Wu Clara Q, Nichols Kelly, Carwana Matthew, Cormier Nicholas, Maratta Christina
Division of Reproductive Endocrinology and Infertility, Ottawa Fertility Centre/The Ottawa Hospital, Department of Obstetrics and Gynecology, University of Ottawa, Ontario, Canada.
Department of Obstetrics and Gynecology, Mount Auburn Hospital, Cambridge, Massachusetts.
Fertil Steril. 2022 Apr;117(4):811-819. doi: 10.1016/j.fertnstert.2022.01.004. Epub 2022 Feb 5.
To evaluate the impact of recurrent pregnancy loss (RPL) on the risk of preterm birth (PTB) in subsequent pregnancies.
Systematic review and meta-analysis.
Not applicable.
PATIENT(S): Pregnant women with and without a history of RPL.
INTERVENTION(S): PubMed, Embase, Google Scholar and Cochrane trial registry were used to identify relevant studies.
MAIN OUTCOME MEASURE(S): The odds ratios (ORs) for the association between RPL and PTB across included studies were evaluated. Effect estimates were pooled using a DerSimonian and Laird random-effects meta-analysis model.
RESULT(S): Eighteen studies met the inclusion criteria. A total of 58,766 women with a history of RPL and 2,949,222 women without a history of RPL were included. A pooled OR of 1.60 (95% confidence interval [CI], 1.45-1.78; 18 observational studies; I = 85.6%) was observed in our random-effects meta-analysis. A trend toward higher odds of PTB is observed with the increasing number of pregnancy losses: 2 RPLs (pooled OR, 1.31; 95% CI, 1.09-1.57; I = 88.9%); ≥2 RPLs (pooled OR, 1.58; 95% CI, 1.27-1.96; I = 71.7%); and ≥3 RPLs (pooled OR, 1.81; 95% CI, 1.58-2.07; I = 73.6%). The analysis of the risk of PTB for patients with unexplained RPL demonstrated a significantly heightened risk of PTB in this subgroup (pooled OR, 2.05; 95% CI, 1.46-2.89; I = 21.0%). Inconsistent adjustment for confounders and significant between-study heterogeneity were noted in this study.
CONCLUSION(S): Despite significant heterogeneity among studies, we found that women with a history of RPL had significantly higher odds of delivering preterm infants in subsequent pregnancies.
CRD 224763.
评估复发性流产（RPL）对后续妊娠中早产（PTB）风险的影响。
系统评价和荟萃分析。
不适用。
有和没有复发性流产病史的孕妇。
使用PubMed、Embase、谷歌学术和Cochrane试验注册库来识别相关研究。
评估纳入研究中复发性流产与早产之间关联的优势比（OR）。使用DerSimonian和Laird随机效应荟萃分析模型汇总效应估计值。
18项研究符合纳入标准。共纳入58766名有复发性流产病史的女性和2949222名无复发性流产病史的女性。在我们的随机效应荟萃分析中观察到汇总OR为1.60（95%置信区间[CI]，1.45 - 1.78；18项观察性研究；I² = 85.6%）。随着流产次数增加，早产几率有升高趋势：2次复发性流产（汇总OR，1.31；95%CI，1.09 - 1.57；I² = 88.9%）；≥2次复发性流产（汇总OR，1.58；95%CI，1.27 - 1.96；I² = 71.7%）；≥3次复发性流产（汇总OR，1.81；95%CI，1.58 - 2.07；I² = 73.6%）。对不明原因复发性流产患者早产风险的分析表明，该亚组早产风险显著升高（汇总OR，2.05；95%CI，1.46 - 2.89；I² = 21.0%）。本研究中注意到混杂因素调整不一致以及研究间存在显著异质性。
尽管研究间存在显著异质性，但我们发现有复发性流产病史的女性在后续妊娠中分娩早产儿的几率显著更高。
CRD 224763。
