The impact of maternal diet in pregnancy and lactation on allergy and atopy outcomes in offspring: A systematic review

Maternal Diet ◽

Risk Of Bias ◽

Controlled Trials ◽

Pregnancy And Lactation ◽

Randomised Controlled ◽

<p>Allergic disease and atopy create a substantial emotional and financial burden for affected individuals and their families. Significant healthcare costs are also incurred with New Zealand children showing consistently high rates of allergic disease when compared with global statistics. The potential to decrease the incidence of allergic disease and atopy through modification of maternal diet has been the subject of recent attention with the possibility for transgenerational impact being of considerable interest. The objectives of this systematic review were firstly to investigate the relationship between maternal diet in pregnancy and lactation on allergic outcomes in the offspring, and to then relate these findings to the New Zealand context. The following databases were accessed as part of this review: PubMed via helicon (advanced search), ProQuest (MEDLINE) via helicon, CINAHL Complete (EBSCO host via helicon). Limits were “humans”. The key search terms were ‘diet’ or ‘supplements’, ‘pregnancy’ or ‘lactation’, ‘allergy’ or ‘atopy’ or ‘asthma; NOT ‘elimination’ or ‘avoidance’. The studies for inclusion in this review were restricted to studies written in the English language. The final search was undertaken 11/04/17 once data extraction completed and one new study found. Initial search was 14/07/16. Search period 14/04/16-11/04/17. Randomised controlled trials and cohort studies that systematically recorded maternal intake of diet or supplements were included. The health-related outcomes assessed were asthma, wheeze, eczema and allergic rhinitis. Data was extracted for this review using the Cochrane Public Health Group’s template. Risk of bias was assessed using the Cochrane risk of bias assessment tool for the randomised controlled trials and the Newcastle-Ottawa Scale for the cohort studies. Risk of bias was assessed again and presented using the Grade summary of findings tables. Overall, 54 studies were included in this review, collectively involving more than 100,000 children and comprising of 16 randomised controlled trials and 38 cohort studies that were selected based on predetermined inclusion and exclusion criteria. Data on vitamins, oligo-elements, food groups and dietary patterns during pregnancy and lactation were also collected. A meta-analysis was not performed due to the diversity in variables, multiple outcomes assessed, and the variety of measurements implemented within the studies. This work presents a comprehensive summary and review of the identified studies that explored the impact of maternal diet in pregnancy and lactation on allergy and atopy outcomes. Although individual studies demonstrated various associations between maternal diet during pregnancy and lactation to impact on health outcomes for the offspring, overall, this work did not show any consistent findings collectively across the studies reviewed. This was due to the differing methods of measurement of association, intake and outcome assessment used in the reviewed studies which further complicated the ability to compare and contrast the findings of the studies with each other. Each study was assessed both for its individual findings and then collectively according to the variables assessed. The findings of this review lend support for the undertaking of additional trials and studies with more consistent and controlled measurements of interventions and outcomes to better facilitate comparisons between studies. Key findings from the reviewed studies, which included only one New Zealand based study, were related to the New Zealand context. Additional New Zealand based information and related works highlighted a need for personally tailored maternal nutrition information to be delivered consistently by all health professionals interacting with pregnant women. Key words: diet, supplements, pregnancy, lactation, allergy, atopy, asthma.</p>

The impact of maternal diet in pregnancy and lactation on allergy and atopy outcomes in offspring: A systematic review

10.26686/wgtn.17131775 ◽

2021 ◽

Author(s):

◽

Melissa Whitehead

Keyword(s):

New Zealand ◽

Cohort Studies ◽

Allergic Disease ◽

Maternal Diet ◽

Risk Of Bias ◽

Controlled Trials ◽

Pregnancy And Lactation ◽

Randomised Controlled ◽

Impact of levothyroxine therapy on obstetric, neonatal and childhood outcomes in women with subclinical hypothyroidism diagnosed in pregnancy: a systematic review and meta-analysis of randomised controlled trials

BMJ Open ◽

10.1136/bmjopen-2018-022837 ◽

2018 ◽

Vol 8 (9) ◽

pp. e022837 ◽

Cited By ~ 11

Author(s):

