ObjectiveTo systematically review the clinical efficacy and effects on pregnancy outcomes of S-adenosy-L-methionine combined with ursodesoxycholic acid in the treatment of intrahepatic cholestasis of pregnancy. MethodsDatabases such as PubMed, The Cochrane Library, CNKI, VIP, WanFang Data were searched for the studies about the clinical efficacy and effects on pregnancy outcomes of S-adenosy-L-methionine combined with ursodesoxycholic acid in the treatment of intrahepatic cholestasis of pregnancy up to December 31st, 2013. Two reviewers independently screened literature, extracted data and evaluated methodological quality. Then meta-analysis was conducted using RevMan 5.0.24 software. ResultsA total of 11 RCTs involving 776 patients were included. The results of meta-analysis showed that, combined medication reduced blood biochemical indexes inlcuding ALT (MD=3.63, 95%CI 0.63 to 6.64, P=0.02), TB (MD=3.70, 95%CI 1.45 to 5.96, P=0.001), and AST (MD=7.61, 95%CI 2.47 to 12.75, P=0.004). Combined therapy significantly decreased the rates of amniotic fluid contamination (OR=0.29, 95%CI 0.19 to 0.45, P=0.000 01), cesarean section (OR=0.53, 95%CI 0.36 to 0.79, P=0.002), postpartum hemorrhage (OR=0.32, 95%CI 0.12 to 0.90, P=0.03), preterm birth (OR=0.36, 95%CI 0.24 to 0.55, P < 0.000 01), fetal distress (OR=0.33, 95%CI 0.19 to 0.58, P=0.000 1) and neonates asphyxia (OR=0.30, 95%CI 0.19 to 0.47, P < 0.000 01). Combined therapy was also beneficial to improving pruritus symptoms (MD=0.20, 95%CI 0.08 to 0.31, P=0.000 08) and benefiting fetus growth (MD=0.45, 95%CI 0.23 to 0.66, P < 0.000 1). ConclusionThe combination of S-adenosy-L-methionine and ursodesoxycholic acid is superior to ursodesoxycholic acid alone in improving clinical symptoms and pregnant outcomes of patients with intrahepatic cholestasis of pregnancy.
Objective To overview the systematic review (SR) of the effects of dietary pattern intervention during pregnancy on pregnant women with gestational diabetes mellitus (GDM). Methods The Cochrane Library, The Joanna Briggs Institute Library, Embase, PubMed, Web of Science, CINAHL, CBM, CNKI, WanFang Data, and VIP databases were electronically searched to collect SR and meta-analysis on the effects of different dietary patterns on maternal and infant outcomes of gestational diabetes mellitus from inception to October 1, 2024. Two reviewers independently screened literature, extracted data, and then AMSTAR 2 tool was used to assess the methodological quality of included studies. Meta-analysis was performed by using RevMan 5.3 software. Results A total of 15 relevant SR were included, the methodological quality of the included SR was generally low, with 3 SR at a low level and 12 SR at a very low level. Major dietary patterns included the low glycemic index (GI) diet, carbohydrate (CHO) restricted diet, energy restricted diet, dietary approaches to stop hypertension (DASH) diet, high-fiber diet, polyunsaturated fatty acid (PUFA) rich diet, soy protein-enriched diet, low glycemic load (GL) diet, and mediterranean diet. A meta-analysis of primary outcome measures showed that the low GI diet, DASH diet and low GL load diet had a lower incidence of blood glucose levels and adverse pregnancy outcomes (including maternal weight gain, insulin use, cesarean section, macrosomia) compared with the control diets. Conclusion It was recommended that GDM pregnant women follow the low GI diet, DASH diet, or low GL diet to control blood glucose levels and improve pregnancy outcomes. There is currently insufficient evidence to support the effects of other dietary patterns on GDM.
Objective To study the advances in research of breast cancer during pregnancy. Methods The literatures in recent years were reviewed. Results A lot of evidences suggested that the diagnosis may be delayed easily. The diagnosis was primarily made by needle aspiration cytology and biopsy. The treatment of pregnant breast cancer was not different from ordinary breast cancer, however the factor of foetus should be taken into account. Termination of pregnancy did not improve survival. Conclusion Pregnant breast cancer is mostly at later stage at the time of diagnosis and has poorer prognosis than ordinary breast cancer. The patients with breast cancer during pregnancy usually have an equivalent survival rate when compared with age and stagematched ordinary group. Future pregnancy may be allowed after two years of treatment in patients with early breast cancer.
Objective To summarize the recent studies on diagnosis and treatment for pregnancy-associated breast cancer （PABC） to provide evidence for diagnosis and treatment for PABC. Methods By PubMed， Medline， and CNKI retrieval system， with “pregnancy-associated breast cancer or PABC， diagnosis of pregnancy-associated breast cancer or PABC， treatment of pregnancy-associated breast cancer or PABC” as key words to retrieval for the recent researches about PABC. All of the publications about studies on diagnosis and treatment for PABC were reviewed and summarized. Results Diagnosis of PABC included ultrasound， mammography， magnetic resonance imaging， needle biopsy， and so on， and the treatment contained surgery， chemotherapy， endocrine therapy， radiation therapy， and targeted therapy. However， when diagnosis and treatment for PABC involved， the impact to patients with pregnancy and fetus must be considered in priority. Conclusions By reviewing the studies of relevant papers about diagnosis and treatment for PABC which can provide a clinical guidance for clinicians. Usage of bevacizumab and lapatinib still needs to further be studied.
