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  1. Thesis ; Online: Efficient inference algorithms for near-deterministic systems

    Chatterjee, Shaunak

    2013  

    Abstract: This thesis addresses the problem of performing probabilistic inference in stochastic systems where the probability mass is far from uniformly distributed among all possible outcomes. Such near-deterministic systems arise in several real-world ... ...

    Abstract This thesis addresses the problem of performing probabilistic inference in stochastic systems where the probability mass is far from uniformly distributed among all possible outcomes. Such near-deterministic systems arise in several real-world applications. For example, in human physiology, the widely varying evolution rates of physiological variables make certain trajectories much more likely than others; in natural language, a very small fraction of all possible word sequences accounts for a disproportionately high amount of probability under a language model. In such settings, it is often possible to obtain significant computational savings by focusing on the outcomes where the probability mass is concentrated. This contrasts with existing algorithms in probabilistic inference---such as junction tree, sum product, and belief propagation algorithms---which are well-tuned to exploit conditional independence relations. The first topic addressed in this thesis is the structure of discrete-time temporal graphical models of near-deterministic stochastic processes. We show how the structure depends on the ratios between the size of the time step and the effective rates of change of the variables. We also prove that accurate approximations can often be obtained by sparse structures even for very large time steps. Besides providing an intuitive reason for causal sparsity in discrete temporal models, the sparsity also speeds up inference. The next contribution is an eigenvalue algorithm for a linear factored system (e.g., dynamic Bayesian network), where existing algorithms do not scale since the size of the system is exponential in the number of variables. Using a combination of graphical model inference algorithms and numerical methods for spectral analysis, we propose an approximate spectral algorithm which operates in the factored representation and is exponentially faster than previous algorithms. The third contribution is a temporally abstracted Viterbi (TAV) algorithm. Starting with a spatio-temporally abstracted coarse representation of the original problem, the TAV algorithm iteratively refines the search space for the Viterbi path via spatial and temporal refinements. The algorithm is guaranteed to converge to the optimal solution with the use of admissible heuristic costs in the abstract levels and is much faster than the Viterbi algorithm for near-deterministic systems. The fourth contribution is a hierarchical image/video segmentation algorithm, that shares some of the ideas used in the TAV algorithm. A supervoxel tree provides the abstraction hierarchy for this application. The algorithm starts working with the coarsest level supervoxels, and refines portions of the tree which are likely to have multiple labels. Several existing segmentation algorithms can be used to solve the energy minimization problem in each iteration, and admissible heuristic costs once again guarantee optimality. Since large contiguous patches exist in images and videos, this approach is more computationally efficient than solving the problem at the finest level of supervoxels. The final contribution is a family of Markov Chain Monte Carlo (MCMC) algorithms for near-deterministic systems when there exists an efficient algorithm to sample solutions for the corresponding deterministic problem. In such a case, a generic MCMC algorithm's performance worsens as the problem becomes more deterministic despite the existence of the efficient algorithm in the deterministic limit. MCMC algorithms designed using our methodology can bridge this gap. The computational speedups we obtain through the various new algorithms presented in this thesis show that it is indeed possible to exploit near-determinism in probabilistic systems. Near-determinism, much like conditional independence, is a potential (and promising) source of computational savings for both exact and approximate inference. It is a direction that warrants more understanding and better generalized algorithms.
    Keywords Artificial intelligence|Computer science
    Subject code 006
    Language ENG
    Publishing date 2013-01-01 00:00:01.0
    Publisher University of California, Berkeley
    Publishing country us
    Document type Thesis ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Book ; Online: A/B Testing for Recommender Systems in a Two-sided Marketplace

    Nandy, Preetam / Venugopalan, Divya / Lo, Chun / Chatterjee, Shaunak

    2021  

    Abstract: Two-sided marketplaces are standard business models of many online platforms (e.g., Amazon, Facebook, LinkedIn), wherein the platforms have consumers, buyers or content viewers on one side and producers, sellers or content-creators on the other. Consumer ...

