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1. ENhancinG vAGinal dElivery in Greece through educational and behavioral interventions among maternity care providers regarding labor management: the ENGAGE stepped-wedge randomized prospective trial protocol

Author

Vrachnis, Nikolaos, Antonakopoulos, Nikolaos, von Dadelszen, Peter, Vidler, Marianne, Maroudias, Georgios, Bone, Jeffrey, Sandhu, Ash, Loukas, Nikolaos, Magee, Laura, Roussos, Nikolaos, Kassaris, Stefania, Fotiou, Alexandros, Zygouris, Dimitrios, Adonakis, Georgios, Akrivis, Christodoulos, Antsaklis, Aris, Athanasiadis, Apostolos, Bontis, Nikolaos, Daniilidis, Angelos, Daponte, Alexandros, Daskalakis, Georgios, Deligeoroglou, Efthimios, Dinas, Konstantinos, Drakakis, Peter, Gerede, Angeliki, Grimbizis, Grigorios, Iacovidou, Nicoletta, Kambas, Nikolaos, Katasos, Theodoros, Katsetos, Christos, Katsikis, Ilias, Makrigiannakis, Antonios, Matalliotakis, Michail, Messini, Christina, Mikos, Themis, Nikolettos, Nikolaos, Pados, Georgios, Paschopoulos, Minas, Patsouras, Konstantinos, Siahanidou, Soultana, Sioulas, Vasileios, Skentou, Chara, Stavros, Sofoklis, Temmerman, Marleen, Tsikouras, Panagiotis, Tsitsis, Vasilios, Vlahos, Nikolaos, Rodolakis, Alexandros, Papageorghiou, Aris, and Loutradis, Dimitrios

Published
2024
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4. Adverse maternal, fetal, and newborn outcomes among pregnant women with SARS-CoV-2 infection: an individual participant data meta-analysis

Author

Smith, Emily R, Oakley, Erin, Grandner, Gargi Wable, Ferguson, Kacey, Farooq, Fouzia, Afshar, Yalda, Ahlberg, Mia, Ahmadzia, Homa, Akelo, Victor, Aldrovandi, Grace, Barr, Beth A Tippett, Bevilacqua, Elisa, Brandt, Justin S, Broutet, Nathalie, Buhigas, Irene Fernández, Carrillo, Jorge, Clifton, Rebecca, Conry, Jeanne, Cosmi, Erich, Crispi, Fatima, Crovetto, Francesca, Delgado-López, Camille, Divakar, Hema, Driscoll, Amanda J, Favre, Guillaume, Flaherman, Valerie J, Gale, Chris, Gil, Maria M, Gottlieb, Sami L, Gratacós, Eduard, Hernandez, Olivia, Jones, Stephanie, Kalafat, Erkan, Khagayi, Sammy, Knight, Marian, Kotloff, Karen, Lanzone, Antonio, Le Doare, Kirsty, Lees, Christoph, Litman, Ethan, Lokken, Erica M, Longo, Valentina Laurita, Madhi, Shabir A, Magee, Laura A, Martinez-Portilla, Raigam Jafet, McClure, Elizabeth M, Metz, Tori D, Miller, Emily S, Money, Deborah, Moungmaithong, Sakita, Mullins, Edward, Nachega, Jean B, Nunes, Marta C, Onyango, Dickens, Panchaud, Alice, Poon, Liona C, Raiten, Daniel, Regan, Lesley, Rukundo, Gordon, Sahota, Daljit, Sakowicz, Allie, Sanin-Blair, Jose, Söderling, Jonas, Stephansson, Olof, Temmerman, Marleen, Thorson, Anna, Tolosa, Jorge E, Townson, Julia, Valencia-Prado, Miguel, Visentin, Silvia, von Dadelszen, Peter, Waldorf, Kristina Adams, Whitehead, Clare, Yassa, Murat, Tielsch, Jim M, Langenegger, Eduard, Sam-Agudu, Nadia A, Gachuno, Onesmus W, Sekikubo, Musa, Mukwege, Denis M, Omore, Richard, Ouma, Gregory, Onyango, Clayton, Otieno, Kephas, Were, Zacchaeus Abaja, Were, Joyce, İlter, Pinar Birol, Mboizi, Robert, Hookham, Lauren, Meli, Federica, Bonanni, Giulia, Romanzi, Federica, Torcia, Eleonora, di Ilio, Chiara, Ananth, Cande V, Hill, Jennifer, Reddy, Ajay, Patrick, Haylea Sweat, Baba, Vuyelwa, and Adam, Mary

Subjects
Biodefense, Pneumonia, Lung, Infant Mortality, Vaccine Related, Emerging Infectious Diseases, Clinical Trials and Supportive Activities, Clinical Research, Pediatric, Perinatal Period - Conditions Originating in Perinatal Period, Preterm, Low Birth Weight and Health of the Newborn, Infectious Diseases, Prevention, Pneumonia & Influenza, Infection, Reproductive health and childbirth, Good Health and Well Being, Infant, Newborn, Pregnancy, Female, Humans, Pregnant Women, Prospective Studies, COVID-19, SARS-CoV-2, Maternal health, Epidemiology, Perinatal COVID PMA Study Collaborators
Abstract

IntroductionDespite a growing body of research on the risks of SARS-CoV-2 infection during pregnancy, there is continued controversy given heterogeneity in the quality and design of published studies.MethodsWe screened ongoing studies in our sequential, prospective meta-analysis. We pooled individual participant data to estimate the absolute and relative risk (RR) of adverse outcomes among pregnant women with SARS-CoV-2 infection, compared with confirmed negative pregnancies. We evaluated the risk of bias using a modified Newcastle-Ottawa Scale.ResultsWe screened 137 studies and included 12 studies in 12 countries involving 13 136 pregnant women.Pregnant women with SARS-CoV-2 infection-as compared with uninfected pregnant women-were at significantly increased risk of maternal mortality (10 studies; n=1490; RR 7.68, 95% CI 1.70 to 34.61); admission to intensive care unit (8 studies; n=6660; RR 3.81, 95% CI 2.03 to 7.17); receiving mechanical ventilation (7 studies; n=4887; RR 15.23, 95% CI 4.32 to 53.71); receiving any critical care (7 studies; n=4735; RR 5.48, 95% CI 2.57 to 11.72); and being diagnosed with pneumonia (6 studies; n=4573; RR 23.46, 95% CI 3.03 to 181.39) and thromboembolic disease (8 studies; n=5146; RR 5.50, 95% CI 1.12 to 27.12).Neonates born to women with SARS-CoV-2 infection were more likely to be admitted to a neonatal care unit after birth (7 studies; n=7637; RR 1.86, 95% CI 1.12 to 3.08); be born preterm (7 studies; n=6233; RR 1.71, 95% CI 1.28 to 2.29) or moderately preterm (7 studies; n=6071; RR 2.92, 95% CI 1.88 to 4.54); and to be born low birth weight (12 studies; n=11 930; RR 1.19, 95% CI 1.02 to 1.40). Infection was not linked to stillbirth. Studies were generally at low or moderate risk of bias.ConclusionsThis analysis indicates that SARS-CoV-2 infection at any time during pregnancy increases the risk of maternal death, severe maternal morbidities and neonatal morbidity, but not stillbirth or intrauterine growth restriction. As more data become available, we will update these findings per the published protocol.

Published
2023

5. Protocol for a sequential, prospective meta-analysis to describe coronavirus disease 2019 (COVID-19) in the pregnancy and postpartum periods

Author

Smith, Emily R, Oakley, Erin, He, Siran, Zavala, Rebecca, Ferguson, Kacey, Miller, Lior, Grandner, Gargi Wable, Abejirinde, Ibukun-Oluwa Omolade, Afshar, Yalda, Ahmadzia, Homa, Aldrovandi, Grace, Akelo, Victor, Barr, Beth A Tippett, Bevilacqua, Elisa, Brandt, Justin S, Broutet, Natalie, Buhigas, Irene Fernández, Carrillo, Jorge, Clifton, Rebecca, Conry, Jeanne, Cosmi, Erich, Delgado-López, Camille, Divakar, Hema, Driscoll, Amanda J, Favre, Guillaume, Flaherman, Valerie, Gale, Christopher, Gil, Maria M, Godwin, Christine, Gottlieb, Sami, Bellolio, Olivia Hernandez, Kara, Edna, Khagayi, Sammy, Kim, Caron Rahn, Knight, Marian, Kotloff, Karen, Lanzone, Antonio, Le Doare, Kirsty, Lees, Christoph, Litman, Ethan, Lokken, Erica M, Longo, Valentina Laurita, Magee, Laura A, Martinez-Portilla, Raigam Jafet, McClure, Elizabeth, Metz, Torri D, Money, Deborah, Mullins, Edward, Nachega, Jean B, Panchaud, Alice, Playle, Rebecca, Poon, Liona C, Raiten, Daniel, Regan, Lesley, Rukundo, Gordon, Sanin-Blair, Jose, Temmerman, Marleen, Thorson, Anna, Thwin, Soe, Tolosa, Jorge E, Townson, Julia, Valencia-Prado, Miguel, Visentin, Silvia, von Dadelszen, Peter, Waldorf, Kristina Adams, Whitehead, Clare, Yang, Huixia, Thorlund, Kristian, and Tielsch, James M

Subjects
Reproductive Medicine, Biomedical and Clinical Sciences, Health Sciences, Clinical Research, Emerging Infectious Diseases, Pediatric, Prevention, Reproductive health and childbirth, Good Health and Well Being, Adolescent, COVID-19, Child, Female, Humans, Infant, Newborn, Meta-Analysis as Topic, Postpartum Period, Pregnancy, Prospective Studies, Retrospective Studies, SARS-CoV-2, General Science & Technology
Abstract

