بررسی همبستگی تعداد زایمان با میزان تراکم استخوان در زنان: مرور سیستماتیک و متاآنالیز

نوع مقاله: مروری

نویسندگان

1 دانشجوی دکتری تخصصی بهداشت باروری، کمیته پژوهشی دانشجویان، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران

2 دانشجوی دکتری تخصصی بهداشت باروری، مرکز تحقیقات مامایی و بهداشت باروری، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران.

3 استادیار گروه مامایی و بهداشت باروری، مرکز تحقیقات مامایی و بهداشت باروری، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران.

چکیده

مقدمه: پوکی استخوان یکی از مشکلات مهم سلامتی در زنان سراسر جهان می‌باشد، بر اساس شواهد موجود، زایمان می‌تواند نقش مهمی در تراکم استخوان زنان داشته باشد، لذا مطالعه حاضر با هدف تعیین همبستگی تعداد زایمان با تراکم استخوان به‌صورت مرور سیستماتیک و متاآنالیز انجام شد.
روش‌کار: در این مطالعه مرور سیستماتیک و متاآنالیز جهت یافتن مقالات، پایگاه‌های بین‌المللی Cochran library، Scopus، PubMed و Web of Science با کلید واژه‌های Parity و Bone Mineral Density (BMD) یاBone Mineral Content یا bone density بدون اعمال محدودیت زمانی و با محدودیت زبان انگلیسی مورد جستجو قرار گرفتند. جهت بررسی کیفیت مقالات از چک لیست اوتا تعدیل شده برای مطالعات مقطعی استفاده شد. جهت بررسی سوگرایی از Egger's test و Funnel plot و جهت بررسی هتروژنیتی از شاخص I2 و Q-test استفاده شد. مقادیر فیشر ترانسفورماسیون برای مطالعات محاسبه شد.
یافته‌ها: در این مطالعه 1336 مقاله مورد بررسی اولیه قرار گرفتند و در نهایت 11 مقاله با 5141 نفر شرکت‌کننده وارد متاآنالیز شدند. در این مطالعه روند کاهش تراکم استخوان در مهره‌های کمر، ران و لگن با تعداد بیش از 5 زایمان نسبت به زنان بدون سابقه زایمان مشاهده شد. در زنان نولی‌پار تراکم استخوان در مهره‌های کمر (001/0>Phetrogeneity، 11/1-75/0:CI 95%، 93/0:M) ، در لگن (001/0=Phetrogeneity، 89/0-84/0:CI 95%، 86/0:M) و در ران (001/0>Phetrogeneity، 09/1-60/0:CI 95%، 84/0:M) بود. میانگین تراکم استخوان در زنان یائسه در ناحیه کمر و ران و لگن کمتر بود. میانگین تراکم استخوان در زنان قاره آفریقا در هر سه ناحیه بالاتر بود. بر اساس نتایج، همبستگی متوسط معکوسی بین میزان تراکم معدنی استخوان در مهره‌های کمر (30/0-، 14/0-CI 95%) 22/0- و لگن (29/0-، 12/0-CI 95%) 21/0- با تعداد زایمان وجود داشت.
نتیجه‌گیری: میانگین تراکم استخوان در زنان نولی‌پار بیشتر است. به‌طور کلی همبستگی منفی بین تراکم معدنی استخوان مهره‌های کمر و لگن با پاریتی بالا وجود دارد، اما به‌دلیل هتروژنیته بالا در زیرگروه‌های آنالیز شده، انجام مطالعات کوهورت پیشنهاد می‌شود.

کلیدواژه‌ها


عنوان مقاله [English]

The correlation of number of parity and bone mineral density (BMD) in women: A systematic review and meta-analysis

نویسندگان [English]

  • Marzieh Saei Ghare Naz 1
  • Farzaneh Rashidi Fakari 2
  • Vida Ghasemi 2
  • Zahra Kiani 2
  • Giti Ozgoli 3
1 PhD Candidate of Reproductive Health, Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
2 PhD Candidate of Reproductive Health, Midwifery and Reproductive Health Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
3 Assistant Professor, Department of Midwifery and Reproductive Health, Midwifery and Reproductive Health Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
چکیده [English]

Introduction: Osteoporosis is a major health problem in women throughout the world. Based on the available evidence, delivery can play an important role in women's bone mineral density. Therefore, this study was performed with aim to determine the correlation between parity and bone mineral density through systematic review and.
Methods: In this systematic review and meta-analysis study, for finding the related articles, the databases of PubMed, Scopus, Cochran library and Web of Science databases were searched without time limitation and with English language restriction by using of the keywords of Parity and Bone Mineral Density (BMD) or Bone Mineral Content or bone density. The adapted Newcastle-Ottawa Scale was used to assess the quality of the cross-sectional articles. Funnel plot and Egger's test was used for publication bias assessing. Q-test and I2 index were used for evaluation of heterogeneity. Fisher’s 𝑟-to-𝑧 transformation was calculated for the studies.
Results: In this study, a total of 1336 papers were reviewed and 11 studies involving 5141 women were included in this meta-analysis. The decreasing trend in lumbar spine, femur and total hip BMD was observed in women with parity ≥5 compared to non-parity women. In nulliparous women, the mean of BMD in lumbar spine was (M:0.93 ,95%CI;0.75-1.11, Phetrogeneity <0.001), in femur (M:0.84 95%CI;0.60-1.09, Phetrogeneity <0.001) and in hip (M:0.86, 95%CI;0.84-0.89, Phetrogeneity =0.001). The mean of BMD in postmenopausal women was lower in lumbar, femur and hip. In African women, the mean of BMD in three sites were higher. There was no reverse moderate correlation between parity and lumbar BMD -0.22 (95% CI -0.14, -0.30) and hip BMD -0.21 (95% CI -0.12, -0.29).
Conclusion: The mean BMD was higher in nulliparous women. There was inverse correlation between lumbar BMD and hip BMD with parity, but because of high heterogeneity in analyzed subgroups, performing cohort studies is recommended.

کلیدواژه‌ها [English]

  • Bone mineral density
  • Meta-analysis
  • Parity
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