    Abstract Two-sided marketplaces are standard business models of many online platforms (e.g., Amazon, Facebook, LinkedIn), wherein the platforms have consumers, buyers or content viewers on one side and producers, sellers or content-creators on the other. Consumer side measurement of the impact of a treatment variant can be done via simple online A/B testing. Producer side measurement is more challenging because the producer experience depends on the treatment assignment of the consumers. Existing approaches for producer side measurement are either based on graph cluster-based randomization or on certain treatment propagation assumptions. The former approach results in low-powered experiments as the producer-consumer network density increases and the latter approach lacks a strict notion of error control. In this paper, we propose (i) a quantification of the quality of a producer side experiment design, and (ii) a new experiment design mechanism that generates high-quality experiments based on this quantification. Our approach, called UniCoRn (Unifying Counterfactual Rankings), provides explicit control over the quality of the experiment and its computation cost. Further, we prove that our experiment design is optimal to the proposed design quality measure. Our approach is agnostic to the density of the producer-consumer network and does not rely on any treatment propagation assumption. Moreover, unlike the existing approaches, we do not need to know the underlying network in advance, making this widely applicable to the industrial setting where the underlying network is unknown and challenging to predict a priori due to its dynamic nature. We use simulations to validate our approach and compare it against existing methods. We also deployed UniCoRn in an edge recommendation application that serves tens of millions of members and billions of edge recommendations daily.
    Keywords Computer Science - Social and Information Networks ; Statistics - Applications ; Statistics - Methodology ; 62K99 ; 62G05 ; 62P30
    Subject code 000
    Publishing date 2021-05-28
    Publishing country us
    Document type Book ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Book ; Online: A State Transition Model for Mobile Notifications via Survival Analysis

    Yuan, Yiping / Zhang, Jing / Chatterjee, Shaunak / Yu, Shipeng / Rosales, Romer

    2022  

    Abstract: Mobile notifications have become a major communication channel for social networking services to keep users informed and engaged. As more mobile applications push notifications to users, they constantly face decisions on what to send, when and how. A ... ...

    Abstract Mobile notifications have become a major communication channel for social networking services to keep users informed and engaged. As more mobile applications push notifications to users, they constantly face decisions on what to send, when and how. A lack of research and methodology commonly leads to heuristic decision making. Many notifications arrive at an inappropriate moment or introduce too many interruptions, failing to provide value to users and spurring users' complaints. In this paper we explore unique features of interactions between mobile notifications and user engagement. We propose a state transition framework to quantitatively evaluate the effectiveness of notifications. Within this framework, we develop a survival model for badging notifications assuming a log-linear structure and a Weibull distribution. Our results show that this model achieves more flexibility for applications and superior prediction accuracy than a logistic regression model. In particular, we provide an online use case on notification delivery time optimization to show how we make better decisions, drive more user engagement, and provide more value to users.

    Comment: 9 pages, 7 figures. Published in WSDM 19'
    Keywords Statistics - Machine Learning ; Computer Science - Machine Learning ; I.2.6
    Subject code 005
    Publishing date 2022-07-07
    Publishing country us
    Document type Book ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Book ; Online: Personalization and Optimization of Decision Parameters via Heterogenous Causal Effects

    Tu, Ye / Basu, Kinjal / Yan, Jinyun / Tiwana, Birjodh / Chatterjee, Shaunak

    2019  

    Abstract: Randomized experimentation (also known as A/B testing or bucket testing) is very commonly used in the internet industry to measure the effect of a new treatment. Often, the decision on the basis of such A/B testing is to ramp the treatment variant that ... ...

    Abstract Randomized experimentation (also known as A/B testing or bucket testing) is very commonly used in the internet industry to measure the effect of a new treatment. Often, the decision on the basis of such A/B testing is to ramp the treatment variant that did best for the entire population. However, the effect of any given treatment varies across experimental units, and choosing a single variant to ramp to the whole population can be quite suboptimal. In this work, we propose a method which automatically identifies the collection of cohorts exhibiting heterogeneous treatment effect (using causal trees). We then use stochastic optimization to identify the optimal treatment variant in each cohort. We use two real-life examples - one related to serving notifications and the other related to modulating ads density on feed. In both examples, using offline simulation and online experimentation, we demonstrate the benefits of our approach. At the time of writing this paper, the method described has been deployed on the LinkedIn Ads and Notifications system.

