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Zhang Y, Ding W, Wu T, Wu S, Wang H, Fawad M, Adane AA, Dai X, Zhu X, Xu X. Pregnancy with multiple high-risk factors: a systematic review and meta-analysis. J Glob Health 2025; 15:04027. [PMID: 39913559 PMCID: PMC11893144 DOI: 10.7189/jogh.15.04027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2025] Open
Abstract
Background A wide spectrum of high-risk factors in pregnancy can lead to adverse pregnancy outcomes or short- or long-term health effects. Despite this, there has been no synthesis of findings on the measurement, potential causes, and health outcomes of multiple high-risk factors in pregnancy (MHFP). We aimed to address this gap by summarising the existing research on this topic. Methods We retrieved studies published up to 3 June 2024 through systematic database searches and used a narrative synthesis approach to summarise the measurement, patterns, causes, and outcomes of MHFP. We also estimated the pooled MHFP prevalence through meta-analysis with a random effects model and performed subgroup analyses and meta-regression to examine potential sources of between-study heterogeneity. Results We included 83 observational studies published between 2010 and 2024, of which 72% were from high-income countries. These studied factors can be grouped into four categories: physical conditions, mental conditions, sociobehavioural problems, and pregnancy history. We identified 16 MHFP patterns, among which co-existing multiple physical conditions were the most common pattern. The overall pooled prevalence of MHFP was 12% (95% confidence interval (CI) = 12-13), with an increasing trend and relatively higher levels in low- and middle-income countries (LMICs). We observed heterogeneity in the measurement of MHFP across the studies, possibly due to the number of risk factors in the definition of MHFP. About 78% of included studies investigated MHFP-associated health outcomes for women and offspring, with only two studies examining long-term maternal or offspring outcomes later in life. Conclusions Research into MHFP has been emerging over the past decade, but is far from complete. The burden of MHFP is increasing worldwide, particularly LMICs. Maternal healthcare systems must shift to a multidisciplinary and integrated framework so as to better design and implement prevention and intervention programmes and sustain the healthy development of the next generation. Registration PROSPERO: CRD42022358889.
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Affiliation(s)
- Yue Zhang
- School of Public Health, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Weijie Ding
- Health Care Department, Huai’an Maternal and Child Health Care Hospital Affiliated to Yangzhou University, Huai’an, Jiangsu, China
| | - Tingting Wu
- School of Public Health, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Songtao Wu
- School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Hui Wang
- School of Public Health, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Health Care Department, Huai’an Maternal and Child Health Care Hospital Affiliated to Yangzhou University, Huai’an, Jiangsu, China
| | - Muhammad Fawad
- School of Public Health, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Akilew Awoke Adane
- Ngangk Yira Institute for Change, Murdoch University, Murdoch, Australia
- Telethon Kids Institute, The University of Western Australia, Nedlands, Australia
| | - Xiaochen Dai
- Department of Health Metrics Science, School of Medicine, University of Washington, Seattle, USA
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, USA
| | - Xiaoqin Zhu
- Health Care Department, Huai’an Maternal and Child Health Care Hospital Affiliated to Yangzhou University, Huai’an, Jiangsu, China
| | - Xiaolin Xu
- School of Public Health, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
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Mazza M, Brisi C, Veneziani G, Lisci FM, Sessa I, Balocchi M, Rossi S, Di Stasio E, Marano G, Abate F, Anesini MB, Boggio G, Ciliberto M, De Masi V, Falsini C, Marzo EM, Avallone C, Serio A, Gonsalez del Castillo A, Kotzalidis GD, Chieffo DPR, Lanzone A, Scambia G, Lai C, Sani G. A Network Analysis of Perinatal Depression, Anxiety, and Temperaments in Women in the First, Second, and Third Trimesters of Pregnancy. J Clin Med 2024; 13:3957. [PMID: 38999520 PMCID: PMC11242710 DOI: 10.3390/jcm13133957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Revised: 06/27/2024] [Accepted: 07/04/2024] [Indexed: 07/14/2024] Open
Abstract
Background/Objectives: Although depression and anxiety are found to be affected by temperaments, little research has studied these relationships in pregnancy. The present study explored the associations among perinatal depression (PD), anxiety dimensions (state, trait, and generalized anxiety disorder (GAD)), and temperaments between women in the three trimesters of pregnancy through a network analysis approach. Moreover, differences in the severity of PD and anxiety between women in the three trimesters were evaluated. Methods: Women in first (N = 31), second (N = 184), and third (N = 54) trimesters of pregnancy were recruited in the present cross-sectional study. The network analysis included PD, anxiety dimensions, and temperaments. Three network models were estimated, and ANOVAs evaluated the differences in the severity of PD and anxiety, including trimesters as a between-subject factor. Results: PD and GAD were the nodes most strongly connected across the three groups. Cyclothymic, depressive, and anxious temperaments were most frequently associated with PD and GAD. Hyperthymic temperament was in the periphery of the three networks. Lastly, women in the first trimester had the highest severity of PD and GAD. Conclusions: PD and GAD showed the strongest associations. Anxiety dimensions had positive associations with PD and GAD, suggesting their role as possible risk factors. Temperaments were differently associated within the network between the three groups. Clinical interventions during pregnancy should target the central variables, considering their direct and indirect relationships.
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Affiliation(s)
- Marianna Mazza
- Unit of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (C.B.); (F.M.L.); (S.R.); (G.M.); (F.A.); (M.B.A.); (G.B.); (M.C.); (V.D.M.); (C.F.); (E.M.M.); (G.D.K.); (G.S.)
