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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 references 26

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

        (2001)
      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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        Preterm-associated visual impairment and estimates of retinopathy of prematurity at regional and global levels for 2010

        Background: Retinopathy of prematurity (ROP) is a leading cause of potentially avoidable childhood blindness worldwide. We estimated ROP burden at the global and regional levels to inform screening and treatment programs, research, and data priorities. Methods: Systematic reviews and meta-analyses were undertaken to estimate the risk of ROP and subsequent visual impairment for surviving preterm babies by level of neonatal care, access to ROP screening, and treatment. A compartmental model was used to estimate ROP cases and numbers of visually impaired survivors. Results: In 2010, an estimated 184,700 (uncertainty range: 169,600–214,500) preterm babies developed any stage of ROP, 20,000 (15,500–27,200) of whom became blind or severely visually impaired from ROP, and a further 12,300 (8,300–18,400) developed mild/moderate visual impairment. Sixty-five percent of those visually impaired from ROP were born in middle-income regions; 6.2% (4.3–8.9%) of all ROP visually impaired infants were born at >32-wk gestation. Visual impairment from other conditions associated with preterm birth will affect larger numbers of survivors. Conclusion: Improved care, including oxygen delivery and monitoring, for preterm babies in all facility settings would reduce the number of babies affected with ROP. Improved data tracking and coverage of locally adapted screening/treatment programs are urgently required.
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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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            Author and article information

            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.

            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
            28388642 5384774 10.1371/journal.pone.0175374 PONE-D-16-25064
            © 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.

            Counts
            Figures: 4, Tables: 2, Pages: 11
            Product
            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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