    Comment: 10 Pages, 5 Figures
    Keywords Statistics - Methodology ; Computer Science - Machine Learning
    Subject code 006
    Publishing date 2019-01-29
    Publishing country us
    Document type Book ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  5. Book ; Online: Measuring Long-term Impact of Ads on LinkedIn Feed

    Yan, Jinyun / Tiwana, Birjodh / Ghosh, Souvik / Liu, Haishan / Chatterjee, Shaunak

    2019  

    Abstract: Organic updates (from a member's network) and sponsored updates (or ads, from advertisers) together form the newsfeed on LinkedIn. The newsfeed, the default homepage for members, attracts them to engage, brings them value and helps LinkedIn grow. ... ...

    Abstract Organic updates (from a member's network) and sponsored updates (or ads, from advertisers) together form the newsfeed on LinkedIn. The newsfeed, the default homepage for members, attracts them to engage, brings them value and helps LinkedIn grow. Engagement and Revenue on feed are two critical, yet often conflicting objectives. Hence, it is important to design a good Revenue-Engagement Tradeoff (RENT) mechanism to blend ads in the feed. In this paper, we design experiments to understand how members' behavior evolve over time given different ads experiences. These experiences vary on ads density, while the quality of ads (ensured by relevance models) is held constant. Our experiments have been conducted on randomized member buckets and we use two experimental designs to measure the short term and long term effects of the various treatments. Based on the first three months' data, we observe that the long term impact is at a much smaller scale than the short term impact in our application. Furthermore, we observe different member cohorts (based on user activity level) adapt and react differently over time.

    Comment: Needs more polish
    Keywords Computer Science - Social and Information Networks ; Computer Science - Machine Learning ; Statistics - Machine Learning
    Subject code 306
    Publishing date 2019-01-29
    Publishing country us
    Document type Book ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  6. Article: Dynamics of Large Multi-View Social Networks: Synergy, Cannibalization and Cross-View Interplay.

    Shi, Yu / Kim, Myunghwan / Chatterjee, Shaunak / Tiwari, Mitul / Ghosh, Souvik / Rosales, Rómer

    KDD : proceedings. International Conference on Knowledge Discovery & Data Mining

    2017  Volume 2016, Page(s) 1855–1864

    Abstract: Most social networking services support multiple types of relationships between users, such as getting connected, sending messages, and consuming feed updates. These users and relationships can be naturally represented as a dynamic multi-view network, ... ...

    Abstract Most social networking services support multiple types of relationships between users, such as getting connected, sending messages, and consuming feed updates. These users and relationships can be naturally represented as a dynamic multi-view network, which is a set of weighted graphs with shared common nodes but having their own respective edges. Different network views, representing structural relationship and interaction types, could have very distinctive properties individually and these properties may change due to interplay across views. Therefore, it is of interest to study how multiple views interact and affect network dynamics and, in addition, explore possible applications to social networking. In this paper, we propose approaches to capture and analyze multi-view network dynamics from various aspects. Through our proposed descriptors, we observe the synergy and cannibalization between different user groups and network views from LinkedIn dataset. We then develop models that consider the synergy and cannibalization per new relationship, and show the outperforming predictive capability of our models compared to baseline models. Finally, the proposed models allow us to understand the interplay among different views where they dynamically change over time.
    Language English
    Publishing date 2017-02-10
    Publishing country United States
    Document type Journal Article
    ISSN 2154-817X
    ISSN 2154-817X
    DOI 10.1145/2939672.2939814
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: The Angelina Jolie effect: Contralateral risk-reducing mastectomy trends in patients at increased risk of breast cancer.

