The presence of a high neutrophil-to-lymphocyte ratio (NLR) has been associated with increased mortality in several malignancies. Here, we quantify the effect of NLR on survival in patients with breast cancer, and examine the effect of clinicopathologic factors on its prognostic value. A systematic search of electronic databases was conducted to identify publications exploring the association of blood NLR (measured pre treatment) and overall survival (OS) and disease-free survival (DFS) among patients with breast cancer. Data from studies reporting a hazard ratio (HR) and 95% confidence interval (CI) or a P value were pooled in a meta-analysis. Pooled HRs were computed and weighted using generic inverse variance. Meta-regression was performed to evaluate the influence of clinicopathologic factors such as age, disease stage, tumor grade, nodal involvement, receptor status, and NLR cutoff on the HR for OS and DFS. All statistical tests were two-sided. Fifteen studies comprising a total of 8563 patients were included. The studies used different cutoff values to classify high NLR (range 1.9–5.0). The median cutoff value for high NLR used in these studies was 3.0 amongst 13 studies reporting a HR for OS, and 2.5 in 10 studies reporting DFS outcomes. NLR greater than the cutoff value was associated with worse OS (HR 2.56, 95% CI = 1.96–3.35; P < 0.001) and DFS (HR 1.74, 95% CI = 1.47–2.07; P < 0.001). This association was similar in studies including only early-stage disease and those comprising patients with both early-stage and metastatic disease. Estrogen receptor (ER) and HER-2 appeared to modify the effect of NLR on DFS, because NLR had greater prognostic value for DFS in ER-negative and HER2-negative breast cancer. No subgroup showed an influence on the association between NLR and OS. High NLR is associated with an adverse OS and DFS in patients with breast cancer with a greater effect on disease-specific outcome in ER and HER2-negative disease. NLR is an easily accessible prognostic marker, and its addition to established risk prediction models warrants further investigation.

Objective. To systematically review the risks of pregnancy outcomes among women of different parity. Material and methods. Electronic databases were searched for studies, in English language, in which primary objective was to assess association between parity and pregnancy outcomes. Meta‐analyses were performed and unadjusted odds ratios (ORs) and mean differences along with 95% confidence interval (CI) were calculated. Main outcome measures. Low birth weight (LBW), preterm birth (PTB), small for gestational age (SGA), birth weight, and gestational age. Results. Forty‐one studies, most with moderate risk of bias were included. Nulliparity was associated with increased unadjusted odds of LBW (OR 1.41, 95% CI 1.26, 1.58) and SGA (OR 1.89, 95% CI 1.82, 1.96) and reduction in birth weight (weighted mean difference −282 g, 95% CI −486, −79 g) but not PTB (OR 1.13, 95% CI 0.96, 1.34). Grand multiparity and great grand multiparity were not associated with LBW (OR 1.10, 95% CI 0.95, 1.32 and OR 0.92, 95% CI 0.78, 1.09) or PTB (OR 0.96, 95% CI 0.77, 1.19 and OR 1.32, 95% CI 0.61, 2.83). Conclusions. Nulliparity was associated with a significantly increased unadjusted risk of LBW/SGA birth, whereas grand multiparity and great grand multiparity were not associated with increased risk of pregnancy outcomes.

Background: Pregnant women who experience domestic violence are at increased risk of adverse outcomes in addition to the risks to themselves. Inadequate prenatal care, higher incidences of high-risk behaviors, direct physical trauma, stress, and neglect are postulated mechanisms. Our objective was to systematically review birth outcomes among women who experienced domestic violence. Methods: Medline, Embase, CINAHL, and bibliographies of identified articles were searched for English language studies. Studies reporting rates of low birth weight, preterm birth, small for gestational age births, birth weight, or gestational age at birth were included. Study quality was assessed for selection, exposure assessment, confounder adjustment, analyses, outcomes assessment, and attrition biases. Unadjusted and adjusted data from included studies were extracted by two reviewers. Summary odds ratio (OR) and confidence intervals (CI) were calculated using the random effects model. Population-attributable risk was calculated. Results: Thirty studies of low to moderate risk of biases were included. Low birth weight (adjusted OR 1.53, 95% CI 1.28-1.82) and preterm births (adjusted OR 1.46, 95% CI 1.27-1.67) were increased among women exposed to domestic violence. As the prevalence of reported domestic violence during pregnancy was low, the population-attributable risk was low. Prospective cohort studies provided robust and consistent results. Conclusions: Maternal exposure to domestic violence was associated with significantly increased risk of low birth weight and preterm birth. Underreporting of domestic violence is hypothesized. Effective programs to identify violence and intervene during pregnancy are essential.