Prepregnancy overweight and obesity as risk factors for birth defects: a cross-sectional study over a 30-year period.

Overweight and obesity are public health problems worldwide despite being modifiable conditions. The association between birth defects and pregestational maternal body mass index is not entirely clear. We aimed to assess the prevalence and estimate the risk of birth defects related to pregestational body mass index and other maternal factors. We explored a 30-year time series database in a cross-section study. We analysed 40,217 cases, among them 2.8% had birth defects. Bivariate analysis showed a higher prevalence of birth defects with increased pre-pregnancy body mass index and in extremes of maternal age, white skin colour, and primiparity. Multivariable logistic regression showed a higher chance of birth defects in women with pre-pregnancy overweight/obesity (OR:1.19 [CI95%:1.01-1.41]), maternal age ≥ 40 years (OR:1.68 [CI95%:1.11-2.54]), and white skin colour (OR:1.44 [CI95%:1.19-1.75]). Maternal weight is a modifiable risk factor that must be considered and addressed in preconception counselling to minimise possible deleterious effects on embryogenesis.IMPACT STATEMENTWhat is already known on this subject? Previous studies have linked some maternal factors with birth defects. However, the association with prepregnancy maternal body mass index is not clear.What do the results of this study add? Our findings provide support for the association of prepregnancy maternal overweight and obesity with birth defects and highlight that BMI is a modified risk factor.What are the implications of these findings for clinical practice and/or further research? Maternal body mass index is a modifiable risk factor, highlighting the importance of preconception counselling for the prevention and possible reduction of factors that increase the risk of birth defects.

Non-pharmacological Interventions for Improving Sleep Quality During Pregnancy: A Systematic Review and Meta-Analysis / Intervenções não-farmacológicas para melhoria da qualidade do sono durante a gravidez: Uma revisão sistemática e metanálise

Abstract Objective To investigate the effect of non-pharmacological interventions to improve sleep quality during pregnancy. Data sources A search was made in the NCBI/PubMed, ClinicalTrials.gov, Embase, BVS, and Web of Science databases. There were no limitations regarding language, sample size, and type of non-pharmacological intervention. We have included prospective clinical trials between July 2014 and July 2019. Selection of studies This study was registered in the Prospective International Registration of Systematic Reviews (PROSPERO) database was performed. Publication bias was also assessed with funnel plots. the primary outcome was the total score in the Pittsburgh Sleep Quality Index (PSQI) before and after intervention. Risk of bias and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria were used for assessing methodological quality. From the 28 retrieved studies, we have selected 8 for qualitative analysis and 6 for meta-analysis. Data collection Two independent reviewers performed the study selection. In the case of disagreement, a third senior reviewer was consulted. The study was initially assessed based on the title, followed by abstract. Lastly, the full text was assessed to be included. Data Synthesis A significant improvement on the sleep quality (PSQI score) was observed when all interventions were grouped (MD = -3.03, 95%CI -4.15 to -1.92, n= 623, i2= 84%, p< 0.001). Analysis by subgroup (music listening: MD = -1.96, 95% CI -3.27 to -0.65, n= 207, i2= 67%, p= 0.003 and other interventions: MD = -3.66, 95% CI -4.93 to -2.40, n= 416, i2 = 80%, p< 0.001) showed an improvement, with high heterogeneity. Risk of bias has shown performance and detection bias for almost studies, and GRADE evidence was very low for all analyzed variables. Conclusion Non-pharmacological interventions—listening to music, physical exercise, relaxation exercises, lettuce seed, sleep hygiene, and acupressure—are effective for improving sleep quality during pregnancy.

Resumo Objetivo Investigar o efeito de intervenções não-farmacológicas para melhorar a qualidade do sono durante a gravidez. Fontes dos dados Uma busca foi feita nas bases de dados NBCI/PubMed, ClinicalTrials.gov, Embase, BVS, e Web of Science. Não houve limitações quanto ao idioma, tamanho da amostra e tipo de intervenção não-farmacológica. Incluímos estudos clínicos prospectivos entre julho de 2014 e julho de 2019. Seleção dos estudos Foi realizado um registro no banco de dados Prospective International Registration of Systematic Reviews (PROSPERO). O viés de publicação foi avaliado com gráficos de funil. O desfecho primário foi a pontuação total do Pittsburgh Sleep Quality Index (PSQI) antes e depois da intervenção. O risco de viés e os critérios Grading of Recommendations Assessment, Development, and Evaluation (GRADE) foram usados para avaliar a qualidade metodológica. Dos 28 estudos encontrados, selecionamos 8 para análise qualitativa e 6 para a metanálise. Coleta de dados Dois revisores independentes realizaram a seleção dos estudos. Em caso de discordância, um terceiro revisor foi consultado. Inicialmente o estudo foi avaliado com base no título e resumo. Para a inclusão, foi avaliado o texto completo. Síntese dos dados Uma melhora significativa na qualidade do sono (PSQI score) foi observada quando todas as intervenções foram agrupadas (MD = -3.03, 95% CI -4.15 a -1.92, n= 623, i2= 84%, p< 0.001). A análise por subgrupo (escutar música: MD = -1.96, 95% CI -3.27 a -0.65, n= 207, i2= 67%, p= 0.003 e outras intervenções: MD = -3.66, 95% CI -4.93 a -2.40, n= 416, i2 = 80%, p< 0.001) também mostrou uma melhora da qualidade do sono, porém com alta heterogeneidade. A análise do risco de viés mostrou que quase todos os estudos avaliados apresentaram viés de desempenho e detecção, e o nível de evidência GRADE foi muito baixo para todas as variáveis analisadas. Conclusão Intervenções não-farmacológicas - ouvir música, exercícios físicos, exercícios de relaxamento, sementes de alface, higiene do sono e acupressão - são eficazes para melhorar a qualidade do sono durante a gravidez.