    Basu, Narendra Nath / Hodson, James / Chatterjee, Shaunak / Gandhi, Ashu / Wisely, Julie / Harvey, James / Highton, Lyndsey / Murphy, John / Barnes, Nicola / Johnson, Richard / Barr, Lester / Kirwan, Cliona C / Howell, Sacha / Baildam, Andrew D / Howell, Anthony / Evans, D Gareth

    Scientific reports

    2021  Volume 11, Issue 1, Page(s) 2847

    Abstract: Contralateral risk-reducing mastectomy (CRRM) rates have tripled over the last 2 decades. Reasons for this are multi-factorial, with those harbouring a pathogenic variant in the BRCA1/2 gene having the greatest survival benefit. On May 14th, 2013, ... ...

    Abstract Contralateral risk-reducing mastectomy (CRRM) rates have tripled over the last 2 decades. Reasons for this are multi-factorial, with those harbouring a pathogenic variant in the BRCA1/2 gene having the greatest survival benefit. On May 14th, 2013, Angelina Jolie shared the news of her bilateral risk-reducing mastectomy (BRRM), on the basis of her BRCA1 pathogenic variant status. We evaluated the impact of this news on rates of CRRM in women with increased risk for developing breast cancer after being diagnosed with unilateral breast cancer. The prospective cohort study included all women with at least a moderate lifetime risk of developing breast cancer who attended our family history clinic (1987-2019) and were subsequently diagnosed with unilateral breast cancer. Rates of CRRM were then compared between patients diagnosed with breast cancer before and after Angelina Jolie's announcement (pre- vs. post-AJ). Of 386 breast cancer patients, with a mean age at diagnosis of 48 ± 8 years, 268 (69.4%) were diagnosed in the pre-AJ period, and 118 (30.6%) in the post-AJ period. Of these, 123 (31.9%) underwent CRRM, a median 42 (interquartile range: 11-54) days after the index cancer surgery. Rates of CRRM doubled following AJ's news, from 23.9% pre-AJ to 50.0% post AJ (p < 0.001). Rates of CRRM were found to decrease with increasing age at breast cancer (p < 0.001) and tumour TNM stage (p = 0.040), and to increase with the estimated lifetime risk of breast cancer (p < 0.001) and tumour grade (p = 0.015) on univariable analysis. After adjusting for these factors, the step-change increase in CRRM rates post-AJ remained significant (odds ratio: 9.61, p < 0.001). The AJ effect appears to have been associated with higher rates of CRRM amongst breast cancer patients with increased cancer risk. CRRM rates were highest amongst younger women and those with the highest lifetime risk profile. Clinicians need to be aware of how media news can impact on the delivery of cancer related services. Communicating objective assessment of risk is important when counselling women on the merits of risk-reducing surgery.
    MeSH term(s) Adult ; BRCA1 Protein/genetics ; Counseling ; Female ; Genetic Predisposition to Disease ; Humans ; Mass Media ; Medical History Taking ; Middle Aged ; Prophylactic Mastectomy/psychology ; Prophylactic Mastectomy/trends ; Prospective Studies ; Unilateral Breast Neoplasms/genetics ; Unilateral Breast Neoplasms/surgery
    Chemical Substances BRCA1 Protein ; BRCA1 protein, human
    Language English
    Publishing date 2021-02-02
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2615211-3
    ISSN 2045-2322 ; 2045-2322
    ISSN (online) 2045-2322
    ISSN 2045-2322
    DOI 10.1038/s41598-021-82654-x
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: SARS-CoV-2 positivity in offspring and timing of mother-to-child transmission: living systematic review and meta-analysis.

