Risk of recurrent spontaneous preterm birth: a systematic review and meta-analysis.
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ABSTRACT: Objective
To determine the risk of recurrent spontaneous preterm birth (sPTB) following sPTB in singleton pregnancies.Design
Systematic review and meta-analysis using random effects models.Data sources
An electronic literature search was conducted in OVID Medline (1948-2017), Embase (1980-2017) and ClinicalTrials.gov (completed studies effective 2017), supplemented by hand-searching bibliographies of included studies, to find all studies with original data concerning recurrent sPTB.Study eligibility criteria
Studies had to include women with at least one spontaneous preterm singleton live birth (<37 weeks) and at least one subsequent pregnancy resulting in a singleton live birth. The Newcastle-Ottawa Scale was used to assess study quality.Results
Overall, 32 articles involving 55?197 women, met all inclusion criteria. Generally studies were well conducted and had a low risk of bias. The absolute risk of recurrent sPTB at <37 weeks' gestation was 30% (95% CI 27% to 34%). The risk of recurrence due to preterm premature rupture of membranes (PPROM) at <37 weeks gestation was 7% (95% CI 6% to 9%), while the risk of recurrence due to preterm labour (PTL) at <37 weeks gestation was 23% (95% CI 13% to 33%).Conclusions
The risk of recurrent sPTB is high and is influenced by the underlying clinical pathway leading to the birth. This information is important for clinicians when discussing the recurrence risk of sPTB with their patients.
SUBMITTER: Phillips C
PROVIDER: S-EPMC5734267 | biostudies-literature | 2017 Jul
REPOSITORIES: biostudies-literature
Publications
Risk of recurrent spontaneous preterm birth: a systematic review and meta-analysis.
Phillips Courtney C Velji Zain Z Hanly Ciara C Metcalfe Amy A
BMJ open 20170705 6
<h4>Objective</h4>To determine the risk of recurrent spontaneous preterm birth (sPTB) following sPTB in singleton pregnancies.<h4>Design</h4>Systematic review and meta-analysis using random effects models.<h4>Data sources</h4>An electronic literature search was conducted in OVID Medline (1948-2017), Embase (1980-2017) and ClinicalTrials.gov (completed studies effective 2017), supplemented by hand-searching bibliographies of included studies, to find all studies with original data concerning recu ...[more]
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Project description:BACKGROUND:Specialised preterm birth clinics care for women at high risk of spontaneous preterm birth. This systematic review assesses current practice within preterm birth clinics globally. METHODS:A comprehensive search strategy was used to identify all studies on preterm birth clinics on the MEDLINE, Embase, PsycINFO, CENTRAL and CINAHL databases. There were no restrictions to study design. Studies were limited to the English language and publications from 1998 onwards. Two reviewers assessed studies for inclusion, performed data extraction and reviewed methodological quality. Primary outcomes were referral criteria, investigations and interventions offered in preterm birth clinics. Secondary outcomes were the timing of planned first and last appointments and frequency of review. RESULTS:Thirty-two records fulfilled eligibility criteria and 20 studies were included in the main analysis following grouping of records describing the same study or clinic. Studies were of mixed study design and methodological quality. A total of 39 clinics were described; outcome data was not available for all clinics. Referral criteria included previous spontaneous preterm birth (38/38, 100%), previous mid-trimester loss (34/38, 89%) and previous cervical surgery (33/38, 87%). All clinics offered transvaginal cervical length scans. Additional investigations varied, including urogenital swabs (16/28, 57%) and fetal fibronectin (8/28, 29%). The primary treatment of choice for a sonographic short cervix was cervical cerclage in 10/33 (30%) clinics and vaginal progesterone in 6/33 (18%), with 10/33 (30%) using multiple first-line options and 6/33 (18%) using a combination of treatments. The majority of clinics planned timing of first review for 12-16?weeks (30/35, 86%) and the frequency of review was usually determined by clinical findings (18/24, 75%). There was a wide variation in gestational age at clinic discharge between 24 and 37?weeks. CONCLUSIONS:There is variation in the referral criteria, investigations and interventions offered in preterm birth clinics and in the timing and frequency of review. Consistency in practice may improve with the introduction of consensus guidelines and national preterm birth prevention programmes. TRIAL REGISTRATION:Systematic review registration number: CRD42019131470.
