{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T07:56:20Z","timestamp":1791186980135,"version":"4.1.0"},"reference-count":88,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100006662","name":"Ardabil University of Medical Sciences","doi-asserted-by":"publisher","award":["IR.ARUMS.MEDICINE.REC.1404.094)."],"award-info":[{"award-number":["IR.ARUMS.MEDICINE.REC.1404.094)."]}],"id":[{"id":"10.13039\/501100006662","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Science Reports"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>Meconium\u2010stained amniotic fluid (MSAF) is a common intrapartum finding associated with adverse perinatal outcomes. Comprehensive global estimates of its prevalence and determinants are lacking. This systematic review and meta\u2010analysis aimed to estimate the global pooled prevalence of MSAF and classify its associated factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We searched Ovid MEDLINE, Scopus, Web of Science, Embase, Cochrane Library, SID, and Google Scholar up to January 1, 2026, for observational studies reporting MSAF prevalence or associated factors. Pooled prevalence with 95% CI was calculated using a random\u2010effects model with Logit transformation. The Knapp\u2013Hartung adjustment and 95% prediction interval were applied. Heterogeneity was quantified using\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      . Subgroup analyses and meta\u2010regression explored heterogeneity sources. Quality was assessed using the Newcastle\u2010Ottawa Scale. Due to high heterogeneity, meta\u2010analysis of risk factors was not feasible; findings were summarized descriptively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Fifty\u2010one studies were included (44 for prevalence; 1,414,705 births). The global pooled prevalence was 13.0% (95% CI: 10.8\u201315.6%; prediction interval: 6.9\u201323.1%;\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200999.71%). Prevalence doubled in low\u2010income compared to high\u2010income countries (22.2% vs. 11.1%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Significant variations were observed by continent (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), country (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and meconium consistency (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.004). Meta\u2010regression showed a significant positive association with mean gestational age (\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u2009=\u20090.077,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.014). Twenty\u2010two risk factors were classified into four domains: Social\/Structural (inadequate antenatal care, delayed referral, low income), Intrapartum (prolonged\/obstructed labor, PROM, oligohydramnios, non\u2010reassuring fetal heart rate pattern [NRFHRP]), Maternal (hypertensive disorders, diabetes, anemia), and Fetal\/Physiological (advanced gestational age, primiparity, macrosomia). The strongest modifiable determinants were intrapartum factors\u2014NRFHRP (adjusted odds ratio [AOR] up to 21.9), obstructed labor (AOR up to 24.6)\u2014and system\u2010level barriers, particularly delayed referral (AOR up to 15.3). Intrauterine growth restriction (IUGR) showed no statistically significant association in any adjusted analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>MSAF affects one in eight pregnancies globally, with a higher burden in low\u2010income settings. Four\u2010domain classification identifies actionable targets\u2014intrapartum monitoring failures and health\u2010system barriers\u2014for quality improvement. Meconium consistency grading offers a simple risk stratification tool. Addressing these factors, particularly in resource\u2010limited settings, can reduce preventable perinatal morbidity and align with global health equity goals.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hsr2.73069","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T11:46:48Z","timestamp":1787744808000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Global Burden of Meconium\u2010Stained Amniotic Fluid: A Systematic Review and Meta\u2010Analysis of Prevalence With Descriptive Synthesis of Determinants"],"prefix":"10.1002","volume":"9","author":[{"given":"Shervin","family":"Tabrizian","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiba","family":"Mirzarahimi","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, Faculty of Medicine Ardabil University of Medical Sciences Ardabil Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mojgan","family":"Mirghafourvand","sequence":"additional","affiliation":[{"name":"Social Determinants of Health Research Center Tabriz University of Medical Sciences Tabriz Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4016-255X","authenticated-orcid":false,"given":"Mahsan","family":"Nabighadim","sequence":"additional","affiliation":[{"name":"Student Research Committee, Faculty of Medicine Ardabil University of Medical Sciences Ardabil Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1201\/9781003102342-25"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2022.11.1283"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.112.2901.150"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.18502\/ijrm.v20i8.11752"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ogrm.2018.02.004"},{"issue":"12","key":"e_1_2_13_7_1","first-page":"2874","article-title":"Fetal Outcome in Meconium Stained Deliveries","volume":"7","author":"Mundhra R.","year":"2013","journal-title":"Journal of Clinical and Diagnostic Research: JCDR"},{"issue":"5","key":"e_1_2_13_8_1","article-title":"Evaluation and Association of Meconium\u2010Stained Amniotic Fluid With Fetal Distress","volume":"17","author":"Karpe N. 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