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Fetal macrosomia in home and birth center births in the United States: Maternal, fetal, and newborn outcomes

Authors:
Sabrina Pillai
Sabrina Pillai
Sabrina Pillai
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Melissa Cheyney at Oregon State University
Melissa Cheyney
Courtney L. Everson at Colorado State University
Courtney L. Everson
Marit Bovbjerg at Oregon State University
Marit Bovbjerg
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Abstract

Background Fetal macrosomia is associated with negative outcomes, although less is known about how severities of macrosomia influence these outcomes. Planned community births in the United States have higher rates of gestational age‐adjusted macrosomia than planned hospital births, providing a novel population to examine macrosomia morbidity. Methods Maternal and neonatal outcomes associated with grade 1 (4000‐4499 g), grade 2 (4500‐4999 g), and grade 3 (≥5000 g) macrosomia were compared to normal birthweight newborns (2500‐3999 g), using data from the MANA Statistics Project—a registry of planned community births, 2012‐2018 (n = 68 966). Outcomes included perineal trauma, postpartum hemorrhage, cesarean birth, neonatal birth injury, shoulder dystocia, neonatal respiratory distress, neonatal intensive care unit (NICU) stay >24 hours, and perinatal death. Logistic regressions controlled for parity and mode of birth, obesity, gestational diabetes, and preeclampsia. Results Sixteen percent of the sample were grade 1 macrosomic, 3.3% were grade 2 macrosomic, and 0.4% were grade 3 macrosomic. Macrosomia grades 1‐3 were associated in a dose‐response fashion with higher odds of all outcomes, compared to non‐macrosomia. The adjusted odds ratios and 95% confidence intervals for postpartum hemorrhage for grade 1, grade 2, and grade 3 macrosomia vs normal birthweight were 1.75 (1.56‐1.96), 2.12 (1.70‐2.63), and 5.18 (3.47‐7.74), respectively. Other outcomes had similar patterns. Discussion The adjusted odds of negative outcomes increase as grade of macrosomia increases in planned community births; results are comparable with the published literature. Pre‐birth fetal weight estimation is imprecise; prenatal supports and shared decision‐making processes should reflect these complexities.
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Birth. 2020;47:409–417. wileyonlinelibrary.com/journal/birt
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409
© 2020 Wiley Periodicals LLC
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BACKGROUND
Fetal macrosomia is defined as birthweight of at least 4000g,
although classifications of >4500 g and >5000 g are also
used.1-4 Higher birthweight newborns are associated with
a number of negative labor and birth outcomes in planned
hospital births, including prolonged labor, genital tract lac-
erations, postpartum hemorrhage, neonatal birth trauma
Received: 30 April 2020
|
Revised: 3 September 2020
|
Accepted: 11 September 2020
DOI: 10.1111/birt.12506
ORIGINAL ARTICLE
Fetal macrosomia in home and birth center births in the United
States: Maternal, fetal, and newborn outcomes
SabrinaPillai MPH1
|
MelissaCheyney PhD, LDM2
|
Courtney L.Everson PhD3
|
Marit L.Bovbjerg PhD, MS1
1College of Public Health and Human
Sciences, Oregon State University,
Corvallis, OR, USA
2College of Liberal Arts, Oregon State
University, Corvallis, OR, USA
3College of Health and Human Sciences,
Colorado State University, Fort Collins,
CO, USA
Correspondence
Sabrina Pillai, College of Public Health and
Human Sciences, Oregon State University,
101 Milam Hall, Corvallis, OR 97331,
USA.
Email: sabrina.pillai@oregonstate.edu
Funding information
This work was supported by Oregon
State University President’s Commission
on the Status of Women and NICHD/
NIH 5R03HD096094. MANA Stats data
collection was funded by the Foundation for
the Advancement of Midwifery.
Abstract
Background: Fetal macrosomia is associated with negative outcomes, although less
is known about how severities of macrosomia influence these outcomes. Planned
community births in the United States have higher rates of gestational age-adjusted
macrosomia than planned hospital births, providing a novel population to examine
macrosomia morbidity.