We urgently need answers to basic epidemiological questions regarding SARS-CoV-2 infection in pregnant and postpartum women and its effect on their newborns. While many national registries, health facilities, and research groups are collecting relevant data, we need a collaborative and methodologically rigorous approach to better combine these data and address knowledge gaps, especially those related to rare outcomes. We propose that using a sequential, prospective meta-analysis (PMA) is the best approach to generate data for policy- and practice-oriented guidelines. As the pandemic evolves, additional studies identified retrospectively by the steering committee or through living systematic reviews will be invited to participate in this PMA. Investigators can contribute to the PMA by either submitting individual patient data or running standardized code to generate aggregate data estimates. For the primary analysis, we will pool data using two-stage meta-analysis methods. The meta-analyses will be updated as additional data accrue in each contributing study and as additional studies meet study-specific time or data accrual thresholds for sharing. At the time of publication, investigators of 25 studies, including more than 76,000 pregnancies, in 41 countries had agreed to share data for this analysis. Among the included studies, 12 have a contemporaneous comparison group of pregnancies without COVID-19, and four studies include a comparison group of non-pregnant women of reproductive age with COVID-19. Protocols and updates will be maintained publicly. Results will be shared with key stakeholders, including the World Health Organization (WHO) Maternal, Newborn, Child, and Adolescent Health (MNCAH) Research Working Group. Data contributors will share results with local stakeholders. Scientific publications will be published in open-access journals on an ongoing basis.

Published
2022

6. Changes in preterm birth and stillbirth during COVID-19 lockdowns in 26 countries

Author

Calvert, Clara, Brockway, Meredith (Merilee), Zoega, Helga, Miller, Jessica E., Been, Jasper V., Amegah, Adeladza Kofi, Racine-Poon, Amy, Oskoui, Solmaz Eradat, Abok, Ishaya I., Aghaeepour, Nima, Akwaowo, Christie D., Alshaikh, Belal N., Ayede, Adejumoke I., Bacchini, Fabiana, Barekatain, Behzad, Barnes, Rodrigo, Bebak, Karolina, Berard, Anick, Bhutta, Zulfiqar A., Brook, Jeffrey R., Bryan, Lenroy R., Cajachagua-Torres, Kim N., Campbell-Yeo, Marsha, Chu, Dinh-Toi, Connor, Kristin L., Cornette, Luc, Cortés, Sandra, Daly, Mandy, Debauche, Christian, Dedeke, Iyabode Olabisi F., Einarsdóttir, Kristjana, Engjom, Hilde, Estrada-Gutierrez, Guadalupe, Fantasia, Ilaria, Fiorentino, Nicole M., Franklin, Meredith, Fraser, Abigail, Gachuno, Onesmus W., Gallo, Linda A., Gissler, Mika, Håberg, Siri E., Habibelahi, Abbas, Häggström, Jonas, Hookham, Lauren, Hui, Lisa, Huicho, Luis, Hunter, Karen J., Huq, Sayeeda, KC, Ashish, Kadambari, Seilesh, Kelishadi, Roya, Khalili, Narjes, Kippen, Joanna, Le Doare, Kirsty, Llorca, Javier, Magee, Laura A., Magnus, Maria C., Man, Kenneth K. C., Mburugu, Patrick M., Mediratta, Rishi P., Morris, Andrew D., Muhajarine, Nazeem, Mulholland, Rachel H., Bonnard, Livia Nagy, Nakibuuka, Victoria, Nassar, Natasha, Nyadanu, Sylvester D., Oakley, Laura, Oladokun, Adesina, Olayemi, Oladapo O., Olutekunbi, Olanike A., Oluwafemi, Rosena O., Ogunkunle, Taofik O., Orton, Chris, Örtqvist, Anne K., Ouma, Joseph, Oyapero, Oyejoke, Palmer, Kirsten R., Pedersen, Lars H., Pereira, Gavin, Pereyra, Isabel, Philip, Roy K., Pruski, Dominik, Przybylski, Marcin, Quezada-Pinedo, Hugo G., Regan, Annette K., Rhoda, Natasha R., Rihs, Tonia A., Riley, Taylor, Rocha, Thiago Augusto Hernandes, Rolnik, Daniel L., Saner, Christoph, Schneuer, Francisco J., Souter, Vivienne L., Stephansson, Olof, Sun, Shengzhi, Swift, Emma M., Szabó, Miklós, Temmerman, Marleen, Tooke, Lloyd, Urquia, Marcelo L., von Dadelszen, Peter, Wellenius, Gregory A., Whitehead, Clare, Wong, Ian C. K., Wood, Rachael, Wróblewska-Seniuk, Katarzyna, Yeboah-Antwi, Kojo, Yilgwan, Christopher S., Zawiejska, Agnieszka, Sheikh, Aziz, Rodriguez, Natalie, Burgner, David, Stock, Sarah J., and Azad, Meghan B.

Published
2023
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12. Halting the Canadian STRIDER randomised controlled trial of sildenafil for severe, early-onset fetal growth restriction: ethical, methodological, and pragmatic considerations

Author

von Dadelszen, Peter, Audibert, François, Bujold, Emmanuel, Bone, Jeffrey N., Sandhu, Ash, Li, Jing, Kariya, Chirag, Chung, Youkee, Lee, Tang, Au, Kelvin, Skoll, M. Amanda, Vidler, Marianne, Magee, Laura A., Piedboeuf, Bruno, Baker, Philip N., Lalji, Sayrin, and Lim, Kenneth I.

Published
2022
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20. Preliminary findings on the experiences of care for women who suffered early pregnancy losses during the COVID-19 pandemic: a qualitative study.

Author

Silverio, SA, George-Carey, R, Memtsa, M, Kent-Nye, FE, Magee, LA, Sheen, KS, Burgess, K, Oza, M, Storey, C, Sandall, J, PUDDLES UK Collaboration, Easter, A, von Dadelszen, P, Jurković, D, Silverio, SA, George-Carey, R, Memtsa, M, Kent-Nye, FE, Magee, LA, Sheen, KS, Burgess, K, Oza, M, Storey, C, Sandall, J, PUDDLES UK Collaboration, Easter, A, von Dadelszen, P, and Jurković, D

Abstract

BACKGROUND: Women who suffer an early pregnancy loss require specific clinical care, aftercare, and ongoing support. In the UK, the clinical management of early pregnancy complications, including loss is provided mainly through specialist Early Pregnancy Assessment Units. The COVID-19 pandemic fundamentally changed the way in which maternity and gynaecological care was delivered, as health systems moved to rapidly reconfigure and re-organise services, aiming to reduce the risk and spread of SARS-CoV-2 infection. PUDDLES is an international collaboration investigating the pandemic's impact on care for people who suffered a perinatal bereavement. Presented here are initial qualitative findings undertaken with UK-based women who suffered early pregnancy losses during the pandemic, about how they navigated the healthcare system and its restrictions, and how they were supported. METHODS: In-keeping with a qualitative research design, in-depth semi-structured interviews were undertaken with an opportunity sample of women (N = 32) who suffered any early pregnancy loss during the COVID-19 pandemic. Data were analysed using a template analysis to understand women's access to services, care, and networks of support, during the pandemic following their pregnancy loss. The thematic template was based on findings from parents who had suffered a late-miscarriage, stillbirth, or neonatal death in the UK, during the pandemic. RESULTS: All women had experienced reconfigured maternity and early pregnancy services. Data supported themes of: 1) COVID-19 Restrictions as Impractical & Impersonal; 2) Alone, with Only Staff to Support Them; 3) Reduction in Service Provision Leading to Perceived Devaluation in Care; and 4) Seeking Their Own Support. Results suggest access to early pregnancy loss services was reduced and pandemic-related restrictions were often impractical (i.e., restrictions added to burden of accessing or receiving care). Women often reported being isolated and, concerning

Published
2024

22. Short-term outcomes of phosphodiesterase type 5 inhibitors for fetal growth restriction: a study protocol for a systematic review with individual participant data meta-analysis, aggregate meta-analysis, and trial sequential analysis

Author

Liauw, Jessica, Groom, Katie, Ganzevoort, Wessel, Gluud, Christian, McKinlay, Christopher J. D., Sharp, Andrew, Mackay, Laura, Kariya, Chirag, Lim, Ken, von Dadelszen, Peter, Limpens, Jacqueline, and Jakobsen, Janus C.

