Family history and pelvic organ prolapse: a systematic review and meta-analysis

• Published in: International Urogynecology Journal Vol. 32; no. 4; pp. 759 - 774
• Main Authors: Samimi, Parisa, Jones, Sarah H., Giri, Ayush
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.04.2021; Springer Nature B.V
• Subjects: Bias; Family medical history; Gynecology; Humans; Medical History Taking; Medicine; Medicine & Public Health; Meta-analysis; Pelvic organ prolapse; Pelvic Organ Prolapse - genetics; Recurrence; Review Article; Risk Factors; Surgery; Systematic review; Urology; Vagina; Systematic review; Pelvic organ prolapse; Prolapse recurrence; Primary prolapse; Family history; Meta-analysis
• ISSN: 0937-3462; 1433-3023
• DOI: 10.1007/s00192-020-04559-z

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). Meta-analysis 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.