    Allotey, John / Chatterjee, Shaunak / Kew, Tania / Gaetano, Andrea / Stallings, Elena / Fernández-García, Silvia / Yap, Magnus / Sheikh, Jameela / Lawson, Heidi / Coomar, Dyuti / Dixit, Anushka / Zhou, Dengyi / Balaji, Rishab / Littmoden, Megan / King, Yasmin / Debenham, Luke / Llavall, Anna Clavé / Ansari, Kehkashan / Sandhu, Gurimaan /
    Banjoko, Adeolu / Walker, Kate / O'Donoghue, Keelin / van Wely, Madelon / van Leeuwen, Elizabeth / Kostova, Elena / Kunst, Heinke / Khalil, Asma / Brizuela, Vanessa / Broutet, Nathalie / Kara, Edna / Kim, Caron Rahn / Thorson, Anna / Oladapo, Olufemi T / Zamora, Javier / Bonet, Mercedes / Mofenson, Lynne / Thangaratinam, Shakila

    BMJ (Clinical research ed.)

    2022  Volume 376, Page(s) e067696

    Abstract: Objectives: To assess the rates of SARS-CoV-2 positivity in babies born to mothers with SARS-CoV-2 infection, the timing of mother-to-child transmission and perinatal outcomes, and factors associated with SARS-CoV-2 status in offspring.: Design: ... ...

    Abstract Objectives: To assess the rates of SARS-CoV-2 positivity in babies born to mothers with SARS-CoV-2 infection, the timing of mother-to-child transmission and perinatal outcomes, and factors associated with SARS-CoV-2 status in offspring.
    Design: Living systematic review and meta-analysis.
    Data sources: Major databases between 1 December 2019 and 3 August 2021.
    Study selection: Cohort studies of pregnant and recently pregnant women (including after abortion or miscarriage) who sought hospital care for any reason and had a diagnosis of SARS-CoV-2 infection, and also provided data on offspring SARS-CoV-2 status and risk factors for positivity. Case series and case reports were also included to assess the timing and likelihood of mother-to-child transmission in SARS-CoV-2 positive babies.
    Data extraction: Two reviewers independently extracted data and assessed study quality. A random effects model was used to synthesise data for rates, with associations reported using odds ratios and 95% confidence intervals. Narrative syntheses were performed when meta-analysis was inappropriate. The World Health Organization classification was used to categorise the timing of mother-to-child transmission (in utero, intrapartum, early postnatal).
    Results: 472 studies (206 cohort studies, 266 case series and case reports; 28 952 mothers, 18 237 babies) were included. Overall, 1.8% (95% confidence interval 1.2% to 2.5%; 140 studies) of the 14 271 babies born to mothers with SARS-CoV-2 infection tested positive for the virus with reverse transcriptase polymerase chain reaction (RT-PCR). Of the 592 SARS-CoV-2 positive babies with data on the timing of exposure and type and timing of tests, 14 had confirmed mother-to-child transmission: seven in utero (448 assessed), two intrapartum (18 assessed), and five during the early postnatal period (70 assessed). Of the 800 SARS-CoV-2 positive babies with outcome data, 20 were stillbirths, 23 were neonatal deaths, and eight were early pregnancy losses; 749 babies were alive at the end of follow-up. Severe maternal covid-19 (odds ratio 2.4, 95% confidence interval 1.3 to 4.4), maternal death (14.1, 4.1 to 48.0), maternal admission to an intensive care unit (3.5, 1.7 to 6.9), and maternal postnatal infection (5.0, 1.2 to 20.1) were associated with SARS-CoV-2 positivity in offspring. Positivity rates using RT-PCR varied between regions, ranging from 0.1% (95% confidence interval 0.0% to 0.3%) in studies from North America to 5.7% (3.2% to 8.7%) in studies from Latin America and the Caribbean.
    Conclusion: SARS-CoV-2 positivity rates were found to be low in babies born to mothers with SARS-CoV-2 infection. Evidence suggests confirmed vertical transmission of SARS-CoV-2, although this is likely to be rare. Severity of maternal covid-19 appears to be associated with SARS-CoV-2 positivity in offspring.
    Systematic review registration: PROSPERO CRD42020178076.
    Readers' note: This article is a living systematic review that will be updated to reflect emerging evidence. Updates may occur for up to two years from the date of original publication.
    MeSH term(s) COVID-19/diagnosis ; COVID-19/transmission ; COVID-19 Nucleic Acid Testing ; COVID-19 Testing/methods ; Female ; Humans ; Infant, Newborn ; Infectious Disease Transmission, Vertical ; Pregnancy ; Pregnancy Complications, Infectious ; Pregnancy Outcome/epidemiology ; SARS-CoV-2
    Language English
    Publishing date 2022-03-16
    Publishing country England
    Document type Journal Article ; Meta-Analysis ; Research Support, Non-U.S. Gov't ; Systematic Review
    ZDB-ID 1362901-3
    ISSN 1756-1833 ; 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
    ISSN (online) 1756-1833
    ISSN 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
    DOI 10.1136/bmj-2021-067696
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Clinical manifestations, prevalence, risk factors, outcomes, transmission, diagnosis and treatment of COVID-19 in pregnancy and postpartum: a living systematic review protocol.

