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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_393"
                     title="SMFM: Gene Variants Linked to Preterm Labor (CME/CE)"
                     score="0.01"
                     href="http://www.medpagetoday.com/MeetingCoverage/SMFM/tb/18295?impressionId=1265783362702"
                     
      Genetic variants involved in regulating inflammation and the extracellular matrix may increase the risk of preterm birth, researchers say.&lt;br&gt;
&lt;br&gt;A single nucleotide polymorphism (SNP) in fetal interleukin-6 (&lt;em&gt;ILR6&lt;/em&gt;) and another in maternal tissue inhibitor of metalloproteinase 2 (&lt;em&gt;TIMP2&lt;/em&gt;) were each associated with a twofold increased risk of spontaneous preterm birth.&lt;br&gt;
&lt;br&gt;Roberto Romero, MD, of the National Institute of Child Health and Human Development, and colleagues reported the findings at the Society for Maternal-Fetal Medicine meeting in Chicago.&lt;/p&gt;
&lt;p&gt;&quot;The genetic makeup of both mother and fetus can contribute to the risk of premature labor,&quot; Romero told &lt;em&gt;MedPage Today&lt;/em&gt;. &quot;Our discovery . . . helps explain why some mothers have premature labor and delivery despite having optimal prenatal care.&quot;&lt;/p&gt;
&lt;p&gt;Inflammatory hormones have been shown to play a role in the labor process, and previous studies have found that a third of preterm infants are born to mothers with a silent amniotic infection.&lt;/p&gt;
&lt;p&gt;Now, the findings suggest that individual genetic variation involved in that inflammatory response may account for discrepancies in preterm births.&lt;/p&gt;
&lt;p&gt;&quot;We have a large body of evidence that proves silent infections are a frequent and important cause of premature labor,&quot; Romero said. &quot;These infections can also attack the fetus before it is born.&quot;&lt;/p&gt;
&lt;p&gt;He explained that the mother&apos;s hormones initiate the onset of labor to get rid of the infected tissue, and the fetus seeks to exit a hostile intrauterine environment that threatens its survival.&lt;/p&gt;
&lt;p&gt;To look at the mechanisms by which this process occurs, Romero and colleagues conducted a case-control study of mothers in Chile to assess genetic factors that could predispose women to spontaneous preterm labor and delivery.&lt;/p&gt;
&lt;p&gt;Patients who delivered prior to 37 weeks gestation served as cases, while women who delivered a normal neonate at term served as controls. There were 223 mothers and 179 fetuses in the case group, and 599 mothers and 628 fetuses in the control group.&lt;/p&gt;
&lt;p&gt;The researchers subsequently examined 190 candidate genes and 775 SNPs.&lt;/p&gt;
&lt;p&gt;They found that the strongest fetal single-locus association with risk of spontaneous preterm birth was in &lt;em&gt;ILR6&lt;/em&gt;, (OR 2.07, 95% CI 1.42 to 3.02,&lt;em&gt; P&lt;/em&gt;=0.0001).&lt;/p&gt;
&lt;p&gt;The strongest maternal single-locus association with spontaneous preterm labor and delivery was in tissue inhibitor of metalloproteinase &lt;em&gt;TIMP2&lt;/em&gt; (OR 1.98, 95% CI 1.38 to 2.83, &lt;em&gt;P&lt;/em&gt;=0.0002). This gene is involved in regulating the extracellular matrix, which holds cells within tissues.&lt;/p&gt;
&lt;p&gt;The associations remained significant after controlling for multiple comparisons, Romero said.&lt;/p&gt;
&lt;p&gt;Global haplotype analysis also indicated an association between a fetal DNA variant in insulin-like growth factor 2 (&lt;em&gt;P&lt;/em&gt;=0.004) as well as maternal alpha 3 type IV collagen isoform 1 (&lt;em&gt;COL4A3&lt;/em&gt;) (&lt;em&gt;P&lt;/em&gt;=0.007).&lt;/p&gt;
&lt;p&gt;&quot;Some women and fetuses carry gene variants that predispose them to the early onset of labor,&quot; Romero said.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The researchers reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_299"
