Correction to: The association between anxiety and disease activity and quality of life in rheumatoid arthritis: a systematic review and meta-analysis.

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Pre-eclampsia is associated with a two-fold increase in diabetes: a systematic review and meta-analysis

Aims/hypothesis: Pre-eclampsia is a pregnancy-specific multi-system disorder and a state of physiological insulin resistance. Our aim is to systematically evaluate and quantify the evidence on the relationship between pre-eclampsia and the future risk of diabetes. Methods: We conducted a systematic review and meta-analysis of studies that evaluated diabetes in women with and without pre-eclampsia. We performed a systematic search of MEDLINE and EMBASE to identify relevant studies. Independent double data extractions were conducted by four reviewers. Random effects meta-analysis was used to estimate the risk of future diabetes following pre-eclampsia. Results: Twenty-one studies were identified with over 2.8 million women including >72,000 women with pre-eclampsia. Meta-analysis of studies that adjusted for potential confounders demonstrated that pre-eclampsia was independently associated with an increased risk of future diabetes (risk ratio (RR) 2.37, 95% CI 1.89, 2.97). This risk appeared in studies that followed up women from <1 year (RR 1.97, 95% CI 1.35, 2.87) and persisted to over 10 years post-partum (RR 1.95, 95% CI 1.28, 2.97). After adjusting for BMI or gestational diabetes, pre-eclampsia was linked with an increased risk of future diabetes (RR 2.38, 95% CI 1.74, 3.24) or (RR 2.36, 95% CI 1.94, 2.88), respectively. Conclusions/interpretation: Pre-eclampsia is independently associated with a two-fold increase in future diabetes. Our study highlights the importance of clinical risk assessment for the future development of diabetes in women with pre-eclampsia. We recommend detailed evaluation of a screening programme for diabetes in this high-risk population

Maternal mortality due to cardiac disease in Sri Lanka.

OBJECTIVE To investigate Sri Lankan maternal deaths due to heart disease and to consider low-cost interventions to reduce these deaths. METHODS A qualitative study based on retrospective audit of all maternal deaths and late maternal deaths in Sri Lanka caused by cardiac disease in 2004. RESULTS A total of 145 maternal deaths were recorded in 2004, for a maternal mortality rate of 38 per 100,000. There were 42 indirect deaths, 25 of which were due to cardiac disease; 23 deaths had a specific cardiac cause listed. Standard care was identified in prepregnancy counseling, contraception, and prenatal community and specialist care. CONCLUSION Cardiac disease is a major cause of maternal mortality in Sri Lanka, second only to postpartum hemorrhage. Rheumatic mitral valve disease is responsible for more than a third of maternal deaths from cardiac disease. Substandard care was identified in all cases; strategies to improve care could allow a reduction in maternal cardiac deaths

088 The impact of anxiety on quality of life and disease activity in rheumatoid arthritis: a systematic review

Background: Co-morbid anxiety and depression are frequent in patients with rheumatoid arthritis (RA), but are often under-recognised and under-treated, contributing to increased morbidity and mortality. Most studies examining the impact of mood problems in RA have focused on depression. The aim of this systematic review was to determine the impact of anxiety in RA on quality of life (QoL) and disease activity.Methods: Databases (Web of Science, PsycINFO, CINAHL, Embase and Medline) were systematically searched for studies examining the impact of anxiety on QoL and disease activity in adults with RA, from inception to October 2017. Primary outcome measures were DAS28 and SF-36, though validated secondary outcome measures were included. Screening for eligibility and data extraction were completed by two independent reviewers, with disagreements resolved by discussion or a third independent reviewer. Quality assessment was carried out using the Newcastle-Ottawa Scale. Findings were brought together using a narrative synthesis framework. For the analysis, data relating to the Physical Component Score (PCS) and Mental Component Score (MCS) subscales of SF-36 were pooled separately. A random effects meta-analysis of correlation coefficients between anxiety and the PCS/ MCS of SF-36 as well as DAS28 was conducted.Results: From 6,404 unique citations, 48 articles were assessed for eligibility. 16 studies (13 cross-sectional, 3 cohort) involving 4012 people were suitable for inclusion in the review. Of these, 6 studies reported QoL outcome measures, 7 examined disease activity and 3 reported both. From the studies reporting QoL, 4 provided suitable data for meta-analysis. Similarly, 4 studies reporting disease activity provided suitable data, and were pooled in the analysis. Overall, anxiety was associated with increased disease activity and worse QoL. Anxiety was correlated with increased DAS28 scores (r = 0.230, CI: 0.099, 0.360), in addition to reduced physical (r= -0.386, CI: -0.575, -0.198) and mental (-0.501, CI: -0.571, -0.431) QoL.Conclusion: Anxiety in patients with RA is associated with increased disease activity and worse QoL in cross sectional analyses. Further studies are required to examine the longer term impact of anxiety and whether intervention strategies may improve outcomes for people with RA