Jennifer M Yamamoto ◽

Jamie L Benham ◽

Kara A Nerenberg ◽

Lois E Donovan

Keyword(s):

Systematic Review ◽

Subclinical Hypothyroidism ◽

Meta Analysis ◽

Risk Of Bias ◽

Controlled Trials ◽

Randomised Trials ◽

Neurodevelopmental Outcomes ◽

Randomised Controlled ◽

ObjectiveTo determine in women with subclinical hypothyroidism diagnosed in pregnancy whether levothyroxine treatment compared with control, impacts important obstetrical or childhood outcomes (specifically IQ) in randomised controlled trials.DesignSystematic review and meta-analysis.Study eligibility criteriaRandomised trials which met all the following were included: (1) reported original data of women with subclinical hypothyroidism diagnosed in pregnancy (by any prespecified study definition); (2) randomised to either levothyroxine or control (placebo or no treatment); (3) reported obstetrical outcomes and/or childhood neurodevelopmental outcomes and (4) published from 1980 to January 2018 in either English or French language.Data sourcesMedline, EMBASE, CINAHL, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov.Outcome measuresObstetrical, neonatal and childhood outcomes including: miscarriage, gestational hypertension, pre-eclampsia, preterm delivery, mode of delivery, neonatal intensive care unit admission, birth weight, gestational age at delivery, childhood IQ and neurodevelopmental scores.Risk of bias assessmentCochrane Risk of Bias Tool (Modified) for Quality Assessment of Randomised Controlled TrialsResultsThree trials of low to unclear risk of bias with 1837 participants were included. Two studies were meta-analysed for maternal and neonatal outcomes and two studies for childhood IQ. No statistically significant differences were found for any clinical outcomes with levothyroxine therapy compared with control.LimitationsOnly three trials were identified for inclusion.ConclusionsThis review, based on three randomised trials in women with subclinical hypothyroidism diagnosed in pregnancy, found no evidence of benefit of levothyroxine therapy on obstetrical, neonatal, childhood IQ or neurodevelopmental outcomes. Current trial evidence does not support the treatment of subclinical hypothyroidism diagnosed in pregnancy.PROSPERO registration numberCRD4201707980.

Efficacy of electronic cigarettes for tobacco smoking cessation: An adapted systematic review

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.1167 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

T O'Dowd

Keyword(s):

Smoking Cessation ◽

Cohort Studies ◽

Electronic Cigarettes ◽

Controlled Trials ◽

Significant Heterogeneity ◽

Smoking Reduction ◽

Significant Difference ◽

Abstract Background Worldwide smoking remains the leading cause of preventable morbidity and mortality. Electronic cigarettes (ECs) are increasingly used by tobacco smokers as an aid to smoking cessation; however, their efficacy remains uncertain. Methods Electronic databases, clinical trial registries and grey literature sources were searched. The aim was to examine randomised controlled trials or prospective cohort studies, published since the 2016 Cochrane review on this topic, that assessed the efficacy of ECs in achieving smoking cessation among current smokers. Results Two RCTs and five cohort studies, including a total of 16,460 participants, were eligible for inclusion. One RCT found sustained 1-year abstinence of 18.0% in the EC group versus 9.9% in the nicotine replacement therapy group (RR: 1.83; 95% CI 1.30 to 2.58; P < 0.001). The second RCT did not find a statistically significant difference in abstinence rates between EC users and non-users (RR 0.71). Of the five included cohort studies, four reported statistically significant RRs. Two found a positive association (RRs of 1.45 and 1.84) between EC use and smoking cessation but two studies showed EC use was associated with reduced smoking cessation (RRs of 0.25 and 0.35). Due to significant heterogeneity between the studies the data were deemed unsuitable for pooling into a meta-analysis. All trials assessing smoking reduction reported higher rates of reduction among EC users. No serious adverse events were reported with EC use. Follow-up periods of included trials ranged from one to four years, with an average of 1.6 years. Conclusions There is limited, low-quality evidence that ECs are an effective intervention for smoking cessation and smoking reduction. The overall quality of evidence is low as it is based on a small number of studies with inconsistent and imprecise results. Due to the short follow-up periods of the included trials, the long-term safety of ECs is unclear from this review. Key messages Limited evidence that electronic cigarettes are an effective smoking cessation intervention. Further well-designed randomised controlled trials are required to investigate the efficacy of ECs for smoking cessation.

