Objective To provide an accurate assessment of complications of pregnancy in women with chronic hypertension, including comparison with population pregnancy data (US) to inform pre-pregnancy and antenatal management strategies. Design Systematic review and meta-analysis. Data sources Embase, Medline, and Web of Science were searched without language restrictions, from first publication until June 2013; the bibliographies of relevant articles and reviews were hand searched for additional reports. Study selection Studies involving pregnant women with chronic hypertension, including retrospective and prospective cohorts, population studies, and appropriate arms of randomised controlled trials, were included. Data extraction Pooled incidence for each pregnancy outcome was reported and, for US studies, compared with US general population incidence from the National Vital Statistics Report (2006). Results 55 eligible studies were identified, encompassing 795 221 pregnancies. Women with chronic hypertension had high pooled incidences of superimposed pre-eclampsia (25.9%, 95% confidence interval 21.0% to 31.5 %), caesarean section (41.4%, 35.5% to 47.7%), preterm delivery 2 =0.286-0.766), with a substantial range of incidences in individual studies around these averages; additional meta-regression did not identify any influential demographic factors. The incidences (the meta-analysis average from US studies) of adverse outcomes in women with chronic hypertension were compared with women from the US national population dataset and showed higher risks in those with chronic hypertension: relative risks were 7.7 (95% confidence interval 5.7 to 10.1) for superimposed pre-eclampsia compared with pre-eclampsia, 1.3 (1.1 to 1.5) for caesarean section, 2.7 (1.9 to 3.6) for preterm delivery Conclusions This systematic review, reporting meta-analysed data from studies of pregnant women with chronic hypertension, shows that adverse outcomes of pregnancy are common and emphasises a need for heightened antenatal surveillance. A consistent strategy to study women with chronic hypertension is needed, as previous study designs have been diverse. These findings should inform counselling and contribute to optimisation of maternal health, drug treatment, and pre-pregnancy management in women affected by chronic hypertension.

https://www.bmj.com/content/bmj/348/bmj.g2301.full.pdf

Chronic hypertension and pregnancy outcomes: systematic review and meta-analysis.

Summary Gestational trophoblastic diseases (GTD) consist of a group of neoplastic disorders arising from placental trophoblastic tissue after normal or abnormal fertilisation. The WHO classification of GTD includes hydatidiform mole, invasive mole, choriocarcinoma, placental site trophoblastic tumour, and miscellaneous and unclassified trophoblastic lesions. GTD have a varying potential for local invasion and metastases and they generally respond to chemotherapy. Broad variations in the distribution of GTD exist worldwide, with higher frequencies in some parts of Asia, the Middle East and Africa, but the extent to which they can be attributed to methodological difficulties in obtaining accurate rates is unclear. Maternal age and a history of GTD have been established as strong risk factors for hydatidiform mole and choriocarcinoma. We review published data on the worldwide distribution of GTD, original data from cancer-registry-based statistics on choriocarcinoma, and major aetiological hypotheses, including parental age, AB0 blood groups, history of GTD, reproductive factors, oral contraceptive use, and other environmental factors.

https://www.thelancet.com/pdfs/journals/lanonc/PIIS1470-2045(03)01245-2.pdf

Epidemiology and aetiology of gestational trophoblastic diseases.

Objective: To determine the accuracy with which a cervicovaginal fetal fibronectin test predicts spontaneous preterm birth in women with or without symptoms of preterm labour. Design: Systematic quantitative review of studies of test accuracy. Data sources: Medline, Embase, PASCAL, Biosis, Cochrane Library, Medion, National Research Register, SCISEARCH, conference papers, manual searching of bibliographies of known primary and review articles, and contact with experts and manufacturer. Study selection: Two reviewers independently selected and extracted data on study characteristics, quality, and accuracy. Data extraction: Accuracy data were used to form 2×2 contingency tables with spontaneous preterm birth before 34 and 37 weeks9 gestation and birth within 7-10 days of testing (for symptomatic pregnant women) as reference standards. Data were pooled to produce summary receiver operating characteristic curves and summary likelihood ratios for positive and negative test results. Data synthesis: 64 primary articles were identified, consisting of 28 studies in asymptomatic women and 40 in symptomatic women, with a total of 26 876 women. Among asymptomatic women the best summary likelihood ratio for positive results was 4.01 (95% confidence interval 2.93 to 5.49) for predicting birth before 34 weeks9 gestation, with corresponding summary likelihood ratio for negative results of 0.78 (0.72 to 0.84). Among symptomatic women the best summary likelihood ratio for positive results was 5.42 (4.36 to 6.74) for predicting birth within 7-10 days of testing, with corresponding ratio for negative results of 0.25 (0.20 to 0.31). Conclusion: Cervicovaginal fetal fibronectin test is most accurate in predicting spontaneous preterm birth within 7-10 days of testing among women with symptoms of threatened preterm birth before advanced cervical dilatation.

