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Liu J, Zhao M, Zhuan J, Song Y, Han Z, Zhao Y, Ma H, Yang X. Obstetric and perinatal outcomes of women with a history of recurrent pregnancy loss: a meta-analysis of cohort studies. Arch Gynecol Obstet 2024; 310:1525-1534. [PMID: 38951259 DOI: 10.1007/s00404-024-07604-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 06/18/2024] [Indexed: 07/03/2024]
Abstract
PURPOSE To assess the risk of adverse obstetric and perinatal outcomes in subsequent pregnancies among women with a history of recurrent pregnancy loss (RPL). METHODS Relevant studies were identified by searching the PubMed, Web of Science, and Embase databases. The pooled effect sizes were reported as odds ratios (OR) with their respective 95% confidence intervals (95% CI), and data analysis was performed using the random effects model. RESULTS A total of 26 studies involving 4,730,728 women were included in this meta-analysis. The results reveal a significant increase in the prevalence of placenta accreta cases after RPL compared to women without RPL (pooled OR 4.04; 95% CI 1.16-14.15; 2 studies; I2 = 94%; P = 0.03). However, no elevated risk of aneuploidies (pooled OR 1.69, 95% CI 0.73-3.90; 5 studies; I2 = 48%; P = 0.22) or congenital anomalies (pooled OR 1.12, 95% CI 0.97-1.30; 7 studies; I2 = 13%; P = 0.12) in subsequent pregnancies of women with RPL was observed. Additionally, a moderate increase in the risk of various other obstetric and perinatal outcomes was found. The magnitude of the elevated risk of these adverse outcomes varied depending on the region. CONCLUSIONS Women with a history of RPL exhibit a significantly elevated risk of placenta accreta in subsequent pregnancies, along with a moderate increase in the risk of various other adverse obstetric and perinatal outcomes. However, RPL does not signify an increased risk of aneuploidies or congenital anomalies in a consecutive pregnancy.
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Affiliation(s)
- Junxiu Liu
- Department of Gynecology, Cangzhou People's Hospital, 7 Qingchi Avenue, Xinhua District, Cangzhou, Hebei, China
| | - Mingyang Zhao
- Department of Gynecology, Cangzhou People's Hospital, 7 Qingchi Avenue, Xinhua District, Cangzhou, Hebei, China
| | - Jia Zhuan
- Department of Gynecology, Cangzhou People's Hospital, 7 Qingchi Avenue, Xinhua District, Cangzhou, Hebei, China
| | - Yanmin Song
- Department of Gynecology, Cangzhou People's Hospital, 7 Qingchi Avenue, Xinhua District, Cangzhou, Hebei, China
| | - Zhe Han
- Department of Gynecology, Cangzhou People's Hospital, 7 Qingchi Avenue, Xinhua District, Cangzhou, Hebei, China
| | - Yuanyuan Zhao
- Department of Gynecology, Cangzhou People's Hospital, 7 Qingchi Avenue, Xinhua District, Cangzhou, Hebei, China
| | - Hua Ma
- Department of Gynecology, Cangzhou People's Hospital, 7 Qingchi Avenue, Xinhua District, Cangzhou, Hebei, China
| | - Xiumei Yang
- Department of Gynecology, Cangzhou People's Hospital, 7 Qingchi Avenue, Xinhua District, Cangzhou, Hebei, China.
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Jia D, Sun F, Han S, Lu L, Sun Y, Song Q. Adverse outcomes in subsequent pregnancies in women with history of recurrent spontaneous abortion: A meta-analysis. J Obstet Gynaecol Res 2024; 50:281-297. [PMID: 38073001 DOI: 10.1111/jog.15848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 11/26/2023] [Indexed: 03/04/2024]
Abstract
OBJECTIVE This study aimed to investigate the association between a history of recurrent spontaneous abortion (RSA) and adverse outcomes in women with spontaneous conception. METHODS A search strategy from the inception to March 3, 2023 was run in PubMed, Embase, Cochrane Library, and Web of Science databases. The odds ratio (OR), and the 95% confidence interval (CI) or point estimation were used as the evaluation indexes. Each outcome measure tested was assessed for heterogeneity using the Cochran Q test. Sensitivity analyses were performed to test the credibility of the meta-analysis results. RESULTS Fifteen studies involving 1 475 389 pregnant women were included. A history of RSA was associated with gestational diabetes (OR: 2.21, 95% CI: 1.70-2.87, p < 0.001), preeclampsia (OR: 2.06, 95% CI: 1.49-2.86, p < 0.001), placenta previa (OR: 1.82, 95% CI: 1.09-3.02, p = 0.021), placental abruption (OR: 1.67, 95% CI: 1.36-2.06, p < 0.001), miscarriage (OR: 6.37, 95% CI: 3.83-10.57, p < 0.001), preterm birth (OR: 1.80, 95% CI: 1.36-2.37, p < 0.001), cesarean section (OR: 1.47, 95% CI: (1.13-1.91, p = 0.004), perinatal death (OR: 2.24, 95% CI: 1.39-3.60, p = 0.001), and neonatal intensive care unit admission (OR: 1.39, 95% CI: 1.01-1.92, p = 0.047). However, the associations of a history of RSA with gestational hypertension, small for gestational age, fetal anomalies, fetal growth restriction, and postpartum hemorrhage were not observed. CONCLUSION This meta-analysis indicates a history of RSA was associated with increased risks of several adverse outcomes in pregnant women with spontaneous conception.
