Remotely delivered interventions to support women with symptoms of anxiety in pregnancy: a mixed methods systematic review of quantitative and qualitative evidence (Preprint)

BACKGROUND Symptoms of anxiety are common in pregnancy, with severe symptoms associated with negative outcomes for women and babies. Low level psychological therapy is recommended as first line treatment options for women with mild to moderate anxiety, with the aim to prevent an escalation of symptoms and provide women with coping strategies. Remotely delivered interventions have been suggested to improve access to treatment and support for women in pregnancy and provide a cost-effective, flexible and timely solution. OBJECTIVE To identify and evaluate remotely delivered, digital or on-line interventions to support women with symptoms of anxiety in pregnancy. METHODS A mixed method systematic review following a convergent segregated approach to synthesise the qualitative and quantitative data. The ACM Digital Library, AMED, ASSIA, CRD, CENTRAL, the Cochrane Library, CINAHL, EMBASE, HTA, IEEE Xplore, JBI, Maternity and Infant Care, Medline, PsycINFO and the Social Science Citation Index were searched in October 2020. Quantitative or qualitative primary research including pregnant women which evaluated remotely delivered interventions reporting measures of anxiety, fear, stress, distress, women’s views, feedback and opinions were included in the review. RESULTS Three qualitative and 14 were quantitative studies included. Populations included a general antenatal population, and pregnant women with anxiety and depression, fear of childbirth, insomnia and pre-term labour. Interventions included CBT, Problem Solving, Mindfulness and Educational designs. Most interventions were delivered via on-line platforms and 8 included direct contact from trained therapists or coaches. A meta-analysis of the quantitative data found for I-CBT and facilitated interventions there was observed beneficial effect in relation to the reduction of anxiety scores (SMD=-0.49; 95% CI=-0.75 to -0.22; SMD=-0.48; 95% CI=-0.75 to -0.22). However, due to limitations in the amount of available data and study quality, the findings should be interpreted with caution. Synthesised findings from quantitative and qualitative data found some evidence to suggest that interventions are more effective when women are motivated to maintain regular participation in interventions. Participation may be enhanced by providing regular contact with therapists, targeting interventions for women with anxiety symptoms; providing peer support forums; including components of relaxation and cognitive based skills; and providing sufficient sessions to develop new skills without being too time consuming. CONCLUSIONS There is limited evidence to suggest that pregnant women may benefit from remotely delivered interventions. The synthesised findings highlighted components of interventions which may improve the effectiveness and acceptability of remotely delivered interventions. These include providing women with contact with a therapist, healthcare professional or peer community. Women may be more motivated to complete interventions which are perceived as relevant or tailored to their needs and situations. Remote interventions may also provide women with greater anonymity to help them feel more confident in disclosing their symptoms.

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Prevalence, incidence and bothersomeness of urinary incontinence in pregnancy: a systematic review and meta-analysis

International Urogynecology Journal ◽

10.1007/s00192-020-04636-3 ◽

2021 ◽

Author(s):

Heidi F. A. Moossdorff-Steinhauser ◽

Bary C. M. Berghmans ◽

Marc E. A. Spaanderman ◽

Esther M. J. Bols

Keyword(s):