Published
2021
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24. Machine learning-enabled maternal risk assessment for women with pre-eclampsia (the PIERS-ML model): a modelling study

Author

Montgomery-Csobán, Tünde, Kavanagh, Kimberley, Murray, Paul, Robertson, Chris, Barry, Sarah J E, Vivian Ukah, U, Payne, Beth A, Nicolaides, Kypros H, Syngelaki, Argyro, Ionescu, Olivia, Akolekar, Ranjit, Hutcheon, Jennifer A, Magee, Laura A, von Dadelszen, Peter, Brown, Mark A., Davis, Gregory K., Parker, Claire, Walters, Barry N., Sass, Nelson, Ansermino, J. Mark, Cao, Vivien, Cundiff, Geoffrey W., von Dadelszen, Emma C.M., Douglas, M. Joanne, Dumont, Guy A., Dunsmuir, Dustin T., Hutcheon, Jennifer A., Joseph, K.S., Lalji, Sayrin, Lee, Tang, Li, Jing, Lim, Kenneth I., Lisonkova, Sarka, Lott, Paula, Menzies, Jennifer M., Millman, Alexandra L., Palmer, Lynne, Payne, Beth A., Qu, Ziguang, Russell, James A., Sawchuck, Diane, Shaw, Dorothy, Still, D. Keith, Ukah, U. Vivian, Wagner, Brenda, Walley, Keith R., Hugo, Dany, Gruslin, The late Andrée, Tawagi, George, Smith, Graeme N., Côté, Anne-Marie, Moutquin, Jean-Marie, Ouellet, Annie B., Lee, Shoo K., Duan, Tao, Zhou, Jian, Haniff, The late Farizah, Mahajan, Swati, Noovao, Amanda, Karjalainend, Hanna, Kortelainen, Alja, Laivuori, Hannele, Ganzevoort, J. Wessel, Groen, Henk, Kyle, Phillipa M., Moore, M. Peter, Pullar, Barbra, Bhutta, Zulfiqar A., Qureshi, Rahat N., Sikandar, Rozina, Bhutta, The late Shereen Z., Cloete, Garth, Hall, David R., van Papendorp, The late Erika, Steyn, D. Wilhelm, Biryabarema, Christine, Mirembe, Florence, Nakimuli, Annettee, Allotey, John, Thangaratinam, Shakila, Nicolaides, Kypros H., Ionescu, Olivia, Syngelaki, Argyro, de Swiet, Michael, Magee, Laura A., von Dadelszen, Peter, Akolekar, Ranjit, Walker, James J., Robson, Stephen C., Broughton-Pipkin, Fiona, Loughna, Pamela, Vatish, Manu, Redman, Christopher W.G., Barry, Sarah J.E., Kavanagh, Kimberley, Montgomery-Csobán, Tunde, Murray, Paul, Robertson, Chris, Tsigas, Eleni Z., Woelkers, Douglas A., Lindheimer, Marshall D., Grobman, William A., Sibai, Baha M., Merialdi, Mario, and Widmer, Mariana

Abstract

Affecting 2–4% of pregnancies, pre-eclampsia is a leading cause of maternal death and morbidity worldwide. Using routinely available data, we aimed to develop and validate a novel machine learning-based and clinical setting-responsive time-of-disease model to rule out and rule in adverse maternal outcomes in women presenting with pre-eclampsia.

Published
2024
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29. External validation of prognostic models to predict stillbirth using International Prediction of Pregnancy Complications (IPPIC) Network database: individual participant data meta-analysis

Author

Allotey, J, Whittle, R, Snell, K, Smuk, M, Townsend, R, von Dadelszen, P, Heazell, A, Magee, L, Smith, G, Sandall, J, Thilaganathan, B, Zamora, J, Riley, R, Khalil, A, Thangaratinam, S, Coomarasamy, A, Kwong, A, Savitri, A, Salvesen, K, Bhattacharya, S, Uiterwaal, C, Staff, A, Andersen, L, Olive, E, Redman, C, Sletner, L, Daskalakis, G, Macleod, M, Abdollahain, M, Ramirez, J, Masse, J, Audibert, F, Magnus, P, Jenum, A, Baschat, A, Ohkuchi, A, Mcauliffe, F, West, J, Askie, L, Mone, F, Farrar, D, Zimmerman, P, Smits, L, Riddell, C, Kingdom, J, van de Post, J, Illanes, S, Holzman, C, van Kuijk, S, Carbillon, L, Villa, P, Eskild, A, Chappell, L, Prefumo, F, Velauthar, L, Seed, P, van Oostwaard, M, Verlohren, S, Poston, L, Ferrazzi, E, Vinter, C, Nagata, C, Brown, M, Vollebregt, K, Takeda, S, Langenveld, J, Widmer, M, Saito, S, Haavaldsen, C, Carroli, G, Olsen, J, Wolf, H, Zavaleta, N, Eisensee, I, Vergani, P, Lumbiganon, P, Makrides, M, Facchinetti, F, Sequeira, E, Gibson, R, Ferrazzani, S, Frusca, T, Norman, J, Figueiro, E, Lapaire, O, Laivuori, H, Lykke, J, Conde-Agudelo, A, Galindo, A, Mbah, A, Betran, A, Herraiz, I, Trogstad, L, Steegers, E, Salim, R, Huang, T, Adank, A, Zhang, J, Meschino, W, Browne, J, Allen, R, Costa, F, Klipstein-Grobusch Browne, K, Crowther, C, Jorgensen, J, Forest, J, Rumbold, A, Mol, B, Giguere, Y, Kenny, L, Ganzevoort, W, Odibo, A, Myers, J, Yeo, S, Goffinet, F, Mccowan, L, Pajkrt, E, Teede, H, Haddad, B, Dekker, G, Kleinrouweler, E, Lecarpentier, E, Roberts, C, Groen, H, Skrastad, R, Heinonen, S, Eero, K, Anggraini, D, Souka, A, Cecatti, J, Monterio, I, Pillalis, A, Souza, R, Hawkins, L, Gabbay-Benziv, R, Crovetto, F, Figuera, F, Jorgensen, L, Dodds, J, Patel, M, Aviram, A, Papageorghiou, A, Khan, K, Allotey J., Whittle R., Snell K. I. E., Smuk M., Townsend R., von Dadelszen P., Heazell A. E. P., Magee L., Smith G. C. S., Sandall J., Thilaganathan B., Zamora J., Riley R. D., Khalil A., Thangaratinam S., Coomarasamy A., Kwong A., Savitri A. I., Salvesen K. A., Bhattacharya S., Uiterwaal C. S. P. M., Staff A. C., Andersen L. B., Olive E. L., Redman C., Sletner L., Daskalakis G., Macleod M., Abdollahain M., Ramirez J. A., Masse J., Audibert F., Magnus P. M., Jenum A. K., Baschat A., Ohkuchi A., McAuliffe F. M., West J., Askie L. M., Mone F., Farrar D., Zimmerman P. A., Smits L. J. M., Riddell C., Kingdom J. C., van de Post J., Illanes S. E., Holzman C., van Kuijk S. M. J., Carbillon L., Villa P. M., Eskild A., Chappell L., Prefumo F., Velauthar L., Seed P., van Oostwaard M., Verlohren S., Poston L., Ferrazzi E., Vinter C. A., Nagata C., Brown M., Vollebregt K. C., Takeda S., Langenveld J., Widmer M., Saito S., Haavaldsen C., Carroli G., Olsen J., Wolf H., Zavaleta N., Eisensee I., Vergani P., Lumbiganon P., Makrides M., Facchinetti F., Sequeira E., Gibson R., Ferrazzani S., Frusca T., Norman J. E., Figueiro E. A., Lapaire O., Laivuori H., Lykke J. A., Conde-Agudelo A., Galindo A., Mbah A., Betran A. P., Herraiz I., Trogstad L., Smith G. G. S., Steegers E. A. P., Salim R., Huang T., Adank A., Zhang J., Meschino W. S., Browne J. L., Allen R. E., Costa F. D. S., Klipstein-Grobusch Browne K., Crowther C. A., Jorgensen J. S., Forest J. -C., Rumbold A. R., Mol B. W., Giguere Y., Kenny L. C., Ganzevoort W., Odibo A. O., Myers J., Yeo S. A., Goffinet F., McCowan L., Pajkrt E., Teede H. J., Haddad B. G., Dekker G., Kleinrouweler E. C., LeCarpentier E., Roberts C. T., Groen H., Skrastad R. B., Heinonen S., Eero K., Anggraini D., Souka A., Cecatti J. G., Monterio I., Pillalis A., Souza R., Hawkins L. A., Gabbay-Benziv R., Crovetto F., Figuera F., Jorgensen L., Dodds J., Patel M., Aviram A., Papageorghiou A., Khan K., Allotey, J, Whittle, R, Snell, K, Smuk, M, Townsend, R, von Dadelszen, P, Heazell, A, Magee, L, Smith, G, Sandall, J, Thilaganathan, B, Zamora, J, Riley, R, Khalil, A, Thangaratinam, S, Coomarasamy, A, Kwong, A, Savitri, A, Salvesen, K, Bhattacharya, S, Uiterwaal, C, Staff, A, Andersen, L, Olive, E, Redman, C, Sletner, L, Daskalakis, G, Macleod, M, Abdollahain, M, Ramirez, J, Masse, J, Audibert, F, Magnus, P, Jenum, A, Baschat, A, Ohkuchi, A, Mcauliffe, F, West, J, Askie, L, Mone, F, Farrar, D, Zimmerman, P, Smits, L, Riddell, C, Kingdom, J, van de Post, J, Illanes, S, Holzman, C, van Kuijk, S, Carbillon, L, Villa, P, Eskild, A, Chappell, L, Prefumo, F, Velauthar, L, Seed, P, van Oostwaard, M, Verlohren, S, Poston, L, Ferrazzi, E, Vinter, C, Nagata, C, Brown, M, Vollebregt, K, Takeda, S, Langenveld, J, Widmer, M, Saito, S, Haavaldsen, C, Carroli, G, Olsen, J, Wolf, H, Zavaleta, N, Eisensee, I, Vergani, P, Lumbiganon, P, Makrides, M, Facchinetti, F, Sequeira, E, Gibson, R, Ferrazzani, S, Frusca, T, Norman, J, Figueiro, E, Lapaire, O, Laivuori, H, Lykke, J, Conde-Agudelo, A, Galindo, A, Mbah, A, Betran, A, Herraiz, I, Trogstad, L, Steegers, E, Salim, R, Huang, T, Adank, A, Zhang, J, Meschino, W, Browne, J, Allen, R, Costa, F, Klipstein-Grobusch Browne, K, Crowther, C, Jorgensen, J, Forest, J, Rumbold, A, Mol, B, Giguere, Y, Kenny, L, Ganzevoort, W, Odibo, A, Myers, J, Yeo, S, Goffinet, F, Mccowan, L, Pajkrt, E, Teede, H, Haddad, B, Dekker, G, Kleinrouweler, E, Lecarpentier, E, Roberts, C, Groen, H, Skrastad, R, Heinonen, S, Eero, K, Anggraini, D, Souka, A, Cecatti, J, Monterio, I, Pillalis, A, Souza, R, Hawkins, L, Gabbay-Benziv, R, Crovetto, F, Figuera, F, Jorgensen, L, Dodds, J, Patel, M, Aviram, A, Papageorghiou, A, Khan, K, Allotey J., Whittle R., Snell K. I. E., Smuk M., Townsend R., von Dadelszen P., Heazell A. E. P., Magee L., Smith G. C. S., Sandall J., Thilaganathan B., Zamora J., Riley R. D., Khalil A., Thangaratinam S., Coomarasamy A., Kwong A., Savitri A. I., Salvesen K. A., Bhattacharya S., Uiterwaal C. S. P. M., Staff A. C., Andersen L. B., Olive E. L., Redman C., Sletner L., Daskalakis G., Macleod M., Abdollahain M., Ramirez J. A., Masse J., Audibert F., Magnus P. M., Jenum A. K., Baschat A., Ohkuchi A., McAuliffe F. M., West J., Askie L. M., Mone F., Farrar D., Zimmerman P. A., Smits L. J. M., Riddell C., Kingdom J. C., van de Post J., Illanes S. E., Holzman C., van Kuijk S. M. J., Carbillon L., Villa P. M., Eskild A., Chappell L., Prefumo F., Velauthar L., Seed P., van Oostwaard M., Verlohren S., Poston L., Ferrazzi E., Vinter C. A., Nagata C., Brown M., Vollebregt K. C., Takeda S., Langenveld J., Widmer M., Saito S., Haavaldsen C., Carroli G., Olsen J., Wolf H., Zavaleta N., Eisensee I., Vergani P., Lumbiganon P., Makrides M., Facchinetti F., Sequeira E., Gibson R., Ferrazzani S., Frusca T., Norman J. E., Figueiro E. A., Lapaire O., Laivuori H., Lykke J. A., Conde-Agudelo A., Galindo A., Mbah A., Betran A. P., Herraiz I., Trogstad L., Smith G. G. S., Steegers E. A. P., Salim R., Huang T., Adank A., Zhang J., Meschino W. S., Browne J. L., Allen R. E., Costa F. D. S., Klipstein-Grobusch Browne K., Crowther C. A., Jorgensen J. S., Forest J. -C., Rumbold A. R., Mol B. W., Giguere Y., Kenny L. C., Ganzevoort W., Odibo A. O., Myers J., Yeo S. A., Goffinet F., McCowan L., Pajkrt E., Teede H. J., Haddad B. G., Dekker G., Kleinrouweler E. C., LeCarpentier E., Roberts C. T., Groen H., Skrastad R. B., Heinonen S., Eero K., Anggraini D., Souka A., Cecatti J. G., Monterio I., Pillalis A., Souza R., Hawkins L. A., Gabbay-Benziv R., Crovetto F., Figuera F., Jorgensen L., Dodds J., Patel M., Aviram A., Papageorghiou A., and Khan K.

