Risk factors for prolapse development in white, black, and Hispanic women
Open accessAbstract
OBJECTIVES: : This study aimed to examine the risk factors for prevalence and incidence of pelvic organ prolapse (POP) in whites, Hispanics, and blacks. METHODS: : This is a secondary analysis of the Women's Health Initiative (WHI) Estrogen plus Progestin Clinical Trial (E + P). Of the original E + P trial population of 16,608, 12,667 women (78.3%; 11,194 whites, 804 blacks, and 669 Hispanics) were included in the final study sample and evaluated during the 5-year period. The outcomes evaluated were any prolapse (WHI prolapse grades 1-3) and WHI prolapse grade 2 or 3. Descriptive analyses, logistic regression, and proportional hazard modeling were performed. RESULTS: : Increasing parity correlates with increasing WHI prolapse grades (0-3) in whites and blacks but not Hispanics. The incidence of grade 2 or 3 POP increased by 250% in white women with 1 child (hazard ratio [HR], 2.50; 95% confidence interval [CI], 1.68-3.71) in comparison to nulliparous women and grew with higher parity. For blacks, a weak association between the parity and grade 2 or 3 POP was noted only in women who had 5 or more kids (HR, 10.41; 95% CI, 1.38-78.77). Blacks were less likely (HR, 0.53; 95% CI, 0.40-0.71) to develop grade 2 or 3 POP compared with whites. For grade 2 or 3 POP, age was found to be a risk factor in whites (odds ratio [OR], 1.03; 95% CI, 1.02-1.04) only and body mass index (≥25 kg/m, <30 kg/m) in whites (OR, 1.64; 95% CI, 1.34-2.02) and Hispanics (OR, 2.87; 95% CI, 1.03-2.02). CONCLUSIONS: : White women are at a much greater risk for developing grade 2 or 3 POP compared with blacks. Parity correlates most strongly with the risk of prolapse development in whites and possibly in grand multiparous blacks.
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Hormone replacement therapy was reported in 2 studies and was only once positively associated with primary pelvic organ prolapse.
“Hormone replacement therapy was reported in 2 studies and was only once positively associated with primary POP”
From Risk factors for primary pelvic organ prolapse and prolapse recurrence: an updated systematic review and meta-analysis (2022) · cites this paper as [36]
The Results (page not available in our copy) report a positive association: new Grade 2/3 prolapse was 17% higher among white women randomized to estrogen plus progestin than among those given placebo. The paper does not establish that hormone replacement therapy was reported in two studies or was positively associated only once across those studies; its finding is limited to that treatment and subgroup. (LLM, conf=0.85)
Experimental — accuracy not yet measuredUrinary incontinence was reported by 2 studies, of which 1 reported mixed and urge urinary incontinence as significant risk factors for primary pelvic organ prolapse.
“Urinary incontinence (UI) was reported by 2 studies, of which 1 reported mixed and urge UI as significant risk factors for primary POP”
From Risk factors for primary pelvic organ prolapse and prolapse recurrence: an updated systematic review and meta-analysis (2022) · cites this paper as [36]
The Results report that urge and mixed urinary incontinence were associated with prevalent prolapse in white participants, with confidence intervals excluding 1. However, those associations were measured at baseline; the passage does not establish either condition as a risk factor for developing new (primary) prolapse. (LLM, conf=0.86)
Experimental — accuracy not yet measuredFor ethnicity, 1 study showed Black ethnicity to be protective against pelvic organ prolapse, and 3 studies showed no association.
“For ethnicity, 1 study showed Black ethnicity to be protective against POP, 36 and 3 studies showed no association.”
From Risk factors for primary pelvic organ prolapse and prolapse recurrence: an updated systematic review and meta-analysis (2022) · cites this paper as [36]
Several previous studies have identified smoking as a protective factor against developing primary anatomic POP.
“Several previous studies have identified smoking as a protective factor against developing primary anatomic POP.23,24”
From Risk factors for pelvic organ prolapse recurrence after sacrospinous hysteropexy or vaginal hysterectomy with uterosacral ligament suspension (2022) · cites this paper as [23]
The Materials and Methods section says the study collected information on current and past smoking, but the retrieved Results and Discussion passages do not identify smoking as protective against developing POP or report that previous studies did so. Searches for smoking and for a protective effect on anatomic prolapse found no passage establishing the claim; page numbers were unavailable in our copy. (LLM, conf=0.76)
Experimental — accuracy not yet measuredMeta-analysis showed a statistically significantly protective effect of past smoking vs never smoking on primary pelvic organ prolapse (n=2, pooled OR 0.78; 95% CI 0.67-0.90).
