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

مراجع

  1. Brown JP, Josse RG; Scientific Advisory Council of the Osteoporosis Society of Canada. 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. CMAJ 2002; 167(10 Suppl):S1-34.
  2. Ethgen O, Tellier V, Sedrine WB, De Maeseneer J, Gosset C, Reginster JY. Health-related quality of life and cost of ambulatory care in osteoporosis: how may such outcome measures be valuable information to health decision makers and payers? Bone 2003; 32(6):718-24.
  3. Dempster DW. Osteoporosis and the burden of osteoporosis-related fractures. Am J Manag Care 2011; 17(6):S164-9.
  4. Abolhassani F, Mohammadi M, Soltani A. Burden of osteoporosis in Iran. Iran J Public Health 2004; 18:28.
  5. Reginster JY, Burlet N. Osteoporosis: a still increasing prevalence. Bone 2006; 38(2):S4-9.
  6. Watts NB, Bilezikian JP, Camacho PM, Greenspan SL, Harris SL, Hodgson SF, et al. American association of clinical endocrinologists medical guidelines for clinical practice for the diagnosis and treatment of postmenopausal osteoporosis. Endocr Pract 2010; 16(Suppl 3):1-37.
  7. Wright NC, Looker AC, Saag KG, Curtis JR, Delzell ES, Randall S, et al. The recent prevalence of osteoporosis and low bone mass in the United States based on bone mineral density at the femoral neck or lumbar spine. J Bone Miner Res 2014; 29(11):2520-6.
  8. Sözen T, Özışık L, Başaran NÇ. An overview and management of osteoporosis. Eur J Rheumatol 2017; 4(1):46-56.
  9. Hemmati FA, Sarokhani DI, Sayehmiri KO, Motadayen MO. Prevalence of osteoporosis in postmenopausal women in Iran: a systematic review and meta-analysis. Iran J Obstet Gynecol Infertil 2018; 21(3):90-102. (Persian).
  10. Madimenos FC, Snodgrass JJ, Liebert MA, Cepon TJ, Sugiyama LS. Reproductive effects on skeletal health in Shuar women of Amazonian Ecuador: a life history perspective. Am J Hum Biol 2012; 24(6):841-52.
  11. McGuigan FE, Murray L, Gallagher A, Davey‐Smith G, Neville CE, Van't Hof R, et al. Genetic and environmental determinants of peak bone mass in young men and women. J Bone Miner Res 2002; 17(7):1273-9.
  12. Kovacs CS. Calcium and bone metabolism in pregnancy and lactation. J Clin Endocrinol Metab 2001; 86(6):2344-8.
  13. Ainy E, Mirmiran P, Mirsaied Ghazi AA, Mohammadi F, Azizi F. Daily intake and serum levels of calcium, phosphorus, magnesium and vitamin D during normal pregnancy. Feyz 2005; 9(1):16-20. (Persian).
  14. Ghaffari M, Tavassoli E, Esmaillzadeh A, Hassanzadeh A. Effect of Health Belief Model based intervention on promoting nutritional behaviors about osteoporosis prevention among students of female middle schools in Isfahan, Iran. J Educ Health Promot 2012; 1:14.
  15.  Kovacs CS. Calcium and bone metabolism during pregnancy and lactation. J Mammary Gland Biol Neoplasia 2005; 10(2):105-18.
  16. Hiz O, Ediz L, Tekeoglu I. Effect of number of pregnancies on bone mineral density. J Int Med Res 2010; 38(5):1816-23.
  17. Demir B, Haberal A, Geyik P, Baskan B, Ozturkoglu E, Karacay O, et al. Identification of the risk factors for osteoporosis among postmenopausal women. Maturitas 2008; 60(3):253-6.
  18. Heidari B, Hosseini R, Javadian Y, Bijani A, Sateri MH, Nouroddini HG. Factors affecting bone mineral density in postmenopausal women. Arch Osteoporos 2015; 10(1):15.
  19. Sharma N, Natung T, Barooah R, Ahanthem SS. Effect of multiparity and prolonged lactation on bone mineral density. J Menopausal Med 2016; 22(3):161-6.
  20. Streeten EA, Ryan KA, McBride DJ, Pollin TI, Shuldiner AR, Mitchell BD. The relationship between parity and bone mineral density in women characterized by a homogeneous lifestyle and high parity. J Clin Endocrinol Metab 2005; 90(8):4536-41.
  21.  Saei Ghare Naz M, Ozgoli G, Aghdashi MA, Salmani F. Prevalence and risk factors of osteoporosis in women referring to the bone densitometry academic center in Urmia, Iran. Global J Health Sci 2016; 8(7):135-45.
  22. Ensom MH, Liu PY, Stephenson MD. Effect of pregnancy on bone mineral density in healthy women. Obstet Gynecol Surv 2002; 57(2):99-111.