Systematic Review ◽

Urinary Incontinence ◽

Pregnant Women ◽

Health Care Providers ◽

Meta Analysis ◽

Care Providers ◽

Case Definitions ◽

Monthly Basis ◽

Policy Makers ◽

In Pregnancy

Abstract Introduction and hypothesis Urinary incontinence (UI) is a common and embarrassing complaint for pregnant women. Reported prevalence and incidence figures show a large range, due to varying case definitions, recruited population and study methodology. Precise prevalence and incidence figures on (bothersome) UI are of relevance for health care providers, policy makers and researchers. Therefore, we conducted a systematic review and meta-analysis to investigate the prevalence and incidence of UI in pregnancy in the general population for relevant subgroups and assessed experienced bother. Methods All observational studies published between January 1998 and October 2018 reporting on prevalence and/or incidence of UI during pregnancy were included. All women, regardless of weeks of gestation and type of UI presented in all settings, were of interest. A random-effects model was used. Subgroup analyses were conducted by parity, trimester and subtype of UI. Results The mean (weighted) prevalence based on 44 included studies, containing a total of 88.305 women, was 41.0% (range of 9–75%). Stress urinary incontinence (63%) is the most prevalent type of UI; 26% of the women reported daily loss, whereas 40% reported loss on a monthly basis. Bother was experienced as mild to moderate. Conclusions UI is very prevalent and rising with the weeks of gestation in pregnancy. SUI is the most common type and in most cases it was a small amount. Bother for UI is heterogeneously assessed and experienced as mild to moderate by pregnant women.

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

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-04250-1 ◽

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.

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Prevalence of Syphilis among Pregnant Women in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

BioMed Research International ◽

10.1155/2019/4562385 ◽

2019 ◽

Vol 2019 ◽

pp. 1-10 ◽

Cited By ~ 1

Author(s):

Siraj Hussen ◽

Birkneh Tilahun Tadesse

Keyword(s):

Systematic Review ◽

Pregnant Women ◽

Screening Program ◽

Meta Analysis ◽

Relevant Literature ◽

Sub Saharan Africa ◽

Cochrane Library ◽

Forest Plot ◽

Pooled Prevalence ◽

Sub Saharan

Objective. Syphilis is one of the most imperative STIs, caused by the spirochete Treponema pallidum. During pregnancy it is associated with disastrous health outcomes in the newborn. In sub-Saharan Africa, study findings on the prevalence of syphilis among pregnant women are highly dispersed and inconsistent. The aim of the current review is to conduct a systematic review and meta-analysis of syphilis in sub-Saharan Africa among pregnant women. Design. Systematic review and meta-analysis. Data Sources. Databases including MEDLINE, PubMed, Cochrane Library, Google Scholar, and HINARI and reference lists of previous prevalence studies were systematically searched for relevant literature from January 1999 to November 2018. Results were presented in forest plot, tables, and figures. Random-effects model was used for the meta-analysis. For the purpose of this review, a case of syphilis was defined as positive treponemal or nontreponemal tests among pregnant women. Data Extraction. Our search gave a total of 262 citations from all searched databases. Of these, 44 studies fulfilling the inclusion criteria and comprising 175,546 subjects were finally included. Results. The pooled prevalence of syphilis among pregnant women in sub-Saharan Africa was 2.9% (95%CI: 2.4%-3.4%). East and Southern African regions had a higher syphilis prevalence among pregnant women (3.2%, 95% CI: 2.3%-4.2% and 3.6%, 95%CI: 2.0%-5.1%, respectively) than the sub-Saharan African pooled prevalence. The prevalence of syphilis among pregnant women in most parts of the region seemed to have decreased over the past 20 years except for the East African region. However, prevalence did not significantly differ by region and time period. Conclusion. This review showed a high prevalence of syphilis in sub-Saharan Africa among pregnant women. The evidence suggests strengthening the screening program during pregnancy as part of the care package during antenatal care visits. Programs focusing on primary prevention of syphilis in women should also be strengthened.

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Iron stores in pregnant women with sickle cell disease: a protocol for a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2018-026497 ◽

2019 ◽

Vol 9 (9) ◽

pp. e026497 ◽

Cited By ~ 2

Author(s):

Desmond Aroke ◽

Benjamin Momo Kadia ◽

Tsi Njim

Keyword(s):

