title: Risk factors for ectopic pregnancy: a comprehensive analysis based on a large case-control, population-based study in France.
abstract: This case-control study was associated with a regional register of ectopic pregnancy between 1993 and 2000 in France. It included 803 cases of ectopic pregnancy and 1,683 deliveries and was powerful enough to investigate all ectopic pregnancy risk factors. The main risk factors were infectious history (adjusted attributable risk = 0.33; adjusted odds ratio for previous pelvic infectious disease = 3.4, 95% percent confidence interval (CI): 2.4, 5.0) and smoking (adjusted attributable risk = 0.35; adjusted odds ratio = 3.9, 95% CI: 2.6, 5.9 for >20 cigarettes/day vs. women who had never smoked). The other risk factors were age (associated per se with a risk of ectopic pregnancy), prior spontaneous abortions, history of infertility, and previous use of an intrauterine device. Prior medical induced abortion was associated with a risk of ectopic pregnancy (adjusted odds ratio = 2.8, 95% CI: 1.1, 7.2); no such association was observed for surgical abortion (adjusted odds ratio = 1.1, 95% CI: 0.8, 1.6). The total attributable risk of all the factors investigated was 0.76. As close associations were found between ectopic pregnancy and infertility and between ectopic pregnancy and spontaneous abortion, further research into ectopic pregnancy should focus on risk factors common to these conditions. In terms of public health, increasing awareness of the effects of smoking may be useful for ectopic pregnancy prevention.
authors.affiliation: INSERM U569, IFR69 (The French Institute of Health and Medical Research), Le Kremlin-Bicêtre, France. Bouyer@vjf.inserm.fr
authors.forename: Jean
authors.initials: J
authors.lastname: Bouyer
authors.forename: Joël
authors.initials: J
authors.lastname: Coste
authors.forename: Taraneh
authors.initials: T
authors.lastname: Shojaei
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Pouly
authors.forename: Hervé
authors.initials: H
authors.lastname: Fernandez
authors.forename: Laurent
authors.initials: L
authors.lastname: Gerbaud
authors.forename: Nadine
authors.initials: N
authors.lastname: Job-Spira
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003141:Communicable Diseases / Q000150:complications; D016001:Confidence Intervals; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D010298:Parity; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000453:epidemiology* / Q000209:etiology; D012042:Registries; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects