Family history and pelvic organ prolapse: a systematic review and meta-analysis
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REVIEW ARTICLE
Family history and pelvic organ prolapse: a systematic review and meta-analysis Parisa Samimi 1 & Sarah H. Jones 2 & Ayush Giri 2,3 Received: 10 July 2020 / Accepted: 2 October 2020 # The International Urogynecological Association 2020
Abstract Introduction and hypothesis Numerous analytic observational studies assess family history as a risk factor for POP and report a wide range of associations. This review aims to systematically evaluate the role of family history of POP in relation to POP risk and its recurrence. Methods A review was performed of the PubMed/MEDLINE database with search criteria specifying family history, risk factors, POP, and their synonyms as title/abstract keywords, as well as MESH terms, up to March 2020. We aggregated evidence across studies with fixed effects (FE) and random effects (RE) meta-analysis. Results Forty-three articles underwent full-text review. Eighteen independent studies evaluating the relationship between family history of POP and POP risk in 3639 POP cases and 10,912 controls were eligible for meta-analysis. Four studies evaluating family history and POP recurrence in 224 recurrent cases and 400 non-recurrent cases were eligible for inclusion into another meta-analyses. A positive family history of POP is on average associated with 2.3- to 2.7-fold increased risk for POP (RE OR = 2.64; 95% CI = 2.07, 3.35) as well as a 1.4-fold increased risk for POP recurrence (FE OR = 1.44; 95% CI = 1.00, 2.08). Metaanalysis estimates of POP risk varied by study design, definition of family history, and model adjustment status. We found evidence that publication bias and recall bias are a possibility. Conclusions Family history of POP is a risk factor for both POP presence and recurrence. However, reported magnitudes may be overestimates due to confounding, recall bias, and publication bias. Keywords Pelvic organ prolapse . Primary prolapse . Prolapse recurrence . Family history . Systematic review . Meta-analysis
Introduction Pelvic organ prolapse (POP) is defined as the descent of one or more pelvic organs into the vaginal space due to Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00192-020-04559-z) contains supplementary material, which is available to authorized users. * Ayush Giri [email protected] 1
Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA
2
Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
3
Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
lack of support of the anterior or posterior vaginal wall, vaginal cuff, or uterus [1, 2]. Up to 50% of postmenopausal women may have POP on clinical examination, and the lifetime risk of undergoing surgery for POP is estimated at 12.6% in the US [3, 4]. Prolapse can result in discomfort, obstructive defecation, increased risk of urinary tract infections, and, more rare
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