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Project description:ObjectivesTo compare the efficacy of bed rest, cervical cerclage (McDonald, Shirodkar, or unspecified type of cerclage), cervical pessary, fish oils or omega fatty acids, nutritional supplements (zinc), progesterone (intramuscular, oral, or vaginal), prophylactic antibiotics, prophylactic tocolytics, combinations of interventions, placebo or no treatment (control) to prevent spontaneous preterm birth in women with a singleton pregnancy and a history of spontaneous preterm birth or short cervical length.DesignSystematic review with bayesian network meta-analysis.Data sourcesThe Cochrane Pregnancy and Childbirth Group's Database of Trials, the Cochrane Central Register of Controlled Trials, Medline, Embase, CINAHL, relevant journals, conference proceedings, and registries of ongoing trials.Eligibility criteria for selecting studiesRandomised controlled trials of pregnant women who are at high risk of spontaneous preterm birth because of a history of spontaneous preterm birth or short cervical length. No language or date restrictions were applied.OutcomesSeven maternal outcomes and 11 fetal outcomes were analysed in line with published core outcomes for preterm birth research. Relative treatment effects (odds ratios and 95% credible intervals) and certainty of evidence are presented for outcomes of preterm birth <34 weeks and perinatal death.ResultsSixty one trials (17 273 pregnant women) contributed data for the analysis of at least one outcome. For preterm birth <34 weeks (40 trials, 13 310 pregnant women) and with placebo or no treatment as the comparator, vaginal progesterone was associated with fewer women with preterm birth <34 weeks (odds ratio 0.50, 95% credible interval 0.34 to 0.70, high certainty of evidence). Shirodkar cerclage showed the largest effect size (0.06, 0.00 to 0.84), but the certainty of evidence was low. 17OHPC (17α-hydroxyprogesterone caproate; 0.68, 0.43 to 1.02, moderate certainty), vaginal pessary (0.65, 0.39 to 1.08, moderate certainty), and fish oil or omega 3 (0.30, 0.06 to 1.23, moderate certainty) might also reduce preterm birth <34 weeks compared with placebo or no treatment. For the fetal outcome of perinatal death (30 trials, 12 119 pregnant women) and with placebo or no treatment as the comparator, vaginal progesterone was the only treatment that showed clear evidence of benefit for this outcome (0.66, 0.44 to 0.97, moderate certainty). 17OHPC (0.78, 0.50 to 1.21, moderate certainty), McDonald cerclage (0.59, 0.33 to 1.03, moderate certainty), and unspecified cerclage (0.77, 0.53 to 1.11, moderate certainty) might reduce perinatal death rates, but credible intervals could not exclude the possibility of harm. Only progesterone treatments are associated with reduction in neonatal respiratory distress syndrome, neonatal sepsis, necrotising enterocolitis, and admission to neonatal intensive care unit compared with controls.ConclusionVaginal progesterone should be considered the preventative treatment of choice for women with singleton pregnancy identified to be at risk of spontaneous preterm birth because of a history of spontaneous preterm birth or short cervical length. Future randomised controlled trials should use vaginal progesterone as a comparator to identify better treatments or combination treatments.Systematic review registrationPROSPERO CRD42020169006.
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Project description:ObjectiveTo determine the accuracy with which a cervicovaginal fetal fibronectin test predicts spontaneous preterm birth in women with or without symptoms of preterm labour.DesignSystematic quantitative review of studies of test accuracy.Data sourcesMedline, 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 selectionTwo reviewers independently selected and extracted data on study characteristics, quality, and accuracy.Data extractionAccuracy data were used to form 2x2 contingency tables with spontaneous preterm birth before 34 and 37 weeks' 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 synthesis64 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 weeks' 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).ConclusionCervicovaginal 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.