Comparative efficacy and safety of interventions for treating head lice: a protocol for systematic review and network meta-analysis

BMJ Paediatrics Open ◽

10.1136/bmjpo-2021-001129 ◽

2021 ◽

Vol 5 (1) ◽

pp. e001129

Author(s):

Bill Stevenson ◽

Wubshet Tesfaye ◽

Julia Christenson ◽

Cynthia Mathew ◽

Solomon Abrha ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Grey Literature ◽

Risk Of Bias ◽

Controlled Trials ◽

Head Lice ◽

Efficacy And Safety ◽

Randomised Controlled ◽

Meta Analyses

BackgroundHead lice infestation is a major public health problem around the globe. Its treatment is challenging due to product failures resulting from rapidly emerging resistance to existing treatments, incorrect treatment applications and misdiagnosis. Various head lice treatments with different mechanism of action have been developed and explored over the years, with limited report on systematic assessments of their efficacy and safety. This work aims to present a robust evidence summarising the interventions used in head lice.MethodThis is a systematic review and network meta-analysis which will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement for network meta-analyses. Selected databases, including PubMed, Embase, MEDLINE, Web of Science, CINAHL and Cochrane Central Register of Controlled Trials will be systematically searched for randomised controlled trials exploring head lice treatments. Searches will be limited to trials published in English from database inception till 2021. Grey literature will be identified through Open Grey, AHRQ, Grey Literature Report, Grey Matters, ClinicalTrials.gov, WHO International Clinical Trials Registry and International Standard Randomised Controlled Trials Number registry. Additional studies will be sought from reference lists of included studies. Study screening, selection, data extraction and assessment of methodological quality will be undertaken by two independent reviewers, with disagreements resolved via a third reviewer. The primary outcome measure is the relative risk of cure at 7 and 14 days postinitial treatment. Secondary outcome measures may include adverse drug events, ovicidal activity, treatment compliance and acceptability, and reinfestation. Information from direct and indirect evidence will be used to generate the effect sizes (relative risk) to compare the efficacy and safety of individual head lice treatments against a common comparator (placebo and/or permethrin). Risk of bias assessment will be undertaken by two independent reviewers using the Cochrane Risk of Bias tool and the certainty of evidence assessed using the Grading of Recommendations, Assessment, Development and Evaluations guideline for network meta-analysis. All quantitative analyses will be conducted using STATA V.16.DiscussionThe evidence generated from this systematic review and meta-analysis is intended for use in evidence-driven treatment of head lice infestations and will be instrumental in informing health professionals, public health practitioners and policy-makers.PROSPERO registration numberCRD42017073375.

A Systematic Review of Cost-Effectiveness Analyses Alongside Randomised Controlled Trials of Acupuncture

Acupuncture in Medicine ◽

10.1136/acupmed-2012-010178 ◽

2012 ◽

Vol 30 (4) ◽

pp. 273-285 ◽

Cited By ~ 38

Author(s):

Song-Yi Kim ◽

Hyangsook Lee ◽

Younbyoung Chae ◽

Hi-Joon Park ◽

Hyejung Lee

Keyword(s):

