The prevalence of celiac disease in women with infertility—A systematic review with meta-analysis

PurposeTo determine the prevalence of celiac disease in infertile women.MethodsA systematic search of four databases was conducted up until February 6, 2020. The search terms “c(o)eliac disease”, “gluten”, “vill(o)us atrophy”, “infertility” and “subfertility” yielded 1142 unique hits. Articles in other languages than English, conference abstracts, letters, and publications where relevant information was missing were excluded. In our main analysis, celiac disease had to be verified by duodenal biopsy. The titles and abstracts, and the full‐text articles were independently reviewed by two researchers. A fixed‐effect model was used to calculate the weighted prevalence.ResultsBased on 11 studies (1617 women), the pooled prevalence of biopsy‐confirmed celiac disease was 0.7% (95% CI = 0.2%‐1.2%) in women with any infertility. Restricting our study population to women with unexplained infertility, the pooled prevalence of biopsy‐confirmed celiac disease was 0.6% (95% CI = 0.0%‐1.6%). When including studies where celiac disease had been defined per serology (20 studies; 5158 women), the pooled prevalence of celiac disease was 1.1% (95% CI = 0.6%‐1.6%) in women with any infertility.ConclusionOur results indicate that celiac disease is not more common in infertile women than in the general population. Celiac screening in infertile women may have low yield.     

Neuromuscular electrical stimulation for muscle strengthening in elderly with knee osteoarthritis – A systematic review

PurposeTo identify if there is evidence in favor of the use of NMES to quadriceps muscle strengthening in elderly with knee OA.Data sources and study selectionA search of PubMed/Medline, PEDro and Cochrane Library produced a total of 76 relevant trials. Six studies that met the inclusion criteria were selected for this review.Data extractionTrials were addressed by inclusion and exclusion criteria and scoring internal validity using PEDro scale.Data synthesesA summary of the sample and design characteristics, and muscle strength results from each study were presented on table.ConclusionThe best-evidence analysis showed moderate evidence in favor of NMES alone or combined with exercise for isometric quadriceps strengthening in elderly with OA. In addition, for the effects of NMES intervention as an adjunct therapy on isokinetic strength at different angular velocities, there was a limited quality of evidence assessed.     

Does antenatal physical therapy for pregnant women with low back pain or pelvic pain improve functional outcomes? A systematic review

Objective. A systematic review was undertaken to update the understanding of the available evidence for antenatal physical therapy interventions for low back or pelvic pain in pregnant women to improve functional outcomes when compared with other treatments or no treatment. Data Sources. Seven electronic databases were systematically searched and supplemented by hand searching through reference lists. Methods of study selection. Two reviewers independently selected trials for inclusion and independently assessed the internal validity of the included trials using the Clinical Appraisal Skills Program tool. Results. Four trials with 566 participants were identified that met the inclusion criteria. The validity of the trials was moderate. Exercise, pelvic support garments and acupuncture were found to improve functional outcomes in pregnant women with low back or pelvic pain. No meta-analysis was performed because of the heterogeneity of functional outcome measures. Conclusions. While there is some evidence that physical therapy using exercise, acupuncture and pelvic supports may be useful, further research needs to consider other treatment modalities used by physical therapists and establish an appropriate, reliable and valid functional outcome measure to assess low back and pelvic pain in pregnancy.     

Experiences of a lifestyle intervention in obese pregnant women – A qualitative study

Objectiveto describe obese women's experiences of participating in a lifestyle intervention and its experienced impact on health and lifestyle.Designqualitative method with a phenomenological lifeworld approach. The interviews were analyzed in accordance with the phenomenological method.Participants and setting11 women who had participated in a lifestyle intervention project, targeting pregnant women with BMI ≥30 in southwestern Sweden, were interviewed a few weeks before delivery.Findingsthe essence of these women's experiences was expressed as: implementing new habits required support, from midwives, partners, relatives, friends, or obese pregnant women in the same situation, or by participating in the intervention itself. The support had to be non-judgmental and with a balanced outlook on weight. Participation had taught them about weight gain control. The women were motivated to try to control their gestational weight gain, although not all of them were initially convinced that this would be possible. The essential structure of participation can be described with the following constituents: ‘‘pregnancy encourages change’’, ‘‘to be supported by non-judgmental people’’, ‘‘from bad habits to conscious choices’’ and; ‘‘barriers to change’’.Key conclusionsin order to implement new habits, participants expressed a need for support, given with a non-judgmental attitude and a balanced outlook on weight. The women experienced that the lifestyle changes could be less burdensome than previously imagined, and that slight changes could yield unexpectedly successful results. In order to maintain a lifestyle change, obese women must perceive some kind of results, i.e. increased quality of life or weight gain control.Implications for practicenon-judgmental support from midwives is crucial. Affinity with other pregnant obese women in an exercise group or dietary group setting is supportive.     

