Dataset Information

Serum Creatinine in Pregnancy: A Systematic Review.

ABSTRACT:

Introduction

Standard assessment of renal function in pregnancy is by measurement of serum creatinine concentration yet normal gestational ranges have not been established. The aim of this systematic review was to define the difference in serum creatinine in a healthy pregnancy compared with concentrations in nonpregnant women to facilitate identification of abnormal kidney function in pregnancy.

Methods

Medline, PubMed, Embase, Web of Science, theses, key obstetric texts, and conference proceedings were searched to July 2017. Eligible studies included quantification of serum creatinine concentration in a pregnant cohort, with either a reported local laboratory reference range or matched quantification in a nonpregnant cohort. The outcomes of interest were the mean and upper reference limits for creatinine in pregnancy, measured as a ratio of pregnant:nonpregnant values. Study heterogeneity was examined by meta-regression analysis.

Results

Forty-nine studies were identified. Data synthesis included 4421 serum creatinine values in pregnancy, weighted according to cohort size. Mean values for serum creatinine in pregnancy were 84%, 77%, and 80% of nonpregnant mean values during the first, second, and third trimesters, respectively. The 97.5th centile (upper limit of the 95% reference range) for serum creatinine in pregnancy was 85%, 80%, and 86% of the nonpregnant upper limit in sequential trimesters.

Conclusion

Based on a nonpregnant reference interval of 45-90 ?mol/l (0.51-1.02 mg/dl), a serum creatinine of >77 ?mol/l (0.87 mg/dl) should be considered outside the normal range for pregnancy. Future work can use this value to explore correlation of adverse pregnancy outcomes with serum creatinine concentration. PROSPERO registration: CRD42017068446.

SUBMITTER: Wiles K

PROVIDER: S-EPMC6409397 | biostudies-literature | 2019 Mar

REPOSITORIES: biostudies-literature

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Publications

Serum Creatinine in Pregnancy: A Systematic Review.

Wiles Kate K Bramham Kate K Seed Paul T PT Nelson-Piercy Catherine C Lightstone Liz L Chappell Lucy C LC

Kidney international reports 20181029 3

<h4>Introduction</h4>Standard assessment of renal function in pregnancy is by measurement of serum creatinine concentration yet normal gestational ranges have not been established. The aim of this systematic review was to define the difference in serum creatinine in a healthy pregnancy compared with concentrations in nonpregnant women to facilitate identification of abnormal kidney function in pregnancy.<h4>Methods</h4>Medline, PubMed, Embase, Web of Science, theses, key obstetric texts, and con ...[more]

PMID: 30899868

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Project description:IntroductionSmoking in pregnancy increases the risk of negative health outcomes. Vaping can be effective for smoking cessation in nonpregnant populations. We conducted a systematic review of vaping in pregnancy, covering prevalence, patterns of use, reasons for use, smoking cessation, and health effects.MethodsFive academic databases were searched on 17 February 2020. Studies reporting prevalence, patterns, reasons, cessation, or health effects of vaping in pregnancy were included; animal and in vitro studies were excluded. A narrative review was used, with risk of bias assessed using Hoy and colleague's tool, the Newcastle-Ottawa scale, and the Consolidated Criteria for reporting Qualitative Research.ResultsTwenty-three studies were identified: 11 survey, 7 qualitative, 3 cohort, and 2 secondary analyses of randomized clinical trials. Prevalence of vaping in pregnancy (four studies) was between 1.2% and 7.0% overall, and <1% among nonsmokers. Twelve studies reported patterns of use, but findings were inconsistent. Twelve of 14 studies asking why pregnant women vaped reported that most vaped to reduce or quit smoking. Mixed findings were reported from six studies on smoking cessation. Of three studies with health-related outcomes, two were underpowered and one reported similar birthweights for babies born to nonsmokers and women who vaped, with both higher (p < .0001) than the birthweight of babies born to smokers.ConclusionsThere were insufficient data to draw conclusions about prevalence, patterns, and effects of vaping in pregnancy on smoking cessation. The limited literature suggests that vaping in pregnancy has little or no effect on birthweight.ImplicationsSmoking causes many negative health outcomes for pregnant women and to babies born to people who smoke. There remains a paucity of research on the effects of vaping in pregnancy. There is, however, the potential for vaping products to reduce the negative health outcomes associated with smoking. More research is needed to develop an evidence base in this area.

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Project description:BackgroundN-acetylcysteine (NAC) is an antioxidant which can regenerate glutathione and is primarily used for acetaminophen overdose. It is also a potential therapy to prevent iatrogenic acute kidney injury or slow the progression of chronic kidney disease. It has been considered in this context by many studies with mixed results. Notably, a biological-mechanism rationale for a protective effect of NAC has never been adequately reported. Among conflicting reports, there appears to be evidence that NAC may artificially lower measured serum creatinine without improving kidney function, potentially by assay interference. Given these mixed results, a systematic review of the literature will be conducted to determine whether there is an effect of NAC on kidney function measured with serum creatinine.ObjectiveTo determine the effect of NAC on kidney function.DesignA systematic review and meta-analysis.SettingsProspective studies, with administration of NAC, in the absence of any other change in kidney function (such as contrast administration or surgery).PatientsAdult humans aged 18 years old or more, either healthy volunteers or with chronic kidney disease, were administered with NAC. Populations having little to no kidney function such as in end-stage kidney disease will be excluded.MeasurementsSerum creatinine and/or cystatin C measurements before and after NAC administration.MethodsAn information specialist will assist in searching MEDLINE, EMBASE, and the Cochrane CENTRAL databases to identify all study types including randomized controlled trials, and prospective cohort studies reporting change in serum creatinine after NAC administration. Two reviewers will independently screen the titles and abstracts of the studies obtained from the search using predefined inclusion criteria and will then extract data from the full texts of selected studies. The weighted mean difference will be calculated for change in creatinine with NAC, using random-effects analysis. Quality assessment will be done with the Cochrane Risk of Bias tool for randomized trials and the Newcastle-Ottawa Scale for observational studies.ResultsThe outcome of interest is kidney function as reported by either change in serum creatinine and/or serum cystatin C measurement for randomized trials or comparing baseline (pre-NAC dose) values and those following the NAC dose.LimitationsPossible heterogeneity and publication bias and lack of mechanistic data.ConclusionsThis systematic review will provide a synthesis of current evidence on the effect of NAC on serum creatinine measurement. These findings will provide clinicians with guidelines and serve as a strong research base for future studies in this field.Systematic review registrationThis review is registered with PROSPERO, CRD42017055984.

Dataset Information

Serum Creatinine in Pregnancy: A Systematic Review.

Introduction

Methods

Results

Conclusion

Publications

Serum Creatinine in Pregnancy: A Systematic Review.

Similar Datasets

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