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Project description:BackgroundGlobally, complications of preterm birth are among the most common cause of neonatal mortality. In Ethiopia, the neonatal mortality reduction is not worthy of attention. Hence, this study reviewed the prevalence of preterm birth and factors associated with preterm birth in Ethiopia.MethodsThe review protocol of this study has been registered in PROSPERO (CRD42017077356). The PRISMA guideline was followed for this review. Studies that assessed the prevalence and/or associated factors of preterm birth in Ethiopia and published from Jan 01, 2009 to Dec 31, 2019 were considered. Studies were searched from the PubMed and Science Direct among medical electronic databases and Google Scholar. Random-effects model was used for detected heterogeneity among studies. Publication bias and sensitivity analysis were assessed. Pooled estimates with its 95% confidence interval were reported using forest plots. The quality of evidence from the review was assessed using GRADE approach.ResultsTwenty-two studies involving a total of 12,279 participants were included. The overall pooled prevalence of preterm birth in Ethiopia was 10.48% (95% CI: 7.98-12.99). Pooled odds ratio showed rural residence (AOR = 2.34, 95% CI: 1.35-4.05), being anemic (AOR = 2.59, 95% CI: 1.85-3.64), < 4 antenatal care visits (AOR = 2.34, 95%CI: 1.73-3.33), pregnancy induced hypertension (AOR = 3.49, 95% CI: 2.45-4.97), prelabor rapture of membrane (AOR = 4.42, 95% CI: 2.28-8.57), antepartum hemorrhage (AOR = 5.02, 95% CI: 2.90-8.68), multiple pregnancies (AOR = 3.89, 95% CI: 2.52-5.99), past adverse birth outcomes (AOR = 3.24, 95% CI: 2.53-4.15) and chronic illness (AOR = 4.89, 95%CI: 3.12-7.66) were associated with increased likelihood of preterm birth. Further, support during pregnancy was associated with reduced occurrence of preterm birth.ConclusionThe pooled national level prevalence of preterm birth in Ethiopia is high. Socio demographic, nutritional, health care, obstetric and gynecologic, chronic illness and medical conditions, behavioral and lifestyle factors are the major associated factors of preterm birth in Ethiopia. This evidence is graded as low grade. Thus, efforts should be intensified to address reported risk factors to relieve the burden of preterm birth in the study setting, Ethiopia.
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Project description:BackgroundUterine fibroids may cause preterm birth. This meta-analysis evaluates the effect of uterine fibroids on the risk of preterm birth and other obstetric outcomes.MethodsUsing the literature review method, the databases PubMed, Medline, Embase and Central were retrieved to obtain relevant research literature. The selected studies were analyzed and evaluated. The literature was a cohort study or a case-control study of pregnant women as the research object and uterine fibroids as the exposure factor to observe adverse events during pregnancy. The chi-square test was used to test for heterogeneity. Subgroup analyses were used to explore sources of heterogeneity. Publication bias was assessed using Egger's test. Enumeration data were described by odds ratio (OR). Measurement data were described by mean difference (MD). Calculate the confidence interval (CI).ResultsA total of 11 studies were included in this study, including 7 cohort studies and 4 case-control studies, with a total of 313,913 women. The probability of uterine fibroids among women was 3.99%. The results of meta-analysis showed that women with uterine fibroids experienced preterm birth <37 weeks (OR =1.43, 95% CI: 1.25 to 1.64, P<0.00001), preterm birth <34 weeks (OR =1.73, 95% CI: 1.34 to 2.25, P<0.0001), premature rupture of membranes (OR =1.38, 95% CI: 1.08 to 1.75, P=0.009), placental abruption (OR =1.60, 95% CI: 1.20 to 2.14, P=0.001), cesarean section (OR =2.09, 95% CI: 1.69 to 2.58, P<0.00001), and postpartum hemorrhage (OR =2.95, 95% CI: 1.86 to 4.66, P<0.00001) were all at higher risk, and the mean gestational age at delivery [mean difference (MD) =-0.58, 95% CI: -0.66 to -0.51, P<0.00001] and birth weight (MD =-117.82, 95% CI: -155.19 to -80.45, P<0.00001) were lower. Egger's test indicated that there was no publication bias among the included studies (P>0.05).ConclusionsPregnant women with uterine fibroids are at higher risk for preterm birth and other adverse obstetric outcomes and require closer monitoring.