Seroprevalence and risk factors for cytomegalovirus infection among pregnant women in southern Taiwan, 2014–2015

ObjectiveTo investigate the seroprevalence of and risk factors for cytomegalovirus (CMV) infection among pregnant women in southern Taiwan.Materials and methodsFrom 2014 to 2015, pregnant women undergoing their first prenatal care visit participated in this study at Kaohsiung Chang Gung Memorial Hospital and Chiayi Chang Gung Memorial Hospital. A serologic test was performed for anti-CMV IgG/IgM. Transabdominal amniocentesis was scheduled for those with seropositive anti-CMV IgM. Extraction of CMV DNA was performed via real-time polymerase chain reaction (PCR). Maternal sociodemographic characteristics and risk factors for CMV seropositivity were analyzed.ResultsA total of 539 pregnant women undergoing their first prenatal visit were included. Eighty-three pregnant women were excluded for delivering at other hospitals. The overall seroprevalence rate of anti-CMV IgG in the remaining 456 cases was 87.28%. The seroprevalence rates of anti-CMV IgG(+)/IgM(+) and IgG(+)/IgM(?) were 1.32% and 85.96%, respectively. According to the anti-CMV IgG avidity test, only 3 pregnant women (0.65%) had primary CMV infection. Two of them underwent amniocentesis, and the results for both were negative for CMV DNA. According to the logistic regression analysis, the seropositivity of anti-CMV IgG was significantly associated with maternal age ≥30 (adjusted OR = 2.08, 95% CI: 1.10–3.94, p = 0.025) and the seropositivity of anti-CMV IgM was significantly associated with gestational weeks ≥37 when delivery (adjusted OR = 7.81, 95% CI: 1.23–49.58, p = 0.029).ConclusionIn southern Taiwan, among pregnant women, the CMV seroprevalence was high (87.28%), but the rate of primary CMV infection was very low (0.65%). Pregnant women aged more than 30 years had a significant risk of CMV seropositivity.     

Chlamydia trachomatis infection in women with ectopic pregnancy

ＣｈｌａｍｙｄｉａｔｒａｃｈｏｍａｔｉｓｉｎｆｅｃｔｉｏｎｉｎｗｏｍｅｎｗｉｔｈｅｃｔｏｐｉｃｐｒｅｇｎａｎｃｙＴａｎｇＪｉａｌｉｎｇＨｕａｎｇＺｉｊｉａｎＨｕａｎｇＸｉａｏｊｕｎＤｅｐｔ．ｏｆＧｙｎａｅｃｏｌｏｇｙ，ＧｕａｎｇｚｈｏｕＭａｔｅｒｎａ...     

Major risk factors for stillbirth in different trimesters of pregnancy—A systematic review

Stillbirth remains an event that has an important impact on global health issues. Different levels of health care between countries suggest that the stillbirth rate may be one of the indicators of the quality of a country's medical system. In this review, major risk factors for stillbirth will be discussed, especially in different trimesters of pregnancy. Early identification of risk factors for stillbirth and appropriate antenatal management may reduce preventable stillbirths and improve general outcomes of pregnancy.     

Is maternal serum relaxin associated with preterm delivery in Chinese pregnant women? A meta-analysis

Objective: A meta-analysis was performed to study the relationship between serum relaxin and preterm delivery in women with singleton pregnancies without estrogen stimulation.

Methods: Cohort and case-control studies were identified through searching databases (PubMed, Embase, Ovid, CBM, Wan fang, VIP, and CNKI). We carried out a continuous variable meta-analysis. The outcome was preterm delivery (gestation age <37 weeks).

