Pooled Prevalence of Adverse Pregnancy and Neonatal Outcomes in Malawi, South Africa, Uganda, and Zimbabwe: Results From a Systematic Review and Meta-Analyses to Inform Trials of Novel HIV Prevention Interventions During Pregnancy

Background: Robust data summarizing the prevalence of pregnancy and neonatal outcomes in low- and middle-income countries are critically important for studies evaluating investigational products for HIV prevention and treatment in pregnant and breastfeeding women. In preparation for studies evaluating the safety of the dapivirine vaginal ring for HIV prevention in pregnancy, we conducted a systematic literature review and meta-analyses to summarize the prevalence of pregnancy and neonatal outcomes in Malawi, South Africa, Uganda, and Zimbabwe.Methods: Ten individual systematic literature reviews were conducted to identify manuscripts presenting prevalence data for 12 pregnancy and neonatal outcomes [pregnancy loss, stillbirth, preterm birth, low birthweight (LBW), neonatal mortality, congenital anomaly, chorioamnionitis, postpartum endometritis, postpartum hemorrhage, gestational hypertension, preeclampsia/eclampsia, and preterm premature rupture of membranes (PPROM)]. Studies included in the meta-analyses were published between January 1, 1998, and July 11, 2018, provided numerator and denominator data to support prevalence estimation, and included women of any HIV serostatus. Random-effects meta-analyses were conducted to estimate the pooled prevalence and 95% confidence interval (CI) for each outcome overall, by country, and by HIV status.Results: A total of 152 manuscripts were included across the 12 outcomes. Overall, the frequency of stillbirth (n = 75 estimates), LBW (n = 68), and preterm birth (n = 67) were the most often reported. However, fewer than 10 total manuscripts reported prevalence estimates for chorioamnionitis, endometritis, or PPROM. The outcomes with the highest pooled prevalence were preterm birth (12.7%, 95%CI 11.2–14.3), LBW (11.7%, 95%CI 10.6–12.9), and gestational hypertension (11.4%, 95%CI 7.8–15.7). Among the outcomes with the lowest pooled prevalence estimates were neonatal mortality (1.7%, 95%CI 1.4–2.1), pregnancy loss [1.9%, 95%CI 1.1–2.8, predominately studies (23/29) assessing losses occurring after the first trimester], PPROM (2.2%, 95%CI 1.5–3.2), and stillbirth (2.5%, 95%CI 2.2–2.7).Conclusions: Although this review identified numerous prevalence estimates for some outcomes, data were lacking for other important pregnancy-related conditions. Additional research in pregnant populations is needed for a thorough evaluation of investigational products, including for HIV prevention and treatment, and to inform better estimates of the burden of adverse pregnancy outcomes globally.

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Chlamydia trachomatis Screening and Treatment in Pregnancy to Reduce Adverse Pregnancy and Neonatal Outcomes: A Review

Frontiers in Public Health ◽

10.3389/fpubh.2021.531073 ◽

2021 ◽

Vol 9 ◽

Author(s):

Kristina N. Adachi ◽

Karin Nielsen-Saines ◽

Jeffrey D. Klausner

Keyword(s):

Birth Weight ◽

Preterm Birth ◽

Low Birth Weight ◽

Adverse Outcomes ◽

Neonatal Outcomes ◽

Premature Rupture Of Membranes ◽

Premature Rupture ◽

Middle Income ◽

Infant Outcomes ◽

Adverse Pregnancy

Chlamydial trachomatis infection has been associated with adverse pregnancy and neonatal outcomes such as premature rupture of membranes, preterm birth, low birth weight, conjunctivitis, and pneumonia in infants. This review evaluates existing literature to determine potential benefits of antenatal screening and treatment of C. trachomatis in preventing adverse outcomes. A literature search revealed 1824 studies with 156 full-text articles reviewed. Fifteen studies were selected after fulfilling inclusion criteria. Eight studies focused on chlamydial screening and treatment to prevent adverse pregnancy outcomes such as premature rupture of membranes, preterm birth, low birth weight, growth restriction leading to small for gestational age infants, and neonatal death. Seven studies focused on the effects of chlamydial screening and treatment on adverse infant outcomes such as chlamydial infection including positive mucosal cultures, pneumonia, and conjunctivitis. Given the heterogeneity of those studies, this focused review was exclusively qualitative in nature. When viewed collectively, 13 of 15 studies provided some degree of support that antenatal chlamydial screening and treatment interventions may lead to decreased adverse pregnancy and infant outcomes. However, notable limitations of these individual studies also highlight the need for further, updated research in this area, particularly from low and middle-income settings.