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Project description:BackgroundStudies of the associations between the genetic polymorphisms of the vascular endothelial growth factor (VEGF) gene and recurrent spontaneous abortion (RSA) have revealed conflicting results. The present meta-analysis was performed to provide a more precise estimation of these relationships and to explore potential sources of heterogeneity that may have influenced the reported disparities.MethodsAn extensive literature search for relevant studies was conducted on PubMed, Embase, and The Cochrane Library through June 6, 2014. Crude odds ratio (OR) with 95% confidence intervals were calculated.Results10 case-control studies including 1,832 RSA patients and 2,271 healthy controls were identified. Meta-analysis indicated that rs1570360, rs3025039, rs2010963, and rs3025020 polymorphisms in the VEGF gene correlated with elevated RSA risk. The rs1570360 variant was statistically significantly relevant to RSA risk among non-Asian populations. Interestingly, the rs3025039 variant was statistically significantly relevant to RSA risk among Asian populations.ConclusionsThe current meta-analysis indicates that rs1570360, rs3025039, rs2010963, and rs3025020 polymorphisms increase RSA susceptibility. Moreover, rs1570360 and rs3025039 polymorphisms may play various roles in RSA susceptibility in various geographic groups.
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Project description:INTRODUCTION:Preterm birth (PTB) is the leading cause of neonatal mortality and short- and long-term morbidity. The aetiology and pathophysiology of spontaneous PTB (sPTB) are still unclear, which makes the identification of reliable and accurate predictor markers more difficult, particularly for unscreened or asymptomatic women. Metabolomics biomarkers have been demonstrated to be potentially accurate biomarkers for many disorders with complex mechanisms such as PTB. Therefore, we aim to perform a systematic review of metabolomics markers associated with sPTB. Our research question is 'What is the performance of metabolomics for predicting spontaneous preterm birth in asymptomatic pregnant women?' METHODS AND ANALYSIS:We will focus on studies assessing metabolomics techniques for predicting sPTB in asymptomatic pregnant women. We will conduct a comprehensive systematic review of the literature from the last 10 years. Only observational cohort and case-control studies will be included. Our search strategy will be carried out by two independent reviewers, who will scan title and abstract before carrying out a full review of the article. The scientific databases to be explored include PubMed, MedLine, ScieLo, EMBASE, LILACS, Web of Science, Scopus and others. ETHICS AND DISSEMINATION:This systematic review protocol does not require ethical approval. We intend to disseminate our findings in scientific peer-reviewed journal, the Preterm SAMBA study open access website, specialists' conferences and to our funding agencies. PROSPERO REGISTRATION NUMBER:CRD42018100172.
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Project description:BACKGROUND: Accumulating evidence implicates early life factors in the aetiology of non-communicable diseases, including asthma/wheezing disorders. We undertook a systematic review investigating risks of asthma/wheezing disorders in children born preterm, including the increasing numbers who, as a result of advances in neonatal care, now survive very preterm birth. METHODS AND FINDINGS: Two reviewers independently searched seven online databases for contemporaneous (1 January 1995-23 September 2013) epidemiological studies investigating the association between preterm birth and asthma/wheezing disorders. Additional studies were identified through reference and citation searches, and contacting international experts. Quality appraisal was undertaken using the Effective Public Health Practice Project instrument. We pooled unadjusted and adjusted effect estimates using random-effects meta-analysis, investigated "dose-response" associations, and undertook subgroup, sensitivity, and meta-regression analyses to assess the robustness of associations. We identified 42 eligible studies from six continents. Twelve were excluded for population overlap, leaving 30 unique studies involving 1,543,639 children. Preterm birth was associated with an increased risk of wheezing disorders in unadjusted (13.7% versus 8.3%; odds ratio [OR] 1.71, 95% CI 1.57-1.87; 26 studies including 1,500,916 children) and adjusted analyses (OR 1.46, 95% CI 1.29-1.65; 17 studies including 874,710 children). The risk was particularly high among children born very preterm (<32 wk gestation; unadjusted: OR 3.00, 95% CI 2.61-3.44; adjusted: OR 2.81, 95% CI 2.55-3.12). Findings were most pronounced for studies with low risk of bias and were consistent across sensitivity analyses. The estimated population-attributable risk of preterm birth for childhood wheezing disorders was ?3.1%. Key limitations related to the paucity of data from low- and middle-income countries, and risk of residual confounding. CONCLUSIONS: There is compelling evidence that preterm birth-particularly very preterm birth-increases the risk of asthma. Given the projected global increases in children surviving preterm births, research now needs to focus on understanding underlying mechanisms, and then to translate these insights into the development of preventive interventions. REVIEW REGISTRATION: PROSPERO CRD42013004965.
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