    Yap, Magnus / Debenham, Luke / Kew, Tania / Chatterjee, Shaunak Rhiju / Allotey, John / Stallings, Elena / Coomar, Dyuti / Lee, Siang Ing / Qiu, Xiu / Yuan, Mingyang / Clavé Llavall, Anna / Dixit, Anushka / Zhou, Dengyi / Balaji, Rishab / van Wely, Madelon / Kostova, Elena / van Leeuwen, Elisabeth / Mofenson, Lynne / Kunst, Heinke /
    Khalil, Asma / Tiberi, Simon / Thomas, James / Brizuela, Vanessa / Broutet, Nathalie / Kara, Edna / Kim, Caron / Thorson, Anna / Rayco-Solon, Pura / Pardo-Hernandez, Hector / Oladapo, Olufemi Taiwo / Zamora, Javier / Bonet, Mercedes / Thangaratinam, Shakila

    BMJ open

    2020  Volume 10, Issue 12, Page(s) e041868

    Abstract: Introduction: Rapid, robust and continually updated evidence synthesis is required to inform management of COVID-19 in pregnant and postpartum women and to keep pace with the emerging evidence during the pandemic.: Methods and analysis: We plan to ... ...

    Abstract Introduction: Rapid, robust and continually updated evidence synthesis is required to inform management of COVID-19 in pregnant and postpartum women and to keep pace with the emerging evidence during the pandemic.
    Methods and analysis: We plan to undertake a living systematic review to assess the prevalence, clinical manifestations, risk factors, rates of maternal and perinatal complications, potential for mother-to-child transmission, accuracy of diagnostic tests and effectiveness of treatment for COVID-19 in pregnant and postpartum women (including after miscarriage or abortion). We will search Medline, Embase, WHO COVID-19 database, preprint servers, the China National Knowledge Infrastructure system and Wanfang databases from 1 December 2019. We will supplement our search with studies mapped by Cochrane Fertility and Gynaecology group, Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), COVID-19 study repositories, reference lists and social media blogs. The search will be updated every week and not be restricted by language. We will include observational cohort (≥10 participants) and randomised studies reporting on prevalence of COVID-19 in pregnant and postpartum women, the rates of clinical manifestations and outcomes, risk factors in pregnant and postpartum women alone or in comparison with non-pregnant women with COVID-19 or pregnant women without COVID-19 and studies on tests and treatments for COVID-19. We will additionally include case reports and series with evidence on mother-to-child transmission of SARS-CoV-2 in utero, intrapartum or postpartum. We will appraise the quality of the included studies using appropriate tools to assess the risk of bias. At least two independent reviewers will undertake study selection, quality assessment and data extraction every 2 weeks. We will synthesise the findings using quantitative random effects meta-analysis and report OR or proportions with 95% CIs and prediction intervals. Case reports and series will be reported as qualitative narrative synthesis. Heterogeneity will be reported as I
    Ethics and dissemination: Ethical approval is not required as this is a synthesis of primary data. Regular updates of the results will be published on a dedicated website (https://www.birmingham.ac.uk/research/who-collaborating-centre/pregcov/index.aspx) and disseminated through publications, social media and webinars.
    Prospero registration number: CRD42020178076.
    MeSH term(s) COVID-19/diagnosis ; COVID-19/physiopathology ; COVID-19/therapy ; COVID-19/transmission ; Female ; Humans ; Infectious Disease Transmission, Vertical ; Meta-Analysis as Topic ; Postpartum Period ; Pregnancy ; Pregnancy Complications, Infectious/diagnosis ; Pregnancy Complications, Infectious/physiopathology ; Pregnancy Complications, Infectious/therapy ; Pregnancy Outcome ; Risk Factors ; Systematic Reviews as Topic
    Language English
    Publishing date 2020-12-02
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 2599832-8
    ISSN 2044-6055 ; 2044-6055
    ISSN (online) 2044-6055
    ISSN 2044-6055
    DOI 10.1136/bmjopen-2020-041868
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis.

