Dorothea Geddes-Barton, Raph Goldacre, Serena Luchenski, Chelsea Daniels, Rhiannon D′Arcy, Marian Knight, Nicola Vousden
Objective
To explore whether women experiencing homelessness during pregnancy have higher risks of adverse pregnancy outcomes compared to housed women.
Design
Population-based retrospective cohort study using national electronic hospital records.
Setting
Maternity services across English NHS hospitals.
Population
Women giving birth at gestational age ≥ 24 weeks from January 1, 2013 to March 31, 2023.
Methods
Data were obtained from the English National Hospital Episode Statistics Admitted Patient Care database. Poisson regression models compared outcomes for women identified as homeless to housed women, adjusting for age, parity, ethnicity, year and pre-existing medical conditions.
Main Outcome Measures
Severe maternal morbidity (SMM), preterm birth (< 37 and < 34 weeks), and low birth weight (< 2500 g).
Results
Among 3 349 601 women giving birth, 3301 (0.1%) experienced homelessness. Rates and adjusted risk ratios (aRR) comparing homeless to housed women were: SMM 2.5% versus 1.6% (aRR 1.28, 95% CI 1.02–1.59); preterm birth 11.8% versus 5.9% (aRR 1.88, 95% CI 1.69–2.08); and small for gestational age 9.0% versus 4.8% (aRR 1.56, 95% CI 1.38–1.76). Stratified by ethnicity, White homeless women had the highest risk for preterm birth and small for gestational age, while Asian homeless women showed the greatest risk for SMM, compared to White housed women.
Conclusions
Homelessness recorded during pregnancy or at birth is associated with poorer maternal and infant outcomes. Interventions focusing on housing stability are key. Future research should explore housing dynamics beyond homelessness, including frequent moves and overcrowding, requiring detailed perinatal housing data.
目的探讨怀孕期间无家可归的妇女是否比住在家里的妇女有更高的不良妊娠结局风险。设计基于人群的回顾性队列研究，使用国家电子医院记录。英国NHS医院的产科服务设置。人口2013年1月1日至2023年3月31日，胎龄≥24周分娩的妇女。方法数据来自英国国家医院事件统计住院患者护理数据库。泊松回归模型比较了被确定为无家可归的妇女和有房妇女的结果，调整了年龄、性别、种族、年龄和先前的医疗条件。主要结局指标：重度产妇发病率（SMM）、早产（< 37周和< 34周）和低出生体重（< 2500 g）。结果在3 349 601名分娩妇女中，有3301名（0.1%）无家可归。无家可归妇女与有房妇女的比率和调整风险比（aRR）分别为：SMM 2.5% vs 1.6% (aRR 1.28, 95% CI 1.02-1.59)；早产11.8%对5.9% (aRR 1.88, 95% CI 1.69-2.08)；胎龄小的为9.0%，胎龄小的为4.8% （aRR 1.56, 95% CI 1.38-1.76）。按种族划分，白人无家可归妇女早产和胎龄小的风险最高，而亚裔无家可归妇女与白人无家可归妇女相比，患SMM的风险最高。结论怀孕期间或出生时的无家可归记录与较差的母婴结局有关。以住房稳定为重点的干预措施是关键。未来的研究应探索住房动态超越无家可归，包括频繁移动和过度拥挤，需要详细的围产期住房数据。
{"title":"Maternal and Infant Outcomes for Women Experiencing Homelessness Before and During Pregnancy: A Retrospective Cohort Study","authors":"Dorothea Geddes-Barton, Raph Goldacre, Serena Luchenski, Chelsea Daniels, Rhiannon D′Arcy, Marian Knight, Nicola Vousden","doi":"10.1111/1471-0528.70050","DOIUrl":"10.1111/1471-0528.70050","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To explore whether women experiencing homelessness during pregnancy have higher risks of adverse pregnancy outcomes compared to housed women.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Population-based retrospective cohort study using national electronic hospital records.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>Maternity services across English NHS hospitals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Population</h3>\u0000 \u0000 <p>Women giving birth at gestational age ≥ 24 weeks from January 1, 2013 to March 31, 2023.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data were obtained from the English National Hospital Episode Statistics Admitted Patient Care database. Poisson regression models compared outcomes for women identified as homeless to housed women, adjusting for age, parity, ethnicity, year and pre-existing medical conditions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>Severe maternal morbidity (SMM), preterm birth (< 37 and < 34 weeks), and low birth weight (< 2500 g).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 3 349 601 women giving birth, 3301 (0.1%) experienced homelessness. Rates and adjusted risk ratios (aRR) comparing homeless to housed women were: SMM 2.5% versus 1.6% (aRR 1.28, 95% CI 1.02–1.59); preterm birth 11.8% versus 5.9% (aRR 1.88, 95% CI 1.69–2.08); and small for gestational age 9.0% versus 4.8% (aRR 1.56, 95% CI 1.38–1.76). Stratified by ethnicity, White homeless women had the highest risk for preterm birth and small for gestational age, while Asian homeless women showed the greatest risk for SMM, compared to White housed women.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Homelessness recorded during pregnancy or at birth is associated with poorer maternal and infant outcomes. Interventions focusing on housing stability are key. Future research should explore housing dynamics beyond homelessness, including frequent moves and overcrowding, requiring detailed perinatal housing data.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 13","pages":"2265-2274"},"PeriodicalIF":4.3,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.70050","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145254575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lisa M Van Den Bersselaar, Ingrid M B H Van De Laar, Marieke J H Baars, Annette Baas, Eelco Dulfer, Apollonia T J M Helderman-Van Den Enden, Yvonne Hilhorst-Hofstee, Robert M Kauling, Marlies J E Kempers, Martijn A Oudijk, Alessandra Maugeri, Hennie T Brüggenwirth, Arjan C Houweling, Serwet Demirdas
