Association of pregnancy complications/risk factors with the development of future long-term health conditions in women: overarching protocol for umbrella reviews

Abstract

IntroductionWith good medical care, most pregnancy complications like pre-eclampsia, gestational diabetes, etc resolve after childbirth. However, pregnancy complications are known to be associated with an increased risk of new long-term health conditions for women later in life, such as cardiovascular disease. These umbrella reviews aim to summarise systematic reviews evaluating the association between pregnancy complications and five groups of long-term health conditions: autoimmune conditions, cancers, functional disorders, mental health conditions and metabolic health conditions (diabetes and hypertension).Methods and analysisWe will conduct searches in Medline, Embase and the Cochrane database of systematic reviews without any language restrictions. We will include systematic reviews with or without meta-analyses that studied the association between pregnancy complications and the future risk of the five groups of long-term health conditions in women. Pregnancy complications were identified from existing core outcome sets for pregnancy and after consultation with experts. Two reviewers will independently screen the articles. Data will be synthesised with both narrative and quantitative methods. Where a meta-analysis has been carried out, we will report the combined effect size from individual studies. For binary data, pooled ORs with 95% CIs will be presented. For continuous data, we will use the mean difference with 95% CIs. The findings will be presented in forest plots to assess heterogeneity. The methodological quality of the studies will be evaluated with the AMSTAR 2 tool or the Cochrane risk of bias tool. The corrected covered area method will be used to assess the impact of overlap in reviews. The findings will be used to inform the design of prediction models, which will predict the risk of women developing these five group of health conditions following a pregnancy complication.Ethics and disseminationNo ethical approvals required. Findings will be disseminated through publications in peer-reviewed journals and conference presentations.

Autoimmune diseases and adverse pregnancy outcomes: an umbrella review

“…There was also a significantly higher odds of neonatal mortality for women with T1DM OR 2.26 (1.74–2.95) or Sjögren’s syndrome OR 1.77 (1.28–2.46). Psoriasis was not significantly related to neonatal mortality (OR 1.13 (0.90–1.43)) (Table 4 ) [ 5 , 42 , 43 ].…”

“…Secondly, we included a wide range of autoimmune conditions and adverse pregnancy outcomes which were identified by scoping searches of the literature and after consultation with subject experts, making this review more relevant and useful. Definitions of the outcomes for inclusion were predefined so that these were uniform across the systematic reviews [ 43 ]. The summary estimates have been converted to odds ratios where possible to facilitate the interpretation of the results.…”

“…The outcomes included were adverse pregnancy outcomes which were considered after consultations with experts (obstetricians and epidemiologists) and after input from patient public involvement and engagement (PPIE) group members. The outcomes definitions were defined prior [ 43 ], and definitions were compared between the reviews. The outcomes are listed in Table 1 .…”

Association between pregnancy-related complications and development of type 2 diabetes and hypertension in women: an umbrella review

“…We also registered the protocol prior to the review in PROSPERO (registration No. CRD42022323718) and the protocol has undergone peer review [ 24 ].…”