scholarly journals Successful and Safe Treatment of Chronic Spontaneous Urticaria with Omalizumab in a Woman during Two Consecutive Pregnancies

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Misbah Nasheela Ghazanfar ◽  
Simon Francis Thomsen
Keyword(s):  
Monoclonal Antibody ◽  
Female Patient ◽  
Chronic Urticaria ◽  
Skin Disease ◽  
Randomised Controlled Trials ◽  
Chronic Spontaneous Urticaria ◽  
Controlled Trials ◽  
Safe Treatment ◽  
Randomised Controlled ◽  
In Pregnancy

Chronic spontaneous urticaria is an itching skin disease characterised by wheals, angioedema, or both present for more than six weeks. Omalizumab is a humanized anti-IgE monoclonal antibody recently approved for treatment of chronic urticaria. Several randomised controlled trials have investigated the safety, tolerability, and efficacy of omalizumab for chronic urticaria. The safety of omalizumab in pregnancy is not known. We describe a female patient with chronic spontaneous urticaria who was treated with omalizumab continuously through two consecutive pregnancies with convincing results and no apparent toxicity.

scholarly journals The effect of iodine deficiency during pregnancy on child development

2019 ◽  
Vol 78 (02) ◽  
pp. 150-160 ◽  
Author(s):  
Sarah C. Bath
Keyword(s):  
School Performance ◽  
Iodine Deficiency ◽  
Public Health Policy ◽  
Observational Studies ◽  
Randomised Controlled Trials ◽  
Controlled Trials ◽  
Neurological Development ◽  
The Past ◽  
Randomised Controlled ◽  
In Pregnancy

It is well known that severe iodine deficiency during pregnancy may cause impaired brain development in the child, with effects on cognitive and motor function, hearing and speech. Whether mild-to-moderate deficiency also affects neurological development is less well known, but in the past decade a number of observational studies have been conducted to answer this question and these studies are reviewed in this article. The picture is now emerging that even mild-to-moderate iodine deficiency during pregnancy may be associated with subtle impairments in cognition and school performance, although the evidence from randomised controlled trials is still lacking. As global efforts to eradicate iodine deficiency in populations continue, it is more likely that mild-to-moderate, rather than severe, iodine deficiency will be the issue of concern in pregnancy, and therefore further research in regions of mild-to-moderate deficiency is required to strengthen the research base and to inform public-health policy.

scholarly journals Respiratory syncytial virus prophylaxis for prevention of recurrent childhood wheeze and asthma: a systematic review

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Lauren Alexandra Quinn ◽  
Michael D. Shields ◽  
Ian Sinha ◽  
Helen E. Groves
Keyword(s):  
Systematic Review ◽  
Monoclonal Antibody ◽  
Relative Risk ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Group Analysis ◽  
Controlled Trials ◽  
Recurrent Wheeze ◽  
Syncytial Virus ◽  
Randomised Controlled

Abstract Background Acute bronchiolitis caused by respiratory syncytial virus (RSV) has been associated with greater risk of recurrent wheezing and asthma. However, it is unclear whether this association is causal. RSV-specific monoclonal antibodies have been shown to reduce RSV-related hospitalisations in high-risk infants, but the longer-term follow-up has given conflicting evidence for prevention of recurrent wheeze or asthma. Objective We performed a systematic review and meta-analysis to determine whether monoclonal antibody prophylaxis against RSV bronchiolitis reduces the risk of subsequent recurrent wheeze or asthma. If so, this may support the hypothesis of causality. Methods Studies were identified via an online database search using Embase, MEDLINE, PubMed, Web of Science and the Cochrane Library. Manufacturers of monoclonal antibodies were contacted directly for unpublished data. The intervention of interest was RSV monoclonal antibody prophylaxis, and the primary outcome measure was recurrent wheeze and/or asthma. Studies were screened according to inclusion/exclusion criteria. Included studies were evaluated for quality and assessed for bias independently by 3 reviewers using the ‘Grading of Recommendations Assessment, Development and Evaluation’ (GRADE) approach. Results were extracted into 2 × 2 outcome tables and a meta-analysis carried out producing forest plots based on relative risk. Heterogeneity was assessed using the I2 statistic. Results The search identified 141 articles, which, after screening, resulted in eight studies (2 randomised controlled trials), thus including 11,195 infants in the meta-analysis. The overall result demonstrated a non-statistically significant reduction in relative risk of developing recurrent wheeze or asthma (RR 0.60; 95% CI 0.31 to 1.16). Study quality was generally low with evidence of publication bias and statistical heterogeneity. However, sub-group analysis excluding studies deemed to be ‘very low’ quality showed a relative risk of 0.42 (95% CI 0.22 to 0.80, p = 0.008). A further sub-group analysis for infants aged 32 to < 36 weeks showed a statistically significant relative risk of 0.35 (95% CI 0.14 to 0.86, p = 0.02). Discussion We did not identify an overall statistically significant benefit. However, our two sub-group analyses did find statistically significant benefits of monoclonal antibody therapy on the risk of recurrent wheeze and asthma. The main limitation of this study is the lack of high-quality randomised controlled trials, highlighting the need for more research in this field.

