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Background Women who undergo bariatric surgery prior to pregnancy are less likely to experience comorbidities associated with obesity such as gestational diabetes and hypertension. However, bariatric surgery, particularly malabsorptive procedures, can make patients susceptible to deficiencies in nutrients that are essential for healthy fetal development. The objective of this systematic review and meta-analysis is to investigate the association between pregnancy after bariatric surgery and adverse perinatal outcomes. Methods and findings Searches were conducted in Medline, Embase, PsycINFO, CINAHL, Scopus, and Google Scholar from inception to June 2019, supplemented by hand-searching reference lists, citations, and journals. Observational studies comparing perinatal outcomes post-bariatric surgery to pregnancies without prior bariatric surgery were included. Outcomes of interest were perinatal mortality, congenital anomalies, preterm birth, postterm birth, small and large for gestational age (SGA/LGA), and neonatal intensive care unit (NICU) admission. Pooled effect sizes were calculated using random-effects meta-analysis. Where data were available, results were subgrouped by type of bariatric surgery. We included 33 studies with 14,880 pregnancies post-bariatric surgery and 3,979,978 controls. Odds ratios (ORs) were increased after bariatric surgery (all types combined) for perinatal mortality (1.38, 95% confidence interval [CI] 1.03-1.85, p = 0.031), congenital anomalies (1.29, 95% CI 1.04-1.59, p = 0.019), preterm birth (1.57, 95% CI 1.38-1.79, p < 0.001), and NICU admission (1.41, 95% CI 1.25-1.59, p < 0.001). Postterm birth decreased after bariatric surgery (OR 0.46, 95% CI 0.35-0.60, p < 0.001). ORs for SGA increased (2.72, 95% CI 2.32-3.20, p < 0.001) and LGA decreased (0.24, 95% CI 0.14-0.41, p < 0.001) after gastric bypass but not after gastric banding. Babies born after bariatric surgery (all types combined) weighed over 200 g less than those born to mothers without prior bariatric surgery (weighted mean difference -242.42 g, 95% CI -307.43 to -177.40 g, p < 0.001). There was low heterogeneity for all outcomes (I.sup.2 < 40%) except LGA. Limitations of our study are that as a meta-analysis of existing studies, the results are limited by the quality of the included studies and available data, unmeasured confounders, and the small number of studies for some outcomes. Conclusions In our systematic review of observational studies, we found that bariatric surgery, especially gastric bypass, prior to pregnancy was associated with increased risk of some adverse perinatal outcomes. This suggests that women who have undergone bariatric surgery may benefit from specific preconception and pregnancy nutritional support and increased monitoring of fetal growth and development. Future studies should explore whether restrictive surgery results in better perinatal outcomes, compared to malabsorptive surgery, without compromising maternal outcomes. If so, these may be the preferred surgery for women of reproductive age. Trial registration PROSPERO CRD42017051537., Author(s): Zainab Akhter 1,*, Judith Rankin 1, Dries Ceulemans 2, Lem Ngongalah 1, Roger Ackroyd 3, Roland Devlieger 2, Rute Vieira 4, Nicola Heslehurst 1 Introduction Obesity is a global [...]

Background There is a global obesity crisis, particularly among women and disadvantaged populations. Early-life intervention to prevent childhood obesity is a priority for public health, global health, and clinical practice. Understanding the association between childhood obesity and maternal pre-pregnancy weight status would inform policy and practice by allowing one to estimate the potential for offspring health gain through channelling resources into intervention. This systematic review and meta-analysis aimed to examine the dose-response association between maternal body mass index (BMI) and childhood obesity in the offspring. Methods and findings Searches in MEDLINE, Child Development & Adolescent Studies, CINAHL, Embase, and PsycInfo were carried out in August 2017 and updated in March 2019. Supplementary searches included hand-searching reference lists, performing citation searching, and contacting authors. Two researchers carried out independent screening, data extraction, and quality assessment. Observational studies published in English and reporting associations between continuous and/or categorical maternal and child BMI or z-score were included. Categorical outcomes were child obesity ([greater than or equal to]95th percentile, primary outcome), overweight/obesity ([greater than or equal to]85th percentile), and overweight (85th to 95th percentile). Linear and nonlinear dose-response meta-analyses were conducted using random effects models. Studies that could not be included in meta-analyses were summarised narratively. Seventy-nine of 41,301 studies identified met the inclusion criteria (n = 59 cohorts). Meta-analyses of child obesity included 20 studies (n = 88,872); child overweight/obesity, 22 studies (n = 181,800); and overweight, 10 studies (n = 53,238). Associations were nonlinear and there were significantly increased odds of child obesity with maternal obesity (odds ratio [OR] 3.64, 95% CI 2.68-4.95) and maternal overweight (OR 1.89, 95% CI 1.62-2.19). Significantly increased odds were observed for child overweight/obesity (OR 2.69, 95% CI 2.10-3.46) and for child overweight (OR 1.80, 95% CI 1.25, 2.59) with maternal obesity. A limitation of this research is that the included studies did not always report the data in a format that enabled inclusion in this complex meta-analysis. Conclusions This research has identified a 264% increase in the odds of child obesity when mothers have obesity before conception. This study provides substantial evidence for the need to develop interventions that commence prior to conception, to support women of childbearing age with weight management in order to halt intergenerational obesity., Author(s): Nicola Heslehurst 1,*, Rute Vieira 1,2, Zainab Akhter 1, Hayley Bailey 1, Emma Slack 1, Lem Ngongalah 1, Augustina Pemu 1, Judith Rankin 1 Introduction Halting childhood obesity is [...]

