McMahon Hayley V, Moss Regan A, Pearce Naya, Sehgal Sakshi, He Zeling, Kriete Monica, Lucier-Julian Zoë, Redd Sara K, Rice Whitney S
Department of Behavioral, Social, and Health Education Sciences, the Center for Reproductive Health Research in the Southeast, and the Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, and the Feminist Women's Health Center, Atlanta, and the Medical College of Georgia, Augusta University, Augusta, Georgia; the Department of Social, Behavioral, and Population Health Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana; and Harrisburg, Pennsylvania.
Obstet Gynecol. 2025 Mar 1;145(3):307-315. doi: 10.1097/AOG.0000000000005821. Epub 2025 Jan 2.
To systematically assess the existing empiric evidence regarding a potential relationship between higher body weight and procedural abortion complications.
EMBASE, MEDLINE, CINAHL, Web of Science, Google Scholar, and Clinicaltrials.gov were searched.
Our search identified 409 studies, which were uploaded to Covidence for review management; 133 duplicates were automatically removed. A team of two reviewers screened 276 studies, and a third reviewer resolved conflicts. Studies were included if they 1) consisted of peer-reviewed research published between 2010 and 2022, 2) were conducted in the United States, 3) included people with a higher body weight (body mass index [BMI] 30 or higher) in the study sample, and 4) assessed at least one outcome of procedural abortion safety stratified by a measure of body weight.
TABULATION, INTEGRATION, AND RESULTS: We extracted study data using Covidence and calculated an odds ratio for each study to facilitate the synthesis of results. Six studies assessing a total of 38,960 participants were included. No studies found a significant relationship between procedural abortion complications and higher body weight overall. Subgroup analysis from one study identified a significant increase in complications specifically among participants with BMIs higher than 40 who had second-trimester abortions. All studies used a retrospective cohort design and fulfilled Newcastle-Ottawa Scale criteria to be considered good quality. Studies varied in terms of clinical settings, patient populations, gestations assessed, clinician training levels, and care protocols.
Overall, higher body weight was not associated with an increased risk of procedural abortion complications in the included studies. The practice of referring patients undergoing procedural abortion with a higher body weight for hospital-based care is not based on recent safety evidence. On the contrary, this practice threatens the health of people with a higher body weight by potentially delaying their access to abortion care, extending their pregnancies into later gestations, and blocking their ability to access an abortion altogether.
系统评估关于较高体重与手术流产并发症之间潜在关系的现有实证证据。
检索了EMBASE、MEDLINE、CINAHL、科学网、谷歌学术和Clinicaltrials.gov。
我们的检索识别出409项研究，将其上传至Covidence进行综述管理；自动去除了133项重复研究。由两名评审员组成的团队筛选了276项研究，第三名评审员解决冲突。纳入的研究需满足以下条件：1）由2010年至2022年间发表的经同行评审的研究组成；2）在美国进行；3）研究样本中包括体重较高的人群（体重指数[BMI]为30或更高）；4）通过体重测量对手术流产安全性的至少一项结果进行分层评估。
制表、整合与结果：我们使用Covidence提取研究数据，并为每项研究计算比值比以促进结果的综合分析。纳入了六项评估总共38960名参与者的研究。没有研究发现手术流产并发症与总体较高体重之间存在显著关系。一项研究的亚组分析发现，在BMI高于40且进行中期流产的参与者中，并发症显著增加。所有研究均采用回顾性队列设计，并符合纽卡斯尔 - 渥太华量表标准，被认为质量良好。研究在临床环境、患者群体、评估的孕周、临床医生培训水平和护理方案方面存在差异。
总体而言，在所纳入的研究中，较高体重与手术流产并发症风险增加无关。将体重较高的手术流产患者转至医院护理的做法并非基于近期的安全证据。相反，这种做法可能会延迟他们获得流产护理的机会，使他们的怀孕持续到更晚孕周，并完全阻碍他们获得流产的能力，从而威胁到体重较高人群的健康。
