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Cholera in Pregnancy: A Systematic Review and Meta-Analysis of Fetal, Neonatal, and Maternal Mortality.

Tran NT, Taylor R, Antierens A, Staderini N - PLoS ONE (2015)

Bottom Line: Random-effect non-linear logistic regression was used to calculate pooled rates and 95% CIs by time period.Studies from the recent period (1991-2013) were compared with studies from 1969-1990.Compared with published national mortality estimates, the RR for fetal death of 5.8 (95% CIs 2.9-11.3) was calculated for Haiti (2013), 1.8 (95% CIs 0.3-10.4) for Senegal (2007), and 2.6 (95% CIs 0.5-14.9) for Peru (1991); there were no significant differences in the RR for neonatal or maternal death.

View Article: PubMed Central - PubMed

Affiliation: Médecins Sans Frontières, Geneva, Switzerland; School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia.

ABSTRACT

Background: Maternal infection with cholera may negatively affect pregnancy outcomes. The objective of this research is to systematically review the literature and determine the risk of fetal, neonatal and maternal death associated with cholera during pregnancy.

Materials and methods: Medline, Global Health Library, and Cochrane Library databases were searched using the key terms cholera and pregnancy for articles published in any language and at any time before August 2013 to quantitatively summarize estimates of fetal, maternal, and neonatal mortality. 95% confidence intervals (CIs) were calculated for each selected study. Random-effect non-linear logistic regression was used to calculate pooled rates and 95% CIs by time period. Studies from the recent period (1991-2013) were compared with studies from 1969-1990. Relative risk (RR) estimates and 95% CIs were obtained by comparing mortality of selected recent studies with published national normative data from the closest year.

Results: The meta-analysis included seven studies that together involved 737 pregnant women with cholera from six countries. The pooled fetal death rate for 4 studies during 1991-2013 was 7.9% (95% CIs 5.3-10.4), significantly lower than that of 3 studies from 1969-1990 (31.0%, 95% CIs 25.2-36.8). There was no difference in fetal death rate by trimester. The pooled neonatal death rate for 1991-2013 studies was 0.8% (95% CIs 0.0-1.6), and 6.4% (95% CIs 0.0-20.8) for 1969-1990. The pooled maternal death rate for 1991-2013 studies was 0.2% (95% CIs 0.0-0.7), and 5.0% (95% CIs 0.0-16.0) for 1969-1990. Compared with published national mortality estimates, the RR for fetal death of 5.8 (95% CIs 2.9-11.3) was calculated for Haiti (2013), 1.8 (95% CIs 0.3-10.4) for Senegal (2007), and 2.6 (95% CIs 0.5-14.9) for Peru (1991); there were no significant differences in the RR for neonatal or maternal death.

Conclusion: Results are limited by the inconsistencies found across included studies but suggest that maternal cholera is associated with adverse pregnancy outcomes, particularly fetal death. These findings can inform a research agenda on cholera in pregnancy and guidance for the timely management of pregnant women with cholera.

No MeSH data available.


Related in: MedlinePlus

Neonatal death rate with maternal cholera: study and pooled estimates per 100 pregnancies with 95% confidence intervals.
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pone.0132920.g003: Neonatal death rate with maternal cholera: study and pooled estimates per 100 pregnancies with 95% confidence intervals.

Mentions: In 1991–2013, fetal death rates associated with symptomatic maternal cholera ranged from 6.0% (95% CIs 1.9–13.9) in Peru/Saona (1991) to 11.5% (95% CIs 4.2–25.1) in Senegal (2006). In 1969–1990, fetal death rates were around 30%, with 32.8% in Nigeria (95% CIs 20.0–50.6), 33.3% in Pakistan (95% CIs 20.4–51.5), and 30.4% in India (95% CIs 23.0–39.5). Pooled meta-analysed fetal death rates by period displayed a statistically significant difference (p <0.0001) between 1991–2013 (7.9%, 95% CIs 5.3–10.4) and 1969–1990 (31.0%, CIs 25.2–36.6). Within both the 1991–2013 and 1969–1990 groups of studies, there was no statistical heterogeneity based on χ2 (p<0.05), and there was minimal non-statistical heterogeneity according to Higgins I2. Further pooled analysis of the 1991–2013 studies did not suggest a difference in risk of fetal death by trimester: first trimester: 6.2%, 95% CIs 0.9–11.4; second trimester: 9.1%, 95% CIs 3.5–14.6; third trimester: 6.7%, 95% CIs 0.7–12.8. When compared with national stillbirth estimates, results indicate an elevated relative risk (RR) of third-trimester fetal death for the cohorts in Haiti (2013) of 5.8 (95% CIs 2.9–11.4 and p<0.0001). Although the RR was elevated in Senegal (2006) at 1.8 (95% CIs 0.3–10.4), the p-value was not significant (p = 0.5295), which was also the case in Peru (1991) with a RR of 2.6 (95% CIs 0.5–14.9 and p = 0.3227). For all four studies of 1991–2013, the RR is 3.83 (95% CIs 2.08–7.05) which is significant at p<0.0001.