“n¼2, pooled OR past vs never, 0.78; 95% CI, 0.67e0.9036,37”
From Risk factors for primary pelvic organ prolapse and prolapse recurrence: an updated systematic review and meta-analysis (2022) · cites this paper as [36]
The Materials and Methods section says the study collected current and past smoking histories, but the Results passages do not report a past-versus-never smoking estimate. Searches for smoking and the claimed OR and confidence interval found no pooled analysis or protective-effect result in our copy; page numbers were not available. (LLM, conf=0.76)
Experimental — accuracy not yet measured
Pulmonary disease was reported by 2 studies and was not associated with primary pelvic organ prolapse.
“Pulmonary disease was reported by 2 studies and was not associated with primary POP”
From Risk factors for primary pelvic organ prolapse and prolapse recurrence: an updated systematic review and meta-analysis (2022) · cites this paper as [36]
The Results (page unavailable) discuss parity, age, BMI, waist circumference, and urinary incontinence as prolapse risk factors, but do not report an analysis of pulmonary disease. Searches for pulmonary disease, COPD, respiratory disease, and chronic cough found no passage establishing either that two studies reported it or that it was not associated with primary POP. (LLM, conf=0.76)
Experimental — accuracy not yet measuredSmoking was found to be significantly protective against primary pelvic organ prolapse in 2 studies, and no association was found in 3 studies.
“Smoking was found to be significantly protective against primary POP in 2 studies 25,36 , and no association was found in 3 studies.”
From Risk factors for primary pelvic organ prolapse and prolapse recurrence: an updated systematic review and meta-analysis (2022) · cites this paper as [36]
The Materials and Methods section says the study collected current and past smoking information. Searches for smoking and a protective or null association found no passage in our copy reporting either finding or the claimed counts of studies. The Results passages provided discuss other risk factors, not smoking. (LLM, conf=0.72)
Experimental — accuracy not yet measuredMeta-analysis showed a statistically significantly protective effect of current smoking vs never smoking on primary pelvic organ prolapse (n=3, pooled OR 0.59; 95% CI 0.46-0.75).
“The results of the meta-analysis showed a statistically significantly protective effect of smoking.(n¼3, pooled OR currently smoking vs never, 0.59; 95% CI, 0.46e0.7525,36,37”
From Risk factors for primary pelvic organ prolapse and prolapse recurrence: an updated systematic review and meta-analysis (2022) · cites this paper as [36]
The Materials and Methods section (page unavailable) says current and past smoking were recorded, but the passages found do not report a smoking–prolapse association. This paper describes a secondary analysis of a clinical-trial cohort, not a three-study meta-analysis; searches for smoking and the pooled OR found no passage supporting the claimed estimate. (LLM, conf=0.76)
Experimental — accuracy not yet measured
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- Authors
- Kudish, B. I., Iglesia, C. B., Gutman, R. E., Sokol, A. I., Rodgers, A. K., Gass, M., O'Sullivan, M. J., Larson, J., Abu-Sitta, M., & Howard, B. V.
- Affiliations
- MedStar Washington Hospital Center (US)
- The University of Texas at San Antonio Health Science Center (US)
- North American Menopause Society (US)
- Women's Health Initiative (US)
- University at Buffalo, State University of New York (US)
- Georgetown University (US)
- Corresponding author
- Kudish, Bela I.
- Iglesia, Cheryl B.
- Gutman, Robert E.
- Sokol, Andrew I.
- Venue
- Female Pelvic Medicine & Reconstructive Surgery
- Published
- 2011-03
- Volume
- 17
- Issue
- 2
- Pages
- 80-90
- ISSN
- 2151-8378 (ISSN-L)
- PMC
- PMC4354733
- OpenAlex
- W1973731913
- Semantic Scholar
- 75e08694707e110d3b13783bb41d99491a7e1989
- Cited by
- 63
- References
- 23
- Citations by year
- 2026: 1 · 2024: 20 · 2023: 5 · 2022: 7 · 2021: 5 · 2020: 5 · 2019: 2 · 2018: 2 · 2017: 4 · 2016: 5 · 2015: 1 · 2014: 2 · 2013: 2 · 2012: 2
- FWCI
- 1.40
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Urogynecology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (n01wh42123-22-0-1, n01wh22110-38-0-0, N01 WH042123, N01 WH022110)
- Topics
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
- Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
- Keywords
- pelvic organ prolapse, risk factors, parity, racial differences, Black women, Hispanic women, white women, body mass index, age, estrogen plus progestin, Women's Health Initiative, nulliparous women, postmenopausal women, racial disparities in health outcomes, uterine fibroids
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