Systematic Review ◽

Sickle Cell Disease ◽

Iron Deficiency ◽

Pregnant Women ◽

Sickle Cell ◽

Iron Deficiency Anaemia ◽

Meta Analysis ◽

Cochrane Library ◽

Cell Disease ◽

Deficiency Anaemia

IntroductionSickle cell disease (SCD) is the most common inherited disease worldwide. The greatest disease burden is seen in sub-Saharan Africa. Early diagnosis and improved care of people living with SCD have led to an increase in the number of women with SCD reaching the reproductive age. Iron deficiency anaemia remains the most common cause of anaemia in pregnancy, affecting 51%–63% of pregnancies in Africa. However, the unavailability of guidelines on supplementation of iron in this pregnant subpopulation often leaves clinicians in a fix. We propose to conduct the first systematic review and possibly a meta-analysis on the prevalence, associated factors and maternal/fetal outcomes of iron deficiency anaemia among pregnant women with SCD.Methods and analysisWe will search the following electronic databases for studies on the iron status of pregnant women with SCD: PubMed, MEDLINE, EMBASE, Google Scholar, African Journals Online, African Index Medicus, Popline and the Cochrane Library. After the selection of eligible studies from the search output, review of full text, data extraction and data synthesis will be performed. Studies obtained from the review shall be evaluated for quality, risk of bias and heterogeneity. Appropriate statistical methods shall be used to pool prevalence estimates for matching studies globally and in subpopulations. This protocol has been reported as per the 2015 guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols.Ethics and disseminationThere is no requirement for ethical approval as the proposed study will use published data. The findings of this study will be published in a peer-reviewed journal and will be presented at conferences.Trial registration numberCRD42018109803.

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Antiepileptic Drug Exposure during Pregnancy and Neonatal Birth Weight Outcomes: Protocol for a Systematic Review and Meta-analysis.

10.21203/rs.3.rs-74193/v1 ◽

2020 ◽

Author(s):

Alekhya Lavu ◽

Christine Vaccaro ◽

Walid Shouman ◽

Silvia Alessi-Severini ◽

Sherif Eltonsy

Keyword(s):

Systematic Review ◽

Birth Weight ◽

Antiepileptic Drug ◽

Drug Exposure ◽

Meta Analysis ◽

Grey Literature ◽

Cochrane Library ◽

Neonatal Birth Weight ◽

Weight Outcomes ◽

In Pregnancy

Abstract Background: The prevalence of epilepsy in pregnant women is estimated at 0.3- 1%. Antiepileptic drug (AED) exposure in-utero has been associated with various adverse health outcomes in neonates including adverse birth weight outcomes. Methods: To summarize the evidence on the association between AED exposure in pregnancy and adverse birthweight outcomes. Studies assessing AED exposure in pregnancy and neonatal birth weight outcome including small for gestational age (SGA), low birth weight (LBW), birth weight (BW), length head circumference and cephalization index will be identified in MEDLINE, EMBASE, Cochrane Library, Scopus, CINAHL, IPA, and Global Health. Open grey, Theses Canada and ProQuest Dissertations will be used to locate grey literature. Eligible study designs include experimental and observational studies. Studies will be assessed for risk of bias using the Newcastle-Ottawa Scale and Meta-analysis will be conducted using a random-effects model. Discussion: The results from this review could improve clinicians’ prescribing decisions by highlighting the safest AEDs for women who are pregnant or planning to conceive based on the best evidence currently available. Systematic review registration: submitted (19/08/2020))

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Regulatory T Cells in Pregnancy Adverse Outcomes: A Systematic Review and Meta-Analysis

Frontiers in Immunology ◽

10.3389/fimmu.2021.737862 ◽

2021 ◽

Vol 12 ◽

Author(s):

Samantha Green ◽

Marina Politis ◽

Kathrine S. Rallis ◽

Alba Saenz de Villaverde Cortabarria ◽

Athina Efthymiou ◽

...

