目的:我们进行了系统评价和荟萃分析,以检查死胎与后续妊娠中各种围产期结局之间的关系。
方法:PubMed,Cochrane图书馆,Embase,WebofScience,和CNKI数据库被搜索到2023年7月。
方法:队列研究报告了死胎与后续妊娠围产期结局之间的关联。
方法:我们根据PRISMA指南进行了系统评价和荟萃分析。使用R和STATA软件进行统计学分析。我们使用随机效应模型来汇集每个感兴趣的结果。我们进行了荟萃回归分析以探索潜在的异质性。证据评估的确定性(质量)采用GRADE方法。
结果:纳入了19项队列研究,涉及4,855,153名参与者。从这些研究中,我们确定了28,322例先前死产的个体符合资格标准。在调整了混杂因素后,低到中等确定性的证据表明,与先前在随后的怀孕中有活产的妇女相比,先前有死胎的妇女有更高的复发性死胎风险(OR:2.68,95%CI:2.01至3.56),早产(OR:3.15,95%CI:2.07至4.80),新生儿死亡(OR:4.24,95%CI:2.65至6.79),SGA/IUGR(OR:1.3,95%CI:1.0至1.8),低出生体重(OR:3.32,95%CI:1.46至7.52),胎盘早剥(OR:3.01,95%CI:1.01至8.98),仪器交付(OR:2.29,95%CI:1.68至3.11),引产(OR:4.09,95%CI:1.88至8.88),剖腹产(OR:2.38,95%CI:1.20至4.73),选择性剖腹产(OR:2.42,95%CI:1.82至3.23),和紧急剖腹产(OR:2.35,95%CI:1.81至3.06),但自然分娩率较低(OR:0.22,95%CI:0.13至0.36)。然而,既往死胎与后续妊娠中的先兆子痫无相关性(OR:1.72,95%CI:0.63~4.70).
结论:我们的系统评价和荟萃分析提供了更全面的了解与先前死产相关的不良妊娠结局。这些发现可用于为考虑在先前的死产后生孩子的夫妇提供咨询。
We conducted a systematic
review and meta-analysis to examine the relationship between stillbirth and various perinatal outcomes in subsequent pregnancy.
PubMed, the Cochrane Library, Embase, Web of Science, and CNKI databases were searched up to July 2023.
Cohort studies that reported the association between stillbirth and perinatal outcomes in subsequent pregnancies were included.
We conducted this systematic
review and meta-analysis in accordance with the PRISMA guidelines. Statistical analysis was performed using R and Stata software. We used random-effects models to pool each outcome of interest. We performed a meta-regression analysis to explore the potential heterogeneity. The certainty (quality) of evidence assessment was performed using the GRADE approach.
Nineteen cohort studies were included, involving 4,855,153 participants. From these studies, we identified 28,322 individuals with previous stillbirths who met the eligibility criteria. After adjusting for confounders, evidence of low to moderate certainty indicated that compared with women with previous live births, women with previous stillbirths had higher risks of recurrent stillbirth (odds ratio, 2.68; 95% confidence interval, 2.01-3.56), preterm birth (odds ratio, 3.15; 95% confidence interval, 2.07-4.80), neonatal death (odds ratio, 4.24; 95% confidence interval, 2.65-6.79), small for gestational age/intrauterine growth restriction (odds ratio, 1.3; 95% confidence interval, 1.0-1.8), low birthweight (odds ratio, 3.32; 95% confidence interval, 1.46-7.52), placental abruption (odds ratio, 3.01; 95% confidence interval, 1.01-8.98), instrumental delivery (odds ratio, 2.29; 95% confidence interval, 1.68-3.11), labor induction (odds ratio, 4.09; 95% confidence interval, 1.88-8.88), cesarean delivery (odds ratio, 2.38; 95% confidence interval, 1.20-4.73), elective cesarean delivery (odds ratio, 2.42; 95% confidence interval, 1.82-3.23), and emergency cesarean delivery (odds ratio, 2.35; 95% confidence interval, 1.81-3.06) in subsequent pregnancies, but had a lower rate of spontaneous labor (odds ratio, 0.22; 95% confidence interval, 0.13-0.36). However, there was no association between previous stillbirth and preeclampsia (odds ratio, 1.72; 95% confidence interval, 0.63-4.70) in subsequent pregnancies.
Our systematic
review and meta-analysis provide a more comprehensive understanding of adverse pregnancy outcomes associated with previous stillbirth. These findings could be used to inform counseling for couples who are considering pregnancy after a previous stillbirth.