子宫肌瘤患者的早产风险：系统评价和荟萃分析。
The risk of preterm birth in women with uterine fibroids: A systematic review and meta-analysis.
机构信息
Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
Amsterdam Reproduction & Development Research institute, Amsterdam, The Netherlands.
出版信息
PLoS One. 2022 Jun 2;17(6):e0269478. doi: 10.1371/journal.pone.0269478. eCollection 2022.
BACKGROUND
Fibroids have been identified as a possible risk factor for preterm birth, however, the magnitude of this risk is unclear. Our objective was to determine the risk of total, spontaneous, and medically indicated preterm birth in women with fibroids.
METHODS
A literature search was performed on 9 June 2021. We selected studies reporting on preterm birth in women with and without fibroids. Fibroids had to be diagnosed by routine ultrasound before or during pregnancy. Main outcomes were total preterm birth <37, <34, <32, and <28 weeks of gestation, and spontaneous and medically indicated preterm birth. Two authors independently performed study selection, data extraction and quality assessment. We performed quality assessment with the Newcastle-Ottawa scale. Meta-analyses were presented as Odds Ratios (ORs) with 95% Confidence Intervals (95%CIs).
MAIN RESULTS
The search yielded 2078 unique articles of which 11 were included. Meta-analysis for preterm birth <37 weeks of gestation included 256,650 singleton deliveries: 12,309 with fibroids and 244,341 without fibroids. Women with fibroids had a higher rate of preterm birth (11.6% versus 9.0%; OR 1.66, 95%CI 1.29-2.14). Fibroids were also associated with preterm birth <34 (OR 1.88, 95%CI 1.34-2.65), <32 (OR 2.03, 95%CI 1.40-2.95) and <28 (OR 2.24, 95%CI 1.45-3.47) weeks of gestation. Data on type of preterm birth was limited: one study showed a significant association of fibroids with spontaneous preterm birth and another with indicated preterm birth. The main limitations of the included studies were the lack of correction for confounders, the risk of ascertainment bias due to possible underreporting of fibroids, and the substantial heterogeneity between studies.
CONCLUSIONS
Our results suggest fibroids are associated with an increased risk of preterm birth, with a stronger risk at earlier gestational ages. We encourage further research to clarify the association between fibroids and preterm birth by systematic myometrial assessment in pregnancy.
REGISTRATION
Prospero database [CRD42020186976].
背景
子宫肌瘤已被确定为早产的一个可能危险因素，但这种风险的程度尚不清楚。我们的目的是确定患有子宫肌瘤的妇女总早产、自发性早产和医学指征性早产的风险。
方法
我们于 2021 年 6 月 9 日进行了文献检索。我们选择了报告有子宫肌瘤和无子宫肌瘤妇女早产的研究。子宫肌瘤必须在妊娠前或妊娠期间通过常规超声诊断。主要结局是总早产<37 周、<34 周、<32 周和<28 周，以及自发性早产和医学指征性早产。两位作者独立进行了研究选择、数据提取和质量评估。我们使用纽卡斯尔-渥太华量表进行质量评估。荟萃分析以比值比（ORs）及其 95%置信区间（95%CIs）表示。
主要结果
检索得到 2078 篇独特的文章，其中 11 篇被纳入。纳入了 256650 例单胎分娩的<37 周早产的荟萃分析：12309 例有子宫肌瘤，244341 例无子宫肌瘤。患有子宫肌瘤的妇女早产率更高（11.6%对 9.0%；OR 1.66，95%CI 1.29-2.14）。子宫肌瘤也与<34 周（OR 1.88，95%CI 1.34-2.65）、<32 周（OR 2.03，95%CI 1.40-2.95）和<28 周（OR 2.24，95%CI 1.45-3.47）的早产相关。关于早产类型的数据有限：一项研究表明，子宫肌瘤与自发性早产显著相关，另一项研究与医学指征性早产相关。纳入研究的主要局限性是缺乏对混杂因素的校正、由于可能漏报子宫肌瘤而导致的确定偏倚风险，以及研究之间存在很大的异质性。
结论
我们的结果表明，子宫肌瘤与早产风险增加相关，在更早的妊娠周数风险更大。我们鼓励进一步研究，通过妊娠期间的系统子宫肌评估来明确子宫肌瘤与早产之间的关联。
注册
Prospéro 数据库[CRD42020186976]。
Zotero 插件