https://www.bmj.com/content/bmj/325/7359/301.full.pdf

Accuracy of cervicovaginal fetal fibronectin test in predicting risk of spontaneous preterm birth: systematic review

Predictive genomic profiling used to produce personalized nutrition and other lifestyle health recommendations is currently offered directly to consumers. By examining previous meta-analyses and HuGE reviews, we assessed the scientific evidence supporting the purported gene-disease associations for genes included in genomic profiles offered online. We identified seven companies that offer predictive genomic profiling. We searched PubMed for meta-analyses and HuGE reviews of studies of gene-disease associations published from 2000 through June 2007 in which the genotypes of people with a disease were compared with those of a healthy or general-population control group. The seven companies tested at least 69 different polymorphisms in 56 genes. Of the 56 genes tested, 24 (43%) were not reviewed in meta-analyses. For the remaining 32 genes, we found 260 meta-analyses that examined 160 unique polymorphism-disease associations, of which only 60 (38%) were found to be statistically significant. Even the 60 significant associations, which involved 29 different polymorphisms and 28 different diseases, were generally modest, with synthetic odds ratios ranging from 0.54 to 0.88 for protective variants and from 1.04 to 3.2 for risk variants. Furthermore, genes in cardiogenomic profiles were more frequently associated with noncardiovascular diseases than with cardiovascular diseases, and though two of the five genes of the osteogenomic profiles did show significant associations with disease, the associations were not with bone diseases. There is insufficient scientific evidence to conclude that genomic profiles are useful in measuring genetic risk for common diseases or in developing personalized diet and lifestyle recommendations for disease prevention.

A Critical Appraisal of the Scientific Basis of Commercial Genomic Profiles Used to Assess Health Risks and Personalize Health Interventions

https://www.fertstert.org/article/S0015-0282(04)03216-9/pdf

Evidence-based investigations and treatments of recurrent pregnancy loss.

Associations between cytokine gene polymorphisms and recurrent pregnancy loss.

Cytokines in recurrent pregnancy loss.

Meditation in health: an operational definition.

Predictive score for the systemic treatment of unruptured ectopic pregnancy with a single dose of methotrexate.

OBJETIVOS: descrever aspectos da assistencia e resultados obstetricos da gravidez em adolescentes atendidas em um centro de atendimento terciario do Ceara e comparar os resultados maternos e perinatais entre adolescentes precoces e tardias. METODOS: em estudo transversal, analitico, avaliaram-se 2.058 casos, sendo 322 (15,6%) de adolescentes precoces e 1.736 (84,4%) tardias, atendidas no ano de 2000. Foram analisados as intercorrencias clinicas no pre-natal, tipo de parto, indicacoes de cesarea, idade gestacional no parto, peso do recem-nascido ao nascimento, adequacao do peso a idade gestacional, indices de Apgar no primeiro e quinto minuto de vida, presenca de malformacoes e obito neonatal. Utilizaram-se o teste exato de Fisher e o c2 na comparacao entre os dois grupos. Calculou-se tambem a razao de prevalencia. RESULTADOS: do total de partos ocorridos no periodo, 25,9% eram de adolescentes e a media de idade destas foi de 17,2 anos. Constatou-se que 88% frequentaram o pre-natal, sendo 60% com numero insuficiente de consultas. As intercorrencias clinicas mais frequentes foram a pre-eclâmpsia (14,7%), a anemia (12,9%) e a infeccao do trato urinario (6,4%), sem diferenca de frequencia entre os grupos. Ocorreram 31,3% de nascimentos por cesarea, sendo a pre-eclâmpsia a principal indicacao nas duas faixas etarias (25 e 23%, respectivamente). A frequencia de Apgar menor que 7 no primeiro minuto foi de 19,9% no grupo das adolescentes precoces e 14,2% entre as tardias (x²=6,96, p=0,008). Nao houve diferenca quanto a frequencia de prematuridade (20,2 vs 16,1%), recem-nascido pequeno para idade gestacional (12,4 vs 10,4%), baixos escores de Apgar de quinto minuto (5,3 vs 3,3%), malformacoes congenitas (3,1 vs 2,7%) e morte neonatal (1,6 vs 3,1%). CONCLUSOES: as gestantes adolescentes precoces e tardias apresentaram evolucao da gestacao e desempenho obstetrico semelhantes, exceto pela diferenca nos escores de Apgar no primeiro minuto.

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Luiz Camano

Papers

Associations between cytokine gene polymorphisms and recurrent pregnancy loss.

Cytokines in recurrent pregnancy loss.

Meditation in health: an operational definition.

Predictive score for the systemic treatment of unruptured ectopic pregnancy with a single dose of methotrexate.

Gestação na adolescência precoce e tardia: há diferença nos riscos obstétricos?