Non-pharmacological Interventions for Improving Sleep Quality During Pregnancy: A Systematic Review and Meta-Analysis.

OBJECTIVE: To investigate the effect of non-pharmacological interventions to improve sleep quality during pregnancy. DATA SOURCES: A search was made in the NCBI/PubMed, ClinicalTrials.gov, Embase, BVS, and Web of Science databases. There were no limitations regarding language, sample size, and type of non-pharmacological intervention. We have included prospective clinical trials between July 2014 and July 2019. SELECTION OF STUDIES: This study was registered in the Prospective International Registration of Systematic Reviews (PROSPERO) database was performed. Publication bias was also assessed with funnel plots. the primary outcome was the total score in the Pittsburgh Sleep Quality Index (PSQI) before and after intervention. Risk of bias and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria were used for assessing methodological quality. From the 28 retrieved studies, we have selected 8 for qualitative analysis and 6 for meta-analysis. DATA COLLECTION: Two independent reviewers performed the study selection. In the case of disagreement, a third senior reviewer was consulted. The study was initially assessed based on the title, followed by abstract. Lastly, the full text was assessed to be included. DATA SYNTHESIS: A significant improvement on the sleep quality (PSQI score) was observed when all interventions were grouped (MD = -3.03, 95%CI -4.15 to -1.92, n = 623, i2 = 84%, p < 0.001). Analysis by subgroup (music listening: MD = -1.96, 95% CI -3.27 to -0.65, n = 207, i2 = 67%, p = 0.003 and other interventions: MD = -3.66, 95% CI -4.93 to -2.40, n = 416, i2 = 80%, p < 0.001) showed an improvement, with high heterogeneity. Risk of bias has shown performance and detection bias for almost studies, and GRADE evidence was very low for all analyzed variables. CONCLUSION: Non-pharmacological interventions-listening to music, physical exercise, relaxation exercises, lettuce seed, sleep hygiene, and acupressure-are effective for improving sleep quality during pregnancy.

OBJETIVO: Investigar o efeito de intervenções não-farmacológicas para melhorar a qualidade do sono durante a gravidez. FONTES DOS DADOS: Uma busca foi feita nas bases de dados NBCI/PubMed, ClinicalTrials.gov, Embase, BVS, e Web of Science. Não houve limitações quanto ao idioma, tamanho da amostra e tipo de intervenção não-farmacológica. Incluímos estudos clínicos prospectivos entre julho de 2014 e julho de 2019. SELEçãO DOS ESTUDOS: Foi realizado um registro no banco de dados Prospective International Registration of Systematic Reviews (PROSPERO). O viés de publicação foi avaliado com gráficos de funil. O desfecho primário foi a pontuação total do Pittsburgh Sleep Quality Index (PSQI) antes e depois da intervenção. O risco de viés e os critérios Grading of Recommendations Assessment, Development, and Evaluation (GRADE) foram usados para avaliar a qualidade metodológica. Dos 28 estudos encontrados, selecionamos 8 para análise qualitativa e 6 para a metanálise. COLETA DE DADOS: Dois revisores independentes realizaram a seleção dos estudos. Em caso de discordância, um terceiro revisor foi consultado. Inicialmente o estudo foi avaliado com base no título e resumo. Para a inclusão, foi avaliado o texto completo. SíNTESE DOS DADOS: Uma melhora significativa na qualidade do sono (PSQI score) foi observada quando todas as intervenções foram agrupadas (MD = -3.03, 95% CI -4.15 a -1.92, n = 623, i2 = 84%, p < 0.001). A análise por subgrupo (escutar música: MD = -1.96, 95% CI -3.27 a -0.65, n = 207, i2 = 67%, p = 0.003 e outras intervenções: MD = -3.66, 95% CI -4.93 a -2.40, n = 416, i2 = 80%, p < 0.001) também mostrou uma melhora da qualidade do sono, porém com alta heterogeneidade. A análise do risco de viés mostrou que quase todos os estudos avaliados apresentaram viés de desempenho e detecção, e o nível de evidência GRADE foi muito baixo para todas as variáveis analisadas. CONCLUSãO: Intervenções não-farmacológicas - ouvir música, exercícios físicos, exercícios de relaxamento, sementes de alface, higiene do sono e acupressão - são eficazes para melhorar a qualidade do sono durante a gravidez.

Maternal outcomes and risk factors for COVID-19 severity among pregnant women.

Pregnant women may be at higher risk of severe complications associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which may lead to obstetrical complications. We performed a case control study comparing pregnant women with severe coronavirus disease 19 (cases) to pregnant women with a milder form (controls) enrolled in the COVI-Preg international registry cohort between March 24 and July 26, 2020. Risk factors for severity, obstetrical and immediate neonatal outcomes were assessed. A total of 926 pregnant women with a positive test for SARS-CoV-2 were included, among which 92 (9.9%) presented with severe COVID-19 disease. Risk factors for severe maternal outcomes were pulmonary comorbidities [aOR 4.3, 95% CI 1.9-9.5], hypertensive disorders [aOR 2.7, 95% CI 1.0-7.0] and diabetes [aOR2.2, 95% CI 1.1-4.5]. Pregnant women with severe maternal outcomes were at higher risk of caesarean section [70.7% (n = 53/75)], preterm delivery [62.7% (n = 32/51)] and newborns requiring admission to the neonatal intensive care unit [41.3% (n = 31/75)]. In this study, several risk factors for developing severe complications of SARS-CoV-2 infection among pregnant women were identified including pulmonary comorbidities, hypertensive disorders and diabetes. Obstetrical and neonatal outcomes appear to be influenced by the severity of maternal disease.