Topic
Pregnancy
About: Pregnancy is a research topic. Over the lifetime, 163969 publications have been published within this topic receiving 4013502 citations. The topic is also known as: pregnancy & gestation.
Papers published on a yearly basis
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TL;DR: Several risk factors for both overweight and obesity in childhood are identifiable during infancy and future research needs to focus on whether it is clinically feasible for healthcare professionals to identify infants at greatest risk.
Abstract: Objective To determine risk factors for childhood
overweight that can be identified during the first year of
life to facilitate early identification and targeted
intervention.
Design Systematic review and meta-analysis.
Search strategy Electronic database search of
MEDLINE, EMBASE, PubMed and CAB Abstracts.
Eligibility criteria Prospective observational studies
following up children from birth for at least 2 years.
Results Thirty prospective studies were identified.
Significant and strong independent associations with
childhood overweight were identified for maternal prepregnancy
overweight, high infant birth weight and rapid
weight gain during the first year of life. Meta-analysis
comparing breastfed with non-breastfed infants found a
15% decrease (95% CI 0.74 to 0.99; I2=73.3%; n=10)
in the odds of childhood overweight. For children of
mothers smoking during pregnancy there was a 47%
increase (95% CI 1.26 to 1.73; I2=47.5%; n=7) in the
odds of childhood overweight. There was some evidence
associating early introduction of solid foods and childhood
overweight. There was conflicting evidence for duration of
breastfeeding, socioeconomic status at birth, parity and
maternal marital status at birth. No association with
childhood overweight was found for maternal age or
education at birth, maternal depression or infant ethnicity.
There was inconclusive evidence for delivery type,
gestational weight gain, maternal postpartum weight loss
and ‘fussy’ infant temperament due to the limited
number of studies.
Conclusions Several risk factors for both overweight
and obesity in childhood are identifiable during infancy.
Future research needs to focus on whether it is clinically
feasible for healthcare professionals to identify infants at
greatest risk.
535 citations
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TL;DR: Treatment of gestational diabetes (GDM) is effective in reducing macrosomia, large for gestational age, shoulder dystocia and pre-eclampsia/hypertensive disorders in pregnancy, and the risk reduction for these outcomes is in general large, the number need to treat is low and the quality of evidence is adequate to justify treatment.
534 citations
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TL;DR: A model was developed to link the predicted birth weight to a fetal weight curve which outlines how this weight is to be reached in an uncomplicated pregnancy and a formula was derived which describes the median fetal weight at each gestation as a proportion of the optimal term weight.
Abstract: The monitoring of fetal weight is an important aspect of antenatal care. To construct an individually adjustable standard, we developed a model to link the predicted birth weight to a fetal weight curve which outlines how this weight is to be reached in an uncomplicated pregnancy. A formula was derived which describes the median fetal weight at each gestation as a proportion of the optimal term weight, and also defines the 90th and 10th centile curves as normal limits. We analyzed a birth weight database of 38,114 singleton, routine ultrasound-dated pregnancies resulting in term deliveries. By stepwise multiple regression analysis, we derived coefficients for the factors that act as variables on term birth weight in our population. Apart from gestational age and sex, the maternal height, weight at first visit, ethnic group, parity and smoking all have significant and independent effects on birth weight. The variation due to ethnic group appears to be physiological in this population. Smoking is associated with a reduction in birth weight, which is independent of maternal physique and related to the number of cigarettes per day as reported at the first visit. We have developed a software program which calculates, on the basis of pregnancy variables entered at the first visit, an adjusted normal range for fetal size. This can be printed out as a chart and used for antenatal surveillance of growth.
534 citations
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TL;DR: The benefits of oral multiple-micronutrient supplementation during pregnancy on maternal, fetal and infant health outcomes was evaluated and a significant decrease in the number of newborn infants identified as low birthweight was found.
Abstract: Background
Multiple-micronutrient (MMN) deficiencies often coexist among women of reproductive age in low- to middle-income countries. They are exacerbated in pregnancy due to the increased demands, leading to potentially adverse effects on the mother and developing fetus. Though supplementation with MMNs has been recommended earlier because of the evidence of impact on pregnancy outcomes, a consensus is yet to be reached regarding the replacement of iron and folic acid supplementation with MMNs. Since the last update of this Cochrane review, evidence from a few large trials has recently been made available, the inclusion of which is critical to inform policy.
Objectives
To evaluate the benefits of oral multiple-micronutrient supplementation during pregnancy on maternal, fetal and infant health outcomes.
Search methods
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (11 March 2015) and reference lists of retrieved articles and key reviews. We also contacted experts in the field for additional and ongoing trials.
Selection criteria
All prospective randomised controlled trials evaluating MMN supplementation with iron and folic acid during pregnancy and its effects on the pregnancy outcome were eligible, irrespective of language or the publication status of the trials. We included cluster-randomised trials, but quasi-randomised trials were excluded.
Data collection and analysis
Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. The quality of the evidence was assessed using the GRADE approach.
