ABSTRACT
OBJECTIVE: To perform systematic review and meta-analysis to evaluate the risk of preeclampsia after chorionic villus sampling (CVS). DATA SOURCES: A systematic search of PubMED and Web of Science from inception through August 2010, and bibliographies of review articles and eligible studies were performed. METHODS OF STUDY SELECTION: Six studies reported the risk of preeclampsia after CVS. All of the identified studies were retrospective and included in analysis. TABULATION, INTEGRATION, AND RESULTS: Reporting quality of the identified studies according to quality assessment scale for methodology in retrospective clinical reporting was moderate. Pooling was performed in two strata for control: (1) patients without any invasive prenatal diagnostic procedure served as control group: no significant difference was found in the odds ratio (OR) of preeclampsia (OR 0.79, 95% CI 0.38-1.64), severe preeclampsia (OR 0.49, 95% CI 0.04-5.78), gestational hypertension (OR 0.76, 95% CI 0.46-1.26), all pregnancy-induced hypertensive disorders (OR 0.80, 95% CI 0.46-1.41) between CVS and control groups. (2) Patients with amniocentesis combined with patients without any invasive prenatal diagnostic procedure served as control group: no significant difference was found in the OR of preeclampsia (OR 0.76, 95% CI 0.37-1.53), severe preeclampsia (OR 0.83, 95% CI 0.14-4.85), all pregnancy-induced hypertensive disorders (OR 0.92, 95% CI 0.55-1.53) between CVS and combined control groups. CONCLUSION: None of the included studies were randomized prospective trials designed to investigate the effect of CVS on preeclampsia. Accordingly, this review is limited by the heterogeneity, small number and retrospective nature of the available studies. CVS does not seem to increase the risk of preeclampsia or other pregnancy-induced hypertensive disorders. However, randomized prospective trials that are designed to investigate the risk of preeclampsia after CVS are needed to make a definite conclusion.
Subject(s)
Chorionic Villi Sampling/adverse effects , Pre-Eclampsia/etiology , Chorionic Villi Sampling/statistics & numerical data , Female , Humans , Hypertension, Pregnancy-Induced/epidemiology , Hypertension, Pregnancy-Induced/etiology , Odds Ratio , Pre-Eclampsia/epidemiology , Pregnancy , RiskSubject(s)
Perfusion Imaging , Pregnancy Complications, Cardiovascular/diagnosis , Pulmonary Artery/diagnostic imaging , Pulmonary Embolism/diagnosis , Tomography, X-Ray Computed , Breast Neoplasms/etiology , Female , Humans , Neoplasms, Radiation-Induced/etiology , Perfusion Imaging/adverse effects , Pregnancy , Pregnancy Complications, Cardiovascular/diagnostic imaging , Pulmonary Embolism/diagnostic imaging , Radiation Dosage , Risk Assessment , Risk Factors , Tomography, X-Ray Computed/adverse effectsABSTRACT
OBJECTIVE: To perform a meta-analysis for an assessment of the risk of preeclampsia or gestational hypertension following chorionic villus sampling (CVS). DATA SOURCE: PubMed was systematically searched from its inception through January 2016. MATERIAL AND METHODS: Nine reports were identified. A pre-specified scale was used to assess their quality. TABULATION INTEGRATION AND RESULTS: We performed pooling into three subgroups with respect to the control group: A) Patients with no invasive prenatal diagnostic procedure served as a control group for comparison. The odds ratios for gestational hypertension (0.76, 95% CI 0.46-1.26), preeclampsia (0.83, 95% CI 0.42-1.67), and severe preeclampsia (0.49, 95% CI 0.04-5.78) or when hypertension categories were pooled (0.80, 95% CI 0.46-1.41) were not significantly different. B) Patients with midtrimester diagnostic amniocentesis and patients with no invasive prenatal diagnostic procedure were combined as a control group for comparison. The odds ratios for preeclampsia (1, 95% CI 0.46-2.18), severe preeclampsia (0.83, 95% CI 0.14-4.85), and pooled hypertension categories (1.07, 95% CI 0.63-1.84) were not significantly different. C) Patients with midtrimester diagnostic amniocentesis served as a control group. There was a significant difference in the odds ratio for preeclampsia between the CVS and amniocentesis groups (2.47, 95% CI 1.14-5.33). There was a marginal difference in the odds ratio for combined pregnancy-induced hypertension categories between the CVS and amniocentesis groups (1.61, 95% CI 1.02-2.53). CONCLUSION: The available data do not indicate an increased risk of preeclampsia or gestational hypertension following first trimester CVS. The heterogeneity and retrospective design of existing studies are limiting factors for our analysis and findings.
Subject(s)
Abruptio Placentae/epidemiology , Abruptio Placentae/etiology , Chorionic Villi Sampling/adverse effects , Pre-Eclampsia/epidemiology , Abruptio Placentae/blood , Abruptio Placentae/diagnosis , Adult , Algorithms , Chorionic Villi Sampling/statistics & numerical data , Female , Humans , Pre-Eclampsia/blood , Pre-Eclampsia/diagnosis , Pregnancy , Pregnancy-Associated Plasma Protein-A/analysis , Prenatal Diagnosis/adverse effects , Prenatal Diagnosis/methods , Review Literature as Topic , alpha-Fetoproteins/analysisABSTRACT
OBJECTIVE: To perform a systematic review and meta-analysis of the effectiveness of combined vitamin C and E (vitCE) supplementation for the prevention of preeclampsia. DATA SOURCES: PubMED, Web of Science, and Cochrane Central Register of Controlled Trials from inception through June 2010, and bibliographies of review articles and eligible studies. METHODS OF STUDY SELECTION: Fifteen eligible studies that evaluated vitCE supplementation for the prevention of preeclampsia were identified. On the basis of prespecified inclusion and exclusion criteria, 9 were included in the meta-analysis. All were randomized controlled trials. The reporting and methodologic quality of the included studies was assessed with the CONSORT checklist and the Jadad scale. TABULATION, INTEGRATION, AND RESULTS: The 9 included studies had moderate-to-high CONSORT and Jadad scores. The incidence of preeclampsia was 9.7% (949 of 9833) in the vitCE group and 9.5% (946 of 9842) in the placebo group. A random effects model was used for pooling and no difference was found in the relative risk (RR) of preeclampsia between the vitCE and placebo groups (RR: 0.98; 95% confidence interval [CI]: 0.87-1.10). The incidence of gestational hypertension was 22.6% (1915 of 8491) in the vitCE group and 20.3% (1728 of 8500) in the placebo group (RR: 1.11, 95% CI: 1.05-1.17). The incidence of placental abruption was 0.58% (43 of 7379) in the vitCE group and 0.87% (64 of 7361) in the placebo group (RR: 0.67, 95% CI: 0.46-0.98). No significant differences were observed for other maternal and neonatal outcomes. CONCLUSION: Combined VitCE supplementation does not decrease the risk of preeclampsia and should not be offered to gravidas for the prevention of preeclampsia or other pregnancy induced hypertensive disorders. Furthermore, combined supplementation with vitCE increased the risk of GH but decreased the risk of placental abruption. However, these latter associations may not be causal, especially since they were the product of multiple statistical comparisons, and the 95% CI around the point estimates almost included one. LEARNING OBJECTIVES: After completion of this educational activity, the obstetrician/gynecologist should be better able to assess the causes of preeclampsia and related conditions; evaluate and interpret the evidence regarding the use of combined vitamins C and E in prevention of preeclampsia and related conditions; and interpret and understand the effects of the supplementation of vitamins C and E for the prevention of preeclampsia or other pregnancy induced hypertensive disorders. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians.