Pooled Prevalence of Adverse Pregnancy and Neonatal Outcomes in Malawi, South Africa, Uganda, and Zimbabwe: Results From a Systematic Review and Meta-Analyses to Inform Trials of Novel HIV Prevention Interventions During Pregnancy

Background: Robust data summarizing the prevalence of pregnancy and neonatal outcomes in low- and middle-income countries are critically important for studies evaluating investigational products for HIV prevention and treatment in pregnant and breastfeeding women. In preparation for studies evaluati...

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Autores principales:	Erica M. Lokken, Anya Mathur, Katherine E. Bunge, Lee Fairlie, Bonus Makanani, Richard Beigi, Lisa Noguchi, Jennifer E. Balkus
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	Malawi Zimbabwe Uganda South Africa pregnancy complications pregnancy outcomes Reproduction QH471-489 Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/bebd0330b6194b179e5cfb1e886c36a4
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spelling	oai:doaj.org-article:bebd0330b6194b179e5cfb1e886c36a42021-12-01T07:21:32ZPooled Prevalence of Adverse Pregnancy and Neonatal Outcomes in Malawi, South Africa, Uganda, and Zimbabwe: Results From a Systematic Review and Meta-Analyses to Inform Trials of Novel HIV Prevention Interventions During Pregnancy2673-315310.3389/frph.2021.672446https://doaj.org/article/bebd0330b6194b179e5cfb1e886c36a42021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/frph.2021.672446/fullhttps://doaj.org/toc/2673-3153Background: Robust data summarizing the prevalence of pregnancy and neonatal outcomes in low- and middle-income countries are critically important for studies evaluating investigational products for HIV prevention and treatment in pregnant and breastfeeding women. In preparation for studies evaluating the safety of the dapivirine vaginal ring for HIV prevention in pregnancy, we conducted a systematic literature review and meta-analyses to summarize the prevalence of pregnancy and neonatal outcomes in Malawi, South Africa, Uganda, and Zimbabwe.Methods: Ten individual systematic literature reviews were conducted to identify manuscripts presenting prevalence data for 12 pregnancy and neonatal outcomes [pregnancy loss, stillbirth, preterm birth, low birthweight (LBW), neonatal mortality, congenital anomaly, chorioamnionitis, postpartum endometritis, postpartum hemorrhage, gestational hypertension, preeclampsia/eclampsia, and preterm premature rupture of membranes (PPROM)]. Studies included in the meta-analyses were published between January 1, 1998, and July 11, 2018, provided numerator and denominator data to support prevalence estimation, and included women of any HIV serostatus. Random-effects meta-analyses were conducted to estimate the pooled prevalence and 95% confidence interval (CI) for each outcome overall, by country, and by HIV status.Results: A total of 152 manuscripts were included across the 12 outcomes. Overall, the frequency of stillbirth (n = 75 estimates), LBW (n = 68), and preterm birth (n = 67) were the most often reported. However, fewer than 10 total manuscripts reported prevalence estimates for chorioamnionitis, endometritis, or PPROM. The outcomes with the highest pooled prevalence were preterm birth (12.7%, 95%CI 11.2–14.3), LBW (11.7%, 95%CI 10.6–12.9), and gestational hypertension (11.4%, 95%CI 7.8–15.7). Among the outcomes with the lowest pooled prevalence estimates were neonatal mortality (1.7%, 95%CI 1.4–2.1), pregnancy loss [1.9%, 95%CI 1.1–2.8, predominately studies (23/29) assessing losses occurring after the first trimester], PPROM (2.2%, 95%CI 1.5–3.2), and stillbirth (2.5%, 95%CI 2.2–2.7).Conclusions: Although this review identified numerous prevalence estimates for some outcomes, data were lacking for other important pregnancy-related conditions. Additional research in pregnant populations is needed for a thorough evaluation of investigational products, including for HIV prevention and treatment, and to inform better estimates of the burden of adverse pregnancy outcomes globally.Erica M. LokkenAnya MathurKatherine E. BungeLee FairlieBonus MakananiRichard BeigiLisa NoguchiJennifer E. BalkusJennifer E. BalkusJennifer E. BalkusFrontiers Media S.A.articleMalawiZimbabweUgandaSouth Africapregnancy complicationspregnancy outcomesReproductionQH471-489Medicine (General)R5-920ENFrontiers in Reproductive Health, Vol 3 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Malawi Zimbabwe Uganda South Africa pregnancy complications pregnancy outcomes Reproduction QH471-489 Medicine (General) R5-920
spellingShingle	Malawi Zimbabwe Uganda South Africa pregnancy complications pregnancy outcomes Reproduction QH471-489 Medicine (General) R5-920 Erica M. Lokken Anya Mathur Katherine E. Bunge Lee Fairlie Bonus Makanani Richard Beigi Lisa Noguchi Jennifer E. Balkus Jennifer E. Balkus Jennifer E. Balkus Pooled Prevalence of Adverse Pregnancy and Neonatal Outcomes in Malawi, South Africa, Uganda, and Zimbabwe: Results From a Systematic Review and Meta-Analyses to Inform Trials of Novel HIV Prevention Interventions During Pregnancy