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Caterina Brisi
- Unit of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (C.B.); (F.M.L.); (S.R.); (G.M.); (F.A.); (M.B.A.); (G.B.); (M.C.); (V.D.M.); (C.F.); (E.M.M.); (G.D.K.); (G.S.)
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giorgio Veneziani
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Via Degli Apuli 1, 00185 Rome, Italy; (G.V.); (C.L.)
| | - Francesco Maria Lisci
- Unit of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (C.B.); (F.M.L.); (S.R.); (G.M.); (F.A.); (M.B.A.); (G.B.); (M.C.); (V.D.M.); (C.F.); (E.M.M.); (G.D.K.); (G.S.)
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Ilenia Sessa
- Unit of Clinical Psychology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (I.S.); (M.B.); (A.S.); (A.G.d.C.); (D.P.R.C.)
| | - Marta Balocchi
- Unit of Clinical Psychology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (I.S.); (M.B.); (A.S.); (A.G.d.C.); (D.P.R.C.)
| | - Sara Rossi
- Unit of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (C.B.); (F.M.L.); (S.R.); (G.M.); (F.A.); (M.B.A.); (G.B.); (M.C.); (V.D.M.); (C.F.); (E.M.M.); (G.D.K.); (G.S.)
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Enrico Di Stasio
- Department of Basic Biotechnological Sciences, Intensive Care and Perioperative Clinics Research, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Giuseppe Marano
- Unit of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (C.B.); (F.M.L.); (S.R.); (G.M.); (F.A.); (M.B.A.); (G.B.); (M.C.); (V.D.M.); (C.F.); (E.M.M.); (G.D.K.); (G.S.)
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Francesca Abate
- Unit of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (C.B.); (F.M.L.); (S.R.); (G.M.); (F.A.); (M.B.A.); (G.B.); (M.C.); (V.D.M.); (C.F.); (E.M.M.); (G.D.K.); (G.S.)
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Maria Benedetta Anesini
- Unit of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (C.B.); (F.M.L.); (S.R.); (G.M.); (F.A.); (M.B.A.); (G.B.); (M.C.); (V.D.M.); (C.F.); (E.M.M.); (G.D.K.); (G.S.)
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Gianluca Boggio
- Unit of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (C.B.); (F.M.L.); (S.R.); (G.M.); (F.A.); (M.B.A.); (G.B.); (M.C.); (V.D.M.); (C.F.); (E.M.M.); (G.D.K.); (G.S.)
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Michele Ciliberto
- Unit of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (C.B.); (F.M.L.); (S.R.); (G.M.); (F.A.); (M.B.A.); (G.B.); (M.C.); (V.D.M.); (C.F.); (E.M.M.); (G.D.K.); (G.S.)
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Valeria De Masi
- Unit of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (C.B.); (F.M.L.); (S.R.); (G.M.); (F.A.); (M.B.A.); (G.B.); (M.C.); (V.D.M.); (C.F.); (E.M.M.); (G.D.K.); (G.S.)
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Cecilia Falsini
- Unit of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (C.B.); (F.M.L.); (S.R.); (G.M.); (F.A.); (M.B.A.); (G.B.); (M.C.); (V.D.M.); (C.F.); (E.M.M.); (G.D.K.); (G.S.)
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Ester Maria Marzo
- Unit of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (C.B.); (F.M.L.); (S.R.); (G.M.); (F.A.); (M.B.A.); (G.B.); (M.C.); (V.D.M.); (C.F.); (E.M.M.); (G.D.K.); (G.S.)
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Carla Avallone
- Unit of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (C.B.); (F.M.L.); (S.R.); (G.M.); (F.A.); (M.B.A.); (G.B.); (M.C.); (V.D.M.); (C.F.); (E.M.M.); (G.D.K.); (G.S.)
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Annamaria Serio
- Unit of Clinical Psychology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (I.S.); (M.B.); (A.S.); (A.G.d.C.); (D.P.R.C.)
| | - Angela Gonsalez del Castillo
- Unit of Clinical Psychology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (I.S.); (M.B.); (A.S.); (A.G.d.C.); (D.P.R.C.)
| | - Georgios Demetrios Kotzalidis
- Unit of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (C.B.); (F.M.L.); (S.R.); (G.M.); (F.A.); (M.B.A.); (G.B.); (M.C.); (V.D.M.); (C.F.); (E.M.M.); (G.D.K.); (G.S.)
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Department of Neurosciences, Mental Health, and Sensory Organs (NESMOS), Sapienza University of Rome, 00189 Rome, Italy
| | - Daniela Pia Rosaria Chieffo
- Unit of Clinical Psychology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (I.S.); (M.B.); (A.S.); (A.G.d.C.); (D.P.R.C.)
| | - Antonio Lanzone
- Department of Gynaecology and Obstetrics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.L.); (G.S.)
| | - Giovanni Scambia
- Department of Gynaecology and Obstetrics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.L.); (G.S.)
| | - Carlo Lai
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Via Degli Apuli 1, 00185 Rome, Italy; (G.V.); (C.L.)
| | - Gabriele Sani
- Unit of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (C.B.); (F.M.L.); (S.R.); (G.M.); (F.A.); (M.B.A.); (G.B.); (M.C.); (V.D.M.); (C.F.); (E.M.M.); (G.D.K.); (G.S.)
- Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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