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Prevalence of the Use of Herbal Medicines among Patients with Cancer: A Systematic Review and Meta-Analysis

Evidence-based Complementary and Alternative Medicine ◽

10.1155/2021/9963038 ◽

2021 ◽

Vol 2021 ◽

pp. 1-18

Author(s):

John Baptist Asiimwe ◽

Prakash B. Nagendrappa ◽

Esther C. Atukunda ◽

Mauda M. Kamatenesi ◽

Grace Nambozi ◽

...

Keyword(s):

Herbal Medicine ◽

Meta Analysis ◽

Herbal Medicines ◽

Patient Characteristics ◽

Medicine Use ◽

Middle Income ◽

Patients With Cancer ◽

Pooled Prevalence ◽

Prevalence Estimates ◽

Meta Analyses

Background. Although herbal medicines are used by patients with cancer in multiple oncology care settings, the magnitude of herbal medicine use in this context remains unclear. The purpose of this review was to establish the prevalence of herbal medicine use among patients with cancer, across various geographical settings and patient characteristics (age and gender categories). Methods. Electronic databases that were searched for data published, from January 2000 to January 2020, were Medline (PubMed), Google Scholar, Embase, and African Index Medicus. Eligible studies reporting prevalence estimates of herbal medicine use amongst cancer patients were pooled using random-effects meta-analyses. Studies were grouped by World Bank region and income groups. Subgroup and meta-regression analyses were performed to explore source of heterogeneity. Results. In total, 155 studies with data for 809,065 participants (53.95% female) met the inclusion criteria. Overall, the pooled prevalence of the use of herbal medicine among patients with cancer was 22% (95% confidence interval (CI): 18%–25%), with the highest prevalence estimates for Africa (40%, 95% CI: 23%–58%) and Asia (28%, 95% CI: 21%–35%). The pooled prevalence estimate was higher across low- and middle-income countries (32%, 95% CI: 23%–42%) and lower across high-income countries (17%, 95% CI: 14%–21%). Higher pooled prevalence estimates were found for adult patients with cancer (22%, 95% CI: 19%–26%) compared with children with cancer (18%, 95% CI: 11%–27%) and for female patients (27%, 95% CI: 19%–35%) compared with males (17%, 95% CI: 1%–47%). Conclusion. Herbal medicine is used by a large percentage of patients with cancer use. The findings of this review highlight the need for herbal medicine to be integrated in cancer care.

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The Impact of Gestational Weight Gain on the Risks of Adverse Maternal and Infant Outcomes among Normal BMI Women with High Triglyceride Levels during Early Pregnancy

Nutrients ◽

10.3390/nu13103454 ◽

2021 ◽

Vol 13 (10) ◽

pp. 3454

Author(s):

Xia-Fei Jiang ◽

Hui Wang ◽

Dan-Dan Wu ◽

Jian-Lin Zhang ◽

Ling Gao ◽

...

Keyword(s):