Cholera in Pregnancy: A Systematic Review and Meta-Analysis of Fetal, Neonatal, and Maternal Mortality.

Tran NT, Taylor R, Antierens A, Staderini N - PLoS ONE (2015)

Neonatal death rate with maternal cholera: study and pooled estimates per 100 pregnancies with 95% confidence intervals.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4503398&req=5

pone.0132920.g003: Neonatal death rate with maternal cholera: study and pooled estimates per 100 pregnancies with 95% confidence intervals.
Mentions: In 1991–2013, fetal death rates associated with symptomatic maternal cholera ranged from 6.0% (95% CIs 1.9–13.9) in Peru/Saona (1991) to 11.5% (95% CIs 4.2–25.1) in Senegal (2006). In 1969–1990, fetal death rates were around 30%, with 32.8% in Nigeria (95% CIs 20.0–50.6), 33.3% in Pakistan (95% CIs 20.4–51.5), and 30.4% in India (95% CIs 23.0–39.5). Pooled meta-analysed fetal death rates by period displayed a statistically significant difference (p <0.0001) between 1991–2013 (7.9%, 95% CIs 5.3–10.4) and 1969–1990 (31.0%, CIs 25.2–36.6). Within both the 1991–2013 and 1969–1990 groups of studies, there was no statistical heterogeneity based on χ2 (p<0.05), and there was minimal non-statistical heterogeneity according to Higgins I2. Further pooled analysis of the 1991–2013 studies did not suggest a difference in risk of fetal death by trimester: first trimester: 6.2%, 95% CIs 0.9–11.4; second trimester: 9.1%, 95% CIs 3.5–14.6; third trimester: 6.7%, 95% CIs 0.7–12.8. When compared with national stillbirth estimates, results indicate an elevated relative risk (RR) of third-trimester fetal death for the cohorts in Haiti (2013) of 5.8 (95% CIs 2.9–11.4 and p<0.0001). Although the RR was elevated in Senegal (2006) at 1.8 (95% CIs 0.3–10.4), the p-value was not significant (p = 0.5295), which was also the case in Peru (1991) with a RR of 2.6 (95% CIs 0.5–14.9 and p = 0.3227). For all four studies of 1991–2013, the RR is 3.83 (95% CIs 2.08–7.05) which is significant at p<0.0001.

Bottom Line: Random-effect non-linear logistic regression was used to calculate pooled rates and 95% CIs by time period.Studies from the recent period (1991-2013) were compared with studies from 1969-1990.Compared with published national mortality estimates, the RR for fetal death of 5.8 (95% CIs 2.9-11.3) was calculated for Haiti (2013), 1.8 (95% CIs 0.3-10.4) for Senegal (2007), and 2.6 (95% CIs 0.5-14.9) for Peru (1991); there were no significant differences in the RR for neonatal or maternal death.

View Article: PubMed Central - PubMed

Affiliation: Médecins Sans Frontières, Geneva, Switzerland; School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia.

ABSTRACT

Background: Maternal infection with cholera may negatively affect pregnancy outcomes. The objective of this research is to systematically review the literature and determine the risk of fetal, neonatal and maternal death associated with cholera during pregnancy.

Materials and methods: Medline, Global Health Library, and Cochrane Library databases were searched using the key terms cholera and pregnancy for articles published in any language and at any time before August 2013 to quantitatively summarize estimates of fetal, maternal, and neonatal mortality. 95% confidence intervals (CIs) were calculated for each selected study. Random-effect non-linear logistic regression was used to calculate pooled rates and 95% CIs by time period. Studies from the recent period (1991-2013) were compared with studies from 1969-1990. Relative risk (RR) estimates and 95% CIs were obtained by comparing mortality of selected recent studies with published national normative data from the closest year.

Results: The meta-analysis included seven studies that together involved 737 pregnant women with cholera from six countries. The pooled fetal death rate for 4 studies during 1991-2013 was 7.9% (95% CIs 5.3-10.4), significantly lower than that of 3 studies from 1969-1990 (31.0%, 95% CIs 25.2-36.8). There was no difference in fetal death rate by trimester. The pooled neonatal death rate for 1991-2013 studies was 0.8% (95% CIs 0.0-1.6), and 6.4% (95% CIs 0.0-20.8) for 1969-1990. The pooled maternal death rate for 1991-2013 studies was 0.2% (95% CIs 0.0-0.7), and 5.0% (95% CIs 0.0-16.0) for 1969-1990. Compared with published national mortality estimates, the RR for fetal death of 5.8 (95% CIs 2.9-11.3) was calculated for Haiti (2013), 1.8 (95% CIs 0.3-10.4) for Senegal (2007), and 2.6 (95% CIs 0.5-14.9) for Peru (1991); there were no significant differences in the RR for neonatal or maternal death.

Conclusion: Results are limited by the inconsistencies found across included studies but suggest that maternal cholera is associated with adverse pregnancy outcomes, particularly fetal death. These findings can inform a research agenda on cholera in pregnancy and guidance for the timely management of pregnant women with cholera.

No MeSH data available.


Related in: MedlinePlus