Induced abortion and ectopic pregnancy: A systematic review and meta-analysis

IF 3.6 2区医学 Q1 MEDICINE, GENERAL & INTERNAL Journal of Evidence‐Based Medicine Pub Date : 2024-06-10 DOI:10.1111/jebm.12619

Xin Wang, Mengcong Deng, Shangchun Wu, Qunxia Mao

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Abstract

Objective

Existing evidence of the relationship between induced abortion and ectopic pregnancy has not been assessed rigorously. This systematic review provides a comprehensive evaluation to examine whether induced abortion (IA) can increase the rate of ectopic pregnancy (EP).

Methods

We searched PubMed, EMBASE, Web of Science, Cochrane, CNKI, WanFang, and Sinomed databases since their inception until February 2023. Eligibility criteria included case-control studies and cohort studies that analyzed induced abortion associated with ectopic pregnancy. Data analyses were conducted by using R-studio Version 1.1.383 software.

Results

A total of 33 case-control studies and 7 cohort studies involving 132,926 participants were included. In case-control studies, there was a significant association between induced abortion and ectopic pregnancy by using single-factor analysis data (OR = 2.32, 95% CI = 1.81–2.98). Subgroup analysis by region suggested no statistical significance in the Americas (OR = 1.15, 95% CI = 0.92–1.43) and Eastern Mediterranean (OR = 3.64, 95% CI = 0.88–15.18). The relationship was significant by using multiple regression analysis data (OR = 1.97, 95% CI = 1.38–2.80). In cohort studies, statistical significance was found (OR = 1.42, 95% CI = 1.001–2.018) after omitting one study in sensitivity analysis. The combined results of the two types of studies suggested that induced abortion would increase the risk of ectopic pregnancy to some degree, but the conclusion needs to be considered with caution.

Conclusion

This study indicated that IA could increase the risk of EP to some degree and the times of IA had a negative impact on the risk. Safe abortion and avoiding repeat abortion due to unintended pregnancy could protect women's fertility.

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人工流产与宫外孕：系统回顾和荟萃分析。

目的：关于人工流产与异位妊娠之间关系的现有证据尚未得到严格评估。本系统综述对人工流产（IA）是否会增加异位妊娠（EP）的发生率进行了全面评估：方法：我们检索了 PubMed、EMBASE、Web of Science、Cochrane、CNKI、万方和 Sinomed 数据库自建立以来至 2023 年 2 月的所有文献。资格标准包括分析与异位妊娠相关的人工流产的病例对照研究和队列研究。数据分析采用 R-studio 1.1.383 版软件：结果：共纳入 33 项病例对照研究和 7 项队列研究，涉及 132926 名参与者。在病例对照研究中，通过使用单因素分析数据，人工流产与宫外孕之间存在显著关联（OR = 2.32，95% CI = 1.81-2.98）。按地区进行的分组分析表明，美洲（OR = 1.15，95% CI = 0.92-1.43）和地中海东部（OR = 3.64，95% CI = 0.88-15.18）没有统计学意义。通过使用多元回归分析数据（OR = 1.97，95% CI = 1.38-2.80），这种关系非常明显。在队列研究中，在敏感性分析中省略一项研究后，发现统计学意义（OR = 1.42，95% CI = 1.001-2.018）。两类研究的综合结果表明，人工流产会在一定程度上增加宫外孕的风险，但这一结论需要慎重考虑：本研究表明，人工流产会在一定程度上增加宫外孕的风险，而人工流产的时间对宫外孕的风险有负面影响。安全人工流产和避免因意外怀孕而再次人工流产可保护妇女的生育能力。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Evidence‐Based Medicine MEDICINE, GENERAL & INTERNAL-

CiteScore

11.20

自引率

1.40%

发文量

期刊介绍： The Journal of Evidence-Based Medicine (EMB) is an esteemed international healthcare and medical decision-making journal, dedicated to publishing groundbreaking research outcomes in evidence-based decision-making, research, practice, and education. Serving as the official English-language journal of the Cochrane China Centre and West China Hospital of Sichuan University, we eagerly welcome editorials, commentaries, and systematic reviews encompassing various topics such as clinical trials, policy, drug and patient safety, education, and knowledge translation.