    Allotey, John / Stallings, Elena / Bonet, Mercedes / Yap, Magnus / Chatterjee, Shaunak / Kew, Tania / Debenham, Luke / Llavall, Anna Clavé / Dixit, Anushka / Zhou, Dengyi / Balaji, Rishab / Lee, Siang Ing / Qiu, Xiu / Yuan, Mingyang / Coomar, Dyuti / Sheikh, Jameela / Lawson, Heidi / Ansari, Kehkashan / van Wely, Madelon /
    van Leeuwen, Elizabeth / Kostova, Elena / Kunst, Heinke / Khalil, Asma / Tiberi, Simon / Brizuela, Vanessa / Broutet, Nathalie / Kara, Edna / Kim, Caron Rahn / Thorson, Anna / Oladapo, Olufemi T / Mofenson, Lynne / Zamora, Javier / Thangaratinam, Shakila

    BMJ (Clinical research ed.)

    2020  Volume 370, Page(s) m3320

    Abstract: Objective: To determine the clinical manifestations, risk factors, and maternal and perinatal outcomes in pregnant and recently pregnant women with suspected or confirmed coronavirus disease 2019 (covid-19).: Design: Living systematic review and meta- ...

    Abstract Objective: To determine the clinical manifestations, risk factors, and maternal and perinatal outcomes in pregnant and recently pregnant women with suspected or confirmed coronavirus disease 2019 (covid-19).
    Design: Living systematic review and meta-analysis.
    Data sources: Medline, Embase, Cochrane database, WHO COVID-19 database, China National Knowledge Infrastructure (CNKI), and Wanfang databases from 1 December 2019 to 6 October 2020, along with preprint servers, social media, and reference lists.
    Study selection: Cohort studies reporting the rates, clinical manifestations (symptoms, laboratory and radiological findings), risk factors, and maternal and perinatal outcomes in pregnant and recently pregnant women with suspected or confirmed covid-19.
    Data extraction: At least two researchers independently extracted the data and assessed study quality. Random effects meta-analysis was performed, with estimates pooled as odds ratios and proportions with 95% confidence intervals. All analyses will be updated regularly.
    Results: 192 studies were included. Overall, 10% (95% confidence interval 7% to 12%; 73 studies, 67 271 women) of pregnant and recently pregnant women attending or admitted to hospital for any reason were diagnosed as having suspected or confirmed covid-19. The most common clinical manifestations of covid-19 in pregnancy were fever (40%) and cough (41%). Compared with non-pregnant women of reproductive age, pregnant and recently pregnant women with covid-19 were less likely to have symptoms (odds ratio 0.28, 95% confidence interval 0.13 to 0.62; I2=42.9%) or report symptoms of fever (0.49, 0.38 to 0.63; I2=40.8%), dyspnoea (0.76, 0.67 to 0.85; I2=4.4%) and myalgia (0.53, 0.36 to 0.78; I2=59.4%). The odds of admission to an intensive care unit (odds ratio 2.13, 1.53 to 2.95; I2=71.2%), invasive ventilation (2.59, 2.28 to 2.94; I2=0%) and need for extra corporeal membrane oxygenation (2.02, 1.22 to 3.34; I2=0%) were higher in pregnant and recently pregnant than non-pregnant reproductive aged women. Overall, 339 pregnant women (0.02%, 59 studies, 41 664 women) with confirmed covid-19 died from any cause. Increased maternal age (odds ratio 1.83, 1.27 to 2.63; I2=43.4%), high body mass index (2.37, 1.83 to 3.07; I2=0%), any pre-existing maternal comorbidity (1.81, 1.49 to 2.20; I2=0%), chronic hypertension (2.0, 1.14 to 3.48; I2=0%), pre-existing diabetes (2.12, 1.62 to 2.78; I2=0%), and pre-eclampsia (4.21, 1.27 to 