子宫内膜异位症与不良妊娠结局的Meta分析

Endometriosis and adverse pregnancy outcomes: a systematic review and meta-analysis

摘要:

目的 系统性评价子宫内膜异位症（EMS）是否增加不良妊娠结局的发病风险，为子宫内膜异位症的围生期监护提供指导。方法 计算机检索2010年1月1日—2020年12月31日在中国知网（CNKI）、中国生物医学文献数据库（CBM）、万方数据库、维普数据库、the Cochrane Library、PubMed、Embase和Web of Science数据库中妊娠结局的相关研究，研究类型为队列和病例对照研究。对符合质量标准的研究结果进行Meta分析。采用RevMan 5.3软件进行分析。结果 最终纳入10项研究，纳入研究对象共2 107 633例。Meta分析结果显示：子宫内膜异位症组不良妊娠结局风险显著增加，包括妊娠期高血压疾病［R^R=1.19（95% CI：1.14，1.25），P <0.05］、死胎［R^R=1.66（95% CI：1.53，1.80），P <0.05］、胎盘早剥［R^R=1.84（95% CI：1.14，2.97），P <0.05］、前置胎盘［R^R=3.31（95% CI：2.55，4.31），P <0.05］、产后出血［R^R=1.30（95% CI：1.01，1.67），P <0.05］及早产［R^R=1.27（95% CI：1.16，1.39），P <0.05］。结论 EMS可显著增加多种不良妊娠结局的发病风险。故对子宫内膜异位症孕妇应加强孕期监护，以降低围生期的各种并发症，从而改善妊娠结局。

Abstract:

Objective To systematically evaluate whether endometriosis increases the risk of adverse pregnancy outcomes, and to provide guidance for perinatal monitoring of endometriosis (EMS).Methods China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Wanfang Database, VIP, Cochrane Library, PubMed, Embase and Web of Science were searched against to obtain cohort and case-control studies on EMS and pregnancy outcomes from January 1st 2010 to December 31st 2020. Meta-analysis was performed on the results that met the quality criteria using RevMan 5.3 software.Results Ten studies were eventually included, with a total of 2,107,633 subjects. Results of the meta-analysis showed that EMS significantly increased the risks of adverse pregnancy outcomes, including hypertensive disorder complicating pregnancy [R^R = 1.19 (95% CI: 1.14, 1.25), P < 0.05], stillbirth [R^R = 1.66 (95% CI: 1.53, 1.80), P < 0.05], placental abruption [R^R = 1.84 (95% CI: 1.14, 2.97), P < 0.05], placenta previa [R^R = 3.31 (95% CI: 2.55, 4.31), P < 0.05], postpartum hemorrhage [R^R = 1.30 (95% CI: 1.01, 1.67), P < 0.05], and premature delivery [R^R = 1.27 (95% CI: 1.16, -1.39), P < 0.05].Conclusions EMS significantly increases the risks of multiple adverse pregnancy outcomes. Therefore, pregnant women with endometriosis should be monitored during pregnancy to reduce perinatal complications, so as to improve the pregnancy outcomes.