Methods: Maternal and neonatal outcomes associated with grade 1 (4000-4499g),
grade 2 (4500-4999g), and grade 3 (≥5000g) macrosomia were compared to nor-
mal birthweight newborns (2500-3999 g), using data from the MANA Statistics
Project—a registry of planned community births, 2012-2018 (n=68966). Outcomes
included perineal trauma, postpartum hemorrhage, cesarean birth, neonatal birth in-
jury, shoulder dystocia, neonatal respiratory distress, neonatal intensive care unit
(NICU) stay >24hours, and perinatal death. Logistic regressions controlled for par-
ity and mode of birth, obesity, gestational diabetes, and preeclampsia.
Results: Sixteen percent of the sample were grade 1 macrosomic, 3.3% were grade
2 macrosomic, and 0.4% were grade 3 macrosomic. Macrosomia grades 1-3 were
associated in a dose-response fashion with higher odds of all outcomes, compared to
non-macrosomia. The adjusted odds ratios and 95% confidence intervals for postpar-
tum hemorrhage for grade 1, grade 2, and grade 3 macrosomia vs normal birthweight
were 1.75 (1.56-1.96), 2.12 (1.70-2.63), and 5.18 (3.47-7.74), respectively. Other
outcomes had similar patterns.
Discussion: The adjusted odds of negative outcomes increase as grade of macroso-
mia increases in planned community births; results are comparable with the pub-
lished literature. Pre-birth fetal weight estimation is imprecise; prenatal supports and
shared decision-making processes should reflect these complexities.
KEYWORDS
birthing centers, fetal macrosomia, home childbirth, pregnancy complications
... It also leads to early childhood stunting, reduces growth and development, and can contribute to chronic poor health and impaired cognitive development [79]. On the other hand, the incidence of macrosomia, as a birth weight more than 4000-4500 g, which is associated with a number of negative birth outcomes including neonatal birth trauma, birth asphyxia, respiratory distress syndrome, neonatal intensive care unit admission and perinatal death [80], is increasing. Although this meta-analysis found that prenatal aquatic activities did not affect birth weight, it did find that prenatal aquatic activities had a positive effect on maternal weight control during pregnancy, which could also reduce the rate of macrosomia to some extent. ...
Influence of prenatal aquatic activities on fetal outcomes and maternal physical and mental outcomes: a systematic review and meta-analysis
Article
Full-text available
  • Oct 2024
Background Aquatic activities are becoming increasingly popular as a form of exercise during pregnancy. However, the effects of these activities on the physical and mental health outcomes of pregnant women during and after pregnancy as well as fetal outcomes remain unclear. This meta-analysis evaluated the current evidence regarding the effects of aquatic activities during pregnancy on neonatal and maternal outcomes. Methods Three databases (PubMed, Cochrane Central electronic database, Embase) were searched from inception to July 17, 2024 for randomized controlled trials (RCTs) comparing the effects of aquatic activities versus standard prenatal care or no exercise on neonatal and maternal outcomes. Pooled outcome measures were determined using random-effects models. Results Ten RCTs including 1949 patients met the criteria for inclusion in this meta-analysis. The results showed that prenatal aquatic activities could significantly improve maternal weight control (mean difference [MD]= -0.91, 95% confidence interval [CI]= -1.64 to -0.18, P = 0.01, I² = 0.00%), improve maternal quality of life (standard mean difference [SMD] = 0.16, 95%CI = 0.03 to 0.28, P = 0.01, I² = 0.00%), and extend fetal birth length (MD = 0.48, 95%CI = 0.10 to 0.87, P = 0.01, I² = 0.00%) compared with standard prenatal care or no exercise, while no significant differences were observed in fetal birth weight, Apgar score at 1 min, Apgar score at 5 min, pH of umbilical cord blood, gestational age, rate of preterm delivery, incidence of postnatal depression and mode of delivery. Conclusions Prenatal aquatic activities can significantly improve maternal weight control and quality of life during pregnancy, and may promote longer birth length. However, additional studies are needed to confirm these findings.
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... Based on the definition, the incidence of macrosomia in China is increasing as the improvement of people's living standards and the change of fertility policy [2][3][4][5]. Macrosomia will increase the risk of shoulder dystocia, labor injury, postpartum hemorrhage and perinatal death [6,7], and it is associated with long-term health problems, there is an increased risk of metabolic diseases such as overweight, obesity, diabetes and affect the mental health of offspring [8][9][10]. The etiology of macrosomia can be divided into non-modifiable factors (i.e. ...