Main results
Nineteen trials (involving 138,538 women) were identified as eligible for inclusion in this review but only 17 trials (involving 137,791 women) contributed data to the review. Fifteen of these 17 trials were carried out in low and middle-income countries and compared MMN supplements with iron and folic acid versus iron with or without folic acid. Two trials carried out in the UK compared MMN with a placebo.
MMN with iron and folic acid versus iron, with or without folic acid (15 trials): MMN resulted in a significant decrease in the number of newborn infants identified as low birthweight (LBW) (average risk ratio (RR) 0.88, 95% confidence interval (CI) 0.85 to 0.91; high-quality evidence) or small-for-gestational age (SGA) (average RR 0.92, 95% CI 0.86 to 0.98; moderate-quality evidence). No significant differences were shown for other maternal and pregnancy outcomes: preterm births (average RR 0.96, 95% CI 0.90 to 1.03; high-quality evidence), stillbirth (average RR 0.97, 95% CI 0.87, 1.09; high-quality evidence), maternal anaemia in the third trimester (average RR 1.03, 95% CI 0.85 to 1.24), miscarriage (average RR 0.91, 95% CI 0.80 to 1.03), maternal mortality (average RR 0.97, 95% CI 0.63 to 1.48), perinatal mortality (average RR 1.01, 95% CI 0.91 to 1.13; high-quality evidence), neonatal mortality (average RR 1.06, 95% CI 0.92 to 1.22; high-quality evidence), or risk of delivery via a caesarean section (average RR 1.04; 95% CI 0.74 to 1.46).
A number of prespecified, clinically important outcomes could not be assessed due to insufficient or non-available data. Single trials reported results for: very preterm birth < 34 weeks, macrosomia, side-effects of supplements, nutritional status of children, and congenital anomalies including neural tube defects and neurodevelopmental outcome: Bayley Scales of Infant Development (BSID) scores. None of these trials reported pre-eclampsia, placental abruption, premature rupture of membranes, cost of supplementation, and maternal well-being or satisfaction.
When assessed according to GRADE criteria, the quality of evidence for the review's primary outcomes overall was good. Pooled results for primary outcomes were based on multiple trials with large sample sizes and precise estimates. The following outcomes were graded to be as of high quality: preterm birth, LBW, perinatal mortality, stillbirth and neonatal mortality. The outcome of SGA was graded to be of moderate quality, with evidence downgraded by one for funnel plot asymmetry and potential publication bias.
We carried out sensitivity analysis excluding trials with high levels of sample attrition (> 20%); results were consistent with the main analysis except for the findings for SGA (average RR 0.91, 95% CI 0.84 to 1.00). We explored heterogeneity through subgroup analyses by maternal height and body mass index (BMI), timing of supplementation and dose of iron. Subgroup differences were observed for maternal BMI for the outcome preterm birth, with significant findings among women with low BMI. Subgroup differences were also observed for maternal BMI and maternal height for the outcome SGA, indicating a significant impact among women with higher maternal BMI and height. The overall analysis of perinatal mortality, although showed a non-significant effect of MMN supplements versus iron with or without folic acid, was found to have substantial statistical heterogeneity. Subgroup differences were observed for timing of supplementation for this outcome, indicating a significantly higher impact with late initiation of supplementation. The findings between subgroups for other primary outcomes were inconclusive.
MMN versus placebo (two trials): A single trial in the UK found no clear differences between groups for preterm birth, SGA, LBW or maternal anaemia in the third trimester. A second trial reported the number of women with pre-eclampsia; there was no evidence of a difference between groups. Other outcomes were not reported.
Authors' conclusions
Our findings support the effect of MMN supplements with iron and folic acid in improving some birth outcomes. Overall, pregnant women who received MMN supplementation had fewer low birthweight babies and small-for-gestational-age babies. The findings, consistently observed in several systematic evaluations of evidence, provide a basis to guide the replacement of iron and folic acid with MMN supplements containing iron and folic acid for pregnant women in low and middle-income countries where MMN deficiencies are common among women of reproductive age. Efforts could focus on the integration of this intervention in maternal nutrition and antenatal care programs in low and middle-income countries.
534 citations
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UNICEF1, Khon Kaen University2, University of Nairobi3, University of Ibadan4, Makerere University5, Abdou Moumouni University6, Peking University7, Pakistan Institute of Medical Sciences8, Government of Nepal9, Indian Council of Medical Research10, Pokhara University11, Chulalongkorn University12, University of Tokyo13, American University of Beirut14, State University of Campinas15, Institute for Health Metrics and Evaluation16, Inter-American Development Bank17, National Autonomous University of Nicaragua18, Dalhousie University19, University of Adelaide20, Emory University21, Uppsala University22, All India Institute of Medical Sciences23, University of Pretoria24, United States Agency for International Development25
TL;DR: High coverage of essential interventions did not imply reduced maternal mortality in the health-care facilities the authors studied, and the maternal severity index (MSI) had good accuracy for maternal death prediction in women with markers of organ dysfunction.
533 citations