Ensiyeh Jenabi1, Zohreh Salimi1, Amir Mohammad Salehi2, Salman Khazaei3. 1. Autism Spectrum Disorders Research Center, Hamadan University of Medical Sciences, Hamadan, Iran. 2. Medical Student, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran. Electronic address: amirchsalehi19171917@gmail.com. 3. Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran.
Abstract
BACKGROUND: The present umbrella review evaluated the environmental risk factors prior to conception associated with placenta accrete spectrum(PAS) based on meta-analyses and systematic reviews. MATERIALS AND METHODS: We searched PubMed, Scopus, and Web of Science until October 14, 2021. All meta-analyses that had focused on assessing the risk factors associated with the PAS were included. We calculated summary effect estimates, 95% CI, heterogeneity I², 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). RESULT: The risk factor of in-vitro fertilization (IVF) (OR 5.03, 95% CI: 3.34, 7.56) was graded as suggestive evidence (class III). The multiple gestation (OR 1.90, 95% CI: 1.26, 2.88) was graded as the risk factor with weak evidence (class IV). Hypertension disorders (OR 0.5, 95% CI: 0.30, 0.82), low socioeconomic status (SES) (OR 0.51, 95% CI: 0.37, 0.71) (class IV) and male fetus (OR 0.79, 95% CI: 0.74, 0.84) (class III) were as the protective factors (class IV). The methodological quality of four of the included meta-analyses, based on AMSTAR 2, was low and three meta-analyses were critically low. CONCLUSION: The multifetal gestation and IVF were environmental risk factors for the PAS, while hypertension disorders, low SES, and male fetus were the protective factors.
BACKGROUND: The present umbrella review evaluated the environmental risk factors prior to conception associated with placenta accrete spectrum(PAS) based on meta-analyses and systematic reviews. MATERIALS AND METHODS: We searched PubMed, Scopus, and Web of Science until October 14, 2021. All meta-analyses that had focused on assessing the risk factors associated with the PAS were included. We calculated summary effect estimates, 95% CI, heterogeneity I², 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). RESULT: The risk factor of in-vitro fertilization (IVF) (OR 5.03, 95% CI: 3.34, 7.56) was graded as suggestive evidence (class III). The multiple gestation (OR 1.90, 95% CI: 1.26, 2.88) was graded as the risk factor with weak evidence (class IV). Hypertension disorders (OR 0.5, 95% CI: 0.30, 0.82), low socioeconomic status (SES) (OR 0.51, 95% CI: 0.37, 0.71) (class IV) and male fetus (OR 0.79, 95% CI: 0.74, 0.84) (class III) were as the protective factors (class IV). The methodological quality of four of the included meta-analyses, based on AMSTAR 2, was low and three meta-analyses were critically low. CONCLUSION: The multifetal gestation and IVF were environmental risk factors for the PAS, while hypertension disorders, low SES, and male fetus were the protective factors.