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      Association of maternal hypertensive disorders with retinopathy of prematurity: A systematic review and meta-analysis

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          Abstract

          Backgroud

          The role of maternal hypertensive disorders in pregnancy (HDP) in the development of retinopathy of prematurity (ROP) is unclear.

          Methods

          Studies were retrieved through literature searches in PubMed, EMBASE, Web of Science and the Cochrane Library up to May 5, 2016 without language restrictions. Cohort or case–control studies that reported the association of maternal hypertensive disorders and retinopathy of prematurity were eligible. Either a fixed- or a random-effects model was used to calculate the overall combined risk estimates.

          Results

          Thirteen cohort studies involving a total of 45082 individuals were included in the review. The pooled odds ratios of maternal hypertensive disorders in pregnancy for any stage and severe stages of ROP was 1.12 (95%CI: 0.90–1.40) and 0.80 (95%CI: 0.47–1.35), respectively. Sensitivity analyses confirmed that no single study qualitatively influenced the pooled OR. However, substantial heterogeneity and publication bias were observed in the meta-analysis.

          Conclusions

          Additional larger, prospective and well-adjusted studies are needed to determine the association between HDP and ROP, especially regarding the effects of different types of maternal hypertensive disorders in pregnancy on retinopathy of prematurity.

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          Most cited references24

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          ACOG practice bulletin. Diagnosis and management of preeclampsia and eclampsia. Number 33, January 2002.

          (2002)
          Hypertensive disease occurs in approximately 12-22% of pregnancies, and it is directly responsible for 17.6% of maternal deaths in the United States (1,2). However, there is confusion about the terminology and classification of these disorders. This bulletin will provide guidelines for the diagnosis and management of hypertensive disorders unique to pregnancy (ie, preeclampsia and eclampsia), as well as the various associated complications. Chronic hypertension has been discussed elsewhere (3).
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            An international classification of retinopathy of prematurity. The Committee for the Classification of Retinopathy of Prematurity.

            (1984)
            Because of modern life-support systems capable of keeping tiny premature infants alive, retinopathy of prematurity has recurred. No classification system currently available adequately describes the observations of the disease being made today. A new classification system, the work of 23 ophthalmologists from 11 countries, is presented in an attempt to meet this need. It emphasizes the location and the extent of the disease in the retina as well as its stages. The term "plus" is employed with the stage to denote progressive vascular incompetence. A computer-compatible diagram for recording the results of the examination employing the new classification system is furnished.
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              Incidence, risk factors of retinopathy of prematurity among very low birth weight infants in Singapore.

              To determine the incidence, risk factors and need for surgery for retinopathy of prematurity (ROP) among very-low-birth-weight (VLBW) infants. This was a retrospective study of all VLBW infants managed by the department over 14 years, from 1988 to 2001. Preterm infants were examined according to the Royal College of Ophthalmologists' guidelines, and retinopathy was graded following the International Classification of ROP. All VLBW infants examined for ROP were included and data were retrieved retrospectively and analysed for maternal, medical, obstetric and neonatal risk factors using logistic regression. Of the 564 VLBW infants who fit the screening criteria, ROP was detected in 165 (29.2%) of VLBW infants; of whom 49% of infants had stage 1 disease, 24% were at stage 2, and 27% were at stage 3 or more. Among 45 infants with stage 3 disease or more, treatment was needed in 62.2% (28/45). No ROP was detected in infants greater than 33 weeks of gestation. Only 0.6 % (1/164) of infants greater than 30 weeks of gestational age (GA) needed surgery for ROP. Using birth weight (BW) criteria, stage 3 ROP was noted only in 1% (6/564) of infants with BW >1000 g. Of all ROP requiring surgery, 89% (25/28) of infants were 1000 g infants. The median age of onset of ROP was 35 weeks (range, 31 to 41) corrected age. By univariate analysis for threshold ROP, preeclampsia, prenatal betamethasone exposure, gestational age, birth weight, 1-minute Apgar score, hyaline membrane disease (HMD), surfactant usage, hypotension, septicaemia, intraventricular haemorrhage duration of supplemental oxygen, ventilation and chronic lung disease were associated with ROP requiring surgery (i.e., threshold ROP, P <0.05). However, using multiple logistic regression analyses for ROP, maternal preeclampsia [odds ratio (OR), 2.52; confidence interval (CI), 1.32 to 4.7], birth weight (OR, 0.99; CI, 0.996 to 0.999), pulmonary haemorrhage (OR, 4.61; CI, 1.04 to 20.4), duration of ventilation (OR, 1.06; CI, 1.04 to 1.08) and duration of continuous positive airway pressure (CPAP) (OR, 1.02; CI, 1.01 to 1.04) were factors predictive of development of threshold ROP. The incidence of ROP among VLBW infants was 29.2%. ROP was strongly associated with smaller, more immature and sicker infants. The median age of onset of ROP was 35 weeks (range, 31 to 40 weeks) postmenstrual age. Infants <30 weeks of GA and/or infant with BW <1000 g are at considerable risk for threshold ROP. The main risk factors for development of threshold ROP by regression analysis are maternal preeclampsia, birth weight, and presence of pulmonary haemorrhage, duration of ventilation and continuous positive pressure ventilation. We suggest that both immaturity and compromised pulmonary function are both important aetiological factors in the development of ROP. Prevention of prematurity, control of preeclampsia, judicious use of ventilation and oxygen therapy are the only promising factors that may reduce the incidence and severity of ROP in this high-risk infant.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                7 April 2017
                2017
                : 12
                : 4
                : e0175374
                Affiliations
                [1 ]Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
                [2 ]Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, Sichuan, China
                [3 ]Department of Pediatrics and Neurology, University of California, San Francisco, San Francisco, California, United States of America
                Centre Hospitalier Universitaire Vaudois, FRANCE
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                • Conceptualization: TTZ LZ.