The association between macrosomia and glucose, lipids and hormones levels in maternal and cord serum: a case-control study
Article
Full-text available
  • Sep 2024
Background The formation of macrosomia is associated with excessive nutrition and/or unable to regulate effectively. This case-control study aims to explore the relationship between macrosomia and glucose, lipids and hormones levels in maternal and cord serum. Methods In the case-control study, 78 pairs of mothers and newborns were recruited who received care at one hospital of Hebei, China between 2016 and 2019. According to the birth weight (BW) of newborns, participants were divided into macrosomia group (BW ≥ 4000 g, n = 39) and control group (BW between 2500 g and 3999 g, n = 39). Maternal vein blood and cord vein blood were collected and assayed. All data were compared between the two groups. Unconditional logistics regression analysis was used to test the relationship between macrosomia and glucose, lipids and hormones in maternal and cord serum. Results In maternal and cord serum, the levels of leptin, leptin/adiponectin ratio (LAR), glucose and triglyceride (TG) in macrosomia group were higher than those in control group, and the levels of high-density lipoprotein cholesterol (HDL-C) were lower. The percentage of maternal glucose and lipids transfer to cord blood did not differ between the two groups. High levels of TG in maternal serum were positively correlated with macrosomia, and high levels of LAR, TG and glucose in cord serum were positively correlated with macrosomia. Conclusion In conclusion, the results of the current study, suggest that the nutrients and metabolism-related hormones in maternal and umbilical cord are closely related to macrosomia. During pregnancy, the nutritional status of pregnant women should be paid attention to and to obtain a good birth outcome.
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... 5-6%, if the fetal weight is 4500.0 or higher, by 12-19% [6]. Due to the presence of a large fetus, due to the fact that the uterine wall is too stretched, there is often hypotonic bleeding in the early stages of childbirth and postpartum [7]. ...
View
... It also leads to early childhood stunting, reduces growth and development, and can contribute to chronic poor health and impaired cognitive development [42]. On the other hand, the incidence of macrosomia, as a birth weight more than 4000 g or 4500 g, which is associated with a number of negative birth outcomes including neonatal birth trauma, birth asphyxia, respiratory distress syndrome, neonatal intensive care unit (NICU) admission and perinatal death [43], is increasing. Although this meta-analysis found that prenatal aquatic activities did not affect birth weight, it did nd that prenatal aquatic activities had a positive effect on maternal weight control during pregnancy, which could also reduce the rate of macrosomia to some extent. ...
Influence of prenatal aquatic activities on fetal outcomes and maternal physical and mental outcomes: a systematic review and meta-analysis
Preprint
Full-text available
  • Sep 2023
Purpose Aquatic activities are becoming increasingly popular as a form of exercise during pregnancy. However, the effects of these activities on the physical and mental health outcomes of pregnant women during and after pregnancy as well as fetal outcomes remain unclear. This meta-analysis evaluated the current evidence regarding the effects of aquatic activities during pregnancy on neonatal and maternal outcomes. Methods Three databases (PubMed, Cochrane, Embase) were searched from inception to March 7, 2023 for randomized controlled trials (RCTs) comparing the effects of aquatic activities versus standard prenatal care or no exercise on neonatal and maternal outcomes. Pooled outcome measures were determined using random-effects models. Results Ten RCTs including 1949 patients met the criteria for inclusion in this meta-analysis. The results showed that prenatal aquatic activities could significantly improve maternal weight control (mean difference [MD]= -0.91, 95% confidence interval [CI]= -1.64 to -0.18, P = 0.01, I² = 0.00%), improve maternal quality of life (standard mean difference [SMD] = 0.16, 95%CI = 0.03 to 0.28, P = 0.01, I² = 0.00%), and extend fetal birth length (MD = 0.48, 95%CI = 0.10 to 0.87, P = 0.01, I² = 0.00%) compared with standard prenatal care or no exercise, while no significant differences were observed in fetal birth weight, Apgar score at 1 minute, Apgar score at 5 minutes, pH of umbilical cord blood, gestational age, rate of preterm delivery, incidence of postnatal depression and mode of delivery. Conclusions Prenatal aquatic activities can significantly improve maternal weight control and quality of life during pregnancy, and may promote longer birth length. However, additional studies are needed to confirm these findings.
View
... Macrosomia has adverse effects on maternal and infant health in the short and long term. It can increase the probability of perineal trauma, postpartum hemorrhage, cesarean section, and shoulder dystocia [6,7]. Moreover, it can increase perinatal mortality, overweightness, obesity, and metabolic diseases, such as diabetes and hypertension in adulthood [8][9][10]. ...