Cost Effectiveness ◽

Usual Care ◽

Risk Of Bias ◽

Economic Evaluations ◽

Controlled Trials ◽

German Studies ◽

Life Years ◽

Randomised Controlled ◽

The Cost

Objective To summarise the evidence on the cost-effectiveness of acupuncture. Methods We identified full economic evaluations such as cost-effectiveness analysis (CEA), cost-utility analysis (CUA) and cost-benefit analysis (CBA) alongside randomised controlled trials (RCTs) that assessed the consequences and costs of acupuncture for any medical condition. Eleven electronic databases were searched up to March 2011 without language restrictions. Eligible RCTs were assessed using the Cochrane criteria for risk of bias and a modified version of the checklist for economic evaluation. The general characteristics and the results of each economic analysis such as incremental cost-effectiveness ratios (ICERs) were extracted. Results Of 17 included studies, nine were CUAs that measured quality-adjusted life years (QALYs) and eight were CEAs that assessed effectiveness of acupuncture based on improvements in clinical symptoms. All CUAs showed that acupuncture with or without usual care was cost-effective compared with waiting list control or usual care alone, with ICERs ranging from ¢3011/QALY (dysmenorrhoea) to ¢22 298/QALY (allergic rhinitis) in German studies, and from £3855/QALY (osteoarthritis) to £9951/QALY (headache) in UK studies. In the CEAs, acupuncture was beneficial at a relatively low cost in six European and Asian studies. All CUAs were well-designed with a low risk of bias, but this was not the case for CEAs. Conclusions Overall, this review demonstrates the cost-effectiveness of acupuncture. Despite such promising results, any generalisation of these results needs to be made with caution given the diversity of diseases and the different status of acupuncture in the various countries.

The role of maternal diet on offspring hyperinsulinaemia and adiposity after birth: a systematic review of randomised controlled trials

Journal of Developmental Origins of Health and Disease ◽

10.1017/s2040174421000623 ◽

2021 ◽

pp. 1-14

Author(s):

Sylvia North ◽

Catherine Crofts ◽

Christian Thoma ◽

Caryn Zinn

Keyword(s):

Cord Blood ◽

Assessment Tool ◽

Maternal Diet ◽

Specific Effect ◽

Lifestyle Changes ◽

Controlled Trials ◽

C Peptide ◽

Blood Insulin ◽

Abstract In utero diet may be directly related to the risk of fetal hyperinsulinaemia and offspring metabolic health. This review examines the relationship between maternal dietary exposures and sub-clinical fetal hyperinsulinaemia and neonatal adiposity. Articles were identified in MEDLINE, Web of Science, Cochrane Controlled Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, SCOPUS, and SPORTDiscus (September 2019–March 2021) using the preferred reporting items for systematic reviews and meta-analyses guidelines. PROSPERO registration ID CRD42020146453. Studies were selected by two independent reviewers. Randomised controlled trials (RCT) involving a dietary intervention with pregnant women (healthy pregnancy, gestational diabetes mellitus and obesity) and reporting fetal cord-blood insulin, c-peptide, glucose or adiposity estimates were included. One author extracted all information on main study characteristics and outcomes. Risk of bias was assessed using the Cochrane Collaboration’s bias risk assessment tool. A total of 733 articles were identified. Fourteen articles from 11 RCTs (3614 participants) were included. Studies reviewed showed no specific effect of maternal diet on neonatal cord blood insulin, c-peptide or glucose levels. Infants born to mothers who followed a low glycaemic load (GL) had lower skin fold thickness compared to controls. Interventions that provided individualised nutrition counselling to women with obesity or previous infant born > 4 kg were also associated with lower adiposity. The studies reviewed suggest that lifestyle-based dietary interventions to improve glycaemia (low GL) have a protective effect against excess adiposity. Future studies should incorporate multi-modal interventions with dietary counselling to support lifestyle changes throughout gestation and include assessments of maternal insulin resistance at recruitment.

Comparative efficacy and acceptability of psychotherapies for panic disorder with or without agoraphobia: systematic review and network meta-analysis of randomised controlled trials

The British Journal of Psychiatry ◽

10.1192/bjp.2021.148 ◽

2021 ◽

pp. 1-13

Author(s):

Davide Papola ◽

Giovanni Ostuzzi ◽

Federico Tedeschi ◽

Chiara Gastaldon ◽

Marianna Purgato ◽

...

Keyword(s):