{"title":"Author Reply.","authors":"Lisa M Van Den Bersselaar, Ingrid M B H Van De Laar, Marieke J H Baars, Annette Baas, Eelco Dulfer, Apollonia T J M Helderman-Van Den Enden, Yvonne Hilhorst-Hofstee, Robert M Kauling, Marlies J E Kempers, Martijn A Oudijk, Alessandra Maugeri, Hennie T Brüggenwirth, Arjan C Houweling, Serwet Demirdas","doi":"10.1111/1471-0528.70046","DOIUrl":"https://doi.org/10.1111/1471-0528.70046","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":" ","pages":""},"PeriodicalIF":4.3,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kyrillus S. Shohdy, Loay Kassem, Boules Gabriel, Emad Barsoum, Tamer Elnahas, Hamdy A. Azim
<p>Identification of patients with homologous recombination deficiency (HRD) is crucial for the better management of patients with epithelial ovarian cancer (EOC) [<span>1</span>]. In limited-resource countries, there is a shortage of HRD testing outcomes due to costly testing, substandard infrastructure and lack of expert know-how [<span>2</span>].</p><p>We conducted a multicentre registry study aiming to evaluate the feasibility and outcomes of in-house HRD testing for patients with EOC in Egypt (Figure 1A). From 2019 to 2022, 589 consecutive patients with a median age of 56 years (range 20–86), from five cancer centres across Egypt, had undergone a successful HRD testing. The study was approved by the Institutional Review Board at Dar El Salam Cancer Centre (Ministry of Health and Population—Egypt).</p><p>HRD testing included <i>BRCA1/2</i> tumour mutation status (t<i>BRCA1/2</i>) and genomic scar score (GSS) status. Briefly, for each FFPE sample submitted, DNA extraction was performed using QIAamp DNA Mini kit (QIAGEN). Then, appropriate libraries preparation according to the manufacturer's protocol with the AmoyDx HRD Panel (Amoy Diagnostics Co. Ltd.) and sequencing was performed using the Illumina NextSeq500 system (Illumina). A custom hybridisation capture panel that targets 27 000 SNPs distributed across the genome was used to infer the GSS. Patients with <i>BRCA1/2</i> mutations or GSS ≥ 50 (i.e., GSS-positive) were considered HRD-positive as previously validated [<span>3</span>] (Figure 1A).</p><p>GSS-positive tumours were detected in 198 (33.6%) of our patients while t<i>BRCA1/2</i> mutations were detected in 113 (19.2%) (Figure 1B). Collectively, 241 patients (41%) were diagnosed as HRD-positive EOC at a median turnaround time of 13 days (range 8–26 days).</p><p>We examined the contribution of the GSS score and t<i>BRCA1/2</i> status to the overall HRD positivity (Figure 1B). In total, 128 patients (21.7%) were positive due to a positive GSS score alone without identified t<i>BRCA1/2</i> mutations. Meanwhile, 43 (7.3%) were HRD-positive due to having <i>BRCA1/2</i> mutations with a negative GSS score. Expectedly, the majority (62%) of patients with <i>BRCA</i> mutations had a positive GSS score, and the majority (80.7%) of patients with <i>BRCA</i> variants of uncertain significance (VUS) were GSS-negative (Figure 1B).</p><p>There was no significant difference in HRD-positive rate in younger age (< 50-year-old) compared to older (63 (38.2%) vs. 178 (42%), <i>p</i> = 0.42) neither in the rate of GSS-positive (51 (30.9%) vs. 147 (34.7%), <i>p</i> = 0.38). However, we identified a significant trend for increasing the rate of HRD-positive across age categories with the highest at age category 40 to < 60 years and lowest at under 40 years (46% vs. 24%, <i>p</i><sub>trend</sub> = 0.034) (Figure 1C).</p><p>We also examined the differences among <i>BRCA1</i>/2 mutations in relation to the GSS score. Intriguingly, patients with <i>BRCA1<
{"title":"Homologous Recombination Deficiency Testing in Women With Ovarian Cancer: An Egyptian Multicentre Study","authors":"Kyrillus S. Shohdy, Loay Kassem, Boules Gabriel, Emad Barsoum, Tamer Elnahas, Hamdy A. Azim","doi":"10.1111/1471-0528.70052","DOIUrl":"10.1111/1471-0528.70052","url":null,"abstract":"<p>Identification of patients with homologous recombination deficiency (HRD) is crucial for the better management of patients with epithelial ovarian cancer (EOC) [<span>1</span>]. In limited-resource countries, there is a shortage of HRD testing outcomes due to costly testing, substandard infrastructure and lack of expert know-how [<span>2</span>].</p><p>We conducted a multicentre registry study aiming to evaluate the feasibility and outcomes of in-house HRD testing for patients with EOC in Egypt (Figure 1A). From 2019 to 2022, 589 consecutive patients with a median age of 56 years (range 20–86), from five cancer centres across Egypt, had undergone a successful HRD testing. The study was approved by the Institutional Review Board at Dar El Salam Cancer Centre (Ministry of Health and Population—Egypt).