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PEOPLE: Lifestyle and comorbidities as risk factors for pelvic organ prolapse—a systematic review and meta-analysis PEOPLE: PElvic Organ Prolapse Lifestyle comorbiditiEs

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Abstract

Introduction and hypothesis

The literature is scarce regarding the effects of comorbidities, clinical parameters, and lifestyle as risk factors for pelvic organ prolapse (POP). This study was performed to systematically review the literature related to body mass index (BMI), waist circumference, diabetes mellitus (DM), hypertension (HT), dyslipidemia, chronic constipation, smoking, chronic cough, occupation, and striae and varicose veins as determinants for POP.

Methods

Search terms in accordance with Medical Subject Headings were used in PubMed, Embase, LILACS, and the Cochrane Library. Clinical comparative studies between women with and without POP and containing demographic and/or clinical raw data related to lifestyle and/or comorbidities were included. The ROBINS-I (risk of bias in non-randomized studies of interventions) instrument was used. Fixed-effects and random-effects models were used for homogeneous and heterogeneous studies, respectively.

Results

Forty-three studies were included in the meta-analysis. BMI < 25 kg/m2 was found to be a protective factor for POP [OR 0.71 (0.51, 0.99); p = 0.04], and BMI > 30 kg/m2 was a risk factor for POP [OR 1.44 (1.37, 1.52); p < 0.00001]. Waist circumference (≥ 88 cm) was reported as a risk factor for POP [OR 1.80 (1.37, 2.38); p < 0.00001], along with HT [OR 1.18 (1.09, 1.27); p = 0.04], constipation [OR 1.77 (1.23, 2.54); p < 0.00001], occupation [OR 1.86 (1.21, 2.86); p < 0.00001], persistent cough [OR 1.52 (1.18, 1.94); p < 0.0001]), and varicose veins [OR 2.01 (1.50, 2.70); p = 0.12].

Conclusions

BMI < 25 kg/m2 is protective while BMI > 30 kg/m2 is a risk factor for POP. Large waist circumference, dyslipidemia, HT, constipation, occupation, persistent cough, and varicose veins are also determinants for POP.

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Authors’ contributions to the manuscript

Fátima Faní Fitz: Conceptualization, research design, data collection, data analysis, writing article

Maria Augusta Tezelli Bortolini: Conceptualization, research design, project management, writing and editing article, review of manuscript before submitting

Gláucia Miranda Varella Pereira: Conceptualization, research design, data collection, data analysis, funds procurement

Gisela Rosa Franco Salerno: Conceptualization, research design, data collection, data analysis, writing article

Rodrigo Aquino Castro: Conceptualization, research design, project management, data collection, writing article, review of manuscript before submitting

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GMVP: Scholarship Grant 2019/26723-5, São Paulo Research Foundation (FAPESP).

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  1. Department of Gynecology, Universidade Federal de São Paulo, Rua Napoleão de Barros, 608 – Vila Clementino, São Paulo, SP, CEP 04024-002, Brazil

    Fátima Faní Fitz, Maria Augusta Tezelli Bortolini, Gisela Rosa Franco Salerno & Rodrigo Aquino Castro

  2. Department of Obstetrics and Gynecology, Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Campinas, SP, Brazil

    Gláucia Miranda Varella Pereira

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Search strategies

PubMed

(Pelvic Organ Prolapse [mh] OR Pelvic Organ Prolapse [tw] OR Vaginal Prolapse [tw] OR Cystocele OR Cystocoele OR Rectocele OR Rectocoele OR hysterocele OR Hysterocele OR Descensus OR Descensus uteri OR Uterine prolapse [tw] OR Procidentia OR Vaginal Lump [tw] OR Vaginal Bulge [tw] OR Vaginal Bulging [tw] OR Pelvic Floor Disorders [mh] OR Pelvic Floor Dysfunction [tw] OR pelvic floor disorders [tw]) AND (risk factors [mh] OR risk factors [tw] OR comorbidities OR smoking OR tobacco OR heavy lifting [tw] OR physical exertion [tw] OR heavy loading [tw] OR exercises OR physical activity [tw] OR constipation OR hard stools [tw] OR defecation OR bowel dysfunction [tw] OR chronic cough [tw] OR asthma OR diabetes OR glucose intolerance [tw] OR pulmonary disease overlap [tw] OR Hyperinsulinemia OR hypertension OR metabolic syndrome [tw] OR body mass index [tw] OR body weight [tw] OR waist circumference [tw] OR connective tissue disorder [tw] OR marfan syndrome [tw] OR Ehlers-Danlos Syndrome [tw] OR collagen diseases [tw] OR joint instability [tw])