Systematic Review ◽

Panic Disorder ◽

Meta Analysis ◽

Risk Of Bias ◽

Psychodynamic Therapy ◽

Controlled Trials ◽

First Line ◽

Short Term ◽

Background Psychotherapies are the treatment of choice for panic disorder, but which should be considered as first-line treatment is yet to be substantiated by evidence. Aims To examine the most effective and accepted psychotherapy for the acute phase of panic disorder with or without agoraphobia via a network meta-analysis. Method We conducted a systematic review and network meta-analysis of randomised controlled trials (RCTs) to examine the most effective and accepted psychotherapy for the acute phase of panic disorder. We searched MEDLINE, Embase, PsycInfo and CENTRAL, from inception to 1 Jan 2021 for RCTs. Cochrane and PRISMA guidelines were used. Pairwise and network meta-analyses were conducted using a random-effects model. Confidence in the evidence was assessed using Confidence in Network Meta-Analysis (CINeMA). The protocol was published in a peer-reviewed journal and in PROSPERO (CRD42020206258). Results We included 136 RCTs in the systematic review. Taking into consideration efficacy (7352 participants), acceptability (6862 participants) and the CINeMA confidence in evidence appraisal, the best interventions in comparison with treatment as usual (TAU) were cognitive–behavioural therapy (CBT) (for efficacy: standardised mean differences s.m.d. = −0.67, 95% CI −0.95 to −0.39; CINeMA: moderate; for acceptability: relative risk RR = 1.21, 95% CI −0.94 to 1.56; CINeMA: moderate) and short-term psychodynamic therapy (for efficacy: s.m.d. = −0.61, 95% CI −1.15 to −0.07; CINeMA: low; for acceptability: RR = 0.92, 95% CI 0.54–1.54; CINeMA: moderate). After removing RCTs at high risk of bias only CBT remained more efficacious than TAU. Conclusions CBT and short-term psychodynamic therapy are reasonable first-line choices. Studies with high risk of bias tend to inflate the overall efficacy of treatments. Results from this systematic review and network meta-analysis should inform clinicians and guidelines.

The Effect of Vitamin D Supplementation on Glycaemic Control in Women with Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16101716 ◽

2019 ◽

Vol 16 (10) ◽

pp. 1716 ◽

Cited By ~ 10

Author(s):

Omorogieva Ojo ◽

Sharon M. Weldon ◽

Trevor Thompson ◽

Elisabeth J. Vargo

Keyword(s):

Diabetes Mellitus ◽

Vitamin D ◽

Glycaemic Control ◽

Gestational Diabetes ◽

Meta Analysis ◽

Vitamin D Supplementation ◽

Risk Of Bias ◽

Controlled Trials ◽

Vitamin D deficiency is highly prevalent amongst pregnant women and is linked to a range of adverse complications, including gestational diabetes. However, there is no consensus among researchers regarding the impact of vitamin D supplementation in alleviating adverse effects in gestational diabetes. The objective of this systematic review and meta-analysis was to determine whether supplementation of vitamin D given to women with gestational diabetes can promote glycaemic control. EMBASE and PubMed were searched up to November, 2018. The selection criteria included randomised controlled trials of the effect of vitamin D supplementation (1000–4762 IU/day) on pregnant women with gestational diabetes mellitus. Study data and outcome measures (fasting blood glucose, glycated haemoglobin and serum insulin) were extracted from included studies. Random-effects models were used for meta-analyses. Heterogeneity tests, and analysis of the risk of bias were conducted. Most of the studies were graded as having either low risk or moderate risk of bias although two studies had a high risk of bias in the areas of blinding of participants and personnel, and incomplete outcome data. On the other hand, the heterogeneity statistic (I2) ranged from 0–41% in the studies included. Five randomised controlled trials were selected for this review and meta-analysis (involving a total of 173 participants supplemented with vitamin D and 153 participants as control drawn from the studies). Vitamin D supplementation was associated with a decrease in fasting blood glucose by a mean of 0.46 mmol/L (−0.68, −0.25) (p < 0.001), glycated haemoglobin by a mean of 0.37% (−0.65, −0.08) (p < 0.01) and serum insulin concentration by mean of 4.10 µIU/mL (−5.50, −2.71) (p < 0.001) compared to controls. This review shows evidence that vitamin D supplementation has the potential to promote glycaemic control in women with Gestational Diabetes Mellitus (GDM). However, due to the limited number of studies in the meta-analysis, the conclusion should be interpreted with caution. Further studies are needed to fully understand the exact mechanism by which vitamin D influences glucose metabolism.