</p><p>HRD testing included <i>BRCA1/2</i> tumour mutation status (t<i>BRCA1/2</i>) and genomic scar score (GSS) status. Briefly, for each FFPE sample submitted, DNA extraction was performed using QIAamp DNA Mini kit (QIAGEN). Then, appropriate libraries preparation according to the manufacturer's protocol with the AmoyDx HRD Panel (Amoy Diagnostics Co. Ltd.) and sequencing was performed using the Illumina NextSeq500 system (Illumina). A custom hybridisation capture panel that targets 27 000 SNPs distributed across the genome was used to infer the GSS. Patients with <i>BRCA1/2</i> mutations or GSS ≥ 50 (i.e., GSS-positive) were considered HRD-positive as previously validated [<span>3</span>] (Figure 1A).</p><p>GSS-positive tumours were detected in 198 (33.6%) of our patients while t<i>BRCA1/2</i> mutations were detected in 113 (19.2%) (Figure 1B). Collectively, 241 patients (41%) were diagnosed as HRD-positive EOC at a median turnaround time of 13 days (range 8–26 days).</p><p>We examined the contribution of the GSS score and t<i>BRCA1/2</i> status to the overall HRD positivity (Figure 1B). In total, 128 patients (21.7%) were positive due to a positive GSS score alone without identified t<i>BRCA1/2</i> mutations. Meanwhile, 43 (7.3%) were HRD-positive due to having <i>BRCA1/2</i> mutations with a negative GSS score. Expectedly, the majority (62%) of patients with <i>BRCA</i> mutations had a positive GSS score, and the majority (80.7%) of patients with <i>BRCA</i> variants of uncertain significance (VUS) were GSS-negative (Figure 1B).</p><p>There was no significant difference in HRD-positive rate in younger age (< 50-year-old) compared to older (63 (38.2%) vs. 178 (42%), <i>p</i> = 0.42) neither in the rate of GSS-positive (51 (30.9%) vs. 147 (34.7%), <i>p</i> = 0.38). However, we identified a significant trend for increasing the rate of HRD-positive across age categories with the highest at age category 40 to < 60 years and lowest at under 40 years (46% vs. 24%, <i>p</i><sub>trend</sub> = 0.034) (Figure 1C).</p><p>We also examined the differences among <i>BRCA1</i>/2 mutations in relation to the GSS score. Intriguingly, patients with <i>BRCA1<","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 13","pages":"2304-2306"},"PeriodicalIF":4.3,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.70052","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145234974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>Excessive bleeding after childbirth, known as postpartum haemorrhage (PPH), remains a leading cause of maternal mortality worldwide. Of the estimated 260,000 maternal deaths in 2023, nearly 45,000 were attributable to PPH [<span>1</span>]. In October 2023, the World Health Organization (WHO) and several partners launched the <i>Roadmap to Combat Postpartum Haemorrhage between 2023 and 2030</i>, a unifying strategy to galvanise action across PPH research, norms, implementation, and advocacy [<span>2</span>]. The Roadmap called on governments, funders, academia, professional societies, industry and innovators, women's groups and civil society to accelerate action for PPH priorities. While this call to action has mobilised the global community toward a more proactive PPH agenda, persistent implementation gaps, systemic inequities, and geopolitical stressors continue to limit progress. To spotlight PPH as a preventable cause of maternal death, a World PPH Day was proposed as an annual global advocacy activity to keep Roadmap objectives on track [<span>3</span>]. As we approach 5 October 2025, the inaugural World PPH Day, the maternal health community is uniting behind a renewed call to action. This commentary reflects on progress since the launch of the Roadmap, highlights lessons from country experiences, and outlines why urgent, coordinated action is necessary to realise its promise.</p><p>Global maternal mortality has declined by 41% between 2000 and 2023 [<span>4</span>]. Reductions in deaths from PPH have contributed significantly to this progress. Yet gains remain uneven. While high-income countries have seen dramatic declines, women in sub-Saharan Africa and South Asia continue to die at disproportionately high rates from PPH, despite availability of effective preventive, diagnostic and treatment measures. These deaths reflect systemic weaknesses, including overburdened health systems, fragile supply chains, and poor quality or inconsistent availability of essential medicines that leave providers unprepared for emergencies.</p><p>Proven solutions to PPH have failed to gain traction due to persistent gaps in policy and programme implementation that are compounded by inadequate domestic funding. Quality-assured essential PPH medicines such as uterotonics, tranexamic acid (TXA), and iron supplements; trained providers; and functional emergency response systems, including blood transfusion facilities, are still not readily available in many high-burden countries. Global stressors such as geopolitical instability, shrinking development funding, climate shocks, and persistent gender inequalities exacerbate these vulnerabilities. In fragile and conflict-affected settings, women face the highest risks, as skilled birth attendance, life-saving PPH commodities and emergency obstetric care are often inaccessible [<span>4</span>].</p><p>Since its launch, the PPH Roadmap has catalysed progress across four strategic areas: research, norms and standards,