The Association between Macrosomia and Amino Acids’ Levels in Maternal and Cord Sera: A Case-Control Study
Article
Full-text available
  • Aug 2023
Unlabelled: This study aims to explore the relationship between macrosomia and amino acids in maternal and cord sera. Methods: In the case-control study, 78 pairs of mothers and newborns were recruited from December 2016 to November 2019. Participants were divided into the macrosomia group (BW ≥ 4000 g, n = 39) and the control group (BW between 2500 g and 3999 g, n = 39) according to the birth weight (BW) of newborns. Maternal vein blood samples were collected before delivery and cord vein blood samples were collected after birth. The levels of amino acids in maternal and cord sera were measured by liquid chromatography and mass spectrometry (LC-MS/MS) in the year 2021. The difference in amino acid levels in maternal and cord sera between the two groups was compared, and the contribution of each amino acid to the difference between the two groups was analyzed. Unconditional logistic regression analysis was used to test the relationship between macrosomia and amino acids. Results: In maternal serum during the antepartum, the levels of asparagine, glutamine, methionine, alanine, and threonine in the macrosomia group were higher but arginine was lower than that in the control group (p < 0.05). In cord serum, the levels of lysine, histidine, phenylalanine, arginine, tryptophan, valine, isoleucine, glutamate, tyrosine, and total essential amino acid (EAA) in the macrosomia group were lower while glutamine was higher than that in the control group (p < 0.05). The ratios of EAA, valine, threonine, methionine, tryptophan, and alanine in maternal serum to those in cord serum were higher, while the ratio of glutamine was lower in the macrosomia group (p < 0.05). Arginine and threonine in maternal serum and glutamate, glutamine, and histidine in cord serum were associated with macrosomia (p < 0.05). Conclusion: Most of the amino acid levels in the maternal sera of the macrosomia group are higher than those in the control group, while most of the amino acids' levels in the cord sera of the macrosomia group are lower than those in the control group. The ratios of some amino acids in maternal serum to those in cord serum were different between the two groups. Arginine and threonine in maternal serum and glutamate, glutamine, and histidine in cord serum are closely related to macrosomia.
View
... In addition to the associated factors found in our study (multiparity, diabetes, and prolonged pregnancy), other risk factors have been found in the literature such as maternal age > 35 years, male sex of the newborn, obesity, and significant weight gain during pregnancy, and gestational diabetes [2,4,[6][7][8][9]. ...
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... macrosomia in the United States was 19.7 percent from 2012 to 2018. 3 Large cohort studies in the UK and China found a prevalence of macrosomia of 12.7% and 5.2%, respectively. 4,5 Meanwhile, previous study in Africa showed high rates of macrosomia in Cameroon at 11%. 6 Recent studies have shown the association between macrosomia and the risk of caesarean section, postpartum bleeding, and vaginal laceration in maternal. ...
Maternal exposure to extreme high‐temperature, particulate air pollution and macrosomia in 14 countries of Africa
Article
Full-text available
  • Jan 2023
Background Macrosomia has increased rapidly worldwide in the past few decades, with a huge impact on health. However, the effect of PM2.5 and extreme high‐temperature (EHT) on macrosomia has been ignored. Objective This study aimed to explore the association between maternal exposure to EHT, PM2.5 and macrosomia based on the Seventh Demographic and Health Survey (DHS) in 14 countries of Africa. Methods The study included detailed demographic information on 106 382 births and maternal. Satellite inversion models estimated monthly mean PM2.5 and mean surface temperature of 2 m (SMT2m). Macrosomia was defined as the birth weight ≥ 4000 g. We used a Cox proportional risk regression model to estimate the association between PM2.5, EHT and macrosomia. We further explored the susceptibility of exposure to EHT and PM2.5 at different pregnancy periods to macrosomia, and plotted the expose‐response curve between PM2.5 and macrosomia risk using a restricted cubic spline function. In addition, the Interplot model was used to investigate the interaction between EHT and PM2.5 on macrosomia. Finally, some potential confounding factors were analysed by stratification. Results There was the positive association between EHT, PM2.5 and macrosomia, and the risk of macrosomia with the increase in concentrations of PM2.5 without clear threshold. Meanwhile, EHT and PM2.5 had a higher effect on macrosomia in middle/later and early/middle stages of pregnancy, respectively. There was a significant interaction between EHT and PM2.5 on macrosomia. Conclusions Maternal exposure to EHT, PM2.5 during pregnancy was associated with an increased risk of macrosomia in Africa.
