Ismail Lars, Normahani Pasha, Standfield Nigel J, Jaffer Usman
Heidelberg University School of Medicine, Heidelberg, Germany.
Imperial Vascular Unit, Imperial College NHS Healthcare Trust, London, United Kingdom.
J Vasc Surg Venous Lymphat Disord. 2016 Oct;4(4):518-524.e1. doi: 10.1016/j.jvsv.2016.06.003. Epub 2016 Aug 4.
The association between pregnancy and the development of varicose veins is uncertain. We aimed to determine whether a history of pregnancy is associated with the development of varicose veins.
We performed a systematic literature search using the databases of PubMed, Embase, Robert Koch-Institut, and Cochrane Central and the references of included papers. Eligible studies were all epidemiologic observational studies in which the outcome "varicose veins" and pregnancy history were assessed. The quality of each study was evaluated on the basis of the Dutch Cochrane review checklist and by the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement. For our meta-analysis, a random effects model was applied to pool odds ratios and 95% confidence intervals across studies.
We found nine eligible studies enrolling 17,109 women. Pregnancy was associated with a significant risk increase in developing varicose veins. The results of our meta-analysis suggest that the odds for women with a history of pregnancy in developing varicose veins significantly increases by 82% (odds ratio, 1.82; 95% CI, 1.43-2.33) compared with women with no history of pregnancy. As expected for epidemiologic observational studies, the heterogeneity was considerably high (I(2) = 81%).
Our meta-analysis strongly supports the hypothesis that there is a significant and strong association between a history of pregnancy and varicose veins. However, qualitative and quantitative differences among studies were evident and were also reflected in a considerably high heterogeneity.
妊娠与静脉曲张发展之间的关联尚不确定。我们旨在确定妊娠史是否与静脉曲张的发展相关。
我们使用PubMed、Embase、罗伯特·科赫研究所和Cochrane中心数据库以及纳入论文的参考文献进行了系统的文献检索。符合条件的研究均为流行病学观察性研究，其中评估了“静脉曲张”结局和妊娠史。根据荷兰Cochrane综述清单并依据STROBE（加强流行病学观察性研究报告）声明对每项研究的质量进行评估。对于我们的荟萃分析，应用随机效应模型汇总各研究的比值比和95%置信区间。
我们发现9项符合条件的研究，共纳入17109名女性。妊娠与静脉曲张发展的风险显著增加相关。我们的荟萃分析结果表明，与无妊娠史的女性相比，有妊娠史的女性发生静脉曲张的几率显著增加82%（比值比，1.82；95%置信区间，1.43 - 2.33）。正如流行病学观察性研究所预期的那样，异质性相当高（I² = 81%）。
我们的荟萃分析有力地支持了妊娠史与静脉曲张之间存在显著且密切关联的假设。然而，研究之间的定性和定量差异明显，这也反映在相当高的异质性上。