{"title":"World Postpartum Haemorrhage Day: Renewing the Global Call to End Deaths From Postpartum Haemorrhage","authors":"PPH Roadmap Advocacy Working Group","doi":"10.1111/1471-0528.70007","DOIUrl":"10.1111/1471-0528.70007","url":null,"abstract":"<p>Excessive bleeding after childbirth, known as postpartum haemorrhage (PPH), remains a leading cause of maternal mortality worldwide. Of the estimated 260,000 maternal deaths in 2023, nearly 45,000 were attributable to PPH [<span>1</span>]. In October 2023, the World Health Organization (WHO) and several partners launched the <i>Roadmap to Combat Postpartum Haemorrhage between 2023 and 2030</i>, a unifying strategy to galvanise action across PPH research, norms, implementation, and advocacy [<span>2</span>]. The Roadmap called on governments, funders, academia, professional societies, industry and innovators, women's groups and civil society to accelerate action for PPH priorities. While this call to action has mobilised the global community toward a more proactive PPH agenda, persistent implementation gaps, systemic inequities, and geopolitical stressors continue to limit progress. To spotlight PPH as a preventable cause of maternal death, a World PPH Day was proposed as an annual global advocacy activity to keep Roadmap objectives on track [<span>3</span>]. As we approach 5 October 2025, the inaugural World PPH Day, the maternal health community is uniting behind a renewed call to action. This commentary reflects on progress since the launch of the Roadmap, highlights lessons from country experiences, and outlines why urgent, coordinated action is necessary to realise its promise.</p><p>Global maternal mortality has declined by 41% between 2000 and 2023 [<span>4</span>]. Reductions in deaths from PPH have contributed significantly to this progress. Yet gains remain uneven. While high-income countries have seen dramatic declines, women in sub-Saharan Africa and South Asia continue to die at disproportionately high rates from PPH, despite availability of effective preventive, diagnostic and treatment measures. These deaths reflect systemic weaknesses, including overburdened health systems, fragile supply chains, and poor quality or inconsistent availability of essential medicines that leave providers unprepared for emergencies.</p><p>Proven solutions to PPH have failed to gain traction due to persistent gaps in policy and programme implementation that are compounded by inadequate domestic funding. Quality-assured essential PPH medicines such as uterotonics, tranexamic acid (TXA), and iron supplements; trained providers; and functional emergency response systems, including blood transfusion facilities, are still not readily available in many high-burden countries. Global stressors such as geopolitical instability, shrinking development funding, climate shocks, and persistent gender inequalities exacerbate these vulnerabilities. In fragile and conflict-affected settings, women face the highest risks, as skilled birth attendance, life-saving PPH commodities and emergency obstetric care are often inaccessible [<span>4</span>].</p><p>Since its launch, the PPH Roadmap has catalysed progress across four strategic areas: research, norms and standards, ","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"133 2","pages":"201-204"},"PeriodicalIF":4.3,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.70007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145209124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T. Caroline Bank, Janet Catov, Jiqiang Wu, Lynn M. Yee, David M. Haas, Rebecca McNeil, Jessica Pippen, Hyagriv N. Simhan, Uma Reddy, Robert M. Silver, Lisa Levine, George Saade, Judith Chung, Courtney D. Lynch, William A. Grobman, Kartik K. Venkatesh
<div> <section> <h3> Objective</h3> <p>To examine whether neighbourhood socioeconomic disadvantage, as measured by the Area Deprivation Index (ADI) in early pregnancy, was associated with severe maternal morbidity (SMM) at delivery hospitalisation.</p> </section> <section> <h3> Design</h3> <p>A prospective multi-site observational cohort.</p> </section> <section> <h3> Setting</h3> <p>A secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be study (nuMoM2b) across eight United States (US) sites from 2010 to 2013.</p> </section> <section> <h3> Study Design</h3> <p>Participant residential address in the first trimester was geocoded at the US census-tract level to calculate the ADI, a standardised metric of neighbourhood socioeconomic disadvantage. We used modified Poisson regression with robust error variance and adjusted for individual-level covariates: age, pre-pregnancy body mass index, chronic hypertension, and pregestational diabetes to examine the association between the ADI [modelled in quartiles from the least (quartile 1, Q1, reference) to the most (Q4) disadvantage] and SMM. Differences in the association between ADI and SMM by self-reported race and ethnicity as a social construct were evaluated with effect modification via an interaction term in the adjusted model.