Systematic Reviews (Apr 2022)

The environmental risk factors prior to conception associated with placental abruption: an umbrella review

  • Ensiyeh Jenabi,
  • Zohreh Salimi,
  • Erfan Ayubi,
  • Saeid Bashirian,
  • Amir Mohammad Salehi

DOI
https://doi.org/10.1186/s13643-022-01915-6
Journal volume & issue
Vol. 11, no. 1
pp. 1 – 9

Abstract

Read online

Abstract Background The present umbrella review evaluated risk factors prior to conception associated with placental abruption based on meta-analyses and systematic reviews. Methods We searched PubMed, Scopus, and Web of Science until June 25, 2021. All meta-analyses that had focused on assessing the risk factors associated with placental abruption were included. We calculated summary effect estimates, 95% CI, heterogeneity I 2, 95% prediction interval, small-study effects, excess significance biases, and sensitive analysis. The quality of the meta-analyses was evaluated with A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2). Results There was no risk factor in the present umbrella review with the high level of evidence (class I or II). Eight risk factors including maternal asthma (RR 1.29 95% CI 1.14, 1.47), prior cesarean section (RR 1.38, 95% CI 1.35–1.42), cocaine using (RR 4.55, 95% CI 1.78–6.50), endometriosis (OR 1.40, 95% CI 1.12–1.76), chronic hypertension (OR 3.13, 95% CI 2.04–4.80), advanced maternal age (OR 1.44, 95% CI 1.35–1.54), maternal smoking (OR 1.80, 95% CI 1.75–1.85) (RR 1.65, 95% CI 1.51–1.80), and use of assisted reproductive techniques (ART) (OR 1.87, 95% CI 1.70–2.06) were graded as suggestive evidence (class III). The other four risk factors including pre-pregnancy underweight (OR 1.38, 95% CI 1.12–1.70), preeclampsia (OR 1.73, 95% CI 1.47–2.04), uterine leiomyoma (OR 2.63, 95% CI 1.38–3.88), and marijuana use (OR 1.78, 95% CI 1.32–2.40) were graded as risk factors with weak evidence (class IV). Conclusion Maternal asthma, prior cesarean section, cocaine use, endometriosis, chronic hypertension, advanced maternal age, maternal smoking, and use of ART, pre-pregnancy underweight, preeclampsia, uterine leiomyoma, and marijuana use were risk factors associated with placental abruption. Although factors associated with placental abruption have been investigated, the current meta-analytic associations cannot disentangle the complex etiology of placental abruption mainly due to their low quality of evidence.

Keywords