vol 7 (12) ◽  
pp. e019468 ◽  
Author(s):  
Bongani Brian Nkambule ◽  
Zibusiso Mkandla ◽  
Tinashe Mutize ◽  
Phiwayinkosi Vusi Dludla
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Cardiovascular Risk ◽  
Platelet Activation ◽  
Meta Analysis ◽  
People Living With Hiv ◽  
Qualitative Synthesis ◽  
Cvd Risk ◽  
Increased Risk ◽  
Statistical Heterogeneity

IntroductionThe incidence of cardiovascular disease (CVD) is now at least threefold higher in HIV-infected patients as compared with the general population. Although platelet activation and reactivity are implicated in the development of CVDs in HIV-infected patients, its precise role remains inconclusive. We aim to assess the association between platelet activation and selected cardiovascular risk factors in HIV-1-infected individuals on highly active antiretroviral treatment (HAART).MethodsThis will be a systematic review and meta-analysis of published studies evaluating the association between platelet activation and CVD risk factors in HAART-treated adults. The search strategy will include medical subject headings words for MEDLINE, and this will be adapted to Embase search headings (Emtree) terms for the EMBASE database. The search will cover literature published between 1 January 1996 to 30 April 2017. Studies will be independently screened by two reviewers using predefined criteria. Relevant eligible full texts will be screened; data will be extracted, and a qualitative synthesis will be conducted. Data extraction will be performed using Review Manager V.5.3. To assess the quality and strengths of evidence across selected studies, the Grading of Recommendations Assessment Development and Evaluation approach will be used. The Cochran’s Q statistic and the I2statistics will be used to analyse statistical heterogeneity between studies. If included studies show high levels of homogeneity, a random effects meta-analysis will be performed using R statistical software.Ethics and disseminationThis will be a review of existing studies and will not require ethical approval. The findings will be disseminated through peer-reviewed publication and presented at local and international conferences. An emerging patient management dilemma is that of the increased incidence of CVD in people living with HIV on HAART. This review may inform treatment and cardiovascular risk stratification of HIV-infected patients at increased risk of developing CVD.PROSPERO registration numberCRD42017062393.

Stroke in Pregnancy and Puerperium: Validated Incidence Trends With Risk Factor Analysis in Finland 1987–2016

Neurology ◽  
2021 ◽  
pp. 10.1212/WNL.0000000000011990
Author(s):  
Liisa Karjalainen ◽  
Minna Tikkanen ◽  
Kirsi Rantanen ◽  
Karoliina Aarnio ◽  
Aino Korhonen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Postpartum Period ◽  
First Trimester ◽  
Class Iii ◽  
Hypertensive Disorders Of Pregnancy ◽  
Risk Factor Management ◽  
Incidence Trends ◽  
Hypertensive Disorders ◽  
Increased Risk

Objective:To investigate whether previously reported increasing incidence of pregnancy-associated stroke (PAS) is observed in chart-validated register data in Finland. In an exploratory analysis, we studied risk factors for PAS.Methods:We performed a retrospective population-based cohort study and nested case-control study in Finland 1987-2016. The Medical Birth Register (MBR) was linked with the Hospital Discharge Register to identify women with incident stroke (ischemic stroke, cerebral venous thrombosis, intracerebral or subarachnoid hemorrhage) during pregnancy or puerperium. Cases were verified from patient records. Incidence of PAS over the study period, in 5-year age groups and pregnancy/postpartum period were calculated per number of deliveries. Three matched controls were selected for each case from MBR to compare risk factors.Results:After chart review, 29.6% (257/868) of cases were PAS. The incidence of PAS was 14.5 (95%CI: 12.8-16.3) per 100,000 deliveries. Incidence increased from 11.1 to 25.2 per 100,000 deliveries from 1987-1991 to 2012-2016 (p<0.0001). Incidence increased by age from 9.8 to 29.9 per 100,000 deliveries from ages 20-24 to ages >40 (p<0.0001). During early postpartum period, incidence was 5-fold greater compared to the first trimester. Maternal mortality was 6.6%. In the multivariable adjusted model, smoking beyond 12 gestational weeks (odds ratio [OR] 1.8, 95%CI: 1.2-2.7), migraine (OR 16.3, 95%CI: 5.3-49.8), and hypertensive disorders of pregnancy (OR 4.0, 95%CI: 2.5-6.3) were the most important risk factors for PAS.Conclusion:PAS incidence is increasing stressing the importance of careful pregnancy surveillance and risk factor management, particularly in older expectant mothers and extending to puerperium.Classification of Evidence:This study provides Class III evidence that smoking beyond 12 gestational weeks, migraine and hypertensive disorders of pregnancy are associated with an increased risk of PAS.