Weight Gain ◽

Preterm Birth ◽

Gestational Diabetes ◽

Early Pregnancy ◽

Pregnancy Outcomes ◽

Gestational Hypertension ◽

Adverse Pregnancy Outcomes ◽

Gestational Weight ◽

Adverse Pregnancy ◽

The Impact

A high maternal triglyceride (mTG) level during early pregnancy is linked to adverse pregnancy outcomes, but the use of specific interventions has been met with limited success. A retrospective cohort study was designed to investigate the impact of gestational weight gain (GWG) on the relationship between high levels of mTG and adverse pregnancy outcomes in normal early pregnancy body mass index (BMI) women. The patients included 39,665 women with normal BMI who had a singleton pregnancy and underwent serum lipids screening during early pregnancy. The main outcomes were adverse pregnancy outcomes, including gestational hypertension, preeclampsia, gestational diabetes, cesarean delivery, preterm birth, and large or small size for gestational age (LGA or SGA) at birth. As a result, the high mTG (≥2.05mM) group had increased risks for gestational hypertension ((Adjusted odds ratio (AOR), 1.80; 95% CI, 1.46 to 2.24)), preeclampsia (1.70; 1.38 to 2.11), gestational diabetes (2.50; 2.26 to 2.76), cesarean delivery (1.22; 1.13 to 1.32), preterm birth (1.42, 1.21 to 1.66), and LGA (1.49, 1.33 to 1.68) compared to the low mTG group, after adjustment for potential confounding factors. Additionally, the risks of any adverse outcome were higher in each GWG subgroup among women with high mTG than those in the low mTG group. High mTG augmented risks of gestational hypertension, preeclampsia, preterm birth, and LGA among women with 50th or greater percentile of GWG. Interestingly, among women who gained less than the 50th percentile of GWG subgroups, there was no relationship between high mTG level and risks for those pregnancy outcomes when compared to low mTG women. Therefore, weight control and staying below 50th centile of the suggested GWG according to gestational age can diminish the increased risks of adverse pregnancy outcomes caused by high mTG during early pregnancy.

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Abstract MP13: Prospective Associations of Prenatal Sedentary Behavior and Physical Activity Trajectories With Adverse Pregnancy Outcomes

Circulation ◽

10.1161/circ.141.suppl_1.mp13 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Bethany Barone Gibbs ◽

Melissa A Jones ◽

John M Jakicic ◽

Arundhathi Jeyebalan ◽

Kara M Whitaker ◽

...

Keyword(s):

Physical Activity ◽

Preterm Birth ◽

Gestational Diabetes ◽

Sedentary Behavior ◽

Pregnancy Outcomes ◽

Intrauterine Growth Restriction ◽

Gestational Hypertension ◽

Growth Restriction ◽

Intrauterine Growth ◽

Adverse Pregnancy

Background: Adverse pregnancy outcomes (APO) are risk factors for future cardiovascular disease. Though factors such as obesity increase the risk of APO, whether patterns of prenatal sedentary behavior (SED) or physical activity are associated with APO is unclear. Methods: This cohort study measured objective SED, steps, and moderate-vigorous intensity physical activity (MVPA) during each trimester of pregnancy. Women were instructed to wear two monitors for 7 d: a thigh-mounted activPAL3 micro to measure SED and steps, and an Actigraph GT3X on an elastic waist belt to measure MVPA. Women also completed a detailed wear log. Data were considered valid with ≥4 d of ≥10 hr of wear. Physician-diagnosed APO (gestational hypertension, preeclampsia, gestational diabetes, preterm birth, or intrauterine growth restriction) were abstracted from medical records by trained research personnel. Growth mixture modelling was used to construct separate SED, steps, and MVPA trajectories across pregnancy. Associations between trajectory groups and APO were evaluated using logistic regression with adjustment for prepregnancy BMI, race, education, and age. Results: Women (n=100) had mean (SD) age 31.2 (4.8) yr, pregnancy BMI 26.2 (6.8) kg/m 2 , and were 25% non-white. Trajectory analyses revealed three groups within each SED, steps, and MVPA (see Table). Nineteen women (19%) had at least one APO: gestational hypertension and/or preeclampsia (n=13), gestational diabetes (n=3), preterm birth (n=6), or intrauterine growth restriction (n=4). High vs. low SED trajectory was associated with more than 6-fold higher odds of APO. Medium and high vs. low steps trajectory was associated with lower odds of APO, but only medium vs. low trajectories were statistically different. MVPA trajectory was not associated with APO risk (see Table). Conclusion: Reducing SED and increasing daily steps, though not increasing MVPA, could be novel intervention targets for reducing APO and future cardiovascular risk in pregnant women.

