Family history and acquired risk factors for pelvic organ prolapse: a case-control study in Japan

Abstract

This case-control study aimed to investigate the association between family history of pelvic organ prolapse (POP) and its development, combined with known clinical risk factors, in Japanese women. Participants included patients aged ≥ 40 years with and without POP. Self-reported questionnaires assessed delivery methods, disease history, and family history until third-degree relatives. Overall, 305 patients with POP and 338 healthy controls were included. After age-matching, a good balance was achieved between the groups (n = 129 each), with a mean age of 67.7 ± 8.3 years in the POP group and 67.4 ± 8.3 years in the control group. Multivariable logistic regression analysis revealed that the POP group had a significantly higher odds ratio for family history of POP (3.06 [1.09-8.56]; p = 0.03), body mass index (BMI) (1.12 [1.03-1.22]; p = 0.01), and parity (1.51 [1.20-1.89]; p = 0.001). An area under the curve of 0.693 was achieved with a family history of POP, BMI ≥ 23.1 kg/m², and parity ≥ 3 for differentiation between the POP and control groups. This suggests that family history of POP combined with BMI and parity may be useful predictors for POP development in Japanese women.

Keywords: Body mass index; Family history; Japanese Pelvic Floor Distress Inventory (J-PFDI-20); Parity; Pelvic organ prolapse.

Fig. 1

Recruitment flowchart of the study participants. A total of 299 patients with POP were recruited from outpatients at multiple institutes in Okinawa, Japan. Healthy women aged ≥ 40 years were recruited from 1148 participants at community- and institution-based health check-ups. Of the 1148 participants, 344 volunteered and answered the questionnaires (30.0% response rate). Considering the 6 newly diagnosed cases, a total of 305 patients in the POP group and 338 participants in the control group were included. Age-matching was achieved in the POP and control groups (n = 129 each) in the final analysis. POP pelvic organ prolapse.

Fig. 2

ROC curve analysis for predicting the risk of POP. (A) POP risk for BMI with continuous variable: The AUC is 0.644 (95% CI 0.576–0.711), and the best cut off value is 23.1 kg/m²; sensitivity and specificity are 0.713 and 0.543, respectively. (B) POP risk for parity with continuous variable: The AUC is 0.643 (95% CI 0.576–0.710), and the best cut off value is 3.0; sensitivity and specificity are 0.705 and 0.524, respectively. (C) POP risk for combined cutoff value of BMI and parity and POP family history with categorical variables: The AUC is 0.693; sensitivity and specificity are 0.535 and 0.771, respectively. ROC receiver operating characteristic, POP pelvic organ prolapse, AUC area under the curve, BMI body mass index.