</p> </section> <section> <h3> Main Outcomes</h3> <p>SMM, based on the US Centers for Disease Control and Prevention definition, and secondarily, SMM without transfusion.</p> </section> <section> <h3> Results</h3> <p>Among 9588 nulliparas, 2.3% (<i>n</i> = 221) experienced any SMM and 0.5% (<i>n</i> = 48) experienced non-transfusion SMM. Individuals living in the most disadvantaged neighbourhoods (Q4) were more likely to experience SMM compared with those in the least disadvantaged neighbourhoods (Q1) (3.4% vs. 2.1%; aRR 1.73; 95% CI: 1.17, 2.58). This association was also significant for non-transfusion SMM (1.0% vs. 0.3%; aRR: 2.82; 95% CI 1.15, 6.93). Individuals who self-identified as non-Hispanic Black were more likely to experience SMM than non-Hispanic White individuals (3.9% vs. 2.1%; <i>p</i> < 0.001). There was no evidence of effect modification by self-reported race and ethnicity (interaction <i>p</i> > 0.05).</p> </section> <section> <h3> Conclusion</h3>
{"title":"Neighbourhood Socioeconomic Disadvantage and Severe Maternal Morbidity: Secondary Analysis of a Prospective Cohort","authors":"T. Caroline Bank, Janet Catov, Jiqiang Wu, Lynn M. Yee, David M. Haas, Rebecca McNeil, Jessica Pippen, Hyagriv N. Simhan, Uma Reddy, Robert M. Silver, Lisa Levine, George Saade, Judith Chung, Courtney D. Lynch, William A. Grobman, Kartik K. Venkatesh","doi":"10.1111/1471-0528.70024","DOIUrl":"10.1111/1471-0528.70024","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To examine whether neighbourhood socioeconomic disadvantage, as measured by the Area Deprivation Index (ADI) in early pregnancy, was associated with severe maternal morbidity (SMM) at delivery hospitalisation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A prospective multi-site observational cohort.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>A secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-To-Be study (nuMoM2b) across eight United States (US) sites from 2010 to 2013.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Design</h3>\u0000 \u0000 <p>Participant residential address in the first trimester was geocoded at the US census-tract level to calculate the ADI, a standardised metric of neighbourhood socioeconomic disadvantage. We used modified Poisson regression with robust error variance and adjusted for individual-level covariates: age, pre-pregnancy body mass index, chronic hypertension, and pregestational diabetes to examine the association between the ADI [modelled in quartiles from the least (quartile 1, Q1, reference) to the most (Q4) disadvantage] and SMM. Differences in the association between ADI and SMM by self-reported race and ethnicity as a social construct were evaluated with effect modification via an interaction term in the adjusted model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcomes</h3>\u0000 \u0000 <p>SMM, based on the US Centers for Disease Control and Prevention definition, and secondarily, SMM without transfusion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 9588 nulliparas, 2.3% (<i>n</i> = 221) experienced any SMM and 0.5% (<i>n</i> = 48) experienced non-transfusion SMM. Individuals living in the most disadvantaged neighbourhoods (Q4) were more likely to experience SMM compared with those in the least disadvantaged neighbourhoods (Q1) (3.4% vs. 2.1%; aRR 1.73; 95% CI: 1.17, 2.58). This association was also significant for non-transfusion SMM (1.0% vs. 0.3%; aRR: 2.82; 95% CI 1.15, 6.93). Individuals who self-identified as non-Hispanic Black were more likely to experience SMM than non-Hispanic White individuals (3.9% vs. 2.1%; <i>p</i> < 0.001). There was no evidence of effect modification by self-reported race and ethnicity (interaction <i>p</i> > 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 ","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 13","pages":"2256-2264"},"PeriodicalIF":4.3,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.70024","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145189490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yi Xiong, Wenrui Huang, Chenxin Wang, Wenjun Ma, Sufang Jin, Jin Lin, Xiaohua Deng, Yingfeng Peng, Yuchang Huang, Xuelian Du, Xia Han
Background
Endometriosis (EMs) is a common gynaecological condition with high recurrence rates after fertility-preserving laparoscopic surgery, and optimal postoperative medical treatment remains unclear.
Objectives
To evaluate the efficacy and safety of various postoperative medical treatments in reducing recurrence, pain and adverse events in EMs patients after fertility-preserving surgery.
Search Strategy
PubMed, Web of Science, CENTRAL and Embase databases searched until August 1, 2024.
Selection Criteria
Randomised controlled trials (RCTs) involving women aged 20–45 years post-fertility-preserving laparoscopic surgery, comparing single postoperative medications with a minimum follow-up of 2 months.