                     title="Teen Pregnancies, Births, and Abortions Increase"
                     score="0.003"
                     href="http://www.medpagetoday.com/OBGYN/Pregnancy/tb/18162?impressionId=1265783362702"
                     
      &lt;p&gt;After a decade of decline, the rate of teenage pregnancies increased by 3% in 2006 as 750,000 women younger than 20 became pregnant, according to a report released by the Guttmacher Institute.&lt;/p&gt;
&lt;p&gt;And as pregnancies increased, so did births  --  41.9 births per 1,000 U.S. teenage girls, which was 4% higher than in 2005  --  and abortions, which increased by 1% from 2005 to 2006.&lt;/p&gt;
&lt;p&gt;In a prepared statement, Planned Parenthood blamed abstinence-only sex education programs for the uptick.&lt;/p&gt;
&lt;p&gt;&quot;It is a tragedy that after a decade of progress in reducing the rate of teenage pregnancy we are witnessing a substantial increase in the number of teens who are getting pregnant,&quot; Planned Parenthood said.&lt;/p&gt;
&lt;p&gt;In a statement released last May in conjunction with the &quot;National Day to Prevent Teen Pregnancy&quot; the American College of Obstetricians and Gynecologists (ACOG), agreed that comprehensive sex education was likely to be more effective than abstinence-only programs.&lt;/p&gt;
&lt;p&gt;&quot;Abstinence works for some teens, but the idea that most teens will wait to have sex indefinitely is rigid and impractical,&quot; said Richard S. Guido, MD, chair of the ACOG&apos;s Committee on Adolescent Health Care.&lt;/p&gt;
&lt;p&gt;But the Guttmacher report suggested that the reasons for increase may be more complex, including &quot;shifts in the racial and ethnic composition of the population, increases in poverty, the growth of abstinence-only sex education programs at the expense of comprehensive programs, and changes in public perception and attitudes toward both teenage and unintended pregnancy.&quot;&lt;/p&gt;
&lt;p&gt;Among black teenagers the pregnancy rate was 126.3 per 1,000 versus 44 per 1,000 non-Hispanic white teenagers.&lt;/p&gt;
&lt;p&gt;A breakdown by state revealed that New Mexico had the highest teenage pregnancy rate, followed by Nevada, Arizona, Texas, and Mississippi.&lt;/p&gt;
&lt;p&gt;Conversely, the lowest teenage pregnancy rate was in New Hampshire  --  33 pregnancies per 1,000  --  followed by Vermont, Maine, Minnesota, and North Dakota.&lt;/p&gt;
&lt;p&gt;Texas had the highest rate of births to teenage mothers  --  62 per 1,000  --  and New York had the highest rate of abortions among teenagers, 41 per 1,000.&lt;/p&gt;
&lt;p&gt;The report was based on data from the National Center for Health Statistics of the U.S. Department of Health and Human Services (number of births), the Guttmacher Institute (total number of abortions), the U.S. Centers for Disease Control and Prevention (age and race/ethnicity distribution of women obtaining abortions), and the Population Estimates Program of the U.S. Bureau of the Census in collaboration with NCHS (population estimates).&lt;/p&gt;
&lt;p&gt;Among other findings in the report: &lt;ul&gt; &lt;li&gt;The pregnancy rate was 71.5 pregnancies per 1,000 girls ages 15-19 and pregnancies occurred among 7% of females in this age group.&lt;/li&gt; &lt;li&gt;Although teenage abortions increased by 1% from 2005 to 2006, the overall teenage abortion rate declined by about a third over the two decades from 1986 to 2006.&lt;/li&gt; &lt;li&gt;The increase in teen pregnancies and births to teenage mothers was observed across all racial and ethnic groups.&lt;/li&gt; &lt;/ul&gt;&lt;/p&gt;