ObjectiveTo explore whether the vaginal environment changes of pregnant women were correlated with pathogenesis of fungal vaginitis. MethodsWe selected 166 women in their early pregnancy in the Obstetrics and Gynaecology Clinic between July 2011 and July 2012 as the study objects (excluding fungal vaginitis patients already confirmed). Two important indicators of changes in pH and the amount of vaginal lactobacilli were chosen to determine changes in the vaginal environment. Using prospective study method, by checking changes in the vaginal environment, the objects were divided into two groups: 96 were in the changing environment group, and 70 were in the normal environment group. Sixty seven of them had a pH value lower or equal to 4.0, and 99 higher than 4.0. Fifty-eight of them had a reduced amount of lactobacillus, and 108 had a normal amount of lactobacillus. The rate of fungal vaginitis in each group was counted. ResultsThe morbidity rate in patients whose pH value was lower than or equal to 4.0 was 17.9% (12/67), while it was 6.1% (6/99) in patients with a pH value higher than 4.0, and the difference was significant (χ2=5.804, P=0.016). The morbidity rate in patients with a reduced amount of lactobacillus was 25.9% (15/58), and it was 2.8% (3/108) in patients with normal lactobacillus, and the difference was also significant (χ2=20.800, P=0.000). The morbidity rate for patients with changing vaginal environment was 16.7% (16/96), and for those with normal environment was 2.9% (2/70), and the difference was significant (χ2=7.985, P=0.005). In those with normal lactobacillus, the reduction of pH value was not correlated with the occurrence of fungal vaginitis (χ2=0.000, P=1.000). ConclusionThe vaginal environment changes during pregnancy (pH value decrease and Lactobacillus decrease) are associated with the incidence of fungal vaginitis, and it can be prevented and treated based on this phenomenon.
Objective To systematically review the association between periodontal disease during pregnancy and the risk of gestational diabetes mellitus (GDM). Methods PubMed, Web of Science, CBM and CNKI databases were electronically searched to collect studies on periodontal disease and GDM from inception to October 23, 2021. Two researchers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.4 software. Results A total of 11 studies were included, involving 2 910 pregnant women. The results of meta-analysis showed that pregnant women with periodontal disease during pregnancy reported more GDM than normal pregnant women (OR=1.81, 95%CI 1.31 to 2.50, P=0.000 3). Conclusion The current evidence suggests that there is a positive association between periodontal disease during pregnancy and the risk of GDM. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.
Objective To formulate an evidence-based treatment plan for a patient with gestational diabetes mellitus. Methods Based on the clinical questions raised from a real-life patient of gestational diabetes mellitus, we searched ACP Journal Club (1991 to Dec. 2006), The Cochrane Library (Issue 4, 2006), MEDLINE (1966 to Dec. 2006) and Chinese Biological Medical Database (1980 to Dec. 2006) for systematic reviews, randomized controlled trials, cohort and case-control studies. We used the following keywords: gestational diabetes, metformin, and pregnancy complication. The quality of the included studies was assessed.Results One meta-analysis (from MEDLINE) and two randomized controlled trials (from the Cochrane Central Register of Controlled Trials) were included. These studies concluded that there was no clear evidence on the benefits of metformin for gestational diabetes. Based on the current evidence, integrated with clinical expertise and the patient’s values, metformin was not used for this patient. Instead, intensive dietary control, blood glucose control, and appropriate exercise were administered. After this individual treatment, the patient gave birth to a healthy baby in 39+4 Weeks. Conclusion The appropriate management for gestational diabetes mellitus has been formulated with the approach of evidence-based medicine. Large-scale, methodologically-sound trials are required.
Objective To compare the economic effectiveness of universal screening, high-risk population screening, and no screening strategies for thyroid disease prevention and control among pregnant women in China through cost-effectiveness analysis, providing evidence-based support for optimizing health policy decisions on prenatal thyroid disease screening. Methods Based on the characteristics of thyroid disorders during pregnancy, a combined decision tree and Markov model was developed to conduct a lifetime cost-effectiveness analysis across three strategies: no screening, high-risk population screening, and universal screening. Sensitivity analyses were performed on key parameters. Results Base-case analysis demonstrated that universal screening was the most cost-effective strategy when the World Health Organization (WHO)-recommended payment threshold of 1×gross domestic product (GDP) per capita was used, with an incremental cost-effectiveness ratio (ICER) of 20636.18 yuan per quality-adjusted life year (QALY) compared to no screening, followed by high-risk population screening (ICER=21071.71 yuan/QALY). The results of the sensitivity analysis showed a strong stability of the model. Conclusions Of the 3 screening programs for thyroid disease in pregnancy, universal screening is the most cost-effective when the WHO-recommended payment threshold of 1×GDP per capita is used.