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Aspirin to Prevent Preeclampsia

Bangladesh Journal of Obstetrics & Gynaecology ◽

10.3329/bjog.v32i2.48282 ◽

2020 ◽

Vol 32 (2) ◽

pp. 106-116

Author(s):

Ferdousi Begum ◽

TA Chowdhury

Keyword(s):

Preterm Birth ◽

High Risk ◽

Low Dose ◽

Growth Restriction ◽

Mortality And Morbidity ◽

Pregnancy And Childbirth ◽

Dose Aspirin ◽

Low Dose Aspirin ◽

Adverse Pregnancy ◽

Meta Analyses

Background: Pre-eclampsia is a major cause of mortality and morbidity during pregnancy and childbirth. There are recommendations on use of medications to prevent preeclampsia, including low dose aspirin. Objective: The objective of this review is to discuss role of aspirin in reducing the incidence and maternal mortality and morbidity due to preeclampsia including its dose and duration of use. Methods: Review of available literature in internet and from libraries. Results: Four large randomized trials have demonstrated a reduction in the incidence of preeclampsia in patients treated with low-dose aspirin prophylaxis compared with placebo/ no treatment (15 versus 19 percent, 18 versus 20 percent, 6.7 versus 7.6 percent, and 1.6 versus 4.3 percent); however, the results were statistically significant in only the last trial. When data from these and other trials were pooled, meta-analyses supported the significance of the trend observed in individual trials. When begun early in the second trimester, use of low-dose aspirin (75-150 mg) reduced the incidence of preeclampsia by at least 10 percent, with the greatest absolute benefit in women at moderate to high risk of developing the disease. Serious sequelae of early onset preeclampsia, such as preterm birth and fetal growth restriction, were also reduced. Conclusion: Low-dose aspirin reduces the frequency of preeclampsia, as well as related adverse pregnancy outcomes (preterm birth, growth restriction), by about 10 to 20 percent when given to women at moderate to high risk of the disease. It has an excellent maternal/ fetal safety profile in pregnancy. WHO recommends Low-dose acetylsalicylic acid (aspirin, 75 mg) for the prevention of preeclampsia in women at high risk of developing the condition; should be initiated before 20 weeks of pregnancy. It should be taken preferably from 13th week of pregnancy, daily, regularly and may be discontinued 5 to 10 days before delivery. Bangladesh J Obstet Gynaecol, 2017; Vol. 32(2) : 106-116

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

BMJ Open ◽

10.1136/bmjopen-2018-027180 ◽

2019 ◽

Vol 9 (5) ◽

pp. e027180 ◽

Cited By ~ 4

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

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Intra-Amniotic Infection with Ureaplasma parvum Causes Preterm Birth and Neonatal Mortality That Are Prevented by Treatment with Clarithromycin

mBio ◽

10.1128/mbio.00797-20 ◽

2020 ◽

Vol 11 (3) ◽

Cited By ~ 2

Author(s):

Kenichiro Motomura ◽

Roberto Romero ◽

Yi Xu ◽

Kevin R. Theis ◽

Jose Galaz ◽

...

Keyword(s):

