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Published on: August 4, 2021
Preterm birth after recurrent pregnancy loss: a systematic review and meta-analysis
Clara Q Wu1, Kelly Nichols2, Matthew Carwana3
1Division of Reproductive Endocrinology and Infertility, Ottawa Fertility Centre/The Ottawa Hospital, Department of Obstetrics and Gynecology, University of Ottawa, Ontario, Canada.
Objective:
To evaluate the impact of recurrent pregnancy loss (RPL) on the risk of preterm birth (PTB) in subsequent pregnancies.
Design:
Systematic review and meta-analysis.
Setting:
Not applicable.
Patient(S):
Pregnant women with and without a history of RPL.
Intervention(S):
PubMed, Embase, Google Scholar and Cochrane trial registry were used to identify relevant studies.
Main Outcome Measure(S):
The odds ratios (ORs) for the association between RPL and PTB across included studies were evaluated. Effect estimates were pooled using a DerSimonian and Laird random-effects meta-analysis model.
Result(S):
Eighteen studies met the inclusion criteria. A total of 58,766 women with a history of RPL and 2,949,222 women without a history of RPL were included. A pooled OR of 1.60 (95% confidence interval [CI], 1.45-1.78; 18 observational studies; I2 = 85.6%) was observed in our random-effects meta-analysis. A trend toward higher odds of PTB is observed with the increasing number of pregnancy losses: 2 RPLs (pooled OR, 1.31; 95% CI, 1.09-1.57; I2 = 88.9%); ≥2 RPLs (pooled OR, 1.58; 95% CI, 1.27-1.96; I2 = 71.7%); and ≥3 RPLs (pooled OR, 1.81; 95% CI, 1.58-2.07; I2 = 73.6%). The analysis of the risk of PTB for patients with unexplained RPL demonstrated a significantly heightened risk of PTB in this subgroup (pooled OR, 2.05; 95% CI, 1.46-2.89; I2 = 21.0%). Inconsistent adjustment for confounders and significant between-study heterogeneity were noted in this study.
Conclusion(S):
Despite significant heterogeneity among studies, we found that women with a history of RPL had significantly higher odds of delivering preterm infants in subsequent pregnancies.
Clinical Trial Registration Number:
CRD 224763.
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