Oral Contraceptives and Health Outcomes: an Umbrella Review of Systematic Reviews and Meta-analyses in Women and Offspring

Y. Zou, Rui Peng, Ke Di Xu, Xiaoru Jiang, Qiuyu Sun, Chunhua Song
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Abstract

Abstract: Aim We herein provide an umbrella review of systematic reviews (SR) and meta-analyses (MAs) of studies of the association of oral contraceptives (OCs) with the risks of multiple health outcomes in women and their descendants. Methods Two investigators retrieved publications from four electronic databases, including PubMed, Embase, Web of Science, and the Cochrane Database of Systematic Reviews up to March 15, 2021. For each association, random/fixed-effects summary effect size and 95% CIs were estimated. Heterogeneity and publication bias were also assessed. The method quality and evidence level for each publication were respectively assessed utilizing the AMSTAR and GRADE checklists. Results A total of 68 articles with 82 unique outcomes were included based on the eligibility criteria. Numerous lines of evidence indicated that OCs had effects on nearly all cardiovascular disease-related outcomes, especially for cerebral venous sinus thrombosis (OR = 7.59, 95% CI: 3.82-15.09). Harmful associations were also found for vulvar vestibulitis (OR = 2.31, 95%CI: 1.03-5.16), preterm birth (OR = 1.17, 95% CI: 1.07-1.27), miscarriage (OR = 1.13, 95% CI: 1.02-1.72), ulcerative colitis (OR = 1.22, 95% CI: 1.06-1.41), Crohn’s disease (OR = 1.24, 95% CI: 1.09-1.40), alveolar osteitis (RR = 1.86, 95% CI: 1.66-2.08), dry socket (RR = 1.8, 95% CI: 1.33-2.43), and interstitial cystitis (OR = 2.1, 95% CI: 1.26-3.49). However, oral contraceptives did not increase the risk of cancer except breast and cervical cancer. Maternal exposure to OCs was linked to an increased risk for the development of respiratory atopic disorders such as asthma (OR = 1.1, 95% CI: 1.02-1.19) and rhinitis (OR = 1.34, 95% CI: 1.07-1.68). Conclusion In summary, although their use obviously reduces the risk of pregnancy- and parturition-related morbidity and mortality for women, OCs were frequently related to more harm than benefit in terms of other health outcomes. This was true for both women and their descendants in this umbrella review. More large-scale prospective studies analysing different doses, structures, and durations of treatment with estrogen and progestin are needed to confirm these effects.
口服避孕药与健康结果:对妇女及其后代的系统评价和荟萃分析的综合综述
摘要:目的本文对口服避孕药(OCs)与妇女及其后代多种健康结果风险的相关性研究的系统综述(SR)和荟萃分析(MA)进行了全面综述。方法两名研究人员检索了截至2021年3月15日的四个电子数据库中的出版物,包括PubMed、Embase、Web of Science和Cochrane系统评价数据库。对于每个关联,估计随机/固定效应汇总效应大小和95%CI。还评估了异质性和发表偏倚。使用AMSTAR和GRADE检查表分别评估了每份出版物的方法质量和证据水平。结果根据资格标准,共纳入68篇文章,82篇独特的结果。大量证据表明,强迫症对几乎所有心血管疾病相关的结果都有影响,尤其是对脑静脉窦血栓形成(OR=7.59,95%CI:3.82-15.09)。外阴前庭炎(OR=2.31,95%CI:1.03-5.16)、早产(OR=1.17,95%CI:1.07-12.7)、流产(OR=1.13,95%CI:1.02-1.72),溃疡性结肠炎(OR=1.22,95%CI:1.06-1.41)、克罗恩病(OR=1.24,95%CI:1.09-1.40)、牙槽骨炎(RR=1.86,95%CI:1.66-2.08)、干插座(RR=1.8,95%CI:1.33-2.43)和间质性膀胱炎(OR=2.1,95%CI:1.26-3.49)。母体接触OCs与哮喘(OR=1.1,95%CI:1.02-1.19)和鼻炎(OR=1.34,95%CI:1.07-1.68)等呼吸道特应性疾病的发病风险增加有关,就其他健康结果而言,强迫症往往弊大于利。在这篇总括性评论中,妇女及其后代都是如此。需要更大规模的前瞻性研究来分析雌激素和孕激素治疗的不同剂量、结构和持续时间,以证实这些效果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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