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Affiliation(s)
- Dan Jia
- Department of Gynecology, Suzhou Hospital of Traditional Chinese Medicine, Suzhou, Jiangsu Province, People's Republic of China
| | - Fengdan Sun
- Department of Gynecology, Suzhou Hospital of Traditional Chinese Medicine, Suzhou, Jiangsu Province, People's Republic of China
| | - Sisi Han
- Department of Gynecology, Qingdao Women's and Children's Hospital, Qingdao, Shandong Province, People's Republic of China
| | - Lijuan Lu
- Department of Gynecology, Suzhou Hospital of Traditional Chinese Medicine, Suzhou, Jiangsu Province, People's Republic of China
| | - Yuanyuan Sun
- Department of Gynecology, Suzhou Hospital of Traditional Chinese Medicine, Suzhou, Jiangsu Province, People's Republic of China
| | - Qingxia Song
- Department of Gynecology, Suzhou Hospital of Traditional Chinese Medicine, Suzhou, Jiangsu Province, People's Republic of China
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Sun H, Mao J, Su X, Du Q. Impact of spontaneous abortion history and induced abortion history on perinatal outcomes of singleton pregnancies. BMC Public Health 2023; 23:2360. [PMID: 38031055 PMCID: PMC10685546 DOI: 10.1186/s12889-023-17264-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 11/20/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND At present, there are several studies on abortion history and perinatal outcomes, but there is no unified conclusion whether the history of abortion and different types of abortion are related to perinatal complications of subsequent pregnancy. We aim to study the impact of different types of abortion history on perinatal outcomes of singleton pregnancies. METHODS This was a retrospective study from a maternity and infant hospital in Shanghai, China from 2016 to 2020. Pregnant women who gave birth to live singleton infant were included (n = 75,773). We classified abortion into spontaneous abortion (SAB) and induced abortion (IA). We compared the perinatal outcomes of singleton pregnancies with different abortion histories and used Logistic regression analysis to evaluate the associations between pre-pregnancy abortion history with perinatal outcomes. RESULTS We observed that pregnant women with a history of abortion were more likely to have a premature delivery (0.99% VS 0.45%), gestational diabetes mellitus (GDM) (13.40% VS 10.29%), placenta abnormality (8.16% VS 5.06%), placenta previa (5.65% VS 3.75%), placenta accreta (0.18% VS 0.04%), and placenta adhesion (2.79% VS 1.03%) than those who obtained singleton pregnancies without a history of abortion. When confounding factors were adjusted, differences in placenta abnormality still existed (excluding placenta abruption). The odds ratios and 95% confidence interval of placenta previa, placenta accreta, and placenta adhesion in pregnant women with only SAB history, only IA history, and both abortion history were 1.294(1.174-1.427), 1.272(1.159-1.396), and 1.390(1.188-1.625), 2.688(1.344-5.374), 2.549(1.268-5.125), and 5.041(2.232-11.386), 2.170(1.872-2.515), 2.028(1.738-2.366), and 3.580(2.917-4.395), respectively. CONCLUSIONS Our research showed that pregnant women who have a history of abortion before pregnancy were more likely to have premature birth, GDM, placenta previa, placenta accreta, and placenta adhesion. After adjusting for confounding factors, we found that the history of SAB, IA, and both SAB and IA history were related to the increased risk of placenta previa, placenta accreta, and placenta adhesion.
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Affiliation(s)
- Hanxiang Sun
- Department of Obstetrics, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Onclogy, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Jing Mao
- Department of Obstetrics, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Onclogy, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Xiujuan Su
- Clinical Research Center, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Onclogy, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China
| | - Qiaoling Du
- Department of Obstetrics, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Onclogy, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, China.