Abstract

Objective: Stillbirth is a potentially preventable complication of pregnancy. Identifying women at high risk of stillbirth can guide decisions on the need for closer surveillance and timing of delivery in order to prevent fetal death. Prognostic models have been developed to predict the risk of stillbirth, but none has yet been validated externally. In this study, we externally validated published prediction models for stillbirth using individual participant data (IPD) meta-analysis to assess their predictive performance. Methods: MEDLINE, EMBASE, DH-DATA and AMED databases were searched from inception to December 2020 to identify studies reporting stillbirth prediction models. Studies that developed or updated prediction models for stillbirth for use at any time during pregnancy were included. IPD from cohorts within the International Prediction of Pregnancy Complications (IPPIC) Network were used to validate externally the identified prediction models whose individual variables were available in the IPD. The risk of bias of the models and cohorts was assessed using the Prediction study Risk Of Bias ASsessment Tool (PROBAST). The discriminative performance of the models was evaluated using the C-statistic, and calibration was assessed using calibration plots, calibration slope and calibration-in-the-large. Performance measures were estimated separately in each cohort, as well as summarized across cohorts using random-effects meta-analysis. Clinical utility was assessed using net benefit. Results: Seventeen studies reporting the development of 40 prognostic models for stillbirth were identified. None of the models had been previously validated externally, and the full model equation was reported for only one-fifth (20%, 8/40) of the models. External validation was possible for three of these models, using IPD from 19 cohorts (491 201 pregnant women) within the IPPIC Network database. Based on evaluation of the model development studies, all three models had an overa

Published
2022

30. Is the closest health facility the one used in pregnancy care-seeking? A cross-sectional comparative analysis of self-reported and modelled geographical access to maternal care in Mozambique, India and Pakistan

Author

Makacha, Liberty, Makanga, Prestige Tatenda, Dube, Yolisa Prudence, Bone, Jeffrey, Munguambe, Khátia, Katageri, Geetanjali, Sharma, Sumedha, Vidler, Marianne, Sevene, Esperança, Ramadurg, Umesh, Charantimath, Umesh, Revankar, Amit, and von Dadelszen, Peter

Published
2020
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33. Pregnancy--An Ideal Period to Identify Women at Risk for Chronic Hypertension.

Author

Charakida, Marietta, Wright, Alan, Magee, Laura A., Syngelaki, Argyro, von Dadelszen, Peter, Akolekar, Ranjit, Wright, David, and Nicolaides, Kypros H.

Abstract

BACKGROUND: Cardiovascular disease is the leading cause of mortality in women. Pregnancy is an ideal period to implement cardiovascular prevention strategies as women seek medical help. We aimed to develop a predictive model to identify women at increased risk for chronic hypertension (CH) based on information collected in the index pregnancy. METHODS: Cohort of 26 511 women seen in 2 consecutive pregnancies. Included were women without CH, with information on maternal characteristics and blood pressure at 11 to 13 weeks' gestation, and the development of preeclampsia or gestational hypertension (GH) in the index pregnancy. Logistic regression models were fitted for the prediction of the development of future CH by the 20th week of the subsequent pregnancy. The performance of screening and risk calibration of the model were assessed. RESULTS: In this study 1560 (5.9%) women developed preeclampsia or GH (index pregnancy), and 215 (0.8%) developed future CH, with a median of 3.0 years later. Predictors of development of future CH were maternal age, weight, and blood pressure; Black and South Asian ethnicity; family history of preeclampsia; parity; and development of preeclampsia or GH. Preeclampsia or GH detected 52.1% (45.2%-58.9%) of future CH. At a screen-positive rate of 10%, a model including maternal characteristics, early pregnancy blood pressure, and development of preeclampsia or GH detected 73.5% (67.1-79.3) of future CH. CONCLUSIONS: Early pregnancy maternal characteristics, blood pressure, and development of preeclampsia or GH identify three-fourths of women at risk for future CH. Our results offer an important preventative strategy for identifying women at increased risk of future CH, which is applicable worldwide. [ABSTRACT FROM AUTHOR]

Published
2024
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38. Development and internal validation of the multivariable CIPHER (Collaborative Integrated Pregnancy High-dependency Estimate of Risk) clinical risk prediction model

Author

Payne, Beth A., Ryan, Helen, Bone, Jeffrey, Magee, Laura A., Aarvold, Alice B., Mark Ansermino, J., Bhutta, Zulfiqar A., Bowen, Mary, Guilherme Cecatti, J., Chazotte, Cynthia, Crozier, Tim, de Pont, Anne-Cornélie J. M., Demirkiran, Oktay, Duan, Tao, Kallen, Marlot, Ganzevoort, Wessel, Geary, Michael, Goffman, Dena, Hutcheon, Jennifer A., Joseph, K. S., Lapinsky, Stephen E., Lataifeh, Isam, Li, Jing, Liskonova, Sarka, Hamel, Emily M., McAuliffe, Fionnuala M., O’Herlihy, Colm, Mol, Ben W. J., Seaward, P. Gareth R., Tadros, Ramzy, Togal, Turkan, Qureshi, Rahat, Vivian Ukah, U., Vasquez, Daniela, Wallace, Euan, Yong, Paul, Zhou, Vivian, Walley, Keith R., von Dadelszen, Peter, and the CIPHER Group

Published
2018
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39. Availability and use of magnesium sulphate at health care facilities in two selected districts of North Karnataka, India

Author

Katageri, Geetanjali, Charantimath, Umesh, Joshi, Anjali, Vidler, Marianne, Ramadurg, Umesh, Sharma, Sumedha, Bannale, Sheshidhar, Payne, Beth A., Rakaraddi, Sangamesh, Karadiguddi, Chandrashekhar, Mungarwadi, Geetanjali, Kavi, Avinash, Sawchuck, Diane, Derman, Richard, Goudar, Shivaprasad, Mallapur, Ashalata, Bellad, Mrutyunjaya, Magee, Laura A., Qureshi, Rahat, von Dadelszen, Peter, and the Community Level Interventions for Pre-eclampsia (CLIP) India Feasibility Working Group