Current methodologies for designing search strategies rely heavily on the knowledge and expertise of information specialists. Yet, the volume and complexity of scientific literature is overwhelming for even the most experienced information specialists, making it difficult to produce robust search strategies for complex systematic reviews. In this case study, we aimed to assess and describe the benefits and limitations of using semi‐automated text‐mining tools for designing search strategies in a systematic review of diagnostic test accuracy. An experienced information specialist designed a search strategy using traditional methods. This strategy was then amended to include additional terms identified by text‐mining tools. We evaluated the usability and expertise required, risk of introducing bias to the search, precision of the search strategy and rated the usefulness of the tools. Thirteen of the 16 investigated tools produced a total of 40 additional terms, beyond those in the original search strategy. This resulted in 11 previously unidentified relevant articles being retrieved. Precision was reduced or remained the same in all cases. After considering all aspects of the investigation we rated each application, with two being 'extremely useful', three being 'useful', three having 'no impact' and eight being 'not very useful'. Comparative analysis revealed discrepancies between similar tools. Our findings have implications for the way in which these methodologies are used and applied to search strategies. If semi‐automated techniques are to become mainstream in information retrieval for complex systematic reviews, we need tailored tools that fit information specialists' requirements across disciplines. [ABSTRACT FROM AUTHOR]

Objective: To measure condition‐specific detection rates for 14 physical conditions screened for by the NHS fetal anomaly screening programme (FASP) fetal anomaly (FA) ultrasound scan. Design: Retrospective audit of 12 694 diagnoses across a 3‐year national cohort. Setting: All English NHS and crown‐dependency hospital trusts providing maternity services. Population: Pregnancies booked for maternity services with an expected date of delivery between 1 April 2017 and 31 March 2020 and at least one diagnosis of a condition screened for by FASP. Methods: Active multi‐source ascertainment, linkage, audit and validation of clinical information to identify the subset of diagnoses meeting the condition‐specific positivity threshold for the FA scan. Main outcome measure: The accuracy of the FA scan compared with diagnostic reference standards. Results: FA scan detection rates were: anencephaly 96.3% (95% confidence interval [CI] 81.7–99.3%), atrioventricular septal defect: 69.2% (95% CI 65.8–72.4%), bilateral renal agenesis: 98.7% (95% CI 95.4–99.6%), cleft lip: 89.5% (95% CI 87.8–90.9%), congenital diaphragmatic hernia: 60.8% (95% CI 56.5–65%), Edwards syndrome: 73.8% (95% CI 67.5–79.3%), exomphalos: 59.4% (95% CI 49.4–68.7%), gastroschisis: 88.6% (95% CI 79–94.1%), hypoplastic left heart syndrome: 92.7% (95% CI 90–94.8%), lethal skeletal dysplasia: 93.2% (95% CI 88.6–96%), Patau syndrome: 82.3% (95% CI 72.4–89.1%), spina bifida: 93.8% (95% CI 91.8–95.3%), tetralogy of Fallot: 75.4% (95% CI 72.1–78.4%) and transposition of the great arteries: 84.9% (95% CI 81.7–87.5%). Conclusions: The performance of the FA scan is above the expectations set in 2010 for most conditions. For the remaining conditions, the majority of fetuses and babies affected are detected before the FA scan. [ABSTRACT FROM AUTHOR]