Keyword(s):

Systematic Review ◽

T Cells ◽

Regulatory T Cells ◽

Pregnant Women ◽

Peripheral Blood ◽

Meta Analysis ◽

Adverse Outcomes ◽

Case Control Studies ◽

Inconsistency Index ◽

In Pregnancy

BackgroundSeveral studies report the role of Regulatory T-cells (Tregs) in the pathophysiology of pregnancy adverse outcomes.ObjectiveThe aim of this systematic review and meta-analysis was to determine whether there is an association between regulatory T cell levels and pregnancy adverse outcomes (PAOs), including pre-eclampsia and preterm birth (PTB).MethodLiterature searches were conducted in PubMed/MEDLINE, Embase, and Cochrane CENTRAL databases. Inclusion criteria were original articles (clinical trials, case-control studies and cohort studies) comparing Tregs, sampled from the decidua or maternal blood, in healthy pregnant women versus women with pre-eclampsia or PTB. The outcome was standardised mean difference (SMD) in Treg numbers. The tau-squared (Tau²), inconsistency index (I²), and chi-squared (χ²) test quantified heterogeneity among different studies. Analyses were performed in RevMan software V.5.4.0 for Mac using a random-effects model with outcome data reported with 95% confidence intervals (CI). This study was prospectively registered with PROSPERO (CRD42020205469). PRISMA guidelines were followed.ResultsFrom 4,085 unique studies identified, 36 were included in qualitative synthesis, and 34 were included in quantitative synthesis (meta-analysis). In total, there were 1,783 participants in these studies: healthy controls=964, pre-eclampsia=759, PTB=60. Thirty-two studies compared Tregs in healthy pregnant women and women with pre-eclampsia, and 30 of these sampled Tregs from peripheral blood showing significantly higher Treg numbers in healthy pregnancies (SMD; 1.46; 95% CI, 1.03–1.88; I²=92%). Four studies sampled Tregs from the maternal decidua showing higher Tregs in healthy pregnancies (SMD, 0.76; 95% CI, -0.13–1.65; I²=84%). No difference was found in the number of Tregs between early versus late pre-eclampsia (SMD,-1.17; 95% CI, -2.79–0.44; I²=94%). For PTB, two studies compared Tregs sampled from the peripheral blood with a tendency for higher Tregs in healthy pregnancies but this did not reach significance (SMD, 2.18; 95% CI, -1.34–5.70; I²=96%). Subcohort analysis using Treg analysis (flow cytometry vs. qPCR vs. immunofluorescence tissue staining) showed similar associations.ConclusionLower Tregs in pregnancy, sampled from the maternal peripheral blood, are associated with pre-eclampsia. There is a need for further studies to confirm a relationship between low Tregs and PTB. As the precise mechanisms by which Tregs may mediate pre-eclampsia and PTB remain unclear, further fundamental research is necessary to elucidate the underlying processes and highlight the causative link.Systematic Review RegistrationPROSPERO, identifier CRD42020205469.

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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 ◽

10.1371/journal.pmed.1003856 ◽

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.

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Anemia in Ugandan pregnant women: a cross-sectional, systematic review and meta-analysis study

Tropical Medicine and Health ◽

10.1186/s41182-021-00309-z ◽

2021 ◽

Vol 49 (1) ◽

Author(s):

Felix Bongomin ◽

Ronald Olum ◽

Andrew Peter Kyazze ◽

Sandra Ninsiima ◽

Gloria Nattabi ◽

...

Keyword(s):