description	Background: Robust data summarizing the prevalence of pregnancy and neonatal outcomes in low- and middle-income countries are critically important for studies evaluating investigational products for HIV prevention and treatment in pregnant and breastfeeding women. In preparation for studies evaluating the safety of the dapivirine vaginal ring for HIV prevention in pregnancy, we conducted a systematic literature review and meta-analyses to summarize the prevalence of pregnancy and neonatal outcomes in Malawi, South Africa, Uganda, and Zimbabwe.Methods: Ten individual systematic literature reviews were conducted to identify manuscripts presenting prevalence data for 12 pregnancy and neonatal outcomes [pregnancy loss, stillbirth, preterm birth, low birthweight (LBW), neonatal mortality, congenital anomaly, chorioamnionitis, postpartum endometritis, postpartum hemorrhage, gestational hypertension, preeclampsia/eclampsia, and preterm premature rupture of membranes (PPROM)]. Studies included in the meta-analyses were published between January 1, 1998, and July 11, 2018, provided numerator and denominator data to support prevalence estimation, and included women of any HIV serostatus. Random-effects meta-analyses were conducted to estimate the pooled prevalence and 95% confidence interval (CI) for each outcome overall, by country, and by HIV status.Results: A total of 152 manuscripts were included across the 12 outcomes. Overall, the frequency of stillbirth (n = 75 estimates), LBW (n = 68), and preterm birth (n = 67) were the most often reported. However, fewer than 10 total manuscripts reported prevalence estimates for chorioamnionitis, endometritis, or PPROM. The outcomes with the highest pooled prevalence were preterm birth (12.7%, 95%CI 11.2–14.3), LBW (11.7%, 95%CI 10.6–12.9), and gestational hypertension (11.4%, 95%CI 7.8–15.7). Among the outcomes with the lowest pooled prevalence estimates were neonatal mortality (1.7%, 95%CI 1.4–2.1), pregnancy loss [1.9%, 95%CI 1.1–2.8, predominately studies (23/29) assessing losses occurring after the first trimester], PPROM (2.2%, 95%CI 1.5–3.2), and stillbirth (2.5%, 95%CI 2.2–2.7).Conclusions: Although this review identified numerous prevalence estimates for some outcomes, data were lacking for other important pregnancy-related conditions. Additional research in pregnant populations is needed for a thorough evaluation of investigational products, including for HIV prevention and treatment, and to inform better estimates of the burden of adverse pregnancy outcomes globally.
format	article
author	Erica M. Lokken Anya Mathur Katherine E. Bunge Lee Fairlie Bonus Makanani Richard Beigi Lisa Noguchi Jennifer E. Balkus Jennifer E. Balkus Jennifer E. Balkus
author_facet	Erica M. Lokken Anya Mathur Katherine E. Bunge Lee Fairlie Bonus Makanani Richard Beigi Lisa Noguchi Jennifer E. Balkus Jennifer E. Balkus Jennifer E. Balkus
author_sort	Erica M. Lokken
title	Pooled Prevalence of Adverse Pregnancy and Neonatal Outcomes in Malawi, South Africa, Uganda, and Zimbabwe: Results From a Systematic Review and Meta-Analyses to Inform Trials of Novel HIV Prevention Interventions During Pregnancy
title_short	Pooled Prevalence of Adverse Pregnancy and Neonatal Outcomes in Malawi, South Africa, Uganda, and Zimbabwe: Results From a Systematic Review and Meta-Analyses to Inform Trials of Novel HIV Prevention Interventions During Pregnancy
title_full	Pooled Prevalence of Adverse Pregnancy and Neonatal Outcomes in Malawi, South Africa, Uganda, and Zimbabwe: Results From a Systematic Review and Meta-Analyses to Inform Trials of Novel HIV Prevention Interventions During Pregnancy
title_fullStr	Pooled Prevalence of Adverse Pregnancy and Neonatal Outcomes in Malawi, South Africa, Uganda, and Zimbabwe: Results From a Systematic Review and Meta-Analyses to Inform Trials of Novel HIV Prevention Interventions During Pregnancy
title_full_unstemmed	Pooled Prevalence of Adverse Pregnancy and Neonatal Outcomes in Malawi, South Africa, Uganda, and Zimbabwe: Results From a Systematic Review and Meta-Analyses to Inform Trials of Novel HIV Prevention Interventions During Pregnancy
title_sort	pooled prevalence of adverse pregnancy and neonatal outcomes in malawi, south africa, uganda, and zimbabwe: results from a systematic review and meta-analyses to inform trials of novel hiv prevention interventions during pregnancy
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/bebd0330b6194b179e5cfb1e886c36a4
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Pooled Prevalence of Adverse Pregnancy and Neonatal Outcomes in Malawi, South Africa, Uganda, and Zimbabwe: Results From a Systematic Review and Meta-Analyses to Inform Trials of Novel HIV Prevention Interventions During Pregnancy

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