Published
2018
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40. The feasibility of task-sharing the identification, emergency treatment, and referral for women with pre-eclampsia by community health workers in India

Author

Charanthimath, Umesh, Vidler, Marianne, Katageri, Geetanjali, Ramadurg, Umesh, Karadiguddi, Chandrashekhar, Kavi, Avinash, Joshi, Anjali, Mungarwadi, Geetanjali, Bannale, Sheshidhar, Rakaraddi, Sangamesh, Sawchuck, Diane, Qureshi, Rahat, Sharma, Sumedha, Payne, Beth A., von Dadelszen, Peter, Derman, Richard, Magee, Laura A., Goudar, Shivaprasad, Mallapur, Ashalata, Bellad, Mrutyunjaya, and the Community Level Interventions for Pre-eclampsia (CLIP) India Feasibility Working Group, Bhutta, Zulfiqar, Naik, Sheela, Mulla, Anis, Kamle, Namdev, Dhamanekar, Vaibhav, Drebit, Sharla K., Kariya, Chirag, Lee, Tang, Li, Jing, Lui, Mansun, Khowaja, Asif R., Tu, Domena K., and Revankar, Amit

Published
2018
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41. External validation of prognostic models to predict stillbirth using International Prediction of Pregnancy Complications (IPPIC) Network database: individual participant data meta-analysis

Author

Allotey, J., Whittle, R., Snell, K. I. E., Smuk, M., Townsend, R., von Dadelszen, P., Heazell, A. E. P., Magee, L., Smith, G. C. S., Sandall, J., Thilaganathan, B., Zamora, J., Riley, R. D., Khalil, A., Thangaratinam, S., Coomarasamy, A., Kwong, A., Savitri, A. I., Salvesen, K. A., Bhattacharya, S., Uiterwaal, C. S. P. M., Staff, A. C., Andersen, L. B., Olive, E. L., Redman, C., Sletner, L., Daskalakis, G., Macleod, M., Abdollahain, M., Ramirez, J. A., Masse, J., Audibert, F., Magnus, P. M., Jenum, A. K., Baschat, A., Ohkuchi, A., Mcauliffe, F. M., West, J., Askie, L. M., Mone, F., Farrar, D., Zimmerman, P. A., Smits, L. J. M., Riddell, C., Kingdom, J. C., van de Post, J., Illanes, S. E., Holzman, C., van Kuijk, S. M. J., Carbillon, L., Villa, P. M., Eskild, A., Chappell, L., Prefumo, F., Velauthar, L., Seed, P., van Oostwaard, M., Verlohren, S., Poston, L., Ferrazzi, E., Vinter, C. A., Nagata, C., Brown, M., Vollebregt, K. C., Takeda, S., Langenveld, J., Widmer, M., Saito, S., Haavaldsen, C., Carroli, G., Olsen, J., Wolf, H., Zavaleta, N., Eisensee, I., Vergani, P., Lumbiganon, P., Makrides, M., Facchinetti, F., Sequeira, E., Gibson, R., Ferrazzani, S., Frusca, T., Norman, J. E., Figueiro, E. A., Lapaire, O., Laivuori, H., Lykke, J. A., Conde-Agudelo, A., Galindo, A., Mbah, A., Betran, A. P., Herraiz, I., Trogstad, L., Smith, G. G. S., Steegers, E. A. P., Salim, R., Huang, T., Adank, A., Zhang, J., Meschino, W. S., Browne, J. L., Allen, R. E., Costa, F. D. S., Klipstein-Grobusch Browne, K., Crowther, C. A., Jorgensen, J. S., Forest, J. -C., Rumbold, A. R., Mol, B. W., Giguere, Y., Kenny, L. C., Ganzevoort, W., Odibo, A. O., Myers, J., Yeo, S. A., Goffinet, F., Mccowan, L., Pajkrt, E., Teede, H. J., Haddad, B. G., Dekker, G., Kleinrouweler, E. C., Lecarpentier, E., Roberts, C. T., Groen, H., Skrastad, R. B., Heinonen, S., Eero, K., Anggraini, D., Souka, A., Cecatti, J. G., Monterio, I., Pillalis, A., Souza, R., Hawkins, L. A., Gabbay-Benziv, R., Crovetto, F., Figuera, F., Jorgensen, L., Dodds, J., Patel, M., Aviram, A., Papageorghiou, A., Khan, K., Clinicum, HUS Gynecology and Obstetrics, Department of Obstetrics and Gynecology, HUS Children and Adolescents, Lastentautien yksikkö, Children's Hospital, Allotey, J, Whittle, R, Snell, K, Smuk, M, Townsend, R, von Dadelszen, P, Heazell, A, Magee, L, Smith, G, Sandall, J, Thilaganathan, B, Zamora, J, Riley, R, Khalil, A, Thangaratinam, S, Coomarasamy, A, Kwong, A, Savitri, A, Salvesen, K, Bhattacharya, S, Uiterwaal, C, Staff, A, Andersen, L, Olive, E, Redman, C, Sletner, L, Daskalakis, G, Macleod, M, Abdollahain, M, Ramirez, J, Masse, J, Audibert, F, Magnus, P, Jenum, A, Baschat, A, Ohkuchi, A, Mcauliffe, F, West, J, Askie, L, Mone, F, Farrar, D, Zimmerman, P, Smits, L, Riddell, C, Kingdom, J, van de Post, J, Illanes, S, Holzman, C, van Kuijk, S, Carbillon, L, Villa, P, Eskild, A, Chappell, L, Prefumo, F, Velauthar, L, Seed, P, van Oostwaard, M, Verlohren, S, Poston, L, Ferrazzi, E, Vinter, C, Nagata, C, Brown, M, Vollebregt, K, Takeda, S, Langenveld, J, Widmer, M, Saito, S, Haavaldsen, C, Carroli, G, Olsen, J, Wolf, H, Zavaleta, N, Eisensee, I, Vergani, P, Lumbiganon, P, Makrides, M, Facchinetti, F, Sequeira, E, Gibson, R, Ferrazzani, S, Frusca, T, Norman, J, Figueiro, E, Lapaire, O, Laivuori, H, Lykke, J, Conde-Agudelo, A, Galindo, A, Mbah, A, Betran, A, Herraiz, I, Trogstad, L, Steegers, E, Salim, R, Huang, T, Adank, A, Zhang, J, Meschino, W, Browne, J, Allen, R, Costa, F, Klipstein-Grobusch Browne, K, Crowther, C, Jorgensen, J, Forest, J, Rumbold, A, Mol, B, Giguere, Y, Kenny, L, Ganzevoort, W, Odibo, A, Myers, J, Yeo, S, Goffinet, F, Mccowan, L, Pajkrt, E, Teede, H, Haddad, B, Dekker, G, Kleinrouweler, E, Lecarpentier, E, Roberts, C, Groen, H, Skrastad, R, Heinonen, S, Eero, K, Anggraini, D, Souka, A, Cecatti, J, Monterio, I, Pillalis, A, Souza, R, Hawkins, L, Gabbay-Benziv, R, Crovetto, F, Figuera, F, Jorgensen, L, Dodds, J, Patel, M, Aviram, A, Papageorghiou, A, Khan, K, Tampere University, Obstetrics and Gynaecology, APH - Quality of Care, Amsterdam Reproduction & Development (AR&D), APH - Personalized Medicine, APH - Digital Health, and Obstetrics and gynaecology

Subjects
Calibration (statistics), Perinatal Death, Overfitting, Cohort Studies, Fetal Development, 0302 clinical medicine, Discriminative model, 3123 Gynaecology and paediatrics, Models, Pregnancy, GROWTH RESTRICTION, Statistics, Medicine, Prenatal, 030212 general & internal medicine, Ultrasonography, RISK, 030219 obstetrics & reproductive medicine, PRETERM, Radiological and Ultrasound Technology, LOW-DOSE ASPIRIN, DIAGNOSIS TRIPOD, Obstetrics and Gynecology, General Medicine, Statistical, Stillbirth, Prognosis, Pregnancy Complication, external validation, individual participant data, intrauterine death, prediction model, stillbirth, Female, Humans, Infant, Newborn, Models, Statistical, Pregnancy Complications, Regression Analysis, Risk Assessment, Ultrasonography, Prenatal, 3. Good health, PREECLAMPSIA, Meta-analysis, Human, Cohort study, Prognosi, MEDLINE, Regression Analysi, WEEKS GESTATION, 03 medical and health sciences, VELOCIMETRY, Radiology, Nuclear Medicine and imaging, RECURRENCE, business.industry, Infant, Newborn, R1, HYPERTENSIVE DISORDERS, Reproductive Medicine, Sample size determination, Cohort Studie, RG, business, RA, Predictive modelling
Abstract

