The association of assisted reproductive technology with fetal malpresentation: a systematic review and meta-analysis

Figures & data

Table 1. Demographics of included studies.

Study	Study type	Country	Time period of study	Maternal age ART (mean ± SD)	Maternal age NC (mean ± SD)	Inclusion criteria	Exclusion criteria
Chen et al. [16]	Retrospective cohort	Australia	2012–2018	35.0 ± 4.8	29.7 ± 5.7	Singleton pregnancies, ART or OI or spontaneous conceived	Multiple pregnancy
Slavov [20]	Ambidirectional cohort	Bulgaria	2013–2017	NA	NA	Singleton pregnancy, gestational age > 22 weeks and birthweight > 600 g	Multiple pregnancy
Noli et al. [21]	Retrospective cohort	Italy	2010–2015	NA	NA	Singleton pregnancy	Multiple pregnancy, transverse or oblique presentation, SGA
Stern et al. [22]	Retrospective cohort	United States	2004–2010	34.5 ± 4.5	27.0 ± 5.9	Singleton pregnancy or fetal death >20 weeks, primiparous women	NA
Zsirai et al. [23]	Retrospective cohort	Hungary	1996–2011	NA	NA	Singleton pregnancy	Multiple pregnancy, transverse or oblique presentation, <37 gestational weeks
Stojnic et al. [24]	Case-control	Serbia	2006–2010	36.450 ± 4.218	35.391 ± 4.174	Singleton pregnancy, >26 weeks gestational age	NA
Romundstad et al. [7]	Retrospective cohort	Norway	1984–2006	NA	NA	Singleton pregnancies with length of gestation of 22 weeks or more and offspring birthweight of at least 500 g	Age < 20 years and parity ≥5 in the spontaneously conceived group
Isaksson et al. [25]	Case-control	Finland	1993–1999	NA	NA	Pregnancies ending in birth	Triplet pregnancies and pregnancies resulting in abortion were excluded from analysis
Reubinoff et al. [26]	Case-control	Israel	1983–1993	32.7 ± 4.1	33.5 ± 4.2	Only pregnancies leading to live births (>25 weeks gestation or >500 g birthweight), ART sample: IVF was the only way to conceive)	NA
Tan et al. [17]	Case-control	England	1978–1987	NA	NA	Patients who delivered live-born or stillborn babies at >28 weeks (cases), sequential deliveries to primiparous women in 1988, 1989 (controls)	NA
Frydman et al. [18]	Case-control	France	1981–1984	32.5 ± 3.5	28.6 ± 4.2	Pregnancies occurring between April 1981 and July 1984	NA

ART: assisted reproductive technology; NC: natural conception; NA: not applicable; OI: ovulation induction.

Table 2. Study characteristics and outcomes.

Study	Sample size (deliveries/post-dropouts)	ART, n	NC, n	Breech after ART	Breech from NC	Transverse or oblique from ART	Transverse or oblique from NC
Chen et al. [16]	264,550	10,694	253,856	710/10,694	12,390/253,856	37/10,694	1012/253,856
Slavov [20]	925	402	523	44/402	23/523	4/402	2/523
Noli et al. [21]	432,822	8531	424,291	566/8531	15,959/424,291	NA	NA
Stern et al. [22]	173,130	5768	167,362	793/5768	19,202/167,362	NA	NA
Zsirai et al. [23]	1,270,061	7838	1,262,223	456/7838	41,242/1,262,223	NA	NA
Stojnic et al. [24]	1268	634	634	80/634	56/634	NA	NA
Romundstad et al. [7]	1,209,151	8229	1,200,922	419/8229	40,386/1,200,922	NA	NA
Isaksson et al. [25]	2315	1970	345	77/1970	11/345	NA	NA
Reubinoff et al. [26]	520	260	260	23/260	17/260	NA	NA
Tan et al. [17]	1472	494	978	20/494	59/978	NA	NA
Frydman et al. [18]	3920	79	3841	11/79	166/3841	NA	NA

ART: assisted reproductive technology; NC: natural conception; NA: not applicable.

Figure 1. (A) Preferred reporting items for systematic reviews and meta-analyses flowchart, (B) ROBINS-1 per study, and (C) ROBINS-1 summary plot.

Figure 2. Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework.

Figure 3. Maternal age (mean ± SD) (A) birthweight (mean ± SD) (B). Images generated with GraphPad Prism V. 9 (GraphPad Software, La Jolla, CA).

Figure 4. Forest plot regarding total malpresentation events.

Figure 5. Forest plot subgroup by study type.

Figure 6. Forest plot subgroup by study weight.

Figure 7. Forest plot subgroup by risk of bias.

Figure 8. Forest plot of studies with adjusted RR.

Figure 9. Funnel plot.

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Data availability statement

The data that support the findings of this study are openly available in figshare at https://doi.org/10.6084/m9.figshare.24316978.