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Zhang J, Liu X, Rao L, Ma R, Wu W, Chen C, Lin Y. Adverse obstetric and perinatal outcomes of patients with history of recurrent miscarriage: a retrospective cohort study. Fertil Steril 2023; 120:626-634. [PMID: 37121567 DOI: 10.1016/j.fertnstert.2023.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 04/20/2023] [Accepted: 04/20/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVE To examine the associations between a history of recurrent miscarriage (RM) and adverse obstetric and perinatal outcomes in the subsequent pregnancy that progressed beyond 24 weeks. DESIGN Retrospective cohort study. SETTING A large tertiary maternity hospital. PATIENT(S) All women who booked for antenatal care and delivery between January 2014 and August 2021 were recorded. The study was limited to women with a singleton pregnancy, and to avoid intraperson correlation, we selected the first record of delivery from each mother in the study, leaving 108,792 deliveries for analysis. Obstetric and perinatal outcomes were compared among 1994 women (1.83%) with a history of ≥2 miscarriages (RM), 11,477 women (10.55%) with a history of 1 miscarriage, and 95,321 women (87.62%) with no history of miscarriage, respectively. INTERVENTION(S) Women with a history of ≥2 miscarriages or RM. MAIN OUTCOME MEASURE(S) Obstetric complications included gestational diabetes mellitus, preeclampsia (subclassified as preterm and term preeclampsia), placenta previa, placenta accreta, and fetal distress. Perinatal outcomes included emergency cesarean section, elective cesarean section, induction, postpartum hemorrhage, preterm birth, stillbirth, Apgar score <7 at 5 minutes, neonatal asphyxia, neonatal sex, congenital; malformation, low birth weight, and neonatal death. RESULT(S) After adjusting for relevant confounders, there was an increased risk of adverse obstetric and perinatal outcomes in a subsequent pregnancy for women with a history of RM, specifically for placental dysfunction disorders: preterm preeclampsia (risk ratio [RR] = 1.58; 95% confidence interval [CI], 1.03-2.32), preterm birth (RR = 1.34; 95% CI, 1.15-1.54)], and abnormal placentation, that is placenta previa (RR = 1.78; 95% CI, 1.36-2.28), and placenta accreta (RR = 4.19; 95% CI, 2.75-6.13). CONCLUSION(S) Significant associations existed between a history of RM and the occurrence of adverse obstetric and perinatal outcomes including placental dysfunction disorders and abnormal placentation. These findings may contribute to the early detection and appropriate intervention for placenta-associated diseases in women with a history of RM, with the goal of avoiding or reducing the associated detrimental effects.
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Affiliation(s)
- Jinwen Zhang
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, People's Republic of China; Institute of Birth Defects and Rare Diseases, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Xiaorui Liu
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, People's Republic of China; Institute of Birth Defects and Rare Diseases, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Lin Rao
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China; Institute of Birth Defects and Rare Diseases, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Ruixiang Ma
- Department of Automation, Shanghai Jiao Tong University, Shanghai, People's Republic of China; Key Laboratory of System Control and Information Processing, Ministry of Education of China, Shanghai, People's Republic of China
| | - Weibin Wu
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, People's Republic of China; Institute of Birth Defects and Rare Diseases, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Cailian Chen
- Department of Automation, Shanghai Jiao Tong University, Shanghai, People's Republic of China; Key Laboratory of System Control and Information Processing, Ministry of Education of China, Shanghai, People's Republic of China
| | - Yi Lin
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China; Sixth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China.
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Association between Abortion History and Perinatal and Neonatal Outcomes of Singleton Pregnancies after Assisted Reproductive Technology. J Clin Med 2022; 12:jcm12010001. [PMID: 36614803 PMCID: PMC9820927 DOI: 10.3390/jcm12010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/14/2022] [Accepted: 12/16/2022] [Indexed: 01/09/2023] Open
Abstract
IMPORTANCE At present, few people have studied the associations between abortion history before pregnancy on the outcomes of women and their infants after assisted reproductive technology (ART). OBJECTIVE To explore the association between the history of abortion and the outcomes of singleton pregnancies after ART. DESIGN This was a retrospective study in a hospital from 2015 to 2020 in Shanghai, China. Pregnant women with live singleton births through ART were included (n = 3043). Abortion was classified into spontaneous abortion (SAB) and induced abortion. We compared the maternal and fetal outcomes of singleton pregnancies obtained through ART with different abortion histories. Logistic regression analysis was used to evaluate the associations between the history of pre-pregnancy abortion with perinatal complications and neonatal outcomes. RESULTS We observed that compared with those who had no abortion history and obtained singleton pregnancies through ART, women who had an abortion history before pregnancy (including SAB or induced abortion history) and only SAB history were more likely to have gestational diabetes mellitus (GDM), thyroid-related diseases, and placenta-related diseases. After adjusting the potential confounding factors, these differences still existed. The adjusted odds ratios (ORs) and 95% confidence interval (CI) of GDM, thyroid-related diseases, and placenta-related diseases in women with a history of abortion and only a history of SAB were 1.239 (1.030-1.492) and 1.240 (1.010-1.522), 1.589 (1.261-2.002) and 1.724 (1.344-2.213), 1.465 (1.183-1.815) and 1.433 (1.132-1.814), respectively. However, we did not observe the association between the history of induced abortion and GDM and thyroid-related diseases. CONCLUSIONS AND RELEVANCE Our research showed that pregnant women with singleton pregnancies through ART who had a history of abortion or only a history of SAB were more likely to have GDM, thyroid-related diseases, and placenta-related diseases. Pregnant women who had both SAB and induced abortion before pregnancy had a higher risk of thyroid-related diseases and placenta-related diseases, while women who had only a history of induced abortion had a higher risk of placenta-related diseases. Further research is needed to explore the biological mechanism of different types of abortion related to subsequent pregnancy.
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Wu CQ, Nichols K, Carwana M, Cormier N, Maratta C. Preterm birth after recurrent pregnancy loss: a systematic review and meta-analysis. Fertil Steril 2022; 117:811-819. [DOI: 10.1016/j.fertnstert.2022.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 12/19/2022]
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