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The environmental risk factors associated with ectopic pregnancy: An umbrella review - 25/01/23

Doi : 10.1016/j.jogoh.2022.102532 
Ensiyeh Jenabi a, Erfan Ayubi b, Salman Khazaei c, Ali Reza Soltanian d, Amir Mohammad Salehi e,
a Mother and Child Care Research Center, Hamadan University of Medical Sciences, Hamadan, Iran 
b Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran 
c Autism Spectrum Disorders Research Center, Hamadan University of Medical Sciences, Hamadan, Iran 
d Modeling of Non-Communicable Disease Research Center, Hamadan University of Medical Sciences, Hamadan, Iran 
e Student Research Committee, Hamadan University of Medical Sciences School of Medicine, Hamadan, Iran 

Corresponding author.

Abstract

Introduction

Ectopic pregnancy(EP) is the implantation of a fertilized ovum outside of the uterine cavity. The incidence of EP has steadily increased around the world. The present umbrella review evaluated risk factors prior to conception associated with EP based on meta-analyses and systematic reviews.

Methods

We searched PubMed, Scopus, and Web of Science until June 25, 2021. All meta-analyses that had focused on assessing the risk factors associated with EP 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).

Results

Two risk factors including chlamydia trachomatis (OR: 3.03) and smoking (OR: 1·77) were graded as suggestive evidence (class III). IUD with pregnant control (OR: 10.63) and endometriosis for case-control studies (OR: 2·66) and tubal ligation with pregnant control (OR: 9.3) were graded as risk factors with weak evidence (class IV). Tubal ligation with non-pregnant control was a protective factor (class IV). IUD with non-pregnant control and endometriosis for cohort studies were not as risk factors for EP.

Conclusion

Two risk factors including chlamydia trachomatis and smoking were graded as suggestive evidence. IUD with pregnant control and endometriosis for case-control studies and tubal ligation with pregnant control were graded as risk factors with weak evidence. Strong evidence for risk factors of EP was not achieved, indicating the degree of uncertainty and bias, which bring an emergency to conduct further no-bias studies.

Systematic review registration

PROSPERO (CRD42021281632)

Le texte complet de cet article est disponible en PDF.

Keywords : Ectopic pregnancy, Chlamydia trachomatis, Risk factor, Umbrella review, Meta-analyses

Abbreviations : EP, AMSTAR 2, PID, OCPs, IUDs, ART, PRISMA, OR


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Vol 52 - N° 2

Article 102532- février 2023 Retour au numéro
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