Siargkas Antonios, Tsakiridis Ioannis, Gatsis Athanasios, De Paco Matallana Catalina, Gil Maria Mar, Chaveeva Petya, Dagklis Themistoklis
Third Department of Obstetrics and Gynecology, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Agiou Dimitriou, 54124 Thessaloniki, Greece.
Institute for Biomedical Research of Murcia, IMIB-Arrixaca, El Palmar, Faculty of Medicine, Universidad de Murcia, 30120 Murcia, Spain.
J Clin Med. 2024 Dec 6;13(23):7438. doi: 10.3390/jcm13237438.
Marginal cord insertion (MCI) is increasingly recognized as a pathological variation that necessitates early diagnosis. Identifying the risk factors associated with MCI is essential for improving prenatal screening and optimizing management strategies. Our meta-analysis systematically and quantitatively synthesizes the current evidence on various potential risk factors for MCI. This systematic review and meta-analysis adhered to the PRISMA and MOOSE guidelines. Comprehensive searches were performed in three databases up until 6 May 2024, identifying observational cohort and case-control studies that examined risk factors for MCI in singleton pregnancies compared with central or eccentric cord insertion. Quality and risk of bias assessment were performed using the Newcastle-Ottawa Scale and the Quality In Prognosis Studies tool, respectively. Statistical analyses employed random-effects models to calculate relative risks (RR) and mean differences with their 95% confidence intervals (95% CI). Heterogeneity was assessed via Cochran's Q and I statistics. A total of 18 studies (14 cohort and 4 case-control), encompassing 51,463 MCI cases and 901,020 control cases, were included. The meta-analysis revealed a prevalence of MCI at 5.71% among singleton pregnancies. Significant risk factors for MCI included the use of assisted reproductive technology (RR = 1.55; 95% CI: 1.34-1.78), chronic hypertension (RR = 1.47; 95% CI: 1.11-1.95), placenta previa (RR = 1.83; 95% CI: 1.62-2.08), and nulliparity (RR = 1.18; 95% CI: 1.08-1.30). No significant associations were found for smoking, maternal age, prior Cesarean section, preexisting diabetes, or Caucasian ethnicity. Sensitivity analyses corroborated the robustness of these findings. This meta-analysis identified assisted reproductive technology, chronic hypertension, placenta previa, and nulliparity as significant risk factors for marginal cord insertion in singleton pregnancies. These findings can inform the development of prenatal screening protocols and enable targeted screenings for high-risk populations.
边缘性脐带插入（MCI）越来越被认为是一种需要早期诊断的病理变异。识别与MCI相关的风险因素对于改善产前筛查和优化管理策略至关重要。我们的荟萃分析系统地、定量地综合了关于MCI各种潜在风险因素的现有证据。 本系统评价和荟萃分析遵循PRISMA和MOOSE指南。截至2024年5月6日，在三个数据库中进行了全面检索，确定了观察性队列研究和病例对照研究，这些研究比较了单胎妊娠中MCI与中央或偏心脐带插入的风险因素。分别使用纽卡斯尔-渥太华量表和预后研究质量工具进行质量和偏倚风险评估。统计分析采用随机效应模型计算相对风险（RR）和平均差异及其95%置信区间（95%CI）。通过Cochran's Q和I统计量评估异质性。 共纳入18项研究（14项队列研究和4项病例对照研究），包括51463例MCI病例和901020例对照病例。荟萃分析显示，单胎妊娠中MCI的患病率为5.71%。MCI的显著风险因素包括使用辅助生殖技术（RR = 1.55；95%CI：1.34-1.78）、慢性高血压（RR = 1.47；95%CI：1.11-1.95）、前置胎盘（RR = 1.83；95%CI：1.62-2.08）和未生育（RR = 1.18；95%CI：1.08-1.30）。未发现吸烟、产妇年龄、既往剖宫产、糖尿病史或白种人种族有显著关联。敏感性分析证实了这些发现的稳健性。 这项荟萃分析确定辅助生殖技术、慢性高血压、前置胎盘和未生育是单胎妊娠边缘性脐带插入的显著风险因素。这些发现可为产前筛查方案的制定提供参考，并为高危人群进行针对性筛查。