  23. Walker MD, Babbar R, Opotowsky A, McMahon D, Liu G, Bilezikian J. Determinants of bone mineral density in Chinese-American women. Osteoporos Int 2007; 18(4):471-8.
  24.  Matsushita H, Kurabayashi T, Tomita M, Honda A, Takakuwa K, Tanaka K. The effect of multiple pregnancies on lumbar bone mineral density in Japanese women: Calcif Tissue Int 2002; 71(1):10-3.
  25. Saei Gharenaz M, Ozgoli G, Aghdashi Ma, Salmany F. Relationship between reproductive factors and decreased bone density in women. J Urmia Nurs Midwifery Facul 2015; 12(10):965-72.
  26. Ozdemir F, Demirbag D, Rodoplu M. Reproductive factors affecting the bone mineral density in postmenopausal women. Tohoku J Exp Med 2005; 205(3):277-85.
  27. Cooke-Hubley S, Zhiwei G, Mugford G, Kaiser SM, Goltzman D, Lesliek WD, et al. Parity and lactation are not associated with BMD loss or incident major fragility fractures over 15 years: Canadian Multicentre Osteoporosis Study (CaMos). Can J Diabetes 2017; 41(5):S2.
  28. Herzog R, Álvarez-Pasquin MJ, Díaz C, Del Barrio JL, Estrada JM, Gil Á. Are healthcare workers’ intentions to vaccinate related to their knowledge, beliefs and attitudes? A systematic review. BMC Public Health 2013; 13(1):154.
  29. Luchini C, Stubbs B, Solmi M, Veronese N. Assessing the quality of studies in meta-analyses: advantages and limitations of the Newcastle Ottawa Scale. World J Meta Anal 2017; 5(4):80-4.
  30. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33(1):159-74.
  31. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 2015; 4(1):1.
  32. El Maghraoui A, Guerboub AA, Mounach A, Ghozlani I, Nouijai A, Ghazi M, et al. Body mass index and gynecological factors as determinants of bone mass in healthy Moroccan women. Maturitas 2007; 56(4):375-82.
  33. Allali F, Maaroufi H, Aichaoui SE, Khazani H, Saoud B, Benyahya B, et al. Influence of parity on bone mineral density and peripheral fracture risk in Moroccan postmenopausal women. Maturitas 2007; 57(4):392-8.
  34. Derakhshan S, Mahmoudi M, Shahsawari S. Effects of multiparity and duration of breast-feeding on maternal bone mineral density in post-menopausal Kurdish women: a retrospective study. Iran J Nucl Med 2017; 25(1):43-50.
  35. Terzi H, Terzi R, Kale E, Kale A. Effect of multiparity on bone mineral density, evaluated with bone turnover markers. Rev Bras Reumatol 2015; 15:108.
  36. Singh R, Gupta S, Awasthi A. Differential effect of predictors of bone mineral density and hip geometry in postmenopausal women: a cross-sectional study. Arch Osteoporos 2015; 10(1):39.
  37. Lenora J, Karlsson MK, Lekamwasam S. Effects of multiparity and prolonged breast-feeding on maternal bone mineral density: a community-based cross-sectional study. BMC Womens Health 2009; 9(1):19.
  38. Hosseinpanah F, Sorouri M, Rambod M, Azizi F. Total duration of breastfeeding is associated with low bone mineral density in Iranian postmenopausal women. Int J Endocrinol Metab 2011; 2010(3):153-8.
  39. Nakaoka D, Sugimoto T, Kaji H, Kanzawa M, Yano S, Yamauchi M, et al. Determinants of bone mineral density and spinal fracture risk in postmenopausal Japanese women. Osteoporos Int 2001; 12(7):548-54.
  40. Gur A, Nas K, Cevik R, Sarac AJ, Ataoglu S, Karakoc M. Influence of number of pregnancies on bone mineral density in postmenopausal women of different age groups. J Bone Miner Metab 2003; 21(4):234-41.
  41. Yılmaz H, Erkin G, Demir Polat H, Küçüksen S, Sallı A, Uğurlu H. Effects of reproductive factors on bone mineral densitometry. Turk J Osteoporos 2012; 18:8-12.
  42. Song SY, Kim Y, Park H, Kim YJ, Kang W, Kim EY. Effect of parity on bone mineral density: a systematic review and meta-analysis. Bone 2017; 101:70-6.
  43. Wang Q, Huang Q, Zeng Y, Liang JJ, Liu SY, Gu X, et al. Parity and osteoporotic fracture risk in postmenopausal women: a dose-response meta-analysis of prospective studies. Osteoporos Int 2016; 27(1):319-30.
  44. Bayray A, Enquselassie F. The effect of parity on bone mineral density in postmenopausal women: a systematic review. J Osteoporos Phys Act 2013; 1(2):1-6.
