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Frequency of recurrent pregnancy loss : a systematic review and meta-analysis
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Contexto: A frequência de Perda Gestacional Recorrente (PGR) refere-se ao número de todas as mulheres numa população que, num momento específico, tiveram dois, três ou mais abortos consecutivos ou não consecutivos, de acordo com os critérios aplicados.
Objetivo: O principal objetivo do presente estudo é determinar a frequência global de PGR. Como objetivos secundários, visámos estimar a frequência de PGR idiopática, de trombofilias, adquiridas e hereditárias, fatores anatómicos, imunológicos, endócrinos, cromossómicos, infecciosos e masculinos.
Métodos: Realizámos uma pesquisa nas seguintes bases de dados: PubMed/Medline, EMBASE, Cochrane Library, Scopus e Web of Science. Para o cálculo da frequência, o número total de mulheres com PGR foi utilizado como denominador. Os dados foram submetidos à transformação de Freeman-Tukey (transformação do arco seno duplo) para evitar frequência negativa no intervalo de confiança (IC), limitando o IC entre 0 e 100%. Agrupámos os dados através de um estimador Empirical Bayes para tau2.
Resultados: Foram incluídos um total de 30 estudos com 9356 mulheres com PGR. Em relação à frequência global de PGR, estimámos uma frequência de 1% (95% CI 1%-1%, tau2<0.01, I2=93%). Para os objetivos secundários, calculámos uma frequência de: 50% para PGR idiopática (95% CI 44%-55%, tau2<0.01, I2=84%); 15% para trombofilias adquiridas (95% CI 6%-26%, tau2=0.06, I2=99%); 14% para trombofilias hereditárias (95% CI 7%-23%, tau2=0.03, I2=94%); 10% para fatores anatómicos (95% CI 6%-14%, tau2=0.02, I2=97%); 10% para fatores imunológicos (95% CI 3%-22%, tau2=0.04, I2=98%); 10% para fatores endocrinológicos (95% CI 7%-14%, tau2<0.01, I2=94%); 36% para fatores masculinos (95% CI 26%-46%); 6% para fatores cromossómicos (95% CI 3%-10%, tau2=0.01, I2=95%); 14% para fatores infeciosos (95% CI 6%-24%, tau2=0.04, I2=97%).
Conclusão: O nosso estudo fornece estimativas atualizadas relativas à frequência global de PGR e relativas à frequência das categorias específicas estudadas, enumeradas acima, contribuindo para a literatura existente.
Background: The frequency of Recurrent Pregnancy Loss (RPL) is the number of all women in a population who, at a specific time point, have had two, three or more consecutive or non-consecutive miscarriages, according to the criteria applied. Objective: The primary objective of this study is to determine the overall frequency of recurrent pregnancy loss. As secondary objectives, we aimed to estimate the frequency of idiopathic, both acquired and hereditary thrombophilia, anatomical, immune, endocrine, chromosomal, infectious, and male factors. Methods: We conducted a search of the following electronic databases: PubMed/Medline, EMBASE, Cochrane Library, Scopus, and Web of Science. For frequency calculation, the total number of individuals screened was used as the denominator. Data was subjected to Freeman-Tukey transformation (double arcsine transformation) to avoid negative frequency in the confidence interval, limiting the CI between 0 and 100%. We pooled data using an Empirical Bayes estimator for tau2. Results: A total of 30 studies with 9356 women with RPL were included. Regarding the overall frequency of RPL, we estimated a frequency of 1% (95% CI 1%-1%, tau2<0.01, I2=93%). For the secondary outcomes, we calculated a frequency: of 50% for idiopathic RPL (95% CI 44%-55%, tau2<0.01, I2=84%); of 15% for acquired thrombophilia (95% CI 6%-26%, tau2=0.06, I2=99%); of 14% for hereditary thrombophilia (95% CI 7%-23%, tau2=0.03, I2=94%); of 10% for anatomical factors (95% CI 6%-14%, tau2=0.02, I2=97%); of 10% for immune factors (95% CI 3%-22%, tau2=0.04, I2=98%); of 10% for endocrine factors (95% CI 7%-14%, tau2<0.01, I2=94%); of 36% for male factors (95% CI 26%-46%); of 6% for chromosomal factors (95% CI 3%-10%, tau2=0.01, I2=95%); of 14% for infectious factors (95% CI 6%-24%, tau2=0.04, I2=97%). Conclusion: Our study provides updated estimates of both the overall frequency of RPL, and the frequency of specific categories studied, contributing to the existing literature.
Background: The frequency of Recurrent Pregnancy Loss (RPL) is the number of all women in a population who, at a specific time point, have had two, three or more consecutive or non-consecutive miscarriages, according to the criteria applied. Objective: The primary objective of this study is to determine the overall frequency of recurrent pregnancy loss. As secondary objectives, we aimed to estimate the frequency of idiopathic, both acquired and hereditary thrombophilia, anatomical, immune, endocrine, chromosomal, infectious, and male factors. Methods: We conducted a search of the following electronic databases: PubMed/Medline, EMBASE, Cochrane Library, Scopus, and Web of Science. For frequency calculation, the total number of individuals screened was used as the denominator. Data was subjected to Freeman-Tukey transformation (double arcsine transformation) to avoid negative frequency in the confidence interval, limiting the CI between 0 and 100%. We pooled data using an Empirical Bayes estimator for tau2. Results: A total of 30 studies with 9356 women with RPL were included. Regarding the overall frequency of RPL, we estimated a frequency of 1% (95% CI 1%-1%, tau2<0.01, I2=93%). For the secondary outcomes, we calculated a frequency: of 50% for idiopathic RPL (95% CI 44%-55%, tau2<0.01, I2=84%); of 15% for acquired thrombophilia (95% CI 6%-26%, tau2=0.06, I2=99%); of 14% for hereditary thrombophilia (95% CI 7%-23%, tau2=0.03, I2=94%); of 10% for anatomical factors (95% CI 6%-14%, tau2=0.02, I2=97%); of 10% for immune factors (95% CI 3%-22%, tau2=0.04, I2=98%); of 10% for endocrine factors (95% CI 7%-14%, tau2<0.01, I2=94%); of 36% for male factors (95% CI 26%-46%); of 6% for chromosomal factors (95% CI 3%-10%, tau2=0.01, I2=95%); of 14% for infectious factors (95% CI 6%-24%, tau2=0.04, I2=97%). Conclusion: Our study provides updated estimates of both the overall frequency of RPL, and the frequency of specific categories studied, contributing to the existing literature.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2024
Palavras-chave
Perda gestacional recorrente Frequência Aborto Revisão sistemática Meta-análise