&lt;p&gt;The authors said that additional research was needed to determine if the disparities in rates by both race and region carry over to adult women.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The report was prepared by Kathryn Kost, Stanley Henshaw, and Liz Carlin of the Guttmacher Institute.&lt;/p&gt;&lt;p&gt;Lawrence Finer, Rebecca Wind, Susheela Singh, and Laura Lindberg provided comments on early drafts.&lt;/p&gt;&lt;p&gt;The report was funded by grants from the Brush Foundation, The California Wellness Foundation (TCWF) and the Annie E. Casey Foundation. The Guttmacher Institute also gratefully acknowledges the general support it receives from individuals and foundations, including major grants from The William and Flora Hewlett Foundation, The David and Lucile Packard Foundation, and the Ford Foundation, which undergirds all of the Institute&apos;s work.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_288"
                     title="SSRIs Affect Breast Milk Production (CME/CE)"
                     score="0.003"
                     href="http://www.medpagetoday.com/Endocrinology/GeneralEndocrinology/tb/18149?impressionId=1265783362702"
                     
      &lt;p&gt;Women taking selective serotonin reuptake inhibitor (SSRI) antidepressants may experience delays in postpartum breast milk production, researchers said.&lt;/p&gt;
&lt;p&gt;Delayed secretory activation occurred in 87.5% of a small group of women taking SSRIs, compared with 43.5% of those not taking the drugs (RR 2, 95% CI 1.51 to 2.67, &lt;em&gt;P&lt;/em&gt;=0.02), according to Aaron M. Marshall, PhD, of the University of Cincinnati.&lt;/p&gt;
&lt;p&gt;The relative risk of delayed activation remained significantly higher (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.05) among SSRI users after adjustment for maternal age, obesity, cesarean delivery, infant gestational age, and infant breastfeeding behavior, the researchers reported online in the &lt;em&gt;Journal of Clinical Endocrinology and Metabolism&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;An early breastfeeding difficulty faced by many women, particularly those who are primiparous, is milk secretion delayed beyond 72 hours postpartum.&lt;/p&gt;
&lt;p&gt;These women also are at risk of early cessation of breastfeeding. In fact, only 11% of mothers in the U.S. breastfeed exclusively for the recommended six months.&lt;/p&gt;
&lt;p&gt;Studies in animal models and cell cultures suggested that serotonin (5-HT) is an important local regulator of lactation homeostasis, and the 5-HT transporter is expressed in mammary tissue at the apical membrane of epithelial cells.&lt;/p&gt;
&lt;p&gt;Serotonin is controlled intracellularly by a balance between synthesis and degradation, while extracellularly its availability is controlled through recycling by the 5-HT transporter.&lt;/p&gt;
&lt;p&gt;The 5-HT transporter also is the target for the most commonly prescribed class of antidepressants in the U.S. and other developed countries. These SSRI antidepressants are typically used to treat postpartum depression.&lt;/p&gt;
&lt;p&gt;The investigators conducted in vitro and animal studies to establish that the 5-HT transporter is expressed in breast tissue, particularly in the apical membranes of mammary epithelial cells, and that pharmacologic inhibition of the transporter disrupts tight junctures leading to a local involution-like effect.&lt;/p&gt;
&lt;p&gt;To examine the potential effect of SSRI inhibition on milk production in women, Marshall and colleagues enrolled 431 mothers as part of a longitudinal cohort study examining barriers to early lactation success.&lt;/p&gt;
&lt;p&gt;All were expecting their first live-born infants, had no known absolute contraindication to breastfeeding, and were at least 19 years old.&lt;/p&gt;
&lt;p&gt;Women taking SSRIs were more likely to have scored higher on a depressive symptom scale (as expected), and were somewhat more likely to be obese or to have had a cesarean delivery.&lt;/p&gt;
&lt;p&gt;Participating mothers were visited between 72 and 96 hours after giving birth to assess their breastfeeding experience and to determine the timing of secretory activation, and then seen again one week later.&lt;/p&gt;
&lt;p&gt;Delayed secretory activation was defined as initiation more than 72 hours postpartum.&lt;/p&gt;