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Relação da posição durante o parto vaginal e a ocorrência de lacerações perineais espontâneas
Article
  • Aug 2024
Objetivo: Verificar a relação da posição adotada durante o parto vaginal e a ocorrência de lacerações espontâneas em parturientes assistidas por enfermeiros obstetras em um Centro de Parto Normal (CPN) do Recife. Métodos: Estudo transversal, caráter descritivo-exploratório com abordagem quantitativa. Realizado no Hospital da Mulher do Recife. A amostra foi formada por 100 parturientes assistidas pela enfermagem obstétrica. O procedimento da coleta foi realizado com suporte do banco de dados do setor. A presente pesquisa foi aprovada pelo Comitê de Ética em Pesquisa da Faculdade Pernambucana de Saúde, sob o número do CAAE 68683623.1.0000.5569. Resultados: Mulheres entre 19 e 24 anos (43,43%) e da raça parda (67,50%) foram os perfis mais predominantes. A população foi majoritariamente pacientes primíparas com 44%. O uso de tecnologias não-invasivas no trabalho de parto, contribuiu na promoção do relaxamento e conforto. Durante o parto vaginal, a posição semi sentada foi a mais adotada. Observou-se que 73,0% apresentaram laceração perineal, sendo 68,44% com lacerações de primeiro grau e 22,22% de segundo grau. Conclusão: Este estudo possibilitou verificar a relação da posição adotada pela parturiente durante o trabalho de parto e ocorrências de lacerações perineias.
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Neonatal mortality risk of large‐for‐gestational‐age and macrosomic live births in 15 countries, including 115.6 million nationwide linked records, 2000–2020
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Full-text available
  • Nov 2023
  • BJOG-INT J OBSTET GY
Objective We aimed to compare the prevalence and neonatal mortality associated with large for gestational age (LGA) and macrosomia among 115.6 million live births in 15 countries, between 2000 and 2020. Design Population‐based, multi‐country study. Setting National healthcare systems. Population Liveborn infants. Methods We used individual‐level data identified for the Vulnerable Newborn Measurement Collaboration. We calculated the prevalence and relative risk (RR) of neonatal mortality among live births born at term + LGA (>90th centile, and also >95th and >97th centiles when the data were available) versus term + appropriate for gestational age (AGA, 10th–90th centiles) and macrosomic (≥4000, ≥4500 and ≥5000 g, regardless of gestational age) versus 2500–3999 g. INTERGROWTH 21st served as the reference population. Main outcome measures Prevalence and neonatal mortality risks. Results Large for gestational age was common (median prevalence 18.2%; interquartile range, IQR, 13.5%–22.0%), and overall was associated with a lower neonatal mortality risk compared with AGA (RR 0.83, 95% CI 0.77–0.89). Around one in ten babies were ≥4000 g (median prevalence 9.6% (IQR 6.4%–13.3%), with 1.2% (IQR 0.7%–2.0%) ≥4500 g and with 0.2% (IQR 0.1%–0.2%) ≥5000 g). Overall, macrosomia of ≥4000 g was not associated with increased neonatal mortality risk (RR 0.80, 95% CI 0.69–0.94); however, a higher risk was observed for birthweights of ≥4500 g (RR 1.52, 95% CI 1.10–2.11) and ≥5000 g (RR 4.54, 95% CI 2.58–7.99), compared with birthweights of 2500–3999 g, with the highest risk observed in the first 7 days of life. Conclusions In this population, birthweight of ≥4500 g was the most useful marker for early mortality risk in big babies and could be used to guide clinical management decisions.