scholarly journals Respiratory syncytial virus prophylaxis for prevention of recurrent childhood wheeze and asthma: a systematic review

2020 ◽  
Author(s):  
Lauren Quinn ◽  
Michael D Shields ◽  
Ian Sinha ◽  
Helen E Groves
Keyword(s):  
Systematic Review ◽  
Monoclonal Antibody ◽  
Relative Risk ◽  
Randomised Controlled Trials ◽  
Meta Analysis ◽  
Group Analysis ◽  
Controlled Trials ◽  
Recurrent Wheeze ◽  
Syncytial Virus ◽  
Randomised Controlled

Abstract Background Acute bronchiolitis caused by Respiratory Syncytial Virus (RSV) has been associated with greater risk of recurrent wheezing and asthma. However, it is unclear whether this association is causal. RSV-specific monoclonal antibodies have been shown to reduce RSV-related hospitalisations in high-risk infants, but the longer term follow-up has given conflicting evidence for prevention of recurrent wheeze or asthma.Objective We performed a systematic review and meta-analysis to determine whether monoclonal antibody prophylaxis against RSV-bronchiolitis reduces the risk of subsequent recurrent wheeze or asthma. If so, this may support the hypothesis of causality.Methods Studies were identified via an online database search. Manufacturers of monoclonal antibodies were contacted directly for unpublished data. The intervention of interest was RSV monoclonal antibody prophylaxis and the primary outcome measure was recurrent wheeze and/or asthma. Studies were screened according to inclusion/exclusion criteria. Included studies were evaluated for quality and assessed for bias independently by 3 reviewers using the ‘Grading of Recommendations Assessment, Development and Evaluation’ (GRADE) approach. Results were extracted into 2 × 2 outcome tables and a meta-analysis carried out producing forest plots based on relative risk. Heterogeneity was assessed using the I2 statistic.Results 11,195 infants were included in the meta-analysis, consisting of eight studies (2 randomised controlled trials). The overall result demonstrated a non-statistically significant reduction in relative risk of developing recurrent wheeze or asthma (RR 0.60; 95% CI 0.31 to 1.16). Study quality was generally low with evidence of publication bias and statistical heterogeneity. Sub-group analysis excluding studies deemed to be ‘very low’ quality showed a relative risk of 0.42 (95% CI: 0.22 to 0.80, p = 0.008). A further sub-group analysis for infants aged 32 to < 36 weeks showed a statistically significant relative risk of 0.35 (95% CI: 0.14 to 0.86, p = 0.02).Discussion We did not identify an overall statistically significant benefit. However, our two subgroup analyses did find statistically significant benefits of monoclonal antibody therapy on the risk of recurrent wheeze and asthma. The main limitation of this study is the lack of high quality randomised controlled trials, highlighting the need for more research in this field.

scholarly journals A systematic review and meta-analysis protocol on the association of malaria in pregnancy and adverse birth outcomes

2020 ◽  
Author(s):  
Vikas Yadav ◽  
Mohan Bairwa ◽  
Deepti Dabar ◽  
Akhil Dhanesh Goel ◽  
Sarika Palepu ◽  
...  
Keyword(s):  
Birth Outcomes ◽  
Effect Size ◽  
Observational Studies ◽  
Randomised Controlled Trials ◽  
Malaria In Pregnancy ◽  
Forest Plot ◽  
Controlled Trials ◽  
Adverse Birth Outcomes ◽  
Randomised Controlled ◽  
In Pregnancy

Abstract: Introduction: Malaria in pregnancy contributes to significant adverse birth outcomes. This study is aimed to quantify the relationship between malaria in pregnancy and occurrence of adverse birth outcomes, including preterm delivery, low birth weight, small for gestational age, miscarriages, and stillbirth. Methods and analysis: Observational studies and Randomised controlled trials reporting data on selected birth outcomes separately for pregnancies, with or without malaria will be included. We will search for studies over various information sources and data extraction will be done from included studies. Pooled odds ratio (OR) will be calculated for each birth outcomes using fixed effect model or random effects models, based on the level of heterogeneity. Forest plot will be prepared with effect size (with 95 percent confidence interval) of each study and pooled effect size. The methodological quality will be assessed for included observational studies using the Newcastle-Ottawa scale (NOS). Cochrane Risk of Bias tool will be used to evaluate bias in randomised controlled trials. For publication bias, funnel plot will be prepared and assessed for asymmetry, along with Egger′s test. Discussion: This study will provide an estimate of the risk of adverse birth outcomes in pregnancies with malaria. Results of this study will contribute towards planning effective service delivery in areas with a higher risk of malaria transmission. Ethics and dissemination: The current study is a review of published literature, and it does not require ethical committee approval. Results of this review will be published in a peer-reviewed journal. PROSPERO registration number: CRD42020153009

scholarly journals The impact of maternal diet in pregnancy and lactation on allergy and atopy outcomes in offspring: A systematic review