&lt;p&gt;Median onset of secretory activation among the SSRI-treated mothers was 85.8 hours compared with 69.1 hours in mothers not using the drugs (&lt;em&gt;P&lt;/em&gt;=0.004).&lt;/p&gt;
&lt;p&gt;Eight women reported regular use of an SSRI medication. Seven experienced definite delayed secretory activation, and the eighth reported activation at 72 hours and therefore did not meet the defined cutoff for delayed activation.&lt;/p&gt;
&lt;p&gt;All women taking SSRIs had experienced secretory activation by their second visit a week after the first interview.&lt;/p&gt;
&lt;p&gt;The researchers noted that most studies on the effects of SSRI use during pregnancy and lactation have focused on the risks for developmental defects or whether the drugs passed into milk during lactation.&lt;/p&gt;
&lt;p&gt;This study, they said, is the first to report data on another important aspect of SSRI use during the peripartum, the effect on milk production.&lt;/p&gt;
&lt;p&gt;They concluded that the risk of delayed secretory activation was twice as great among primiparous women using an SSRI medication, and although the fraction of women taking the drugs was small, the risk was significant and remained so after adjustment for potential confounding factors.&lt;/p&gt;
&lt;p&gt;Further examination of this relationship is needed in larger groups of mothers, the researchers said, and in studies to determine if there are differences among the antidepressant medications.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;This work was supported by the National Institutes of Health, the USDA Cooperative State Research, Education, and Extension Service, and the Department of Health and Human Services.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_244"
                     title="No Explanation for Smaller Babies"
                     score="-0.002"
                     href="http://www.medpagetoday.com/OBGYN/GeneralOBGYN/tb/18095?impressionId=1265783362702"
                     
      &lt;p&gt;The birth weight of term babies appears to be dropping in America without much explanation as to why, researchers said.&lt;/p&gt;
&lt;p&gt;Mean birth weight dropped 52 g (1.8 oz) overall from 1990 through 2005, according to Emily Oken, MD, MPH, of Harvard Medical School and Harvard Pilgrim Health Care in Boston, and colleagues.&lt;/p&gt;
&lt;p&gt;Fewer babies were large for gestational age as well in 2005  --  a 1.4% drop from 1990, they reported in the February issue of &lt;em&gt;Obstetrics &amp;amp; Gynecology&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;These changes among term, singleton births &quot;were not explained by trends in maternal and neonatal characteristics, changes in obstetric practices, or concurrent decreases in gestational length,&quot; Oken&apos;s group wrote.&lt;/p&gt;
&lt;p&gt;What consequence these modest changes over time might have for infants is unclear, but size at birth is known to predict long-term health and chronic disease risk, the researchers noted.&lt;/p&gt;
&lt;p&gt;The trend toward declining birth weight for gestational age appeared to be a continuation of that reported from the 1980s to 1990s.&lt;/p&gt;
&lt;p&gt;Mean birth weight had previously been on the rise since the 1950s, but U.S. national surveillance data suggesting a reversal in this trend didn&apos;t account for an increase in preterm deliveries and other factors.&lt;/p&gt;
&lt;p&gt;So, the researchers looked at the national trend by analyzing a total of 36,827,828 singleton births carried to term (37 to 41 weeks), along with data on their mothers in the National Center for Health Statistics Natality Data Sets for the years 1990 through 2005.&lt;/p&gt;
&lt;p&gt;The researchers excluded births in California, &quot;which does not report maternal weight gain during pregnancy,&quot; and those without recorded gestational age, birth weight, or neonatal sex.&lt;/p&gt;
&lt;p&gt;During this decade and a half, there were no clear shifts in the proportion of infants who were boys, who were firstborns, or whose mothers had received first trimester prenatal care.&lt;/p&gt;
