Systematically review risks of an infant being born with low birth weight (LBW), preterm birth (PTB) or small for gestational age (SGA) among married and unmarried women. Medline, Embase, CINAHL, and bibliographies of identified articles were searched for English language studies. Studies reporting birth outcomes of married and unmarried (single and cohabitant) were included. Two reviewers independently collected data and assessed the quality of the studies for biases in sample selection, exposure assessment, confounder, analytical, outcome assessments, and attrition. Meta-analyses were performed using random effect model for both unadjusted and adjusted data and odds ratio (OR), and 95% confidence interval (CI) were calculated. Twenty-one studies of low to moderate risk of bias were included. Compared to married mothers unadjusted odds of (a) LBW was increased among unmarried (OR 1.46, 95%CI 1.25-1.71), single (OR 1.65, 95%CI 1.44-1.88) and cohabitating (OR 1.29, 95%CI 1.25-1.32) mothers; (b) PTB was increased among unmarried (OR 1.22, 95%CI 1.14-1.31), single (OR 1.54, 95%CI 1.39-1.72) and cohabitating (OR 1.15, 95%CI 1.08-1.23) mothers and (c) SGA birth was increased among unmarried (OR 1.45, 95%CI 1.32-1.61), single (OR 1.70, 95%CI 1.47-1.97) and cohabitating (OR 1.36, 95%CI 1.30-1.42) mothers. Meta-analyses of adjusted odds estimates confirmed these findings at marginally lower odds. Maternal unmarried status is associated with an increased risk of LBW, PTB and SGA births.

Background  History of induced termination of pregnancy (I‐TOP) is suggested as a precursor for infant being born low birthweight (LBW), preterm (PT) or small for gestational age (SGA). Infection, mechanical trauma to the cervix leading to cervical incompetence and scarred tissue following curettage are suspected mechanisms. Objective  To systematically review the risk of an infant being born LBW/PT/SGA among women with history of I‐TOP. Search strategy  Medline, Embase, CINAHL and bibliographies of identified articles were searched for English language studies. Selection criteria  Studies reporting birth outcomes to mothers with or without history of induced abortion were included. Data collection and analyses  Two reviewers independently collected data and assessed the quality of the studies for biases in sample selection, exposure assessment, confounder adjustment, analytical, outcome assessments and attrition. Meta‐analyses were performed using random effect model and odds ratio (OR), weighted mean difference and 95% confidence interval (CI) were calculated. Main results  Thirty‐seven studies of low–moderate risk of bias were included. A history of one I‐TOP was associated with increased unadjusted odds of LBW (OR 1.35, 95% CI 1.20–1.52) and PT (OR 1.36, 95% CI 1.24–1.50), but not SGA (OR 0.87, 95% CI 0.69–1.09). A history of more than one I‐TOP was associated with LBW (OR 1.72, 95% CI 1.45–2.04) and PT (OR 1.93, 95% CI 1.28–2.71). Meta‐analyses of adjusted risk estimates confirmed these findings. Conclusions  A previous I‐TOP is associated with a significantly increased risk of LBW and PT but not SGA. The risk increased as the number of I‐TOP increased.

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Achievement of a busulfan area-under-the-concentration versus time curve (AUC) of 900 to 1500 μM·min is associated with improved hematopoietic stem cell transplant (HSCT) outcomes. Multiple pediatric busulfan dosing guidelines aim to achieve this target. The authors' objective was to describe the AUCs achieved after simulated dosing using available pediatric i.v. busulfan dosing guidelines. The health records of children who received i.v. busulfan for HSCT conditioning at The Hospital for Sick Children were reviewed. Busulfan AUCs were calculated for each patient based on plasma busulfan concentrations using either a 1-compartment model or a validated limited-sampling strategy. Published pediatric busulfan dosing guidelines were identified. Initial busulfan doses were determined for all patients using each dosing guideline and total body weight (TBW). For overweight patients (TBW-to-ideal body weight [IBW] ≥ 1.25), initial busulfan doses were also determined using IBW and adjusted IBW (IBWadj). The resulting AUCs were simulated. The proportion of subjects (TBW/IBW < 1.25, TBW/IBW ≥ 1.25, and infants) with an AUC within target (900 to 1500 μM·min) after dosing simulation with each guideline was compared. One hundred eleven children (mean age, 6.2 years [SD, ±5.2]) who received i.v. busulfan were included. When dosing with each of the 12 i.v. busulfan dosing guidelines identified was simulated using TBW in 97 non-overweight patients, the proportion of patients with an AUC within the target range varied from 51% to 74% and from 45% to 64% in infants. Use of IBW or IBWadj to calculate initial busulfan doses in overweight children improved the performance of most guidelines. Current busulfan dosing guidelines vary in their ability to achieve AUCs within the target range. For children who are not overweight, we recommend 1 of 3 high-performing guidelines that allow individualization of the target busulfan AUC. Use of either IBW or IBWadj in overweight children improves the performance of most guidelines. Regardless of the guideline used, therapeutic drug monitoring is essential to verify achievement of the target AUC.

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