Listeriosis in pregnancy: An umbrella review of maternal exposure, treatment and neonatal complications.

BACKGROUND: Listeria monocytogenes is a commonly found organism in processed and prepared food and the disease of listeriosis is associated with a high morbidity and mortality. Compared with the general population, the risk of being diagnosed with listeriosis increases during pregnancy. Listeriosis can lead to miscarriage, spontaneous preterm labour and preterm birth, stillbirth and congenital neonatal infections. OBJECTIVES: We conducted a universal review of listeriosis in pregnancy and in the newborn. SEARCH STRATEGY: The EMBASE, PubMed, Cinahl and Web of Science databases were searched for systematic reviews indexed before 1 December 2020. SELECTION CRITERIA: Any systematic reviews evaluating the prevalence, treatment, diagnosis and effects of listeriosis during pregnancy and up to 4 weeks postnatally were included. DATA COLLECTION AND ANALYSIS: Eligibility assessment, data extraction and quality assessment by the Methodological Quality Assessment of Systematic Reviews (AMSTAR-2) were performed in duplicate. MAIN RESULTS: We identified 397 citations of which nine systematic reviews comprising 330 studies and 487 patients' reviews were included. Most systematic reviews (seven of nine) were of moderate to high quality. Prevention in pregnant women was based on adherence to strict dietary recommendations, such as reheating leftovers until steamed and avoiding unpasteurised dairy products. Listeriosis infections were likely to occur in the third trimester (66%) rather than in the first trimester (3%) of pregnancy. Symptoms are mostly fever and other flu-like symptoms, such as fatigue. Diagnosis was primarily made by culture of the pathogen. Intravenous amoxicillin or ampicillin were first-line treatment. CONCLUSIONS: Listeriosis, a rare but serious infectious disease in pregnancy, can cause devastating consequences for the fetus and newborn. Appropriate preventative treatment should be initiated during early pregnancy to avoid complications. TWEETABLE ABSTRACT: Listeria is commonly found in processed and prepared food. Prevention is the best way to avoid listeriosis during pregnancy.

Management and monitoring of opioid use in pregnancy.

Opioid use during pregnancy has serious consequences for mother and baby. The true extent of the problem is unknown and there is a need for better screening. Existing guidelines with respect to the management of pregnant women with opioid use are based on limited evidence. To improve recommendations for optimal identification, management, and treatment, publications on opioids in pregnancy were reviewed. Published literature from 2007 to 2017 was searched in PubMed, Cochrane and Embase databases. The review employed 60 publications from 210 studies identified, that were of varying quality and included randomized controlled trials, systematic reviews, meta-analyses, and Cochrane reviews. The prevalence of opioid use in pregnancy is underestimated. Screening by urine testing and self-reporting is acceptable to identify fetal exposure. To minimize risk, opioid agonist pharmacotherapy should replace the continued use of opioids or detoxification. Current guidelines recommend methadone and buprenorphine equally. However, recent studies indicate that buprenorphine has advantages over methadone. Accordingly, we suggest buprenorphine as first-line therapy. Future studies should elaborate on better objective screening methods to prevent the consequences of fetomaternal opioid exposure.

Phthalate exposure from drugs during pregnancy and possible risk of preterm birth and small for gestational age.

