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Evaluating the increase in total body water during pregnancy in healthy parturients: A Systematic Review and Meta-analysis
Abstract Number: S4B-3
Abstract Type: Original Research
Background: Weight gain during pregnancy has been associated with plasma volume expansion, increased cardiac output and retention of sodium and water . Total body water (TBW) increase is likely to be greater in women with pregnancies complicated by gestational hypertension and preeclampsia; in addition, increased fluid states and rostral fluid shift have also been associated with sleep disordered breathing . In this systematic review and meta-analysis, we aimed to evaluate the changes in TBW during pregnancy in healthy women.
Methods: Electronic literature search of Medline, Medline in-process, Embase, Cochrane Database of Systematic Reviews databases, international conference proceedings, and abstracts was conducted for the period of 1946 to March 2017 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols guideline. We included cohort studies and randomized controlled trials using bioelectrical impedance analysis to investigate TBW changes in uncomplicated pregnancies. TBW estimates at various time points during pregnancy were recorded, and estimates were pooled to evaluate change of TBW over time. Meta-analysis was performed by fitting a random effect model, accounting for variations between studies. The pooled slope of TBW change over time was estimated by Markov Chain Monte Carlo method. Estimates were reported as mean and 95% highest posterior density (95% HPD) in liters (L).
Results: Our initial screening resulted in 1784 articles. In this meta-analysis, 17 studies (n=1759 patients) were included and we examined the changes in TBW trend over time from pre-pregnancy to delivery. The average population pre-pregnancy TBW was assumed to be 32 L and we found that TBW increased consistently across studies from pre-pregnancy period to until the time of delivery. The pooled estimate of the slope was statistically significantly different from zero and indicated an increase in TBW by 0.168 L (95% HPD 0.038-0.307 L) for every 1-week increase in gestational age (Figure 1).
Conclusion: Our study shows that the TBW increases with the increasing gestational age in healthy women with uncomplicated pregnancies. It will be interesting to evaluate whether the slope of increase in TBW is different in complicated pregnancies such as pre-eclampsia or sleep disordered breathing.
References: 1. Anesthesiology 1965; 26:393-99; 2. Indian J Med Res. 2010; 131: 285-301.