Efficacy, duration of protection, birth outcomes, and infant growth associated with influenza vaccination in pregnancy: a pooled analysis of three randomised controlled trials

The Lancet Respiratory Medicine ◽

10.1016/s2213-2600(19)30479-5 ◽

2020 ◽

Vol 8 (6) ◽

pp. 597-608 ◽

Cited By ~ 3

Author(s):

Saad B Omer ◽

Dayna R Clark ◽

Shabir A Madhi ◽

Milagritos D Tapia ◽

Marta C Nunes ◽

...

Keyword(s):

Influenza Vaccination ◽

Birth Outcomes ◽

Pooled Analysis ◽

Infant Growth ◽

Controlled Trials ◽

Randomised Controlled ◽

Duration Of Protection ◽

Surgical interventions for women with stress urinary incontinence: systematic review and network meta-analysis of randomised controlled trials

BMJ ◽

10.1136/bmj.l1842 ◽

2019 ◽

pp. l1842 ◽

Cited By ~ 6

Author(s):

Mari Imamura ◽

Jemma Hudson ◽

Sheila A Wallace ◽

Graeme MacLennan ◽

Michal Shimonovich ◽

...

Keyword(s):

Urinary Incontinence ◽

Stress Urinary Incontinence ◽

Adverse Events ◽

Meta Analysis ◽

Risk Of Bias ◽

Controlled Trials ◽

Surgical Interventions ◽

Randomised Controlled ◽

Meta Analyses

Abstract Objectives To compare the effectiveness and safety of surgical interventions for women with stress urinary incontinence. Design Systematic review and network meta-analysis. Eligibility criteria for selecting studies Randomised controlled trials evaluating surgical interventions for the treatment of stress urinary incontinence in women. Methods Identification of relevant randomised controlled trials from Cochrane reviews and the Cochrane Incontinence Specialised Register (searched May 2017), which contains trials identified from the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Medline In-Process, Medline Epub Ahead of Print, CINAHL, ClinicalTrials.gov, and WHO ICTRP. The reference lists of relevant articles were also searched. Primary outcomes were “cure” and “improvement” at 12 months, analysed by means of network meta-analyses, with results presented as the surface under the cumulative ranking curve (SUCRA). Adverse events were analysed using pairwise meta-analyses. Risk of bias was assessed using the Cochrane risk of bias tool. The quality of evidence for network meta-analysis was assessed using the GRADE approach. Results 175 randomised controlled trials assessing a total of 21 598 women were included. Most studies had high or unclear risk across all risk of bias domains. Network meta-analyses were based on data from 105 trials that reported cure and 120 trials that reported improvement of incontinence symptoms. Results showed that the interventions with highest cure rates were traditional sling, retropubic midurethral sling (MUS), open colposuspension, and transobturator MUS, with rankings of 89.4%, 89.1%, 76.7%, and 64.1%, respectively. Compared with retropubic MUS, the odds ratio of cure for traditional sling was 1.06 (95% credible interval 0.62 to 1.85), for open colposuspension was 0.85 (0.54 to 1.33), and for transobtrurator MUS was 0.74 (0.59 to 0.92). Women were also more likely to experience an improvement in their incontinence symptoms after receiving retropubic MUS or transobturator MUS compared with other surgical procedures. In particular, compared with retropubic MUS, the odds ratio of improvement for transobturator MUS was 0.76 (95% credible interval 0.59 to 0.98), for traditional sling was 0.69 (0.39 to 1.26), and for open colposuspension was 0.65 (0.41 to 1.02). Quality of evidence was moderate for retropubic MUS versus transobturator MUS and low or very low for retropubic MUS versus the other two interventions. Data on adverse events were available mainly for mesh procedures, indicating a higher rate of repeat surgery and groin pain but a lower rate of suprapubic pain, vascular complications, bladder or urethral perforation, and voiding difficulties after transobturator MUS compared with retropubic MUS. Data on adverse events for non-MUS procedures were sparse and showed wide confidence intervals. Long term data were limited. Conclusions Retropubic MUS, transobturator MUS, traditional sling, and open colposuspension are more effective than other procedures for stress urinary incontinence in the short to medium term. Data on long term effectiveness and adverse events are, however, limited, especially around the comparative adverse events profiles of MUS and non-MUS procedures. A better understanding of complications after surgery for stress urinary incontinence is imperative. Systematic review registration PROSPERO CRD42016049339.