Data Collection and Analysis
Two reviewers independently extracted data and assessed quality using ROB 2.0 and CINeMA. Bayesian network meta-analysis calculated odds ratios (OR) and mean differences (MD) for recurrence rates, VAS pain reduction and adverse events.
Main Results
Sixteen RCTs (n = 1605 participants) evaluated 10 drugs: danazol, desogestrel, dienogest, gestrinone, goserelin, leuprolide, LNG-IUS, medroxyprogesterone, oral contraceptives and triptorelin. Only LNG-IUS significantly reduced recurrence rates (OR 0.12, 95% CI 0.02–0.63) and showed the greatest reduction in VAS pain scores (MD −24.96, 95% CI −41.76 to −8.75). Danazol significantly increased weight gain, and goserelin increased hot flashes.
Conclusions
LNG-IUS combined with laparoscopic surgery appears most effective in reducing recurrence and pain in EMs patients. Danazol and goserelin should be used cautiously due to notable adverse effects.
背景子宫内膜异位症（EMs）是一种常见的妇科疾病，在保留生育能力的腹腔镜手术后具有高复发率，最佳的术后药物治疗尚不清楚。目的评价各种术后药物治疗在减少保生育手术后EMs患者复发、疼痛和不良事件方面的疗效和安全性。检索STRATEGYPubMed， Web of Science， CENTRAL和Embase数据库，检索截止日期为2024年8月1日。选择标准：随机对照试验（rct）纳入年龄在20-45岁的保留生育能力的腹腔镜手术后妇女，比较术后单一药物治疗和至少2个月的随访。数据收集和分析两名评论者独立提取数据并使用ROB 2.0和CINeMA评估质量。贝叶斯网络荟萃分析计算复发率、VAS疼痛减轻和不良事件的优势比（OR）和平均差异（MD）。主要结果16项随机对照试验（n = 1605名受试者）评估了10种药物：达那唑、地格孕酮、地诺孕酮、戈舍瑞林、左炔脲、LNG-IUS、甲羟孕酮、口服避孕药和雷普妥林。只有LNG-IUS显著降低复发率（OR 0.12, 95% CI 0.02-0.63）， VAS疼痛评分降低幅度最大（MD -24.96, 95% CI -41.76 ~ -8.75）。达那唑显著增加体重，戈舍林增加潮热。结论slng - ius联合腹腔镜手术对减少EMs患者的复发和疼痛最有效。达那唑和戈舍林有明显的不良反应，应谨慎使用。
{"title":"Effectiveness and Safety of Postoperative Medical Treatments Following Fertility-Preserving Surgery for Endometriosis: A Network Meta-Analysis","authors":"Yi Xiong, Wenrui Huang, Chenxin Wang, Wenjun Ma, Sufang Jin, Jin Lin, Xiaohua Deng, Yingfeng Peng, Yuchang Huang, Xuelian Du, Xia Han","doi":"10.1111/1471-0528.70016","DOIUrl":"10.1111/1471-0528.70016","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Endometriosis (EMs) is a common gynaecological condition with high recurrence rates after fertility-preserving laparoscopic surgery, and optimal postoperative medical treatment remains unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To evaluate the efficacy and safety of various postoperative medical treatments in reducing recurrence, pain and adverse events in EMs patients after fertility-preserving surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Search Strategy</h3>\u0000 \u0000 <p>PubMed, Web of Science, CENTRAL and Embase databases searched until August 1, 2024.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Selection Criteria</h3>\u0000 \u0000 <p>Randomised controlled trials (RCTs) involving women aged 20–45 years post-fertility-preserving laparoscopic surgery, comparing single postoperative medications with a minimum follow-up of 2 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Collection and Analysis</h3>\u0000 \u0000 <p>Two reviewers independently extracted data and assessed quality using ROB 2.0 and CINeMA. Bayesian network meta-analysis calculated odds ratios (OR) and mean differences (MD) for recurrence rates, VAS pain reduction and adverse events.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Results</h3>\u0000 \u0000 <p>Sixteen RCTs (<i>n</i> = 1605 participants) evaluated 10 drugs: danazol, desogestrel, dienogest, gestrinone, goserelin, leuprolide, LNG-IUS, medroxyprogesterone, oral contraceptives and triptorelin. Only LNG-IUS significantly reduced recurrence rates (OR 0.12, 95% CI 0.02–0.63) and showed the greatest reduction in VAS pain scores (MD −24.96, 95% CI −41.76 to −8.75). Danazol significantly increased weight gain, and goserelin increased hot flashes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>LNG-IUS combined with laparoscopic surgery appears most effective in reducing recurrence and pain in EMs patients. Danazol and goserelin should be used cautiously due to notable adverse effects.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"133 2","pages":"253-262"},"PeriodicalIF":4.3,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Linked article: This is a mini commentary on Kingdon et al., pp. 2024–2039 in this issue. To view this article, visit https://doi.org/10.1111/1471-0528.18269.