Objective Stillbirth is a potentially preventable complication of pregnancy. Identifying women at high risk of stillbirth can guide decisions on the need for closer surveillance and timing of delivery in order to prevent fetal death. Prognostic models have been developed to predict the risk of stillbirth, but none has yet been validated externally. In this study, we externally validated published prediction models for stillbirth using individual participant data (IPD) meta-analysis to assess their predictive performance. Methods MEDLINE, EMBASE, DH-DATA and AMED databases were searched from inception to December 2020 to identify studies reporting stillbirth prediction models. Studies that developed or updated prediction models for stillbirth for use at any time during pregnancy were included. IPD from cohorts within the International Prediction of Pregnancy Complications (IPPIC) Network were used to validate externally the identified prediction models whose individual variables were available in the IPD. The risk of bias of the models and cohorts was assessed using the Prediction study Risk Of Bias ASsessment Tool (PROBAST). The discriminative performance of the models was evaluated using the C-statistic, and calibration was assessed using calibration plots, calibration slope and calibration-in-the-large. Performance measures were estimated separately in each cohort, as well as summarized across cohorts using random-effects meta-analysis. Clinical utility was assessed using net benefit. Results Seventeen studies reporting the development of 40 prognostic models for stillbirth were identified. None of the models had been previously validated externally, and the full model equation was reported for only one-fifth (20%, 8/40) of the models. External validation was possible for three of these models, using IPD from 19 cohorts (491 201 pregnant women) within the IPPIC Network database. Based on evaluation of the model development studies, all three models had an overall high risk of bias, according to PROBAST. In the IPD meta-analysis, the models had summary C-statistics ranging from 0.53 to 0.65 and summary calibration slopes ranging from 0.40 to 0.88, with risk predictions that were generally too extreme compared with the observed risks. The models had little to no clinical utility, as assessed by net benefit. However, there remained uncertainty in the performance of some models due to small available sample sizes. Conclusions The three validated stillbirth prediction models showed generally poor and uncertain predictive performance in new data, with limited evidence to support their clinical application. The findings suggest methodological shortcomings in their development, including overfitting. Further research is needed to further validate these and other models, identify stronger prognostic factors and develop more robust prediction models. (c) 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Published
2022
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42. The 2017 American College of Cardiology and American Heart Association blood pressure categories in the second half of pregnancy—a systematic review of their association with adverse pregnancy outcomes.

Author

Slade, Laura J., Wilson, Milly, Mistry, Hiten D., Bone, Jeffrey N., Bello, Natalie A., Blackman, Maya, Syeda, Nuhaat, von Dadelszen, Peter, and Magee, Laura A.

Subjects
BLOOD pressure, PREGNANCY outcomes, DIASTOLIC blood pressure, SYSTOLIC blood pressure, BLOOD pressure measurement
Abstract

A relationship between the 2017 American College of Cardiology and American Heart Association blood pressure thresholds and adverse pregnancy outcomes has been reported, but few studies have explored the diagnostic test properties of these cutoffs when used within pregnancy. Electronic databases were searched (2017–2021) for measurements of blood pressure in pregnancy at >20 weeks, classified according to the 2017 American College of Cardiology and American Heart Association criteria, and their relationship with pregnancy outcomes. Blood pressure was categorized as "normal" (systolic blood pressure of <120 mm Hg and diastolic blood pressure of <80 mm Hg), "elevated blood pressure" (systolic blood pressure of 120–129 mm Hg and diastolic blood pressure of <80 mm Hg), "stage 1 hypertension" (systolic blood pressure of 130–139 mm Hg and/or diastolic blood pressure of 80–89 mm Hg), and "stage 2 hypertension" (systolic blood pressure of ≥140 mm Hg and/or diastolic blood pressure of ≥90 mm Hg). Studies recording blood pressure at or above 20 weeks gestation were included. Meta-analyses were used to investigate the strength of the association between blood pressure cutoffs and adverse outcomes, and the diagnostic test properties were calculated accounting for gestation. There were 12 included studies. The American College of Cardiology or American Heart Association blood pressure categories were determined from peak blood pressures at any point from 20 weeks of gestation and at specific gestational ages (20–27, 28–32, or 33–36 weeks of gestation), as available. A higher (vs normal) blood pressure category was consistently associated with adverse outcomes. The strength of association between blood pressure categories and adverse outcomes was the greatest with "stage 2 hypertension" (blood pressure of ≥140/90 mm Hg). The results were similar when peak blood pressure was reported either at any time from 20 weeks of gestation or within gestational age groups (as above). No blood pressure category was useful as a diagnostic "rule-out test" for adverse outcomes, as all negative likelihood ratios were ≥0.2. Only "stage 2 hypertension" was useful as a "rule in-test," with positive likelihood ratios of ≥5.0, for maximum blood pressure at >20 weeks of gestation for preeclampsia and blood pressure within any gestational age groups for preeclampsia, eclampsia, stroke, maternal death, and stillbirth. From 20 weeks of gestation, blood pressure thresholds of 140 mm Hg (systolic) and 90 mm Hg (diastolic) were useful in identifying women at increased risk of adverse pregnancy outcomes, irrespective of the specific gestational age at blood pressure measurement. Lowering the blood pressure threshold for abnormal blood pressure at >20 weeks of gestation would not assist clinicians in identifying women at heightened maternal or perinatal risk. No American College of Cardiology or American Heart Association blood pressure threshold can provide reassurance that women are unlikely to develop adverse outcomes. [ABSTRACT FROM AUTHOR]

Published
2023
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45. Standardising definitions for the pre-eclampsia core outcome set: A consensus development study

Author

Duffy, J. M. N., Cairns, A. E., Magee, L. A., von Dadelszen, P., van 't Hooft, J., Gale, C., Brown, M., Chappell, L. C., Grobman, W. A., Fitzpatrick, R., Karumanchi, S. A., Lucas, D. N., Mol, B., Stark, M., Thangaratinam, S., Wilson, M. J., Williamson, P. R., Ziebland, S., Mcmanus, R. J., Abalos, E. J., Adamson, C. C. D., Akadri, A. A., Akturk, Z., Allegaert, K., Angel-Muller, E., Antretter, J., Ashdown, H. F., Audibert, F., Auger, N., Aygun, C., Babic, I., Bagga, R., Baker, J. M., Beebeejaun, Y., Bhakta, P., Bhandari, V., Bhattacharya, S., Blanker, M. H., Bloomfield, F. H., Bof, A., Brennan, S. M., Broekhuijsen, K., Broughton Pipkin, F., Browne, J. L., Browning, R. M., Bull, J. W., Butt, A., Button, D., Campbell, J. P., Campbell, D. M., Carbillon, L., Carthy, S., Casely, E., Cave, J. A., Cecatti, J. G., Chamillard, M. E., Chassard, D., Checheir, N. C., Chulkov, V. S., Cluver, C. A., Crawford, C. F., Daly, M. C., Darmochwal-Kolarz, D. A., Davies, R. E., Davies, M. W., Dawson, J. S., Dobson, N., Dodd, C. N., Donald, F., Duley, L., Epstein-Mares, J., Erez, O., Evans, E., Farlie, R. N., Ferris, A. V., Frankland, E. M., Freeman, D. J., Gainder, S., Ganzevoort, W., Gbinigie, O. A., Gerval, M. -O., Ghosh, S. K., Gingel, L. J., Glogowska, M., Goodlife, A., Gough, K. L., Green, J. R., Gul, F., Haggerty, L., Hall, D. R., Hallman, M., Hamilton, L. M., Hammond, S. J., Harlow, S. D., Hays, K. E., Hickey, S. C., Higgins, M., Hinton, L., Hobson, S. R., Hogg, M. J., Hollands, H. J., Homer, C. S. E., Hoodbhoy, Z., Howell, P., Huppertz, B., Husain, S., Jacoby, S. D., Jacqz-Aigrain, E., Jenkins, G., Jewel, D., Johnson, M. J., Johnston, C. L., Jones, P. M., Kantrowitz-Gordon, I., Khan, R. -U., Kirby, L. J., Kirk, C., Knight, M., Korey, M. T., Lee, G. J., Lee, V. W., Levene, L. S., Londero, A. P., Lust, K. M., Mackenzie, V., Malha, L., Mattone, M., Mccartney, D. E., Mcfadden, A., Mckinstry, B. H., Middleton, P. F., Mills, D. J., Mistry, H. D., Mitchell, C. A., Mockler, J. C., Molsher, S. -A., Monast, E. S., Moodley, J., Mooij, R., Moore, E. L., Morgan, L., Moulson, A., Mughal, F., Mundle, S. R., Munoz, M. A., Murray, E., Nagata, C., Nair, A. S., Nakimuli, A., Nath, G., Newport, R. S., Oakeshott, P., Ochoa-Ferraro, M. R., Odendaal, H., Ohkuchi, A., Oliveira, L., Ortiz-Panozo, E., Oudijk, M. A., Oygucu, S. E., Paech, M. J., Painter, R. C., Parry, C. L., Payne, B. A., Pearson, E. L., Phupong, V., Pickett, N., Pickles, K. A., Plumb, L. K., Prefumo, F., Preston, R., Ray, J. G., Rayment, J., Regan, L. V., Rey, E., Robson, E. J., Rubin, A. N., Rubio-Romero, J. A., Rull, K., Sass, N., Sauve, N., Savory, N. A., Scott, J. R., Seaton, S. E., Seed, P. T., Shakespeare, J. M., Shand, A. W., Sharma, S., Shaw, T. Y., Smedley, K. L., Smith, D., Smith Conk, A., Soward, D., Stepan, H., Stroumpoulis, K., Surendran, A., Takeda, S., Tan, L., Theriot, B. S., Thomas, H. F., Thompson, K., Thompson, P. I., Thompson, M. J., Toms, L., Torney, K. L. H. T., Treadwell, J. S., Tucker, K. L., Turrentine, M. A., Van Hecke, O., Van Oostwaard, M. F., Vasquez, D. N., Vaughan, D. J. A., Vinturache, A., Walker, J., Wardle, S. P., Wasim, T., Waters, J. H., Whitehead, C. L., Wolfson, A., Yeo, S., Zermansky, A. G., (iHOPE), International Collaboration to Harmonise Outcomes for Pre-eclampsia, Life Course Epidemiology (LCE), University of Oxford, University College London, King’s College London, Academic Medical Center, Imperial College London, St George Hospital and University of New South Wales, Northwestern University, Cedars-Sinai Medical Center, London North West University Healthcare NHS Trust, Monash University, University of Adelaide, Barts and The London School of Medicine and Dentistry, University of Sheffield, University of Liverpool, Centro Rosarino de Estudios Perinatales, Chelsea and Westminster Hospital NHS Foundation Trust, Babcock University, Ailem Academic Counselling, KU Leuven, Universidad Nacional de Colombia, Northwell Health, Université de Montréal, University of Montreal Hospital Centre, Ondokuz Mayıs University, Prince Sultan Military Medical City, Postgraduate Institute of Medical Education and Research, Fetal Medicine Research Institute, University Hospital Limerick, Drexel University, University of Aberdeen, University of Groningen, University of Auckland, Haaglanden Medisch Centrum, Nottingham University Medical School, Utrecht University, King Edward Memorial Hospital for Women, Imperial College Healthcare NHS Trust, Jean-Verdier Hospital, Downland Practice, Universidade Estadual de Campinas (UNICAMP), Université Lyon, University of North Carolina School of Medicine, South Ural State Medical University, Stellenbosch University, Irish Neonatal Health Alliance, University of Rzeszow, Royal Brisbane and Women’s Hospital, Nottingham University Hospitals NHS Trust, University Hospitals of Leicester, North Bristol NHS Trust, University of Nottingham, Soroka University Medical Center Ben Gurion University of the Negev, St George’s University Hospitals NHS Foundation Trust, Hospitalsenhed Midt, University of Glasgow, Amsterdam Universitair Medische Centra, All India Institute of Medical Sciences Patna, Luton and Dunstable University Hospital, Khyber Medical University Institution of Medical Sciences, Midwife Mid Essex Hospitals NHS Trust, University of Oulu, University of Michigan, Bastyr University, Irish Nurses and Midwives Organisation, University of Toronto, Barts Health NHS Trust, University Hospitals Plymouth NHS Trust, Burnet Institute, Aga Khan University, Medical University of Graz, Homerton University Hospital NHS Foundation Trust, Mount Royal University, Université de Paris, Royal Surrey County Hospital, University Hospital Southampton NHS Foundation Trust, University of Washington School of Nursing, Evelina London Children's Hospital Neonatal Unit, University of Sydney, University of Leicester, Academic Hospital of Udine, NHS Borders, Weill Cornell Medical College, University of Dundee, University of Edinburgh, South Australian Health and Medical Research Institute, Monash University and Monash Health, United Lincolnshire Hospitals NHS Trust, University of Kwa Zulu-Natal, Beatrix Hospital, Keele University, Government Medical College, Institut Catala de la Salut. IdiapJgol, National Center for Child Health and Development, Basavatarakam Indo-American Cancer Hospital and Research Institute, Axon Anaesthesia Associates, Pennine Acute Hospitals NHS Trust, University of London, Norfolk and Norwich University Hospital, Jichi Medical University School of Medicine, Universidade Estadual Paulista (UNESP), National Institute of Public Health, University of Kyrenia, King Edward Memorial Hospital, Amsterdam University Centres, University of British Columbia, Chulalongkorn University, University of Brescia, University Of British Columbia, University of Montreal, Women's Clinic of Tartu University Hospital, Universidade Federal de São Paulo (UNIFESP), Université de Sherbrooke, University Hospital of Wales, University of Iowa, King's College London, Westmead Hospital, Princess Royal Maternity, Leipzig University, Centre Hospitalier Public du Cotentin, Lewisham and Greenwich NHS Trust, Juntendo University Faculty of Medicine, Western Sydney University, National Institute of Health Research, University of Washington, Baylor College of Medicine, Capelle aan den Ijssel, Sanatorio Anchorena, Oxford University Hospitals NHS Foundation Trust, University of Leeds, Institute of Medical Sciences, UPMC Magee Womens Hospital, Penn Medicine Princeton Health, University of North Carolina at Chapel Hill, and Obstetrics and Gynaecology