EMBASE

(‘pelvic organ prolapse’ OR cystocele OR rectocele OR ‘uterus prolapse’ OR ‘vaginal lump’ OR ‘vaginal bulge’ OR ‘vaginal bulging’ OR ‘pelvic floor disorder’) AND (‘risk factor’ OR comorbidity OR smoking OR ‘tobacco use’ OR ‘heavy lifting’ OR ‘physical activity, capacity and performance’ OR ‘physical activity’ OR ‘exercise tolerance’ OR exercise OR constipation OR ‘hard feces’ OR ‘defecation disorder’ OR defecation OR enteropathy OR ‘chronic cough’ OR asthma OR ‘insulin dependent diabetes mellitus’ OR ‘glucose intolerance’ OR ‘lung disease’ OR hyperinsulinem OR hypertension OR ‘metabolic syndrome x’ OR ‘body mass’ OR ‘body weight’ OR ‘waist circumference’ OR ‘connective tissue disease’ OR ‘marfan syndrome’ OR ‘ehlers danlos syndrome’ OR ‘collagen disease’ OR ‘joint instability’) AND [embase]/lim AND [english]/lim

Cochrane Library

(‘pelvic organ prolapse’ OR cystocele OR rectocele OR ‘uterus prolapse’ OR ‘vaginal lump’ OR ‘vaginal bulge’ OR ‘vaginal bulging’ OR ‘pelvic floor disorder’) AND (‘risk factor’ OR comorbidity OR smoking OR ‘tobacco use’ OR ‘heavy lifting’ OR ‘physical activity, capacity and performance’ OR ‘physical activity’ OR ‘exercise tolerance’ OR exercise OR constipation OR ‘hard feces’ OR ‘defecation disorder’ OR defecation OR enteropathy OR ‘chronic cough’ OR asthma OR ‘insulin dependent diabetes mellitus’ OR ‘glucose intolerance’ OR ‘lung disease’ OR hyperinsulinem OR hypertension OR ‘metabolic syndrome x’ OR ‘body mass’ OR ‘body weight’ OR ‘waist circumference’ OR ‘connective tissue disease’ OR ‘marfan syndrome’ OR ‘ehlers danlos syndrome’ OR ‘collagen disease’ OR ‘joint instability’)

LILACS

("prolapso uterino" OR "prolapso vaginal" OR "uterine prolapse" OR "vaginal bulge" OR "vaginal bulging" OR rectocele$ OR cistocele$ OR "prolapse de orgao pélvico" OR "pelvic organ prolapse") AND ("fatores de risco" OR "risk factors" OR exercici$ OR "levantamento de peso" OR "atividade física" OR hipertensão OR comorbidade$ OR "intolerância a insulina" OR "habito de fumar cigarros" OR cigarr$ OR nicotina$ OR constipac$ OR "doencas do colageno" OR "collagen diseases" OR "diabetes mellitus" OR "circumferencia abdominal" OR "waist circumference" OR "sindrome de marfan" OR "marfan syndrome" OR "indice de massa corporal" OR "doencas pulmonares" OR hiperinsulinem$ OR "doencas pulmonares" OR "lung diseases" OR "joint instability" OR "ehlers danlos syndrome")

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Fitz, F.F., Bortolini, M.A.T., Pereira, G.M.V. et al. PEOPLE: Lifestyle and comorbidities as risk factors for pelvic organ prolapse—a systematic review and meta-analysis PEOPLE: PElvic Organ Prolapse Lifestyle comorbiditiEs. Int Urogynecol J 34, 2007–2032 (2023). https://doi.org/10.1007/s00192-023-05569-3

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