&lt;p&gt;Trends in maternal characteristics linked to fetal growth were mixed.&lt;/p&gt;
&lt;p&gt;On the one hand, there was an increase in maternal characteristics linked to greater fetal growth: more education, older age, diabetes before or during pregnancy, gestational weight gain of at least 46 lb, and nonsmoking during pregnancy.&lt;/p&gt;
&lt;p&gt;In the other direction, there was also an increase in neonates born to mothers with hypertension, gestational weight gain under 16 lb, and who were Hispanic or black or unmarried.&lt;/p&gt;
&lt;p&gt;Cesarean delivery dropped from 22.0% in 1990 to 19.8% in 1995 and then rose to 28.3% in 2005.&lt;/p&gt;
&lt;p&gt;A recent &lt;a href=&quot;http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/17619&quot; mce_href=&quot;http://www.medpagetoday.com/Pediatrics/GeneralPediatrics/17619&quot; target=&quot;_blank&quot;&gt;national study &lt;/a&gt;has suggested that this increase in C-section has continued, reaching 31.8% of all births in 2007.&lt;/p&gt;
&lt;p&gt;But across every maternal characteristic, there was a mean drop in birth weight from 2000 to 2005.&lt;/p&gt;
&lt;p&gt;The decline was particularly steep, at 79 g (2.8 oz) from 1990 to 2005 in a homogenous subgroup limited to low-risk infants who had not been induced or delivered by cesarean section  --  an analysis designed &quot;to account for trends in maternal and neonatal characteristics and obstetric practices.&quot;&lt;/p&gt;
&lt;p&gt;Among these low-risk births, decreases were seen within each gestational age group from 37 to 41 weeks, though the greatest declines were in the highest gestational age group (-71g versus -9 g in the 37-weeks group).&lt;/p&gt;
&lt;p&gt;Large-for-gestational-age births became less common after 2000, dropping to 8.9% by 2005, compared with a fairly stable 10.3% from 1990 to 2000.&lt;/p&gt;
&lt;p&gt;Again, this downward trend was more noticeable in the low-risk subgroup.&lt;/p&gt;
&lt;p&gt;Small-for-gestational-age births, though taking a small dip between 1996 and 1999, have remained fairly steady at 10.2% to 10.3% over the 16-year study period.&lt;/p&gt;
&lt;p&gt;Among low-risk infants, the trend in low-weight births increased from 1990 to 2005 (from 7.2% to 8.1%).&lt;/p&gt;
&lt;p&gt;Gestational duration dropped by an average of 2.4 days overall, by 2.31 days in the low-risk subgroup, and for those born after induction of labor, cesarean delivery, or both.&lt;/p&gt;
&lt;p&gt;Regression analyses seeking to explain the trends in birth weight showed attenuation of the trend, with adjustment for gestational age at birth and amplification by adjustment for maternal height and body mass index before pregnancy.&lt;/p&gt;
&lt;p&gt;However, none of the analyses showed a clear explanation, the researchers said.&lt;/p&gt;
&lt;p&gt;They cautioned that despite the large nationally representative sample, birth record data is inherently limited, since gestational length may not be accurate.&lt;/p&gt;
&lt;p&gt;The study also lacked data on potentially important factors not included in the birth records, such as maternal diet, stress, and socioeconomics, they added.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The study was supported by grants from the National Institutes of Health. The researchers reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_203"
                     title="Doppler Exam Improves Outcomes in High-Risk Pregnancy (CME/CE)"
                     score="-0.002"
                     href="http://www.medpagetoday.com/OBGYN/Pregnancy/tb/18044?impressionId=1265783362702"
                     
      Using Doppler ultrasound to examine fetal circulation reduces perinatal death in high-risk pregnancies by 29%, an updated Cochrane Review found.&lt;br&gt;
&lt;br&gt;In a pooled analysis of 16 studies involving 10,225 babies, the perinatal death rate was 1.2% when Doppler ultrasound was used and 1.7% when it was not, according to Zarko Alfirevic, MD, of the University of Liverpool in England, and colleagues.&lt;br&gt;