Subjects
Adult, medicine.medical_specialty, Consensus, Delphi Technique, Standardization, Birth weight, Psychological intervention, Randomised controlled trials, 030204 cardiovascular system & hematology, Outcome (game theory), 03 medical and health sciences, Hypertension in pregnancy, Outcome measure, 0302 clinical medicine, Pre-Eclampsia, Pregnancy, Consensus development study, Internal Medicine, medicine, Humans, Set (psychology), 030219 obstetrics & reproductive medicine, Eclampsia, business.industry, Pregnancy Outcome, Obstetrics and Gynecology, Core outcome set, Reference Standards, medicine.disease, Pre-eclampsia, Pregnancy Complications, Core (game theory), Treatment Outcome, Systematic review, Family medicine, 1114 Paediatrics and Reproductive Medicine, Female, International Collaboration to Harmonise Outcomes for Pre-eclampsia (iHOPE), business
Abstract

Made available in DSpace on 2022-04-28T19:29:02Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-07-01 Medical Research Council Canada National Institute for Health Research Objectives: To develop consensus definitions for the core outcome set for pre-eclampsia. Study design: Potential definitions for individual core outcomes were identified across four formal definition development initiatives, nine national and international guidelines, 12 Cochrane systematic reviews, and 79 randomised trials. Eighty-six definitions were entered into the consensus development meeting. Ten healthcare professionals and three researchers, including six participants who had experience of conducting research in low- and middle-income countries, participated in the consensus development process. The final core outcome set was approved by an international steering group. Results: Consensus definitions were developed for all core outcomes. When considering stroke, pulmonary oedema, acute kidney injury, raised liver enzymes, low platelets, birth weight, and neonatal seizures, consensus definitions were developed specifically for low- and middle-income countries because of the limited availability of diagnostic interventions including computerised tomography, chest x-ray, laboratory tests, equipment, and electroencephalogram monitoring. Conclusions: Consensus on measurements for the pre-eclampsia core outcome set will help to ensure consistency across future randomised trials and systematic reviews. Such standardization should make research evidence more accessible and facilitate the translation of research into clinical practice. Video abstract can be available at: www.dropbox.com/s/ftrgvrfu0u9glqd/6.%20Standardising%20definitions%20in%20teh%20pre-eclampsia%20core%20outcome%20set%3A%20a%20consensus%20development%20study.mp4?dl=0. Nuffield Department of Primary Care Health Sciences University of Oxford Institute for Women’s Health University College London Department of Women and Children’s Health School of Life Course Sciences King’s College London Department of Obstetrics and Gynecology Amsterdam UMC Academic Medical Center Academic Neonatal Medicine Imperial College London Department of Renal Medicine St George Hospital and University of New South Wales Department of Obstetrics and Gynaecology Feinberg School of Medicine Northwestern University Health Services Research Unit Nuffield Department of Population Health University of Oxford Cedars-Sinai Medical Center London North West University Healthcare NHS Trust Women’s Health Care Research Group Department of Obstetrics and Gynaecology Monash University Department of Obstetrics and Gynaecology University of Adelaide Women’s Health Research Unit Barts and The London School of Medicine and Dentistry School of Health and Related Research University of Sheffield MRC North West Hub for Trials Methodology Research Department of Biostatistics University of Liverpool Centro Rosarino de Estudios Perinatales Chelsea and Westminster Hospital NHS Foundation Trust Babcock University Ailem Academic Counselling KU Leuven Universidad Nacional de Colombia Northwell Health University of Oxford Université de Montréal University of Montreal Hospital Centre Ondokuz Mayıs University Prince Sultan Military Medical City Postgraduate Institute of Medical Education and Research King's Fertility Fetal Medicine Research Institute University Hospital Limerick Drexel University University of Aberdeen University of Groningen University of Auckland Haaglanden Medisch Centrum Nottingham University Medical School Utrecht University King Edward Memorial Hospital for Women Imperial College Healthcare NHS Trust Jean-Verdier Hospital Downland Practice University of Campinas Université Lyon University of North Carolina School of Medicine South Ural State Medical University Stellenbosch University Irish Neonatal Health Alliance University of Rzeszow Royal Brisbane and Women’s Hospital Nottingham University Hospitals NHS Trust University Hospitals of Leicester North Bristol NHS Trust University of Nottingham Soroka University Medical Center Ben Gurion University of the Negev St George’s University Hospitals NHS Foundation Trust Hospitalsenhed Midt University of Glasgow Amsterdam Universitair Medische Centra All India Institute of Medical Sciences Patna Luton and Dunstable University Hospital Khyber Medical University Institution of Medical Sciences Midwife Mid Essex Hospitals NHS Trust University of Oulu University of Michigan Bastyr University Irish Nurses and Midwives Organisation University of Toronto Barts Health NHS Trust University Hospitals Plymouth NHS Trust Burnet Institute Aga Khan University Medical University of Graz Homerton University Hospital NHS Foundation Trust Mount Royal University Université de Paris Royal Surrey County Hospital University Hospital Southampton NHS Foundation Trust University of Washington School of Nursing Evelina London Children's Hospital Neonatal Unit University of Sydney University of Leicester Academic Hospital of Udine NHS Borders Weill Cornell Medical College University of Dundee University of Edinburgh South Australian Health and Medical Research Institute University of Sheffield Monash University and Monash Health United Lincolnshire Hospitals NHS Trust University of Kwa Zulu-Natal Beatrix Hospital Keele University Government Medical College Institut Catala de la Salut. IdiapJgol University College London National Center for Child Health and Development Basavatarakam Indo-American Cancer Hospital and Research Institute Axon Anaesthesia Associates Pennine Acute Hospitals NHS Trust St George's University of London Norfolk and Norwich University Hospital Jichi Medical University School of Medicine São Paulo State University National Institute of Public Health University of Kyrenia King Edward Memorial Hospital Amsterdam University Centres University of British Columbia Chulalongkorn University University of Brescia University Of British Columbia University of Montreal Women's Clinic of Tartu University Hospital Universidade Federal de São Paulo Université de Sherbrooke University Hospital of Wales University of Iowa King's College London Westmead Hospital Princess Royal Maternity Leipzig University Centre Hospitalier Public du Cotentin Lewisham and Greenwich NHS Trust Juntendo University Faculty of Medicine Western Sydney University National Institute of Health Research University of Washington Baylor College of Medicine Capelle aan den Ijssel Sanatorio Anchorena Oxford University Hospitals NHS Foundation Trust University of Leeds Institute of Medical Sciences UPMC Magee Womens Hospital Penn Medicine Princeton Health University of North Carolina at Chapel Hill São Paulo State University

