Aberdeen Center for Women's Health Research, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.
Obstetrics & Gynecology, Aberdeen Maternity Hospital, NHS Grampian, Aberdeen, UK.
Acta Obstet Gynecol Scand. 2020 Dec;99(12):1584-1594. doi: 10.1111/aogs.13940. Epub 2020 Jul 9.
Miscarriage, a spontaneous pregnancy loss at <24 weeks' gestation, is a common complication of pregnancy but the etiologies of miscarriage and recurrent miscarriage are not fully understood. Other obstetric conditions such as preeclampsia and preterm birth, which may share similar pathophysiology to miscarriage, exhibit familial patterns, suggesting inherited predisposition to these conditions. Parental genetic polymorphisms have been associated with unexplained miscarriage, suggesting there could be a genetically inherited predisposition to miscarriage. This systematic review and meta-analysis of observational studies aimed to assess the association between family history of miscarriage and the risk of miscarriage in women.
A systematic review and meta-analysis of observational studies was carried out in accordance with Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. Electronic searches using databases (MEDLINE, EMBASE and CINAHL) were carried out to identify eligible studies from 1946 until 2019. Observational studies (cohort or case-control) were included. Human studies only were included. Participants were women of reproductive age. Exposure was a family history of one or more miscarriage(s). The primary outcome was miscarriage in women. Abstracts were screened and data were extracted by two independent reviewers. Study quality was assessed using Critical Appraisal Skills Program (CASP) tools. Data were pooled from individual studies using the Mantel-Haenszel method to produce pooled odds ratios (ORs) with 95% confidence intervals (95% CI). Systematic review registration number (PROSPERO): CRD42019127950.
Thirteen studies were identified in the systematic review; 10 were eligible for inclusion in the meta-analysis. Twelve studies reported an association between family history of miscarriage and miscarriage in women. In all, 41 287 women were included in the meta-analysis. Women who miscarried were more likely to report a family history of miscarriage (pooled unadjusted OR 1.90, 95% CI 1.37-2.63). Overall study quality and size varied, with few adjusting for confounding factors. Results should be interpreted with caution as the associations presented are based on unadjusted analyses only.
Women who miscarry may be more likely to have a family history of miscarriage. Further research is required to confirm or refute the findings.
流产，即妊娠 24 周前的自发性妊娠丢失，是一种常见的妊娠并发症，但流产和复发性流产的病因尚不完全清楚。其他产科疾病，如子痫前期和早产，其发病机制可能与流产相似，表现出家族模式，表明这些疾病存在遗传易感性。父母的遗传多态性与不明原因的流产有关，这表明流产可能存在遗传易感性。本系统评价和观察性研究的荟萃分析旨在评估流产家族史与女性流产风险之间的关联。
按照观察性研究荟萃分析中的流行病学（MOOSE）指南进行系统评价和荟萃分析。使用数据库（MEDLINE、EMBASE 和 CINAHL）进行电子检索，以确定从 1946 年到 2019 年期间符合条件的研究。纳入观察性研究（队列或病例对照）。仅纳入人类研究。研究对象为育龄妇女。暴露因素为一次或多次流产的家族史。主要结局是女性流产。通过两名独立评审员筛选摘要并提取数据。使用批判性评估技能计划（CASP）工具评估研究质量。使用 Mantel-Haenszel 方法从个体研究中汇总数据，以产生具有 95%置信区间（95%CI）的汇总优势比（OR）。系统评价注册号（PROSPERO）：CRD42019127950。
系统评价中确定了 13 项研究；其中 10 项符合纳入荟萃分析的标准。12 项研究报告了流产家族史与女性流产之间的关联。共有 41287 名女性纳入荟萃分析。流产的女性更有可能报告流产家族史（汇总未调整 OR 1.90，95%CI 1.37-2.63）。总体研究质量和规模存在差异，很少有研究对混杂因素进行调整。由于所呈现的关联仅基于未调整的分析，因此结果应谨慎解释。
流产的女性更有可能有流产家族史。需要进一步的研究来证实或反驳这些发现。