Public Health ◽

Systematic Review ◽

Blood Pressure ◽

Pregnant Women ◽

Meta Analysis ◽

Referral Hospital ◽

Cross Sectional ◽

Anemia In Pregnancy ◽

Prevalence Of Anemia ◽

In Pregnancy

Abstract Background Anemia in pregnancy represents a global public health concern due to wide ranging maternal and neonatal adverse outcomes in all peripartum periods. We estimated the prevalence and factors associated with anemia in pregnancy at a national obstetrics and gynecology referral hospital in Uganda and in addition performed a systematic review and meta-analysis of the overall burden of anemia in pregnancy in Uganda. Methods We conducted a cross-sectional study among 263 pregnant women attending the antenatal care clinic of Kawempe National Referral Hospital, Kampala, Uganda, in September 2020. Anemia in pregnancy was defined as a hemoglobin level of < 11.0 g/dl and microcytosis as a mean corpuscular volume (MCV) of < 76 fL. We also performed a systematic review (PROSPERO Registration ID: CRD42020213001) and meta-analysis of studies indexed on MEDLINE, Embase, African Journal Online, ClinicalTrials.gov, ICTRP, and the Cochrane Library of systematic review between 1 January 2000 and 31 September 2020 reporting on the prevalence of anemia in pregnancy in Uganda. Results The prevalence of anemia was 14.1% (n= 37) (95%CI 10.4–18.8), of whom 21 (56.8%) had microcytic anemia. All cases of anemia occurred in the second or third trimester of pregnancy and none were severe. However, women with anemia had significantly lower MCV (75.1 vs. 80.2 fL, p<0.0001) and anthropometric measurements, such as weight (63.3 vs. 68.9kg; p=0.008), body mass index (25.2 vs. 27.3, p=0.013), hip (98.5 vs. 103.8 cm, p=0.002), and waist (91.1 vs. 95.1 cm, p=0.027) circumferences and mean systolic blood pressure (BP) (118 vs 125 mmHg, p=0.014). Additionally, most had BP within the normal range (59.5% vs. 34.1%, p=0.023). The comparison meta-analysis of pooled data from 17 published studies of anemia in pregnancy in Uganda, which had a total of 14,410 pregnant mothers, revealed a prevalence of 30% (95% CI 23–37). Conclusions Despite our study having a lower prevalence compared to other studies in Uganda, these findings further confirm that anemia in pregnancy is still of public health significance and is likely to have nutritional causes, requiring targeted interventions. A larger study would be necessary to demonstrate potential use of basic clinical parameters such as weight or blood pressure as screening predictors for anemia in pregnancy.

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Effectiveness of topical and ablative therapies in treatment of anogenital warts: a systematic review and network meta-analysis

BMJ Open ◽

10.1136/bmjopen-2018-027765 ◽

2019 ◽

Vol 9 (10) ◽

pp. e027765 ◽

Cited By ~ 4

Author(s):

Samantha Barton ◽

Victoria Wakefield ◽

Colm O'Mahony ◽

Steven Edwards

Keyword(s):

Systematic Review ◽

Carbon Dioxide Laser ◽

Meta Analysis ◽

Treatment Options ◽

Risk Of Bias ◽

Cochrane Library ◽

Anogenital Warts ◽

Complete Clearance ◽

End Of Treatment ◽

Significant Difference

ObjectiveTo generate estimates of comparative clinical effectiveness for interventions used in the treatment of anogenital warts (AGWs) through the systematic review, appraisal and synthesis of data from randomised controlled trials (RCTs).DesignSystematic review and network meta-analysis of RCTs. Search strategies were developed for MEDLINE, Embase, the Cochrane Library and the Web of Science. For electronic databases, searches were run from inception to March 2018. The systematic review was carried out following the general principles recommended in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.ParticipantsPeople aged ≥16 years with clinically diagnosed AGWs (irrespective of biopsy confirmation).InterventionsTopical and ablative treatments recommended by the British Association for Sexual Health and HIV for the treatment of AGWs, either as monotherapy or in combination versus each other.Outcome measuresComplete clearance of AGWs at the end of treatment and at other scheduled visits, and rate of recurrence.ResultsThirty-seven RCTs met inclusion criteria. Twenty studies were assessed as being at unclear risk of bias, with the remaining studies categorised as high risk of bias. Network meta-analysis indicates that, of the treatment options compared, carbon dioxide laser therapy is the most effective treatment for achieving complete clearance of AGWs at the end of treatment. Of patient-applied topical treatments, podophyllotoxin 0.5% solution was found to be the most effective at achieving complete clearance, and was associated with a statistically significant difference compared with imiquimod 5% cream and polyphenon E 10% ointment (p<0.05). Few data were available on recurrence of AGWs after complete clearance. Of the interventions evaluated, surgical excision was the most effective at minimising risk of recurrence.ConclusionOf the studies assessed, as a collective, the quality of the evidence is low. Few studies are available that evaluate treatment options versus each other.Trial registration numberCRD42013005457

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

10.21203/rs.3.rs-148324/v1 ◽

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

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