2021 ◽  
Author(s):  
◽  
Melissa Whitehead
Keyword(s):  
New Zealand ◽  
Cohort Studies ◽  
Allergic Disease ◽  
Randomised Controlled Trials ◽  
Maternal Diet ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Pregnancy And Lactation ◽  
Randomised Controlled ◽  
In Pregnancy

<p>Allergic disease and atopy create a substantial emotional and financial burden for affected individuals and their families. Significant healthcare costs are also incurred with New Zealand children showing consistently high rates of allergic disease when compared with global statistics. The potential to decrease the incidence of allergic disease and atopy through modification of maternal diet has been the subject of recent attention with the possibility for transgenerational impact being of considerable interest.  The objectives of this systematic review were firstly to investigate the relationship between maternal diet in pregnancy and lactation on allergic outcomes in the offspring, and to then relate these findings to the New Zealand context.   The following databases were accessed as part of this review: PubMed via helicon (advanced search), ProQuest (MEDLINE) via helicon, CINAHL Complete (EBSCO host via helicon). Limits were “humans”. The key search terms were ‘diet’ or ‘supplements’, ‘pregnancy’ or ‘lactation’, ‘allergy’ or ‘atopy’ or ‘asthma; NOT ‘elimination’ or ‘avoidance’. The studies for inclusion in this review were restricted to studies written in the English language. The final search was undertaken 11/04/17 once data extraction completed and one new study found. Initial search was 14/07/16. Search period 14/04/16-11/04/17.  Randomised controlled trials and cohort studies that systematically recorded maternal intake of diet or supplements were included. The health-related outcomes assessed were asthma, wheeze, eczema and allergic rhinitis. Data was extracted for this review using the Cochrane Public Health Group’s template. Risk of bias was assessed using the Cochrane risk of bias assessment tool for the randomised controlled trials and the Newcastle-Ottawa Scale for the cohort studies. Risk of bias was assessed again and presented using the Grade summary of findings tables.  Overall, 54 studies were included in this review, collectively involving more than 100,000 children and comprising of 16 randomised controlled trials and 38 cohort studies that were selected based on predetermined inclusion and exclusion criteria. Data on vitamins, oligo-elements, food groups and dietary patterns during pregnancy and lactation were also collected. A meta-analysis was not performed due to the diversity in variables, multiple outcomes assessed, and the variety of measurements implemented within the studies.   This work presents a comprehensive summary and review of the identified studies that explored the impact of maternal diet in pregnancy and lactation on allergy and atopy outcomes. Although individual studies demonstrated various associations between maternal diet during pregnancy and lactation to impact on health outcomes for the offspring, overall, this work did not show any consistent findings collectively across the studies reviewed. This was due to the differing methods of measurement of association, intake and outcome assessment used in the reviewed studies which further complicated the ability to compare and contrast the findings of the studies with each other. Each study was assessed both for its individual findings and then collectively according to the variables assessed. The findings of this review lend support for the undertaking of additional trials and studies with more consistent and controlled measurements of interventions and outcomes to better facilitate comparisons between studies.   Key findings from the reviewed studies, which included only one New Zealand based study, were related to the New Zealand context. Additional New Zealand based information and related works highlighted a need for personally tailored maternal nutrition information to be delivered consistently by all health professionals interacting with pregnant women.   Key words: diet, supplements, pregnancy, lactation, allergy, atopy, asthma.</p>

scholarly journals Blood pressure monitoring in high-risk pregnancy to improve the detection and monitoring of hypertension (the BUMP 1 and 2 trials): protocol for two linked randomised controlled trials

BMJ Open ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. e034593 ◽  
Author(s):  
Greig Dougall ◽  
Marloes Franssen ◽  
Katherine Louise Tucker ◽  
Ly-Mee Yu ◽  
Lisa Hinton ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Usual Care ◽  
Pregnant Women ◽  
Randomised Controlled Trials ◽  
Primary Outcome ◽  
Controlled Trials ◽  
Self Monitoring ◽  
Pregnancy Hypertension ◽  
Randomised Controlled ◽  
In Pregnancy