链接文章：这是本期对Kingdon et al., pp. 2024-2039的迷你评论。要查看本文，请访问https://doi.org/10.1111/1471-0528.18269。
{"title":"Boosting the Signal-to-Noise Ratio: Core Information for Caesarean Birth","authors":"Susan P. Walker","doi":"10.1111/1471-0528.70012","DOIUrl":"10.1111/1471-0528.70012","url":null,"abstract":"<p><b>Linked article:</b> This is a mini commentary on Kingdon et al., pp. 2024–2039 in this issue. To view this article, visit https://doi.org/10.1111/1471-0528.18269.</p>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"132 13","pages":"2040-2041"},"PeriodicalIF":4.3,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Larissa I. van der Windt, Jim A. L. Meliezer, Eva Pajkrt, Marc E. A. Spaanderman, Hubertina C. J. Scheepers, Ben W. Mol, Martijn A. Oudijk, Anita C. J. Ravelli, Carolien Roos
Objective
To evaluate school performance at 12 years of age in children prenatally exposed to maintenance tocolysis with nifedipine versus placebo.
Design
12-year follow-up of the multicentre APOSTEL 2 trial, in which participants with threatened preterm birth between 26+0 and 32+2 weeks of gestation, who remained pregnant after initial 48-h tocolysis, were randomised to nifedipine maintenance tocolysis or placebo for up to 12 days.
Setting
The APOSTEL 2 trial was conducted in 11 Dutch hospitals from 2008 to 2010. School outcomes were assessed at age 12.
Participants
Children from singleton and multiple pregnancies born to APOSTEL 2 participants.
Methods
School performance data were received through linkage with a national registry (Statistics Netherlands).
Main Outcome Measures
A high track recommendation for secondary school, adjusted for maternal education level, socioeconomic status, and child's biological sex.
Results
Of 492 eligible children, 357 were included (follow-up rate 73%). In the nifedipine group, significantly fewer children received a high track recommendation for secondary school, 67/189 (35.4%), compared to 74/168 (44.0%) in the placebo group (adjusted risk ratio (aRR) 0.76; 95% confidence interval (CI) 0.61–0.95). Outcomes were significantly poorer in children with the longest nifedipine exposure (9–14 days) compared to those not exposed (aRR 0.58; 95% CI 0.41–0.83).
Conclusions
Children prenatally exposed to maintenance tocolysis with nifedipine had significantly poorer school performance at 12 years of age compared to those exposed to placebo. These findings further discourage nifedipine's use for maintenance tocolysis, and more research is warranted regarding its long-term effects on child development.
目的评价产前使用硝苯地平与安慰剂进行维持性早孕的12岁儿童的学业表现。设计对多中心APOSTEL 2试验进行了12年的随访，在该试验中，妊娠26+0至32+2周的先兆早产患者，在最初48小时的分娩后仍然怀孕，随机分配到硝苯地平维持性分娩组或安慰剂组，最长12天。APOSTEL 2试验于2008年至2010年在荷兰11家医院进行。在12岁时评估学校成绩。APOSTEL 2参与者所生的单胎和多胎儿童。方法通过与国家登记处（荷兰统计局）的联系接收学校绩效数据。主要结局指标：根据母亲教育水平、社会经济地位和儿童生理性别调整后的中学高跟踪推荐。结果在492例符合条件的儿童中，纳入357例（随访率73%）。在硝苯地平组中，获得中学高跟踪推荐的儿童明显减少，为67/189(35.4%)，而安慰剂组为74/168(44.0%)(调整风险比（aRR） 0.76；95%置信区间（CI） 0.61-0.95)。硝苯地平暴露时间最长的儿童（9-14天）的预后明显较未暴露儿童差（aRR 0.58; 95% CI 0.41-0.83）。结论产前使用硝苯地平进行维持性早孕的儿童在12岁时的学习成绩明显低于安慰剂组。这些发现进一步劝阻硝苯地平用于维持性分娩，并且需要对其对儿童发育的长期影响进行更多的研究。
{"title":"School Performance After Maintenance Tocolysis With Nifedipine for Threatened Preterm Birth: 12-Year Follow-Up of the APOSTEL 2 Trial","authors":"Larissa I. van der Windt, Jim A. L. Meliezer, Eva Pajkrt, Marc E. A. Spaanderman, Hubertina C. J. Scheepers, Ben W. Mol, Martijn A. Oudijk, Anita C. J. Ravelli, Carolien Roos","doi":"10.1111/1471-0528.70030","DOIUrl":"10.1111/1471-0528.70030","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate school performance at 12 years of age in children prenatally exposed to maintenance tocolysis with nifedipine versus placebo.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>12-year follow-up of the multicentre APOSTEL 2 trial, in which participants with threatened preterm birth between 26<sup>+0</sup> and 32<sup>+2</sup> weeks of gestation, who remained pregnant after initial 48-h tocolysis, were randomised to nifedipine maintenance tocolysis or placebo for up to 12 days.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Setting</h3>\u0000 \u0000 <p>The APOSTEL 2 trial was conducted in 11 Dutch hospitals from 2008 to 2010. School outcomes were assessed at age 12.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Participants</h3>\u0000 \u0000 <p>Children from singleton and multiple pregnancies born to APOSTEL 2 participants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p><b>S</b>chool performance data were received through linkage with a national registry (Statistics Netherlands).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Outcome Measures</h3>\u0000 \u0000 <p>A high track recommendation for secondary school, adjusted for maternal education level, socioeconomic status, and child's biological sex.