BACKGROUND: Phthalates are chemical compounds present in a wide range of consumer products and are thought to be endocrine disruptors. Though not commonly known, phthalates are present in some medication with previous studies finding up to 50-fold higher urinary metabolite concentrations among exposed compared to the general population. Previous studies on environmental phthalate exposure and pregnancy outcomes have been contradictory and inconclusive and all previous studies have assessed phthalate exposure using biomarkers despite a known rapid metabolism of phthalates. OBJECTIVE: To determine whether phthalate exposure from pharmaceutical drugs have effects on preterm birth (PTB) and small for gestational age (SGA). STUDY DESIGN: We conducted a nested case-control study among women in Denmark with a recorded singleton birth and included women who conceived between January 1st, 2004 and December 31st, 2015. To mitigate drug effect and confounding by underlying disease we included pregnancies exposed to selected study drugs, and compared pregnancies exposed to phthalate containing drugs to pregnancies exposed to phthalate free generic drugs. Using Danish health registries, we identified 30,899 singleton pregnancies exposed to study drugs available in both phthalate-containing and phthalate free versions. Using conditional logistic regression, we estimated associations between phthalate exposure and the risk of PTB and SGA. Birth weight according to gestational age was defined by INTERGROWTH-21st (SGA-I) and by Marsal's equation (SGA-M) for expected birthweight. RESULTS: We included 1965 PTBs, 1315 SGA-Is, and 891 SGA-M cases, matched to 19,537, 12,008, and 7573 controls, respectively. Orthophthalate exposure during the third trimester was positively associated with PTB with a crude OR of 1.36 (95% CI: 1.06-1.76). The association was mainly due to diethyl phthalate. Exposure to phthalate polymers in third trimester was associated with a risk of PTB with crude ORs of 2.08 (CI: 1.16-3.71. No associations were found between orthophthalate or phthalate polymer exposure and SGA. CONCLUSION: Exposure to some phthalate-containing pharmaceutical drugs during third trimester is associated with preterm birth.

Lifestyle interventions to maternal weight loss after birth: a systematic review.

BACKGROUND: Over the past decades, there has been an increase in overweight and obesity in women of childbearing age, as well as the general population. Overweight and obesity are related to a later, increased risk of type 2 diabetes and cardiovascular diseases. Increasing weight between pregnancies has a negative impact on the development of the fetus in a subsequent pregnancy. It is also related to long-term obesity and overweight for the woman. Accordingly, weight control in women of the childbearing age is important for both women and their offspring. Information and communication technology (ICT) has become an integrated part of many peoples' lives, and it has the potential to prevent disease. In this systematic review, we summarize the evidence from randomized controlled trials to compare effects of different ICT-based interventions to support postpartum women to achieve weight loss. METHODS: A systematic search was performed in PubMed, Embase, PsycInfo, CINAHL, Web of Science, Scopus, and Cochrane, searching on terms, such as postpartum, weight loss, telemedicine, and randomized controlled trials. Two independent researchers undertook study selection and data extraction. Results were reported narratively. The systematic review only included studies that were randomized controlled trials. RESULTS: Eight studies were included in the systematic review. All of them were characterized by applying one or more ICT components to assist postpartum women in weight control, and had weight loss as an outcome measure. A significant difference was found in weight loss between control group and intervention group in the majority of the studies. However, five of the studies had a relatively short follow-up period (40 days to 16 weeks), six of the studies had a relatively small sample size (18 to 66 women), and half of the studies indicated challenges with adherence to the interventions over time. CONCLUSION: ICT-based interventions can support postpartum women to achieve a healthy lifestyle and weight control. Future studies should focus on larger sample sizes, longer follow-up periods, and adherence to the interventions. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018080731.

Preterm labor: current tocolytic options for the treatment of preterm labor.

While tocolytic therapy may not be indicated in all cases of spontaneous preterm labor (SPTL), the evidence that they are superior to placebo is robust. The perfect tocolytic that is 100% efficacious and 100% safe does not exist and efforts should continue to develop and introduce safer and more effective agents. A reduction in the rate of neonatal mortality and morbidity using tocolysis has not been shown but no tocolytic study has been powered by numbers sufficient to demonstrate such an effect. Tocolytics can delay delivery long enough to administer a course of antepartum glucocorticoids and arrange in utero transfer to a center with neonatal intensive care facilities, both of which reduce neonatal mortality and morbidity. Few tocolytics (ß2-agonists and atosiban) are licensed for use as tocolytics and only one was developed specifically to treat preterm labor (atosiban). Accordingly, most tocolytics have multi-organ adverse effects. Currently, based on the evidence of safety and efficacy, atosiban should be the first-choice tocolytic for the treatment of SPTL to prevent or delay preterm birth.