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Maternal oral contraceptive pill use and the risk of atopic diseases in the offspring: A systematic review and meta-analysis
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  • Apr 2020
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Efficacy and safety of cryotherapy, cold cone or thermocoagulation compared to LEEP as a therapy for cervical intraepithelial neoplasia: Systematic review
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  • Mar 2020
  • REV SAUDE PUBL
Objectives: To determine the efficacy and safety of the use of cryotherapy, cold knife or thermocoagulation compared to Loop Electrosurgical Excision Procedure (LEEP) for the treatment of cervical intraepithelial neoplasia. Methods: Systematic review with meta-analysis of randomized controlled trials in women with cervical intraepithelial neoplasia undergoing treatment with cryotherapy, cold knife, or thermo-coagulation compared with LEEP, to estimate its efficacy and safety. The search was conducted on MEDLINE/PUBMED, Cochrane Central Register of Controlled Trials (CENTRAL) and Scopus, until September 2018. Results: The total of 72 studies were identified, of which only 8 studies met the inclusion criteria. The treatment of CIN with cold knife decreases the risk of residual disease compared with LEEP (RR, 0.54, 95%CI, 0.30-0.96, p = 0.04). The management of premalignant lesions with cryotherapy, compared with LEEP, increases the risk of disease recurrence by 86% (RR, 1.86, 95%CI, 1.16-2.97, p = 0.01), increases the risk of infections (RR, 1.17, 95%CI, 1.08-1.28, p < 0.001) and reduces the risk of minor bleeding by 51% (RR, 0.49, 95%CI) %, 0.40-0.59, p ≤ 0.001). Conclusions: The treatment of premalignant lesions of cervical cancer with cold knife reduces the risk of residual disease. Nevertheless, cryotherapy reduces the risk of minor bleeding in the 24 hours after treatment and increases the risk of recurrence of disease and infections.
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Comparison of health care resource utilization among preterm and term infants hospitalized with Human Respiratory Syncytial Virus infections: A systematic review and meta-analysis of retrospective cohort studies
Article
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Introduction Data on the variation in the medical resource utilization rate of Human Respiratory Syncytial Virus (HRSV) infected children by gestational age have recently been made available. This review aimed to determine whether prematurity is independently associated with the use of medical resources in hospitalized children for HRSV infections. Methods We conducted this systematic review on cohort studies published on the medical resources use in preterm and full-term patients hospitalized for confirmed HRSV infections. We searched PubMed, Embase, and Global Index medicus for eligible studies. The standardized mean difference (SMD) and Risk Ratio (RR) with their 95% confidence intervals (95% CI) were estimated as summary statistics with random effects meta-analysis. The overall results were adjusted to the common confounders by stratified analyses. Results A total of 14 articles (20 studies) were included. Compared to full-term, preterm hospitalized with HRSV infections had more frequent intensive care unit admission (RR = 2.6, 95% CI = 1.9–3.5), increased length of stay in hospital (SMD = 0.6, 95% CI = 0.5–0.8) and intensive care unit (SMD = 0.6, 95% CI = 0.4–0.8) and increased case fatality rate (RR = 6.9, 95% CI = 2.0–23.8). Mechanical ventilation utilization was more frequent in preterm children ≤ 2 years (RR = 15.5, 95% CI = 8.9–26.4) and those who did not receive prophylaxis against HRSV (RR = 15.9, 95% CI = 9.1–27.9)] than in full-term children. No differences were identified in the frequency of emergency department visits, oxygen utilization, and the age at the first HRSV episode between preterm and full-term infants. Conclusions Regardless of gestational age, preterm infants hospitalized for HRSV infections, especially those ≤ 2 years, have an increased frequency of use of health resources and poor outcomes compared to full-term infants. HRSV vaccine development programs for pregnant women should be accelerated. Clinical trials registration Review registration PROSPERO, CRD42019124375.
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Global burden of antenatal depression and its association with adverse birth outcomes: An umbrella review
Article
Full-text available
  • Feb 2020
  • BMC PUBLIC HEALTH
Background: Women of childbearing age are at high risk of developing depression and antenatal depression is one of the most common mood disorders. Antenatal depression is also associated with a number of poor maternal and infant outcomes, however, there remains a lack of focus on mental issues in antenatal care, particularly in lower income countries. This systematic review of reviews provides useful evidence regarding the burden of antenatal depression which may provide guidance for health policy development and planning. Methods: We searched CINAHL(EBSCO), MEDLINE (via Ovid), PsycINFO, Emcare, PubMed, Psychiatry Online, and Scopus databases for systematic reviews that based on observational studies that were published in between January 1st, 2007 and August 31st, 2018. We used the Assessment of Multiple Systematic Reviews (AMSTAR) checklist scores to assess the quality of the included reviews. We applied vote counting and narrative review to summarize the prevalence of antenatal depression and its associated factors, while statistical pooling was conducted for estimating the association of antenatal depression with low birth weight and preterm birth. This systematic review of reviews was registered on PROSPERO with protocol number CRD42018116267. Results: We have included ten reviews (306 studies with 877,246 participants) on antenatal depression prevalence and six reviews (39 studies with 75,451 participants) conducted to identify the effect of antenatal depression on preterm and low birth weight. Globally, we found that antenatal depression prevalence ranged from 15 to 65%. We identified the following prominent risk factors based on their degree of influence: Current or previous exposure to different forms of abuse and violence (six reviews and 73 studies); lack of social and/or partner support (four reviews and 47 studies); personal or family history of any common mental disorder (three reviews and 34 studies). The risk of low birth weight and preterm birth was 1.49 (95%CI: 1.32, 1.68; I2 = 0.0%) and 1.40 (95%CI: 1.16, 1.69; I2 = 35.2%) times higher among infants born from depressed mothers. Conclusions: Globally, antenatal depression prevalence was high and could be considered a common mental disorder during pregnancy. Though the association between antenatal depression and adverse birth outcomes appeared to be modest, its absolute impact would be significant in lower-income countries with a high prevalence of antenatal depression and poor access to quality mental health services.