Preterm Birth ◽

Inflammatory Response ◽

Neonatal Outcomes ◽

Amniotic Cavity ◽

Local Inflammatory Response ◽

Content Type ◽

Ureaplasma Parvum ◽

Adverse Pregnancy

ABSTRACT Intra-amniotic infection is strongly associated with adverse pregnancy and neonatal outcomes. Most intra-amniotic infections are due to Ureaplasma species; however, the pathogenic potency of these genital mycoplasmas to induce preterm birth is still controversial. Here, we first laid out a taxonomic characterization of Ureaplasma isolates from women with intra-amniotic infection, which revealed that Ureaplasma parvum is the most common bacterium found in this clinical condition. Next, using animal models, we provided a causal link between intra-amniotic inoculation with Ureaplasma species and preterm birth. Importantly, the intra-amniotic inoculation of Ureaplasma species induced high rates of mortality in both preterm and term neonates. The in vivo potency of U. parvum to induce preterm birth was not associated with known virulence factors. However, term-derived and preterm-derived U. parvum isolates were capable of inducing an intra-amniotic inflammatory response. Both U. parvum isolates invaded several fetal tissues, primarily the fetal lung, and caused fetal inflammatory response syndrome. This bacterium was also detected in the placenta, reproductive tissues, and most severely in the fetal membranes, inducing a local inflammatory response that was replicated in an in vitro model. Importantly, treatment with clarithromycin, a recently recommended yet not widely utilized antibiotic, prevented the adverse pregnancy and neonatal outcomes induced by U. parvum. These findings shed light on the maternal-fetal immunobiology of intra-amniotic infection. IMPORTANCE Preterm birth is the leading cause of neonatal morbidity and mortality worldwide. Multiple etiologies are associated with preterm birth; however, 25% of preterm infants are born to a mother with intra-amniotic infection, most commonly due to invasion of the amniotic cavity by Ureaplasma species. Much research has focused on establishing a link between Ureaplasma species and adverse pregnancy/neonatal outcomes; however, little is known about the taxonomy of and host response against Ureaplasma species. Here, we applied a multifaceted approach, including human samples, in vivo models, and in vitro manipulations, to study the maternal-fetal immunobiology of Ureaplasma infection during pregnancy. Furthermore, we investigated the use of clarithromycin as a treatment for this infection. Our research provides translational knowledge that bolsters scientific understanding of Ureaplasma species as a cause of adverse pregnancy/neonatal outcomes and gives strong evidence for the use of clarithromycin as the recommended treatment for women intra-amniotically infected with Ureaplasma species.

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Auditory and visual hallucination prevalence in Parkinson's disease and dementia with Lewy bodies: a systematic review and meta-analysis

Psychological Medicine ◽

10.1017/s0033291718003161 ◽

2018 ◽

Vol 49 (14) ◽

pp. 2342-2353 ◽

Cited By ~ 4

Author(s):

Charlotte Louise Eversfield ◽

Llwyd David Orton

Keyword(s):

Systematic Review ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Dementia With Lewy Bodies ◽

Meta Analysis ◽

Lewy Bodies ◽

Eligibility Criteria ◽

Pooled Prevalence ◽

Prevalence Estimates ◽

Meta Analyses

AbstractBackgroundNon-motor features of Parkinson's disease (PD) and dementia with Lewy bodies (DLB), such as auditory hallucinations (AH), contribute to disease burden but are not well understood.MethodsSystematic review and random-effects meta-analyses of studies reporting AH associated with PD or DLB. Prevalence of visual hallucinations (VH) in identified studies meeting eligibility criteria were included in meta-analyses, facilitating comparison with AH. Synthesis of qualitative descriptions of AH was performed. PubMed, Web of Science and Scopus databases were searched for primary journal articles, written in English, published from 1970 to 2017. Studies reporting AH prevalence in PD or DLB were screened using PRISMA methods.ResultsSearches identified 4542 unique studies for consideration, of which, 26 met inclusion criteria. AH pooled prevalence in PD was estimated to be 8.9% [95% confidence interval (CI) 5.3–14.5], while in DLB was estimated to be 30.8% (±23.4 to 39.3). Verbal hallucinations, perceived as originating outside the head, were the most common form of AH. Non-verbal AH were also common while musical AH were rare. VH were more prevalent, with an estimated pooled prevalence in PD of 28.2% (±19.1 to 39.5), while in DLB they were estimated to be 61.8% (±49.1 to 73.0). Meta-regression determined that the use of validated methodologies to identify hallucinations produced higher prevalence estimates.ConclusionsAH and VH present in a substantial proportion of PD and DLB cases, with VH reported more frequently in both conditions. Both AH and VH are more prevalent in DLB than PD. There is a need for standardised use of validated methods to detect and monitor hallucinations.

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Does Aerobic Vaginitis Have Adverse Pregnancy Outcomes? Prospective Observational Study

Infectious Diseases in Obstetrics and Gynecology ◽

10.1155/2020/5842150 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Mahmoud F. Hassan ◽

Nancy M. A. Rund ◽

Osama El-Tohamy ◽

Mahmoud Moussa ◽

Yahia Z. Ali ◽

...