14.0; I2=0%) were associated with severe covid-19 in pregnancy. In pregnant women with covid-19, increased maternal age, high body mass index, non-white ethnicity, any pre-existing maternal comorbidity including chronic hypertension and diabetes, and pre-eclampsia were associated with serious complications such as admission to an intensive care unit, invasive ventilation and maternal death. Compared to pregnant women without covid-19, those with the disease had increased odds of maternal death (odds ratio 2.85, 1.08 to 7.52; I2=0%), of needing admission to the intensive care unit (18.58, 7.53 to 45.82; I2=0%), and of preterm birth (1.47, 1.14 to 1.91; I2=18.6%). The odds of admission to the neonatal intensive care unit (4.89, 1.87 to 12.81, I2=96.2%) were higher in babies born to mothers with covid-19 versus those without covid-19.
    Conclusion: Pregnant and recently pregnant women with covid-19 attending or admitted to the hospitals for any reason are less likely to manifest symptoms such as fever, dyspnoea, and myalgia, and are more likely to be admitted to the intensive care unit or needing invasive ventilation than non-pregnant women of reproductive age. Pre-existing comorbidities, non-white ethnicity, chronic hypertension, pre-existing diabetes, high maternal age, and high body mass index are risk factors for severe covid-19 in pregnancy. Pregnant women with covid-19 versus without covid-19 are more likely to deliver preterm and could have an increased risk of maternal death and of being admitted to the intensive care unit. Their babies are more likely to be admitted to the neonatal unit.
    Systematic review registration: PROSPERO CRD42020178076.
    Readers' note: This article is a living systematic review that will be updated to reflect emerging evidence. Updates may occur for up to two years from the date of original publication. This version is update 1 of the original article published on 1 September 2020 (BMJ 2020;370:m3320), and previous updates can be found as data supplements (https://www.bmj.com/content/370/bmj.m3320/related#datasupp). When citing this paper please consider adding the update number and date of access for clarity.
    MeSH term(s) Betacoronavirus ; COVID-19 ; Coronavirus Infections/diagnosis ; Coronavirus Infections/epidemiology ; Coronavirus Infections/etiology ; Coronavirus Infections/therapy ; Female ; Global Health/statistics & numerical data ; Humans ; Infant, Newborn ; Intensive Care, Neonatal/statistics & numerical data ; Pandemics ; Pneumonia, Viral/diagnosis ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/etiology ; Pneumonia, Viral/therapy ; Pregnancy ; Pregnancy Complications, Infectious/epidemiology ; Pregnancy Complications, Infectious/etiology ; Pregnancy Complications, Infectious/therapy ; Premature Birth/epidemiology ; Premature Birth/virology ; Prognosis ; Risk Factors ; SARS-CoV-2
    Keywords covid19
    Language English
    Publishing date 2020-09-01
    Publishing country England
    Document type Journal Article ; Meta-Analysis ; Research Support, Non-U.S. Gov't ; Systematic Review
    ZDB-ID 1362901-3
    ISSN 1756-1833 ; 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
    ISSN (online) 1756-1833
    ISSN 0959-8154 ; 0959-8146 ; 0959-8138 ; 0959-535X ; 1759-2151
    DOI 10.1136/bmj.m3320
    Database MEDical Literature Analysis and Retrieval System OnLINE

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