Results: Fifteen studies were included, involving 1607 women with a singleton pregnancy. The pooled standard mean deviation (SMD) of 15 studies was 0.559 (95%CI: 0.002–1.196) and the heterogeneity was 96.6%. To reduce the heterogeneity, we chose random effects model and made subgroup analysis according to gestational age at sample testing (<18 weeks and ≥18 weeks) and race of included pregnant women. The pooled SMD of gestational age at sample testing ≥18 weeks and Chinese were 1.19 (95%CI: 0.63–1.75) and 1.61 (95%CI: 0.82–2.41) and the heterogeneity values (measured by I²) were 93.5% and 76.5%, respectively.

Conclusions: Elevated maternal serum relaxin of later than 18 weeks of gestational age is associated with singleton preterm birth in Chinese women. It might be an important information to prevent singleton preterm delivery in Chinese women. What’s already known about this topic? Previous reports reveal that there is a relationship between elevated maternal serum relaxin and preterm birth. However, the included articles contained twin pregnancies and estrogen stimulation, which obviously resulted in higher relaxin concentrations. What does this study add?     

Does smoking increase risk of ovarian cancer? A systematic review

OBJECTIVES: Although early reports suggested that smoking was not associated with ovarian cancer risk, recent studies have reported positive associations for cancers of the mucinous subtype. We sought to clarify the relationship between smoking and ovarian cancer by histological subtype. METHODS: We conducted a systematic literature review and meta-analysis of studies investigating the association between smoking and risk of the different histological subtypes of epithelial ovarian cancer. Eight population-based case-control studies, one pooled analysis of case-control studies, and one cohort study met the inclusion criteria. Summary relative risks (RR), 95% confidence intervals (CI), and tests for heterogeneity were generated from random effects models. RESULTS: Combined, these studies included a total of 910 women with mucinous and 5564 with non-mucinous ovarian cancers. There was a significant doubling of risk of mucinous ovarian cancer in current smokers compared to never smokers (summary RR 2.1, 95% CI 1.7-2.7), but no increased risk of serous (1.0, 95% CI 0.8-1.2) or endometrioid (0.8, 95% CI 0.6-1.1) cancers and a significant risk reduction for clear cell cancers (0.6, 95% CI 0.3-0.9). The risk of mucinous cancer increased with increasing amount smoked but returned to that of never smokers within 20-30 years of stopping smoking. CONCLUSIONS: Meta-analysis suggests that current smoking doubles a woman's risk of developing mucinous ovarian cancer. Stopping smoking returns the risk to normal in the long term. Smoking may thus be one of the few modifiable factors offering potential for primary prevention of mucinous ovarian cancer.     

Association of young and advanced age of pregnant women with the risk of isolated congenital abnormalities in Hungary – a population-based case-matched control study

Objective: To analyze the possible association of maternal age with the risk of all congenital abnormalities (CAs) in a population-based large case-matched control data set.

Methods: The Hungarian Case-Control Surveillance of Congenital Abnormalities included 21?494 cases with isolated CA and their 34?311 matched controls. First the distribution of maternal age groups in 24 CA-groups and their matched controls was compared. In the second step, young (19 years or less) and advanced (35 years or more) age groups were compared. Finally, the subgroups of neural-tube defects, congenital heart defects and abdominal wall's CA were evaluated separately.

Results: A higher risk of gastroschisis, congenital heart defects, particularly left-sided obstructive defects, undescended testis and clubfoot was found in the youngest age group (19 years or less) of cases. The higher proportion of pregnant women with advanced age (i.e. 35 years or more) showed only a borderline excess in cases with clubfoot. The so-called U-shaped risk of maternal age distribution was found in cases with clubfoot and in the total group of isolated CAs.

Conclusions: The maternal age is a contributing factor to the origin of some isolated CAs mainly in young pregnant women.     

Midwife-led care unit for ‘low risk’ pregnant women in a Japanese hospital

Objectives.?To examine the obstetric outcomes of our ‘low risk’ pregnant women under the midwife-led delivery care compared with those under the obstetric shared care.

Methods.?A retrospective cohort study compared outcomes of labor under midwife ‘primary’ care with those under obstetric shared care. The factors examined were: maternal age, parity, gestational age at delivery, length of labor, augmentation of labor pains, delivery mode, episiotomy, perineal laceration, postpartum hemorrhage, neonatal birth weight, Apgar score, and umbilical artery pH. In this study, pregnant women were initially considered ‘low risk’ at admission when they had no history of medical, gynecological, or obstetric problems and no complications during the present pregnancy.