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Economic burden of maternal morbidity – A systematic review of cost-of-illness studies
Article
Full-text available
Aim To estimate the economic burden of common health problems associated with pregnancy and childbirth, such as incontinence, mental health problems, or gestational diabetes, excluding acute complications of labour or birth, or severe acute adverse maternal outcomes. Methods Searches for relevant studies were carried out to November 2019 in Medline, Embase, CINAHL, PsycINFO and EconLit databases. After initial screening, all results were reviewed for inclusion by two authors. An adapted version of a previously developed checklist for cost-of-illness studies was used for quality appraisal. All costs were converted to 2018 Euro using national consumer price indices and purchasing power parity conversion factors. Results Thirty-eight relevant studies were identified, some of which reported incremental costs for more than one health problem (16 gestational diabetes, 13 overweight/obesity, 8 mental health, 4 hypertensive disorders, 2 nausea and vomiting, 2 epilepsy, 1 intimate partner violence). A high level of heterogeneity was observed in both the methods used, and the incremental cost estimates obtained for each morbidity. Average incremental costs tended to be higher in studies that modelled a hypothetical cohort of women using data from a range of sources (compared to analyses of primary data), and in studies set in the United States. No studies that examined the economic burden of some common pregnancy-related morbidities, such as incontinence, pelvic girdle pain, or sexual health problems, were identified. Conclusion Our findings indicate that maternal morbidity is associated with significant costs to health systems and society, but large gaps remain in the evidence base for the economic burden of some common health problems associated with pregnancy and childbirth. More research is needed to examine the economic burden of a range of common maternal health problems, and future research should adopt consistent methodological approaches to ensure comparability of results.
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Trends in the incidence of fetal macrosomia and its phenotypes in the United States, 1971–2017
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  • Feb 2020
  • ARCH GYNECOL OBSTET
Purpose Studies have reported a surge in the prevalence of obesity among various demographic groups including pregnant women in the U.S. Given the association between maternal obesity and risk of fetal macrosomia, we hypothesized that the incidence of fetal macrosomia will be on the rise in the U.S. We examined trends in fetal macrosomia and macrosomia phenotypes in the U.S. among singleton live births within the gestational age of 28–42 weeks inclusive. Methods This was a retrospective cohort study covering the period 1971–2017 using U.S. Natality Data files. We applied Joinpoint regression models to derive the average annual percentage change in the outcome. We measured incidence and trends of fetal macrosomia which was defined as birth weight ≥ 4000 g. We further subdivided macrosomia into its phenotypes as previously recommended: Grade 1 (4000–4499 g), Grade 2 (4500–4999 g) and Grade 3 (≥ 5000 g). Results A total of 147,331,305 singleton births over the entire study period of 47 years were analyzed. From a baseline incidence of 8.84%, the rate of fetal macrosomia declined to 8.07% by the end of the study representing a drop of 8.70% in relative terms. The greatest drop was among infants with Grade 3 macrosomia, the most severe and lethal phenotype. The most impactful factors were maternal age and gestational weight gain. Conclusion This study is the largest population-based study conducted regarding fetal macrosomia. The rate of fetal macrosomia declined over the previous 5 decades with the most substantial drop observed in the phenotype with the worst prognosis.