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 492 eligible children, 357 were included (follow-up rate 73%). In the nifedipine group, significantly fewer children received a high track recommendation for secondary school, 67/189 (35.4%), compared to 74/168 (44.0%) in the placebo group (adjusted risk ratio (aRR) 0.76; 95% confidence interval (CI) 0.61–0.95). Outcomes were significantly poorer in children with the longest nifedipine exposure (9–14 days) compared to those not exposed (aRR 0.58; 95% CI 0.41–0.83).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Children prenatally exposed to maintenance tocolysis with nifedipine had significantly poorer school performance at 12 years of age compared to those exposed to placebo. These findings further discourage nifedipine's use for maintenance tocolysis, and more research is warranted regarding its long-term effects on child development.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"133 2","pages":"334-344"},"PeriodicalIF":4.3,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.70030","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182657","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The Weight of Evidence—BMI and the Burden on Pelvic Floor Function: A Commentary","authors":"Charlotte S. Goutallier, Peter L. Dwyer","doi":"10.1111/1471-0528.70038","DOIUrl":"10.1111/1471-0528.70038","url":null,"abstract":"","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"133 2","pages":"208-210"},"PeriodicalIF":4.3,"publicationDate":"2025-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145140164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Deepthika Jeyaraman, Dimuth P. Peiris, Mark Lambie, Kate Bramham, Richard Fish, Haia Alahmdi, Mamas A. Mamas, Pensée Wu
Background
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.
Objective
To quantify and perform a meta-analysis of the risk of adverse cardiovascular and renal outcomes following AKI in pregnancy.
Search Strategy
A systematic search of MEDLINE, Cochrane Library and EMBASE from inception until 23 January 2024.
Selection Criteria
Studies investigating adverse cardiovascular and renal outcomes in pregnant patients with AKI.
Data Collection and Analysis
Two reviewers independently performed screening, data extraction and quality assessment. A random-effects model was used to estimate risk.
Main Results
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.
Conclusions
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.
背景：妊娠期急性肾损伤（AKI）与母体和胎儿的不良结局相关。然而，关于妊娠期AKI与心脏和肾脏预后相关的证据有限。目的对妊娠期AKI后心血管和肾脏不良结局的风险进行量化和荟萃分析。检索策略：对MEDLINE、Cochrane图书馆和EMBASE进行系统检索，从成立到2024年1月23日。选择标准：调查妊娠AKI患者心血管和肾脏不良结局的研究。数据收集和分析两名审稿人独立进行筛选、数据提取和质量评估。采用随机效应模型估计风险。主要结果共纳入17项研究，纳入孕妇50 285 836例，其中36 806例发生AKI。我们的证据综合显示，妊娠期AKI与复合不良肾脏结局风险增加52倍（OR 52.37; 95% CI 4.67-587.63）、心力衰竭风险增加23倍（OR 22.55; 95% CI 4.39-115.71）和卒中风险增加23倍（OR 22.92; 95% CI 2.32-226.65）以及孕产妇死亡风险增加9.3倍和3.9倍（OR 9.26; 95% CI 2.53-33.96）和重症监护病房入院风险增加（OR 3.86; 95% CI 1.93-7.71）相关。结论：研究表明妊娠期AKI与心血管和肾脏不良结局相关。妊娠期AKI患者的仔细监测和随访可能有助于早期发现和管理一些不良的心血管和肾脏结局。
{"title":"Cardiovascular and Renal Outcomes Following Acute Kidney Injury in Pregnancy: A Systematic Review and Meta-Analysis","authors":"Deepthika Jeyaraman, Dimuth P. Peiris, Mark Lambie, Kate Bramham, Richard Fish, Haia Alahmdi, Mamas A. Mamas, Pensée Wu","doi":"10.1111/1471-0528.18352","DOIUrl":"10.1111/1471-0528.18352","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To quantify and perform a meta-analysis of the risk of adverse cardiovascular and renal outcomes following AKI in pregnancy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Search Strategy</h3>\u0000 \u0000 <p>A systematic search of MEDLINE, Cochrane Library and EMBASE from inception until 23 January 2024.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Selection Criteria</h3>\u0000 \u0000 <p>Studies investigating adverse cardiovascular and renal outcomes in pregnant patients with AKI.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Data Collection and Analysis</h3>\u0000 \u0000 <p>Two reviewers independently performed screening, data extraction and quality assessment. A random-effects model was used to estimate risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Main Results</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":50729,"journal":{"name":"Bjog-An International Journal of Obstetrics and Gynaecology","volume":"133 1","pages":"44-51"},"PeriodicalIF":4.3,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.18352","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145134131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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