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

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). 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.

Keywords: Family history; Meta-analysis; Pelvic organ prolapse; Primary prolapse; Prolapse recurrence; Systematic review.

Figure 1.

Flow chart summarizing systematic review process

Figures 2a-b.

Forest plots showing (a) minimum and (b) maximum meta-analysis odds ratios for the association between family history of POP and POP in participants.

Figure 3a-b.

Funnel plots of studies included in the (a) minimum and (b) maximum meta-analysis sets for the association between family history of POP and POP in participants* *Funnel plots suggest potential for small study bias as demonstrated by asymmetry in the plots. Statistical evidence for small study bias was also detected for the maximum analysis sets.

Figure 4a-c.

Forest plots of sensitivity analyses showing associations between family history of POP and participant POP status by study design (a), adjustment of confounders (b) and method of outcome assessment (c)

Figure 5a-b.

Sensitivity analysis of the association between family history of POP and participant POP status by type of family history that was assessed (a) and in whom (b)