Keyword(s):

Preterm Birth ◽

Pregnant Women ◽

Pregnancy Outcomes ◽

Prospective Observational Study ◽

Late Pregnancy ◽

Neonatal Outcomes ◽

Aerobic Vaginitis ◽

Neonatal Icu ◽

Maternal And Neonatal Outcomes ◽

Adverse Pregnancy

Background. Aerobic vaginitis (AV) is an aberration within the balanced vaginal microbiota. Only few reports have documented the adverse pregnancy outcomes related to AV. Nonetheless, the exact role of AV in pregnancy and the potential benefit of its screening need further study. Our goal was to evaluate the association between aerobic vaginitis (AV) in late pregnancy and maternal and neonatal outcomes. Methods. In this prospective observational study, a total of 600 singleton pregnant women with intact fetal membranes at a gestational age of 34-36 weeks were recruited (one hundred women with AV and 500 pregnant women without AV). The study protocol excluded patients with other forms of vaginal infection. Pregnancy outcomes were traced and documented. The primary outcome was the association between AV and preterm labor. The current study compared the maternal and neonatal outcomes among pregnant women with and without AV in unadjusted and adjusted analyses with the odds ratio (OR) and 95% confidence interval (CI) reported. Results. There was an association between AV and with preterm birth (adjusted OR 3.06, 95% CI 1.58-5.95) and prelabor rupture of membranes (adjusted OR 6.17, 95% CI 3.24-11.7). For neonatal outcomes, AV was associated with a higher incidence of neonatal ICU admission (adjusted OR 2.19, 95% CI 1.1-4.34). Severe forms of AV significantly increased the incidence of PTB (p=0.0014) and PROM (p=0.0094) when compared to less severe forms of AV. Conclusion. AV is common in late pregnancy and is linked to a diversity of adversative pregnancy outcomes including preterm birth, PROM, and neonatal ICU admission. Moreover, the incidence of PTB and PROM might further increase with the severity of AV. Clinicians should pay more consideration to vaginal microbiota assessment during pregnancy.

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Pregnancy and Neonatal Outcomes With Levothyroxine Treatment in Women With Subclinical Hypothyroidism Based on New Diagnostic Criteria: A Systematic Review and Meta-Analysis

Frontiers in Endocrinology ◽

10.3389/fendo.2021.797423 ◽

2021 ◽

Vol 12 ◽

Author(s):

Zheng Ding ◽

Yindi Liu ◽

Spyridoula Maraka ◽

Nadia Abdelouahab ◽

He-Feng Huang ◽

...

Keyword(s):

Systematic Review ◽

Pregnant Women ◽

Diagnostic Criteria ◽

Subclinical Hypothyroidism ◽

Pregnancy Loss ◽

Gestational Hypertension ◽

Meta Analysis ◽

Neonatal Outcomes ◽

Control Group ◽

American Thyroid Association

BackgroundSubclinical hypothyroidism (SCH) during pregnancy has been associated with multiple adverse maternal and neonatal outcomes. However, the potential benefits of levothyroxine (LT4) supplementation remain controversial. Variations across studies in diagnostic criteria for SCH may, in part, explain the divergent findings on the subject. This study aimed to assess the effect of LT4 treatment on pregnancy and neonatal outcomes among pregnant women who were diagnosed as SCH based on the most recent diagnostic criteria.MethodsWe conducted a systematic review and meta-analysis of the literature published from inception to January 2020. The search strategy targeted the studies on pregnancy and neonatal outcomes following LT4 treatment in women with SCH based on 2017 American Thyroid Association diagnostic criteria. Pooled effect sizes were estimated using fixed and random effect models, according to the absence or presence of heterogeneity which was assessed using the I-squared statistic. Sources of heterogeneity and the stability of results were evaluated through sensitivity analysis.ResultsOf the 2781 identified references, 306 full-text articles were screened for eligibility. Finally, 6 studies including a total of 7955 participants were retained for analysis. Summary effect estimates indicated that pregnant women with SCH treated with LT4 had a lower risk of pregnancy loss [odds ratio (OR) = 0.55, 95% confidence interval (CI): 0.43-0.71], preterm birth (OR=0.63, 95% CI: 0.41-0.98) and gestational hypertension (OR = 0.78, 95% CI: 0.63-0.97) than those in control group.ConclusionLT4 treatment in pregnant women with SCH may reduce the risk of pregnancy loss, preterm delivery and gestational hypertension.

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