Results.?There were 1031 pregnant women initially considered ‘low risk’ at admission. At admission, 878 of them (85%) requested to give birth under midwife care; however 364 of these women (42%) were transferred to obstetric shared care during labor. The average length of labor under the midwife ‘primary’ care was significantly longer than that under the obstetric shared care. However, there were no significant differences in the rate of prolonged labor (≥24?h). There were no significant differences in other obstetric or neonatal outcomes between the two groups.

Conclusions.?There was no evidence indicating that midwife ‘primary’ care is unsafe for ‘low risk’ pregnant women. Therefore, midwifery care is recommended for ‘low risk’ pregnant women.     

Do normal-weight women pregnant with twins are at the lowest risk of developing preeclampsia?

Objective: To determine the relation between preeclampsia (PE) and pregravid body mass index (BMI) in twin pregnancy.

Methods: Retrospective cohort study of 542 women pregnant with twins.

Results: Forty-nine patients developed PE (9%). Underweight, overweight and obese women were at a higher risk of PE than normal-weight mothers. There was no linear (p?=?0.7) but significant U-shaped relation between BMI and PE (p?2.

Conclusions: Nonlinear relation between PE occurrence and BMI suggests that using homogeneous PE risks of BMI groups may be incorrect.     

Telomere homeostasis in IUGR placentas – A review

Telomeres are nucleoprotein structures located at the termini of chromosomes. They are essential for chromosome stability. Telomeres become shorter due to mitotic cycles and environmental factors. When telomeres are shortened and therefore dysfunctional, cellular senescence occurs and organ dysfunction might develop. During pregnancy, fetal growth restriction secondary to placental insufficiency has been linked to impaired telomere homeostasis in which telomeres are shorter, telomerase is decreased, and compensatory mechanisms of telomere capture are enhanced. These characteristics, along with increased signs of senescence, indicate telomere dysfunction in trophoblasts from placentas affected by intrauterine growth restriction (IUGR).This review summarizes the information currently available regarding telomere homeostasis in trophoblasts from human pregnancies affected by IUGR. Improved understanding of placental physiology might help in the development of treatment options for fetuses with IUGR.     

Are pregnant women in New Zealand iodine deficient? A cross-sectional survey

Severe iodine deficiency in pregnancy can result in cretinism. There is growing concern that less severe iodine deficiency may also affect fetal growth and development. A handful of prior small New Zealand studies focussed on pregnant women living in Dunedin. This study utilised biochemical, clinical and dietary indices to assess iodine status of 170 women living throughout New Zealand. The median urinary iodine concentration (UIC) of the women was 38 μg/L, well below the 150 μg/L cut-off value that indicates adequate iodine status; 7% of women had goitre. Not surprisingly, iodine intake was also low at 48 μg/day. The majority of women had TSH and FT4 concentrations within pregnant reference ranges, suggesting that despite the low UIC observed in these women, thyroid hormone production appeared unaffected.     

Association of serum glypican-4 levels with cardiovascular risk predictors in women with polycystic ovary syndrome – a pilot study

Objective: Glypican-4 (Gpc4) is an adipokine which interacts with the insulin receptor and affects insulin sensitivity in proteoglycans. Insulin resistance plays a crucial role in the etiology of polycystic ovary syndrome (PCOS). PCOS is associated with metabolic disturbances such as abdominal obesity, dyslipidemia and type 2 diabetes. Thus, higher levels of Gpc4 released from visceral adipose tissue in women with PCOS may suggest an increased risk of cardiovascular disease (CVD).

Design: The aim of this pilot study was to determine whether the serum Gpc4 level is associated with cardiovascular risk predictors in women with PCOS.

Methods: Sixty-two women with PCOS according to the Rotterdam criteria (20–35 years old) and 43 healthy controls were studied. Cardiovascular risk predictors such as obesity indices, fat deposits according to dual-energy X-ray absorptiometry, biochemical lipid profile parameters and Homeostasis Model Assessment were estimated.

Results: The serum Gpc4 level in PCOS women was significantly higher (2.61?±?1.17?ng/ml) than in the control group (1.55?±?0.47?ng/ml) and correlated with waist circumference, waist-to-hip ratio, total fat and android fat deposit to gynoid fat deposit ratio only in the PCOS group.

Conclusion: The Gpc4 level was higher in the PCOS group and correlated with CVD risk predictors, especially fat distribution.