IntroductionSelf-monitoring of blood pressure (BP) in pregnancy could improve the detection and management of pregnancy hypertension, while also empowering and engaging women in their own care. Two linked trials aim to evaluate whether BP self-monitoring in pregnancy improves the detection of raised BP during higher risk pregnancies (BUMP 1) and whether self-monitoring reduces systolic BP during hypertensive pregnancy (BUMP 2).Methods and analysesBoth are multicentre, non-masked, parallel group, randomised controlled trials. Participants will be randomised to self-monitoring with telemonitoring or usual care. BUMP 1 will recruit a minimum of 2262 pregnant women at higher risk of pregnancy hypertension and BUMP 2 will recruit a minimum of 512 pregnant women with either gestational or chronic hypertension. The BUMP 1 primary outcome is the time to the first recording of raised BP by a healthcare professional. The BUMP 2 primary outcome is mean systolic BP between baseline and delivery recorded by healthcare professionals. Other outcomes will include maternal and perinatal outcomes, quality of life and adverse events. An economic evaluation of BP self-monitoring in addition to usual care compared with usual care alone will be assessed across both study populations within trial and with modelling to estimate long-term cost-effectiveness. A linked process evaluation will combine quantitative and qualitative data to examine how BP self-monitoring in pregnancy is implemented and accepted in both daily life and routine clinical practice.Ethics and disseminationThe trials have been approved by a Research Ethics Committee (17/WM/0241) and relevant research authorities. They will be published in peer-reviewed journals and presented at national and international conferences. If shown to be effective, BP self-monitoring would be applicable to a large population of pregnant women.Trial registration numberNCT03334149

scholarly journals The impact of maternal diet in pregnancy and lactation on allergy and atopy outcomes in offspring: A systematic review

2021 ◽  
Author(s):  
◽  
Melissa Whitehead
Keyword(s):  
New Zealand ◽  
Cohort Studies ◽  
Allergic Disease ◽  
Randomised Controlled Trials ◽  
Maternal Diet ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Pregnancy And Lactation ◽  
Randomised Controlled ◽  
In Pregnancy

<p>Allergic disease and atopy create a substantial emotional and financial burden for affected individuals and their families. Significant healthcare costs are also incurred with New Zealand children showing consistently high rates of allergic disease when compared with global statistics. The potential to decrease the incidence of allergic disease and atopy through modification of maternal diet has been the subject of recent attention with the possibility for transgenerational impact being of considerable interest.  The objectives of this systematic review were firstly to investigate the relationship between maternal diet in pregnancy and lactation on allergic outcomes in the offspring, and to then relate these findings to the New Zealand context.   The following databases were accessed as part of this review: PubMed via helicon (advanced search), ProQuest (MEDLINE) via helicon, CINAHL Complete (EBSCO host via helicon). Limits were “humans”. The key search terms were ‘diet’ or ‘supplements’, ‘pregnancy’ or ‘lactation’, ‘allergy’ or ‘atopy’ or ‘asthma; NOT ‘elimination’ or ‘avoidance’. The studies for inclusion in this review were restricted to studies written in the English language. The final search was undertaken 11/04/17 once data extraction completed and one new study found. Initial search was 14/07/16. Search period 14/04/16-11/04/17.  Randomised controlled trials and cohort studies that systematically recorded maternal intake of diet or supplements were included. The health-related outcomes assessed were asthma, wheeze, eczema and allergic rhinitis. Data was extracted for this review using the Cochrane Public Health Group’s template. Risk of bias was assessed using the Cochrane risk of bias assessment tool for the randomised controlled trials and the Newcastle-Ottawa Scale for the cohort studies. Risk of bias was assessed again and presented using the Grade summary of findings tables.  Overall, 54 studies were included in this review, collectively involving more than 100,000 children and comprising of 16 randomised controlled trials and 38 cohort studies that were selected based on predetermined inclusion and exclusion criteria. Data on vitamins, oligo-elements, food groups and dietary patterns during pregnancy and lactation were also collected. A meta-analysis was not performed due to the diversity in variables, multiple outcomes assessed, and the variety of measurements implemented within the studies.   This work presents a comprehensive summary and review of the identified studies that explored the impact of maternal diet in pregnancy and lactation on allergy and atopy outcomes. Although individual studies demonstrated various associations between maternal diet during pregnancy and lactation to impact on health outcomes for the offspring, overall, this work did not show any consistent findings collectively across the studies reviewed. This was due to the differing methods of measurement of association, intake and outcome assessment used in the reviewed studies which further complicated the ability to compare and contrast the findings of the studies with each other. Each study was assessed both for its individual findings and then collectively according to the variables assessed. The findings of this review lend support for the undertaking of additional trials and studies with more consistent and controlled measurements of interventions and outcomes to better facilitate comparisons between studies.   Key findings from the reviewed studies, which included only one New Zealand based study, were related to the New Zealand context. Additional New Zealand based information and related works highlighted a need for personally tailored maternal nutrition information to be delivered consistently by all health professionals interacting with pregnant women.   Key words: diet, supplements, pregnancy, lactation, allergy, atopy, asthma.</p>

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