&lt;br&gt;The number needed to treat was 203 (95% CI 103 to 4352).&lt;br&gt;
&lt;br&gt;In an interview, Alfirevic said that that high number and &quot;absolutely huge&quot; confidence interval reflects the lack of quality evidence.&lt;br&gt;
&lt;br&gt;&quot;I think that, indeed, one can question whether this is a good value for money,&quot; he said, noting that there have not been any formal cost-effectiveness analyses.&lt;br&gt;
&lt;br&gt;But, because there are no obvious negative effects from the examination, he said, &quot;I would expect that most patients would say Yes.&quot;&lt;p&gt;&lt;/p&gt;
&lt;p&gt;The review updated a previous one conducted in 1996, which came to similar conclusions about the use of Doppler ultrasound.&lt;/p&gt;
&lt;p&gt;Abnormal fetal circulation detected on ultrasound may indicate poor fetal prognosis and allow life-saving interventions to be performed.&lt;/p&gt;
&lt;p&gt;However, a false-positive finding could encourage inappropriate early delivery, which could result in increased problems associated with prematurity, Alfirevic and his colleagues wrote.&lt;/p&gt;
&lt;p&gt;So they conducted a review to assess the risks and benefits of adding Doppler ultrasound to protocols for evaluating fetal well-being in women with high-risk pregnancies, including those with diabetes, hypertension, and heart problems or those with intrauterine growth restriction, pregnancies that have progressed beyond term, and those who&apos;ve had a previous miscarriage or stillbirth.&lt;/p&gt;
&lt;p&gt;The researchers looked at randomized and quasi-randomized controlled trials comparing the use of Doppler ultrasound with no ultrasound or with electronic fetal monitoring. In general, they said, the studies were not high quality.&lt;/p&gt;
&lt;p&gt;In fact, the quality of the studies assessing Doppler ultrasound versus no ultrasound for the effect on perinatal death rates was &quot;very low,&quot; the authors wrote, which is &quot;of concern given the borderline significance of the pooled meta-analysis result.&quot;&lt;/p&gt;
&lt;p&gt;There was insufficient evidence to assess the effect of the use of ultrasound on serious neonatal morbidity, the other primary outcome.&lt;/p&gt;
&lt;p&gt;Although Alfirevic said he and his colleagues were concerned that the use of Doppler ultrasound might increase invasive obstetrical procedures, in 10 of the studies there were actually fewer inductions of labor (pooled RR 0.89, 95% CI 0.80 to 0.99) and fewer cesarean deliveries in 14 studies (pooled RR 0.90, 95% CI 0.84 to 0.97).&lt;/p&gt;
&lt;p&gt;The use of Doppler ultrasound had no effect on rates of operative vaginal births or on the proportion of babies born with Apgar scores under 7 at five minutes.&lt;/p&gt;
&lt;p&gt;According to Alfirevic, the overall low quality of the evidence did not allow for recommendations regarding patients who would most benefit from the addition of Doppler ultrasound or regarding the best approaches following an abnormal result.&lt;/p&gt;
&lt;p&gt;&quot;Doppler studies of the umbilical artery should be incorporated and should be a part of the protocols for fetal monitoring in high-risk pregnancies, particularly those who are at risk of placental insufficiency,&quot; he said.&lt;/p&gt;
&lt;p&gt;&quot;But we are not in a position at the moment to be more specific than that.&quot;&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The review received internal support from the University of Liverpool and external support from the U.K. National Institute for Health Research (NIHR). One of Alfirevic&apos;s co-authors is supported by the NIHR NHS Cochrane Collaboration Program grant scheme award for NHS-prioritized centrally-managed, pregnancy and childbirth systematic reviews.&lt;/p&gt;&lt;p&gt;The authors reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
</recommendedContent>