Giri Ayush, Hartmann Katherine E, Hellwege Jacklyn N, Velez Edwards Digna R, Edwards Todd L
Division of Epidemiology, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN.
Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, TN.
Am J Obstet Gynecol. 2017 Jul;217(1):11-26.e3. doi: 10.1016/j.ajog.2017.01.039. Epub 2017 Feb 7.
Studies evaluating the association between obesity and pelvic organ prolapse report estimates that range from negative to positive associations. Heterogeneous definitions for pelvic organ prolapse and variable choices for categorizing obesity measures have made it challenging to conduct meta-analysis.
We systematically evaluated evidence to provide quantitative summaries of association between degrees of obesity and pelvic organ prolapse, and identify sources of heterogeneity.
We searched for all indexed publications relevant to pelvic organ prolapse up until June 18, 2015, in PubMed/MEDLINE to identify analytical observational studies published in English that reported risk ratios (relative risk, odds ratio, or hazard ratio) for body mass index categories in relation to pelvic organ prolapse. Random effects meta-analyses were conducted to report associations with pelvic organ prolapse for overweight and obese body mass index categories compared with women in the normal-weight category (referent: body mass index <25 kg/m).
Of the 70 studies that reported evidence on obesity and pelvic organ prolapse, 22 eligible studies provided effect estimates for meta-analysis of the overweight and obese body mass index categories. Compared with the referent category, women in the overweight and obese categories had meta-analysis risk ratios of at least 1.36 (95% confidence interval, 1.20-1.53) and at least 1.47 (95% confidence interval, 1.35-1.59), respectively. Subgroup analyses showed effect estimates for objectively measured clinically significant pelvic organ prolapse were higher than for self-reported pelvic organ prolapse. Other potential sources of heterogeneity included proportion of postmenopausal women in study and reported study design.
Overweight and obese women are more likely to have pelvic organ prolapse compared with women with body mass index in the normal range. The finding that the associations for obesity measures were strongest for objectively measured, clinically significant pelvic organ prolapse further strengthens this evidence. However, prospective investigations evaluating obesity and pelvic organ prolapse are few.
评估肥胖与盆腔器官脱垂之间关联的研究报告的估计值范围从负相关到正相关。盆腔器官脱垂的定义异质性以及肥胖测量分类的不同选择使得进行荟萃分析具有挑战性。
我们系统地评估证据，以提供肥胖程度与盆腔器官脱垂之间关联的定量总结，并确定异质性来源。
我们在PubMed/MEDLINE中检索了截至2015年6月18日所有与盆腔器官脱垂相关的索引出版物，以识别用英文发表的分析性观察性研究，这些研究报告了体重指数类别与盆腔器官脱垂相关的风险比（相对风险、比值比或风险比）。进行随机效应荟萃分析，以报告超重和肥胖体重指数类别的女性与正常体重类别的女性（对照：体重指数<25kg/m²）相比与盆腔器官脱垂的关联。
在70项报告肥胖与盆腔器官脱垂证据的研究中，22项符合条件的研究提供了超重和肥胖体重指数类别的荟萃分析效应估计值。与对照类别相比，超重和肥胖类别的女性荟萃分析风险比分别至少为1.36（95%置信区间，1.20-1.53）和至少1.47（95%置信区间，1.35-1.59）。亚组分析显示，客观测量的具有临床意义的盆腔器官脱垂的效应估计值高于自我报告的盆腔器官脱垂。其他潜在的异质性来源包括研究中绝经后女性的比例和报告的研究设计。
与体重指数在正常范围内的女性相比，超重和肥胖女性更有可能发生盆腔器官脱垂。肥胖测量与客观测量的、具有临床意义的盆腔器官脱垂的关联最强这一发现进一步强化了这一证据。然而，评估肥胖与盆腔器官脱垂的前瞻性研究很少。