  45. Hillier TA, Rizzo JH, Pedula KL, Stone KL, Cauley JA, Bauer DC, et al. Nulliparity and fracture risk in older women: the study of osteoporotic fractures. J Bone Miner Res 2003; 18(5):893-9.
  46. Yılmaz H, Erkin G, Demir Polat H, Küçüksen S, Sallı A, Uğurlu H. Effects of reproductive factors on bone mineral densitometry. Turk J Osteoporos 2012; 18:8-12.
  47. Alam IP, Haque MA, Chowdhury SB. Influence of number of parity on bone mineral density among postmenopausal women. J Bangladesh Coll Phys Surg 2015; 33(2):75-8.
  48. Olausson H, Laskey MA, Goldberg GR, Prentice A. Changes in bone mineral status and bone size during pregnancy and the influences of body weight and calcium intake. Am J Clin Nutr 2008; 88(4):1032-9.
  49. Mori T, Ishii S, Greendale GA, Cauley JA, Ruppert K, Crandall CJ, et al. Parity, lactation, bone strength, and 16-year fracture risk in adult women: findings from the study of women's health across the nation (SWAN). Bone 2015; 73:160-6.
  50. Jang DG, Kwon JY, Choi SK, Ko HS, Shin JC, Park IY. Prevalence of low bone mineral density and associated risk factors in Korean puerperal women. J Korean Med Sci 2016; 31(11):1790-6.
  51. Mori T, Ishii S, Greendale GA, Cauley JA, Sternfeld B, Crandall CJ, et al. Physical activity as determinant of femoral neck strength relative to load in adult women: findings from the hip strength across the menopause transition study. Osteoporos Int 2014; 25(1):265-72.
  52. Gunderson EP. Childbearing and obesity in women: weight before, during, and after pregnancy. Obstet Gynecol Clini North Am 2009; 36(2):317-32.
  53. Nehring I, Schmoll S, Beyerlein A, Hauner H, von Kries R. Gestational weight gain and long-term postpartum weight retention: a meta-analysis. Am J Clin Nutr 2011; 94(5):1225-31.
  54. Sanz-Salvador L, García-Pérez MÁ, Tarín JJ, Cano A. Bone metabolic changes during pregnancy: a period of vulnerability to osteoporosis and fracture. Eur J Endocrinol 2015; 172(2):R53-65.
  55. Jesmin F, Begum F, Enamullah CA, Alam F. Relationship between bone mineral density and parity in women of reproductive age group. Bangladesh J Nucl Med 2015; 18(2):117-20.
  56. Yazdani S, Iranpour A, Sohrabi M, Kolahi A, Sarbakhs P. The determination of clinical decision rule for estimation of mineral bone density in Iranian women. Iran J Endocrinol Metab 2009; 10(5):511-8.
  57. Heidari B, Heidari P, Nourooddini HG, Hajian-Tilaki KO. Relationship between parity and bone mass in postmenopausal women according to number of parities and age. J Reprod Med 2013; 58(9-10):389-94.
  58. Limbong EA, Syahrul F. Risk ratio of osteoporosis according to body mass index, parity, and caffein consumption. J Berkala Epidemiol 2015; 3(2):194-204.
  59. Demirtaş Ö, Demirtaş G, Hurşitoğlu BS, Terzi H, Şekerci Z, Ök N. Is grand multiparity a risk factor for osteoporosis in postmenopausal women of lower socioeconomic status? Eur Rev Med Pharmacol Sci 2014; 18(18):2709-14.
  60. More C, Bettembuk P, Bhattoa H, Balogh A. The effects of pregnancy and lactation on bone mineral density. Osteoporos Int 2001; 12(9):732-7.
  61. Diédhiou D, Weryha G, Angelousi A, Agopiantz M, Norou Diop S, Morel O, et al. Impact of parity on fracture risk after menopause: a systematic review. J Hum Endocrinol 2017; 2(9):1-10.
  62. Karlsson MK, Ahlborg HG, Karlsson C. Maternity and bone mineral density. Acta Orthop 2005; 76(1):2-13.
  63. Yeo UH, Choi CJ, Choi WS, Kim KS. Relationship between breast-feeding and bone mineral density among Korean women in the 2010 Korea National Health and Nutrition Examination Survey. J Bone Miner Metab 2016; 34(1):109-17.
  64. Sharifi F, Sharifi N. The effect of educational intervention on lifestyle modification associated with osteoporosis in female students. Iran J Obstet Gynecol Infertil 2017; 20(7):36-43. (Persian).
  65. Afrasiabi S, Gashmard R, Malchi F, Rabiee Z, Bagherzadeh R, Hosein Nezhad A, et al. Evaluation of knowledge, attitude and performance of high school girls about osteoporosis in 2011. Iran J Obstet Gynecol Infertil 2016; 18(184):20-8. (Persian). 
مجله زنان، مامایی و نازایی ایران
دوره 22، شماره 2
اردیبهشت 1398
صفحه 73-83

فایل ها

هم رسانی

ارجاع به این مقاله

آمار