Published
2020
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46. An internally validated prediction model for critical COVID-19 infection and intensive care unit admission in symptomatic pregnant women

Author

Kalafat, E. Prasad, S. Birol, P. Tekin, A.B. Kunt, A. Di Fabrizio, C. Alatas, C. Celik, E. Bagci, H. Binder, J. Le Doare, K. Magee, L.A. Mutlu, M.A. Yassa, M. Tug, N. Sahin, O. Krokos, P. O'brien, P. von Dadelszen, P. Palmrich, P. Papaioannou, G. Ayaz, R. Ladhani, S.N. Kalantaridou, S. Mihmanli, V. Khalil, A. and Kalafat, E. Prasad, S. Birol, P. Tekin, A.B. Kunt, A. Di Fabrizio, C. Alatas, C. Celik, E. Bagci, H. Binder, J. Le Doare, K. Magee, L.A. Mutlu, M.A. Yassa, M. Tug, N. Sahin, O. Krokos, P. O'brien, P. von Dadelszen, P. Palmrich, P. Papaioannou, G. Ayaz, R. Ladhani, S.N. Kalantaridou, S. Mihmanli, V. Khalil, A.

Abstract

Background: Pregnant women are at an increased risk of mortality and morbidity owing to COVID-19. Many studies have reported on the association of COVID-19 with pregnancy-specific adverse outcomes, but prediction models utilizing large cohorts of pregnant women are still lacking for estimating the risk of maternal morbidity and other adverse events. Objective: The main aim of this study was to develop a prediction model to quantify the risk of progression to critical COVID-19 and intensive care unit admission in pregnant women with symptomatic infection. Study Design: This was a multicenter retrospective cohort study including 8 hospitals from 4 countries (the United Kingdom, Austria, Greece, and Turkey). The data extraction was from February 2020 until May 2021. Included were consecutive pregnant and early postpartum women (within 10 days of birth); reverse transcriptase polymerase chain reaction confirmed SARS-CoV-2 infection. The primary outcome was progression to critical illness requiring intensive care. The secondary outcomes included maternal death, preeclampsia, and stillbirth. The association between the primary outcome and 12 candidate predictors having a known association with severe COVID-19 in pregnancy was analyzed with log-binomial mixed-effects regression and reported as adjusted risk ratios. All the potential predictors were evaluated in 1 model and only the baseline factors in another. The predictive accuracy was assessed by the area under the receiver operating characteristic curves. Results: Of the 793 pregnant women who were positive for SARS-CoV-2 and were symptomatic, 44 (5.5%) were admitted to intensive care, of whom 10 died (1.3%). The ‘mini-COvid Maternal Intensive Therapy’ model included the following demographic and clinical variables available at disease onset: maternal age (adjusted risk ratio, 1.45; 95% confidence interval, 1.07–1.95; P=.015); body mass index (adjusted risk ratio, 1.34; 95% confidence interval, 1.06–1.66; P=.010); and

Published
2022

47. Maternal and perinatal outcomes of SARS-CoV-2 infection in unvaccinated pregnancies during Delta and Omicron waves

Author

Kalafat, Erkan (ORCID 0000-0003-0658-138X & YÖK ID 197389), Birol Ilter, P.; Prasad, S.; Mutlu, M.A.; Tekin, A.B.; O'Brien, P.; von Dadelszen, P.; Magee, L.A.; Tekin, S.; Tug, N.; Khalil, A., School of Medicine, Kalafat, Erkan (ORCID 0000-0003-0658-138X & YÖK ID 197389), Birol Ilter, P.; Prasad, S.; Mutlu, M.A.; Tekin, A.B.; O'Brien, P.; von Dadelszen, P.; Magee, L.A.; Tekin, S.; Tug, N.; Khalil, A., and School of Medicine

Abstract

Objective: there is little evidence related to the effects of the Omicron severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant on pregnancy outcomes, particularly in unvaccinated women. This study aimed to compare pregnancy outcomes of unvaccinated women infected with SARS-CoV-2 during the pre-Delta, Delta and Omicron waves. Methods: this was a retrospective cohort study conducted at two tertiary care facilities: Sancaktepe Training and Research Hospital, Istanbul, Turkey, and St George's University Hospitals NHS Foundation Trust, London, UK. Included were women who tested positive for SARS-CoV-2 by real-time reverse-transcription polymerase chain reaction (RT-PCR) during pregnancy, between 1 April 2020 and 14 February 2022. The cohort was divided into three periods according to the date of their positive RT-PCR test: (i) pre-Delta (1 April 2020 to 8 June 2021 in Turkey, and 1 April 2020 to 31 July 2021 in the UK), (ii) Delta (9 June 2021 to 27 December 2021 in Turkey, and 1 August 2021 to 27 December 2021 in the UK) and (iii) Omicron (after 27 December 2021 in both Turkey and the UK). Baseline data collected included maternal age, parity, body mass index, gestational age at diagnosis and comorbidities. The primary outcome was the need for oxygen supplementation, classified as oxygen support via nasal cannula or breather mask, non-invasive mechanical ventilation with continuous positive airway pressure (CPAP) or high-flow oxygen, mechanical ventilation with intubation, or extracorporeal membrane oxygenation (ECMO). Inferences were made after balancing of confounders, using an evolutionary search algorithm. Selected confounders were maternal age, body mass index and gestational age at diagnosis of infection. Results: during the study period, 1286 unvaccinated pregnant women with RT-PCR-proven SARS-CoV-2 infection were identified, comprising 870 cases during the pre-Delta period, 339 during the Delta wave and 77 during the Omicron wave. In the confound, NA

Published
2022

48. COVID-19 booster doses in pregnancy and global vaccine equity

Author

Kalafat, Erkan (ORCID 0000-0003-0658-138X & YÖK ID 197389), Magee, L.A.; Von Dadelszen, P.; Heath, P.; Khalil A, School of Medicine, Kalafat, Erkan (ORCID 0000-0003-0658-138X & YÖK ID 197389), Magee, L.A.; Von Dadelszen, P.; Heath, P.; Khalil A, and School of Medicine

Abstract

NA

Published
2022

49. Systematic review and meta-analysis of the effectiveness and perinatal outcomes of COVID-19 vaccination in pregnancy

Author

Kalafat, Erkan (ORCID 0000-0003-0658-138X & YÖK ID 197389), Prasad, S.; Blakeway, H.; Townsend, R.; O’Brien, P.; Morris, E.; Draycott, T.; Thangaratinam, S.; Le Doare, K.; Ladhani, S.; von Dadelszen, P.; Magee, L.A.; Heath, P.; Khalil, A., School of Medicine, Kalafat, Erkan (ORCID 0000-0003-0658-138X & YÖK ID 197389), Prasad, S.; Blakeway, H.; Townsend, R.; O’Brien, P.; Morris, E.; Draycott, T.; Thangaratinam, S.; Le Doare, K.; Ladhani, S.; von Dadelszen, P.; Magee, L.A.; Heath, P.; Khalil, A., and School of Medicine

Abstract

Safety and effectiveness of COVID-19 vaccines during pregnancy is a particular concern affecting vaccination uptake by this vulnerable group. Here we evaluated evidence from 23 studies including 117,552 COVID-19 vaccinated pregnant people, almost exclusively with mRNA vaccines. We show that the effectiveness of mRNA vaccination against RT-PCR confirmed SARS-CoV-2 infection 7 days after second dose was 89 center dot 5% (95% CI 69 center dot 0-96 center dot 4%, 18,828 vaccinated pregnant people, I-2 = 73 center dot 9%). The risk of stillbirth was significantly lower in the vaccinated cohort by 15% (pooled OR 0 center dot 85; 95% CI 0 center dot 73-0 center dot 99, 66,067 vaccinated vs. 424,624 unvaccinated, I-2 = 93 center dot 9%). There was no evidence of a higher risk of adverse outcomes including miscarriage, earlier gestation at birth, placental abruption, pulmonary embolism, postpartum haemorrhage, maternal death, intensive care unit admission, lower birthweight Z-score, or neonatal intensive care unit admission (p > 0.05 for all). COVID-19 mRNA vaccination in pregnancy appears to be safe and is associated with a reduction in stillbirth. Pregnant women have been disproportionately under-vaccinated against COVID-19, partly because they were excluded from initial trials. This systematic review and meta-analysis supports efficacy of vaccination in pregnancy, and finds no evidence of adverse maternal or perinatal outcomes., NA

Published
2022

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