BackgroundThe global burden of postpartum hemorrhage (PPH) in women with placenta previa is a major public health concern. Although there are different reports on the incidence of PPH in different countries, to date, no research has reviewed them.ObjectiveThe aim of this study was to calculate the average point incidence of PPH in women with placenta previa.MethodsA systematic review and meta-analysis of observational studies estimating PPH in women with placenta previa was conducted through literature searches in four databases in Jul 2016. This study was totally conducted according to the MOOSE guidelines and in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses standard.ResultsFrom 1148 obtained studies, 11 included in the meta-analysis, which involved 5146 unique pregnant women with placenta previa. The overall pooled incidence of PPH was 22.3% (95% CI 15.8–28.7%). In the subgroup, the prevalence was 27.4% in placenta previas, and was 14.5% in low-lying placenta previa; the highest prevalence was estimated in Northern America (26.3%, 95%CI 11.0–41.6%), followed by the Asia (20.7%, 95%CI 12.8–28.6%), Australia (19.2%, 95% CI 17.2–21.1%) and Europe (17.8%, 95% CI, 11.5%-24.0%).ConclusionsThe summary estimate of the incidence of PPH among women with placenta previa was considerable in this systematic review. The results will be crucial in prevention, treatment, and identification of PPH among pregnant women with placenta previa and will be contributed to the planning and implantation of relevant public health strategies.

Background Gestational weight gain (GWG) has implications for perinatal outcomes, the guidelines for maternal weight gain, however, remain understudied among twin pregnancies. This study aimed to assess the associations between perinatal outcomes and GWG among twin pregnancies, based on the US institute of Medicine (IOM) 2009 guidelines. Methods A retrospective cohort study of pregnant women with viable twins ≥26 weeks of gestation, was conducted in Foshan, China, during July 2015 and June 2018. Maternal BMI was categorized based on Chinese standard and GWG was categorized as below, within and above the IOM 2009 recommendations. Underweight women were excluded for analysis. Perinatal outcomes were compared among these groups. To assess the independent impact of GWG on the perinatal outcomes, conventional multivariable regression and general estimated equation (GEE) were utilized for maternal outcomes and neonatal outcomes, respectively. Results A total of 645 mothers with twin pregnancies were included, of whom 15.0, 41.4 and 43.6% gained weight below, within and above guidelines, respectively. Compared to weight gain within guidelines, inadequate weight gain was associated with increased risks in spontaneous preterm birth < 37 weeks (aOR:3.55; 95% CI: 1.73–7.28) and < 35 weeks (aOR:2.63; 95% CI: 1.16–5.97). Women who gained weight above guidelines were more likely to have gestational hypertension disorder (aOR: 2.36; 95% CI: 1.32–4.21), pre-eclampsia (aOR: 2.59; 95% CI: 1.29–5.21) and have fetuses weighted >90th percentile and less likely to have fetuses weighted < 2500 g and < 1500 g. Conclusions Maintenance of gestational weight gain within the normal range could decrease the risk of adverse perinatal outcomes. However, the causality between pre-eclampsia and gestational weight gain requires further investigations.

To what extent could alcohol consumption affects female fertility is still unclear. The aim of this study was to quantitatively summarize the dose-response relation between total and specific types of alcohol beverage (beer, wine, and spirits) consumption in female and the fecundability. Four electronic databases were searched. Observational studies (cohort and case-control) that provided female alcohol consumption and fecundity were eligible. Nineteen studies, involving 98657 women, were included in this study. Compared to non-drinkers, the combined estimate (with relative risk, RR) of alcohol consumers on fecundability was 0.87 (95% CI 0.78–0.95) for overall 19 studies. Compared to non-drinkers, the pooled estimates were 0.89 (95% CI 0.82–0.97) for light drinkers (≤12.5 g/day of ethanol) and 0.77 (95% CI 0.61–0.94) for moderate-heavy drinkers (>12.5 g/day of ethanol). Moreover, compared to non-drinkers, the corresponding estimates on fecundability were 0.98 (95% CI 0.85–1.11), 1.02 (95% CI 0.99–1.05), and 0.92 (95% CI 0.83–1.01) for studies focused on wine, beer and spirits, respectively. Dose-response meta-analysis suggested a linear association between decreased fecundability and every 12.5 g/d increasing in alcohol consumption with a RR 0.98 (95% CI 0.97–0.99). This first systematic review and meta-analysis suggested that female alcohol consumption was associated with a reduced fecundability.