                • Data curation: TTZ LZ DZM.

                • Formal analysis: FYZ YQ.

                • Investigation: TTZ FYZ LZ YQ.

                • Methodology: TTZ LZ.

                • Project administration: TTZ LZ DZM.

                • Software: FYZ YQ.

                • Supervision: TTZ DZM.

                • Validation: LZ DZM.

                • Visualization: FYZ YQ.

                • Writing – original draft: TTZ LZ YQ.

                • Writing – review & editing: TTZ LZ DZM.

                Article
                PONE-D-16-25064
                10.1371/journal.pone.0175374
                5384774
                28388642
                c04fbcc0-a4eb-42b3-a365-0be96defb7f9
                © 2017 Zhu et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 22 June 2016
                : 26 March 2017
                Page count
                Figures: 4, Tables: 2, Pages: 11
                Funding
                Funded by: National Natural Science Foundation of China (CN)
                Award ID: No.81330016, 81300524, 81172174, 81270724, 81200462 and 81501301
                Funded by: om the State Commission of Science Technology of China
                Award ID: 2013CB967404, 2012BAI04B04
                Funded by: a grant of clinical discipline program (neonatology) from the Ministry of Health of China
                Award ID: 1311200003303
                This work was supported by the National Science Foundation of China (No.81330016, 81630038, and 81270724), grants from the State Commission of Science Technology of China (2012BAI04B04), grants from the Ministry of Education of China (IRT0935), grants from the Science and Technology Bureau of Sichuan province (2014SZ0149), and a grant of clinical discipline program (neonatology) from the Ministry of Health of China (1311200003303. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Ophthalmology
                Retinal Disorders
                Retinopathy
                Retinopathy of Prematurity
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Pregnancy
                Pregnancy Complications
                Preeclampsia
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Pregnancy
                Pregnancy Complications
                Preeclampsia
                Medicine and Health Sciences
                Vascular Medicine
                Blood Pressure
                Hypertension
                Hypertensive Disorders in Pregnancy
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Pregnancy
                Hypertensive Disorders in Pregnancy
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Pregnancy
                Hypertensive Disorders in Pregnancy
                People and Places
                Population Groupings
                Age Groups
                Children
                Infants
                People and Places
                Population Groupings
                Families
                Children
                Infants
                Medicine and Health Sciences
                Vascular Medicine
                Blood Pressure
                Hypertension
                Research and Analysis Methods
                Mathematical and Statistical Techniques
                Statistical Methods
                Meta-Analysis
                Physical Sciences
                Mathematics
                Statistics (Mathematics)
                Statistical Methods
                Meta-Analysis
                Medicine and Health Sciences
                Pediatrics
                Biology and Life Sciences
                Physiology
                Physiological Parameters
                Body Weight
                Birth Weight
                Medicine and Health Sciences
                Physiology
                Physiological Parameters
                Body Weight
                Birth Weight
                Custom metadata
                All relevant data are within the paper and its Supporting Information files.

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