The environmental risk factors prior to conception associated with placenta accreta spectrum: An umbrella review - 16/05/22
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Highlights |
• | invitro fertilization was graded as a risk factor with suggestive evidence. |
• | multiple gestations was graded as a risk factor with weak evidence. |
• | Hypertension disorders, low socioeconomic status, and male fetus were the protective factors |
Abstract |
Background |
The present umbrella review evaluated the environmental risk factors prior to conception associated with placenta accrete spectrum(PAS) based on meta-analyses and systematic reviews.
Materials and methods |
We searched PubMed, Scopus, and Web of Science until October 14, 2021. All meta-analyses that had focused on assessing the risk factors associated with the PAS were included. We calculated summary effect estimates, 95% CI, heterogeneity I², 95% prediction interval, small-study effects, excess significance biases, and sensitive analysis. The quality of the meta-analyses was evaluated with A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2).
Result |
The risk factor of in-vitro fertilization (IVF) (OR 5.03, 95% CI: 3.34, 7.56) was graded as suggestive evidence (class III). The multiple gestation (OR 1.90, 95% CI: 1.26, 2.88) was graded as the risk factor with weak evidence (class IV). Hypertension disorders (OR 0.5, 95% CI: 0.30, 0.82), low socioeconomic status (SES) (OR 0.51, 95% CI: 0.37, 0.71) (class IV) and male fetus (OR 0.79, 95% CI: 0.74, 0.84) (class III) were as the protective factors (class IV). The methodological quality of four of the included meta-analyses, based on AMSTAR 2, was low and three meta-analyses were critically low.
Conclusion |
The multifetal gestation and IVF were environmental risk factors for the PAS, while hypertension disorders, low SES, and male fetus were the protective factors.
Abstract
The present umbrella review evaluated the environmental risk factors prior to conception associated with placenta accrete spectrum based on meta-analysis and systematic reviews. We searched PubMed, Scopus, and Web of Science until October 14, 2021. All meta-analyses that had focused on assessing the risk factors associated with placenta accrete spectrum were included. We calculated summary effect estimates, 95% CI, heterogeneity I², 95% prediction interval, small-study effects, excess significance biases, and sensitive analysis. The quality of the meta-analyses was evaluated with A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2). The risk factors of in-vitro fertilization (IVF) (OR 5.03, 95% CI: 3.34, 7.56) was graded as suggestive evidence (class III). The multiple gestations (OR 1.90, 95% CI: 1.26, 2.88) was graded as risk factor with weak evidence (class IV). Hypertension disorders (OR 0.5, 95% CI: 0.30, 0.82), low socioeconomic status (SES) (OR 0.51, 95% CI: 0.37, 0.71) (class IV) and male fetus (OR 0.79, 95% CI: 0.74, 0.84) (class III) were as the protective factors (class IV). The quality of five of the included meta-analyses, based on AMSTAR 2, was low and one meta-analysis was critically low (Table 3 and S3). The multifetal gestations and IVF were environmental risk factors for placenta accrete spectrum, while hypertension disorders, low socioeconomic status and male fetus were as the protective factors.
Le texte complet de cet article est disponible en PDF.Keywords : Placenta accrete spectrum, risk factor, Umbrella review
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