Kelly Margaret Hughes, Mason Aberoumand, Anna Lene Seidler, Phoebe Swan, Mona Aboulghar, Maria de Lourdes Brizot, Clifton Brock, Marta Benito Vielba, Nathan Fox, Cynthia Gyamfi-Bannerman, Lindsay Kindinger, Giorgio Pagani, Alfredo Perales Marin, Viola Seravalli, Mariarosaria Di Tommaso, Omer Weitzner, Katharina Worda, Lukas Staub, Shaun Brennecke, Shakila Thangaratinam, Ben W Mol, Rui Wang
{"title":"宫颈长度对无症状双胎妊娠妇女自发性早产的预后价值：个体参与者数据的荟萃分析","authors":"Kelly Margaret Hughes, Mason Aberoumand, Anna Lene Seidler, Phoebe Swan, Mona Aboulghar, Maria de Lourdes Brizot, Clifton Brock, Marta Benito Vielba, Nathan Fox, Cynthia Gyamfi-Bannerman, Lindsay Kindinger, Giorgio Pagani, Alfredo Perales Marin, Viola Seravalli, Mariarosaria Di Tommaso, Omer Weitzner, Katharina Worda, Lukas Staub, Shaun Brennecke, Shakila Thangaratinam, Ben W Mol, Rui Wang","doi":"10.1136/bmjmed-2024-000877","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To quantify the prognostic value of mid-trimester cervical length for spontaneous preterm birth in asymptomatic women with twin pregnancy and to assess whether other factors may modify any association.</p><p><strong>Designs: </strong>A two stage meta-analysis of individual participant data in a Cox proportional hazard model was performed using cervical length as a continuous variable.</p><p><strong>Data sources: </strong>Medline, Embase, Cochrane, and LILACS, among others, were searched to identify eligible studies; the search was from 1 January 2000 to 30 September 2020. Risk of bias was assessed with the QUIPS tool. Studies were from eight countries between 2001 and 2018.</p><p><strong>Eligibility criteria: </strong>Individual participant data were sought for eligible studies that reported mid-trimester (defined between 16 and 26 weeks) transvaginal sonographic cervical length and also gestational age at birth in asymptomatic women with twin pregnancy. The primary outcome was spontaneous preterm birth before 37 weeks.</p><p><strong>Results: </strong>Among 29 eligible studies, authors of 17 studies provided individual participant data for 6437 women with a twin pregnancy (69.1% of individual participant data). Mean cervical length measurement was 39 mm (SD=9, range 1-74 mm). 2889 women (44.9%) delivered before 37 weeks' gestation, and 934 (14.9%) delivered before 34 weeks. Each 1 mm increase in cervical length was associated with a 4.0% reduction in the rate of spontaneous preterm birth before 37 weeks (hazard ratio 0.96 (95% confidence interval 0.95 to 0.97)), and a 6.8% reduction in the rate of spontaneous preterm birth before 34 weeks' gestation (0.93 (0.92 to 0.95)). The prognostic value remained stable in models adjusting for different sets of variables.</p><p><strong>Conclusion: </strong>The prognostic value of cervical length for spontaneous preterm birth in twin pregnancy is on a continuous scale. 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Risk of bias was assessed with the QUIPS tool. Studies were from eight countries between 2001 and 2018.</p><p><strong>Eligibility criteria: </strong>Individual participant data were sought for eligible studies that reported mid-trimester (defined between 16 and 26 weeks) transvaginal sonographic cervical length and also gestational age at birth in asymptomatic women with twin pregnancy. The primary outcome was spontaneous preterm birth before 37 weeks.</p><p><strong>Results: </strong>Among 29 eligible studies, authors of 17 studies provided individual participant data for 6437 women with a twin pregnancy (69.1% of individual participant data). Mean cervical length measurement was 39 mm (SD=9, range 1-74 mm). 