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The PrEP Care Continuum Among Cisgender Women Who Sell Sex and/or Use Drugs Globally: A Systematic Review
Article
Full-text available
  • May 2020
  • AIDS BEHAV
HIV prevalence among cisgender female sex workers (FSW) and/or women who use drugs (WWUD) is substantially higher compared to similarly aged women. Consistent with PRISMA guidelines, we conducted the first systematic review on the pre-exposure prophylaxis (PrEP) continuum among FSW and/or WWUD, searching PubMed, Embase, CINAHL, PsycInfo, and Sociological Abstracts. Eligibility criteria included: reporting a PrEP related result among FSW and/or WWUD aged 18 + ; peer-reviewed; and published in English between 2012 and 2018. Our search identified 1365 studies; 26 met eligibility requirements, across the following groups: FSW (n = 14), WWUD (n = 9) and FSW-WWUD (n = 3). Studies report on at least one PrEP outcome: awareness (n = 12), acceptability (n = 16), uptake (n = 4), and adherence (n = 8). Specific barriers span individual and structural levels and include challenges to daily adherence, cost, and stigma. Combining health services and long-acting PrEP formulas may facilitate better PrEP uptake and adherence. The limited number of studies indicates a need for more research.
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Maternal and Neonatal Complications of Fetal Macrosomia: Systematic Review and Meta-analysis
Article
  • Mar 2020
(Abstracted from Ultrasound Obstet Gynecol 2019;54:308–318) Pregnancy involving fetal macrosomia (defined as birth weight >4000 g) has been associated with significant adverse outcomes to both mother and child. However, accurate estimates of these risks in the literature are limited, and guidelines are lacking from professional bodies.
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Does Hormone Replacement Therapy Impact the Prognosis in Endometrial Cancer Survivors? A Systematic Review
Article
  • Feb 2020
Purpose: The objective of this study was to evaluate the impact of hormone replacement therapy (HRT) on the prognosis in endometrial cancer (EC) survivors. Methods: The research was conducted using the following electronic databases: MEDLINE (PubMed), Web of Science, ClinicalTrial.gov, and Cochrane Library. We performed a review of studies published from January 1986 to January 2019. We selected studies that included EC patients submitted to surgery with curative intent and postoperative use of HRT. Result: Seven of 1,332 abstracts considered were eligible: 4 retrospective series, 1 prospective study, 1 randomized controlled trial, and 1 population study. Globally in the observed studies there was not a significant increase in the recurrence rate, measured by the relative risk, in the EC survivors using HRT compared with the controls in tumour stages I and II. The bias was that HRT was prescribed only to low-risk patients, who were young and had a low stage of disease. Conclusion: This systematic review shows that HRT use had no negative effect on prognosis in EC survivors in tumour stages I and II.
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Interpregnancy Weight Change and Hypertension During Pregnancy: A Systematic Review and Meta-analysis
Article
  • Dec 2019
  • OBSTET GYNECOL
Objective: To synthesize evidence regarding the association between interpregnancy weight change and hypertensive disorders of pregnancy. Data sources: MEDLINE, EMBASE, Cochrane Library, Web of Science, and ClinicalTrials.gov databases were systematically searched from the databases' interception until April 2019. Search strategy included the terms: "interpregnancy," "intergestational," "hypertension" and "hypertensive disorders." Methods of study selection: Studies that assessed the relationship between interpregnancy weight change and hypertensive disorders of pregnancy were included. Twelve studies and 415,605 women were included in this systematic review and meta-analysis. We used Mendeley reference manager during the review process. Odds ratios (ORs) for the most adjusted models reported by the included articles and the corresponding 95% CIs were calculated. The no weight change category defined by each study was used as the reference category. Tabulation, integration, and results: Overall, there was an increased risk of hypertensive disorders of pregnancy associated with interpregnancy weight gain (OR 1.37; 95% CI 1.21-1.53; I=62.1%; P<.001). Additionally, interpregnancy weight loss was associated with lower risk of developing hypertensive disorders of pregnancy (OR 0.87; 95% CI 0.75-0.99; I=54.9%; P=.01), Finally, meta-regression showed that interpregnancy weight gain was associated with a graded increase in the risk of hypertensive disorders of pregnancy. Conclusion: This systematic review and meta-analysis provides evidence that interpregnancy weight gain is associated with an increased risk of hypertensive disorders of pregnancy, gestational hypertension, and preeclampsia. Systematic review registration: PROSPERO, CRD42018103002.
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