The percentages of low birth weight (LBW) increased from 7.7% in 2005 to 11.3% in 2011 and declined to 8.1% in 2017. For very low birth weight (VLBW) individuals, the proportion declined −1.0% annually, from 2.5% in 2005 to 1.4% in 2017. Among moderately low birth weight (MLBW) individuals, the proportion first increased 12.8% annually, from 5.0% in 2005 to 9.3% in 2011, and then declined −3.8% annually, from 9.4% in 2011 to 7.0% in 2017. The percentages of macrosomia monotone decreased from 4.0% in 2005 to 2.5% in 2017, an annual decline of −4.0%. Multiple regression analyses showed that boys, maternal age, hypertensive disorders complicating pregnancy (HDCP), and diabetes were significant risk factors for LBW. Boys, maternal age, gestational age, HDCP, diabetes, and maternal BMI were significant risk factors for macrosomia. Although the relevant figures declined slightly in our study, it is likely that LBW and macrosomia will remain a major public health issue over the next few years in China. More research aimed at control and prevention of these risk factors for LBW and macrosomia and their detrimental outcome in the mother and perinatal child should be performed in China.

Non-syndromic orofacial clefts (NSOFC), which include cleft lip and palate (CLP), cleft lip only (CLO), and cleft palate only (CPO), contains a range of disorders affecting the lips and oral cavity. No systematic review and meta-analysis has been carried out to synthesize the prevalence of NSOFC in Chinese perinatal infants. We aimed to quantify and understand the variation of prevalence national and regional levels. Four English databases and four Chinese databases were searched using a comprehensive search strategy from inception to April 2017. The random effect model was used for this meta-analysis. To determine the sources of heterogeneity, subgroup analyses and meta-regression were conducted based on different categories. The protocol has been pre-registered in the PROSPERO, number CRD42017062293. 110 studies, including 15,094,978 Chinese perinatal infants, were eligible for inclusion. The pooled prevalence rate for NSOFC was 1.67‰ (95% CI 1.53–1.82), varying with provinces. The pooled prevalence estimate was 0.56‰ (0.50–0.63) for CLO, 0.82‰ (0.73–0.90) for CLP, and 0.27‰ (0.24–0.30) for CPO. Significant associations were found between overall prevalence estimates and survey year and study region. The prevalence of NSOFC was severe in Chinese perinatal infants, varying with provinces. The results will serve as a baseline for future assessment of the overall effectiveness of NSOFC control, and will also support and inform health policy for planning and helping health debates.

No abstract

Supplemental Digital Content is available in the text

Background The management of poor sleep during pregnancy is important for maternal and foetal health. The aim of the present study was to investigate the prevalence of poor sleep quality and risk factors for poor sleep during different trimesters of pregnancy for better management of sleep during pregnancy. Methods A cross-sectional study was conducted among pregnant women in Foshan Women’s and Children’s Hospital. In total, 2281 pregnant women were analysed, and the Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. Cluster logistic regression was used to analyse the risk factors for poor sleep among all participants, and logistic regression models were built to identify potential risk factors for poor sleep quality in different trimesters of pregnancy. Results Over half of the participants reported poor sleep quality (51.8%). The rate of poor sleep was lowest in the second trimester. Women who were unmarried had >12 years of education, exercised <3 days/week, were in the third trimester, had a high level of nausea and vomiting during pregnancy (NVP) and had a history of infertility had a higher risk of poor sleep. Pregnancy-related factors contributed most to poor sleep. In the first trimester, the main risk factors for poor sleep were a history of infertility and a high level of NVP. In the second trimester, only a high level of NVP was a risk factor for poor sleep. In the last trimester, the risk factors for poor sleep were more education years, exercise <3 days/week and high levels of NVP. Conclusion The prevalence and risk factors for poor sleep were different in different trimesters. Clinicians should screen and address poor sleep prior to the first and, especially, the third trimester of pregnancy. Management of poor sleep should be consistent throughout pregnancy and be adjusted in different trimesters.