scholarly journals Prevalence and impact of frailty in patients with atrial fibrillation: a systematic review and meta-analysis

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Proietti ◽  
G.F Romiti ◽  
V Raparelli ◽  
I Diemberger ◽  
G Boriani ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Systematic Review ◽  
Meta Analysis ◽  
Frailty Index ◽  
Prevalence Odds Ratio ◽  
Frail Patients ◽  
Pooled Prevalence ◽  
Increased Risk ◽  
Inconsistency Index

Abstract Background Frailty is a clinical syndrome characterized by a reduced physiologic function, increased vulnerability to stressors, and an increased risk of adverse outcomes. Patients with Atrial Fibrillation (AF) are often burdened with a high number of comorbidities and prone to frailty. The prevalence of frailty, its management and association with major outcomes in patients with AF are still unclear. Purpose To estimate the pooled prevalence of frailty in patients with AF, as well as its association with AF-related risk factors and comorbidities, oral anticoagulants (OAC) prescription, and major outcomes. Methods We systematically searched PubMed and EMBASE, from inception to 31st January 2021, for studies reporting the prevalence of frailty (irrespective of the tool used for assessment). Pooled prevalence, odds ratio (OR), and 95% Confidence Intervals (CI) were computed using random-effect models; heterogeneity was assessed through the inconsistency index (I2). This study was registered in PROSPERO: CRD42021235854. Results A total of 1,116 studies were retrieved from the literature search, and 31 were finally included in the systematic review (n=842,521 patients). The frailty pooled prevalence was 39.6% (95% CI=29.2%-51.0%, I2=100%; Figure 1). Significant subgroup differences were observed according to geographical location (higher prevalence found in European-based cohorts; p=0.003) and type of tool used for the assessment (higher prevalence in studies using the Clinical Frailty Scale and Tilburg Frailty Index tools; p&lt;0.001). Meta-regressions showed that study-level mean age and prevalence of hypertension, diabetes, and history of stroke were directly associated with frailty prevalence. Frailty was significantly associated with a 29% reduced probability of OAC prescription in observational studies (OR=0.71, 95% CI=0.62–0.81). Frail patients with AF were at higher risk of all-cause death (OR=4.12, 95% CI=3.15–5.41), ischemic stroke (OR=1.55, 95% CI=1.01–2.38), and bleeding (OR=1.55, 95% CI=1.12–2.14), compared to non-frail patients with AF. Conclusions In this systematic review and meta-analysis analysis, the prevalence of frailty was high in patients with AF, and associated with study-level mean age and prevalence of several stroke risk factors. Frailty may influence the management of patients, and worsening the prognosis for all major AF-related outcomes. FUNDunding Acknowledgement Type of funding sources: None. Prevalence of Frailty among AF patients

scholarly journals Primary CNS tumors in adults and environmental factors: an update

2020 ◽  
pp. 176-181
Author(s):  
S.G. Berntsson ◽  
Keyword(s):  
Risk Factors ◽  
Brain Tumor ◽  
Mobile Phone ◽  
Meta Analysis ◽  
Cns Tumors ◽  
Acoustic Neurinoma ◽  
Low Grade ◽  
Mobile Phone Use ◽  
Increased Risk

The incidence of adult primary brain tumors is increasing in some European countries. High-dose ionizing irradiation, rare genetic syndromes, and genetic predisposition in 5 % of families are a few established environmental risk factors for brain tumor. Mobile phone use that causes near brain exposure to radiofrequency electromagnetic waves and thus creates risks of CNS tumors has been the focus of many studies. Nine meta-analyses were available on this subject. The Interphone multi-center case-control study is the largest one to date; it included 2.708 glioma and 2.409 meningioma cases and matched controls in 13 countries. Studies exploring metals (cadmium, lead), pesticides, outdoor pollution, virus, and risk of glioma created by exposure to them were reviewed. Interphone study did not show increased risk of glioma or meningioma in mobile-phone users. One recent meta-analysis in 2017 found that prolonged exposure i.e.,> 10 years of all phone types was associated with increased risk of ipsilateral CNS tumor locations. In another meta-analysis, long-term use of mobile-phones was found to be a risk factor for low-grade glioma. In case of all durations regarding mobile phone use and both sides of the head, the results of pooling data were more discordant. A large prospective study in 2014 showed that long term use vs never use increased risks of acoustic neurinoma (10+ years: RR = 2.46, 95 % CI = 1.07–5.64, P = 0.03), but not of glioma or meningioma. Studies of other risk factors showed no/weak/contradictory association with brain tumor risk. In the absence of robust and consistent evidence, a causal relation between radiofrequency exposure and CNS tumors was not found. Large prospective studies of this kind regarding a disease with low incidence require a high number of participants and a long follow-up period.

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