2889 women (44.9%) delivered before 37 weeks' gestation, and 934 (14.9%) delivered before 34 weeks. Each 1 mm increase in cervical length was associated with a 4.0% reduction in the rate of spontaneous preterm birth before 37 weeks (hazard ratio 0.96 (95% confidence interval 0.95 to 0.97)), and a 6.8% reduction in the rate of spontaneous preterm birth before 34 weeks' gestation (0.93 (0.92 to 0.95)). The prognostic value remained stable in models adjusting for different sets of variables.</p><p><strong>Conclusion: </strong>The prognostic value of cervical length for spontaneous preterm birth in twin pregnancy is on a continuous scale. 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引用次数: 0
摘要
目的：量化妊娠中期宫颈长度对无症状双胎妊娠妇女自发性早产的预后价值，并评估其他因素是否可能改变其相关性。设计：对Cox比例风险模型中的个体参与者数据进行两阶段荟萃分析，使用颈椎长度作为连续变量。数据来源：检索Medline、Embase、Cochrane和LILACS等，以确定符合条件的研究；搜索时间为2000年1月1日至2020年9月30日。使用QUIPS工具评估偏倚风险。研究在2001年至2018年期间来自八个国家。入选标准：对报告无症状双胎妊娠妇女妊娠中期（定义在16至26周之间）经阴道超声检查宫颈长度和出生时胎龄的合格研究寻求个体参与者数据。主要结局为37周前自然早产。结果：在29项符合条件的研究中，17项研究的作者提供了6437名双胎妊娠妇女的个体参与者数据（占个体参与者数据的69.1%）。平均颈椎长度测量值为39 mm （SD=9，范围1-74 mm）。37周前分娩2889例（44.9%），34周前分娩934例（14.9%）。宫颈长度每增加1毫米，37周前自发性早产率降低4.0%（风险比0.96(95%可信区间0.95 ~ 0.97)），34周前自发性早产率降低6.8%（0.93(0.92 ~ 0.95)）。在调整不同变量集的模型中，预后值保持稳定。结论：宫颈长度对双胎妊娠自发性早产的预后有连续的预测价值。目前还没有确定可以可靠地预测或排除所有自发性早产的特定宫颈长度。研究注册号：CRD42020146987。
Prognostic value of cervical length for spontaneous preterm birth in asymptomatic women with twin pregnancy: meta-analysis of individual participant data.
Objective: To quantify the prognostic value of mid-trimester cervical length for spontaneous preterm birth in asymptomatic women with twin pregnancy and to assess whether other factors may modify any association.
Designs: A two stage meta-analysis of individual participant data in a Cox proportional hazard model was performed using cervical length as a continuous variable.
Data sources: Medline, Embase, Cochrane, and LILACS, among others, were searched to identify eligible studies; the search was from 1 January 2000 to 30 September 2020. Risk of bias was assessed with the QUIPS tool. Studies were from eight countries between 2001 and 2018.
Eligibility criteria: Individual participant data were sought for eligible studies that reported mid-trimester (defined between 16 and 26 weeks) transvaginal sonographic cervical length and also gestational age at birth in asymptomatic women with twin pregnancy. The primary outcome was spontaneous preterm birth before 37 weeks.
Results: Among 29 eligible studies, authors of 17 studies provided individual participant data for 6437 women with a twin pregnancy (69.1% of individual participant data). Mean cervical length measurement was 39 mm (SD=9, range 1-74 mm). 2889 women (44.9%) delivered before 37 weeks' gestation, and 934 (14.9%) delivered before 34 weeks. Each 1 mm increase in cervical length was associated with a 4.0% reduction in the rate of spontaneous preterm birth before 37 weeks (hazard ratio 0.96 (95% confidence interval 0.95 to 0.97)), and a 6.8% reduction in the rate of spontaneous preterm birth before 34 weeks' gestation (0.93 (0.92 to 0.95)). The prognostic value remained stable in models adjusting for different sets of variables.
Conclusion: The prognostic value of cervical length for spontaneous preterm birth in twin pregnancy is on a continuous scale. No specific cervical length has been identified that can reliably predict or exclude all spontaneous preterm births.
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