Acute kidney injury (AKI) in pregnancy is associated with adverse maternal and foetal outcomes. However, there is limited evidence regarding cardiac and renal outcomes associated with AKI in pregnancy.
To quantify and perform a meta-analysis of the risk of adverse cardiovascular and renal outcomes following AKI in pregnancy.
A systematic search of MEDLINE, Cochrane Library and EMBASE from inception until 23 January 2024.
Studies investigating adverse cardiovascular and renal outcomes in pregnant patients with AKI.
Two reviewers independently performed screening, data extraction and quality assessment. A random-effects model was used to estimate risk.
A total of 17 studies were included with 50 285 836 pregnant women, of which 36 806 women were affected by AKI. Our evidence synthesis showed that AKI in pregnancy is associated with a 52-fold increase in the risk of composite adverse renal outcomes (OR 52.37; 95% CI 4.67–587.63), a 23-fold increase in the risk of heart failure (OR 22.55; 95% CI 4.39–115.71) and stroke (OR 22.92; 95% CI 2.32–226.65), as well as a 9.3-fold and 3.9-fold increased risk of maternal mortality (OR 9.26; 95% CI 2.53–33.96) and intensive care unit admission (OR 3.86; 95% CI 1.93–7.71), respectively.
The study shows that AKI in pregnancy is associated with adverse cardiovascular and renal outcomes. Careful monitoring and follow-up of patients with AKI in pregnancy may enable earlier detection and management of some adverse cardiovascular and renal outcomes.
This scoping review was undertaken as part of an NIHR-commissioned study, APPRAISE, to develop a patient-reported outcome measure (PROM) and experience measure (PREM) to assess outcomes relevant to surgery for pelvic organ prolapse (POP), stress urinary incontinence (SUI) and pelvic mesh complications surgery, with cross-cultural applicability.
To identify PROMs and PREMs used to assess POP, SUI and mesh complication surgery; to compare the length, recall periods, response options of these tools and the outcomes/experiences assessed.
Three databases searched from inception to September 2023 were screened by two independent reviewers.
Primary studies using subjective measures to assess POP, SUI and mesh complication surgery for women aged 16+ years were eligible for inclusion. Related systematic reviews were also reviewed.
Data were extracted into a piloted electronic form by one reviewer and checked by a second. A narrative synthesis of the data was performed.
Of the 2079 included primary studies, 1607 (77%) used a PROM with evidence of psychometric testing. Five hundred and twenty-two (25%) studies used one PROM; 1082 studies (52%) used two or more PROMs. One hundred and fifty-one measures were extracted; of these, condition-specific measures were the most highly cited. There was limited use of PROMs specific to surgery, mental health, body image and PREMs. Some outcomes (e.g., urinary symptoms, emotional wellbeing) are measured in a significantly higher proportion of PROMs than other outcomes.
Currently, no existing validated PROM evaluates all patient-reported outcomes relevant to surgery for POP, SUI or mesh complications.
Linked article: This is a mini commentary on Bottemanne et al., pp. 412–419 in this issue. To view this article visit https://doi.org/10.1111/1471-0528.18306.
To determine the association of self-assessed caffeine consumption with adverse pregnancy outcomes (APO).
Secondary analysis of births in the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b). Caffeine intake was assessed by the self-reported Food Frequency Questionnaire reflecting consumption in the three months prior to the first trimester visit.
nuMoM2b was a prospectively collected cohort.
This is a large US-based cohort of pregnant patients.
High caffeine intake was defined as ≥ 200 mg/day. Logistic models assessed associations between high intake and APO, adjusted for confounders. We also grouped caffeine intake in 50 mg increments and tested whether increased consumption was associated with increased odds of APO.
APO were defined as a composite of intrauterine foetal demise > 20 weeks' gestation, hypertensive disorders of pregnancy, preterm birth and small for gestational age infant.
The primary analysis included 7345 participants with live births or pregnancy loss > 20 weeks' gestation, for whom the median daily caffeine intake was 63.28 mg/day. 841 (11.4%) of patients had high intake and 2168 (29.5%) had an APO. When adjusted for confounders, high intake was not associated with increased odds of APO (aOR 0.99, 95% CI 0.84–1.16), nor was it associated with any individual APO. We found no significant increased odds of APO per 50 mg increase in caffeine intake.
High caffeine intake assessed in the periconceptual period was not associated with the risk of APO. Further research exploring biomarkers and longitudinal childhood outcomes is needed to clarify limitations with regard to intake.
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