Retained versus removed copper intrauterine device during pregnancy: An updated systematic review and meta‐analysis
Abstract Introduction Intrauterine devices (IUDs) are highly effective contraceptives. Despite their effectiveness, pregnancies can occur during IUD use, and the management of such cases, particularly when the pregnancy is desired, remains controversial. Material and Methods We conducted a systemati...
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Wiley
2025-05-01
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| Series: | Acta Obstetricia et Gynecologica Scandinavica |
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| Online Access: | https://doi.org/10.1111/aogs.15061 |
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| author | Gabriela Oliveira Gonçalves Molino Ana Clara Felix de Farias Santos Maírla Marina Ferreira Dias Ana Gabriela Alves Pereira Nicole dos Santos Pimenta Pedro Henrique Costa Matos da Silva |
| author_facet | Gabriela Oliveira Gonçalves Molino Ana Clara Felix de Farias Santos Maírla Marina Ferreira Dias Ana Gabriela Alves Pereira Nicole dos Santos Pimenta Pedro Henrique Costa Matos da Silva |
| author_sort | Gabriela Oliveira Gonçalves Molino |
| collection | DOAJ |
| description | Abstract Introduction Intrauterine devices (IUDs) are highly effective contraceptives. Despite their effectiveness, pregnancies can occur during IUD use, and the management of such cases, particularly when the pregnancy is desired, remains controversial. Material and Methods We conducted a systematic review and meta‐analysis to evaluate outcomes in women who unintentionally conceived while using IUDs and chose to continue their pregnancies. We searched PubMed, Embase, and Cochrane databases to identify studies comparing women who removed their IUD after pregnancy discovery to those who retained it. The primary outcomes assessed were miscarriage, bleeding during pregnancy, and preterm delivery. Secondary outcomes included cesarean delivery, chorioamnionitis, congenital malformations, intrauterine growth restriction, preterm premature rupture of membranes, and stillbirth. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for the binary outcomes using random‐effects models to account for variability across studies. The certainty of evidence was measured using the Grading of Recommendations Assessment, Development, and Evaluation approach. Results From 3719 records, 4 cohorts were included. Among the 693 pregnant women analyzed, 402 had their IUD removed, while 291 retained the device. The analysis focused on copper IUDs, with most studies reporting removal during the first trimester and after ultrasound evaluation, although gaps in standardized reporting practices and removal methods were noted. Significant benefits were observed for the IUD‐removed group, including reduced incidences of bleeding during gestation (OR 0.42; 95% CI 0.24 to 0.73; p < 0.01. Moderate certainty of evidence), and miscarriage (OR 0.29; 95% CI 0.17 to 0.48; p < 0.01. Moderate certainty of evidence). There was no significant difference in preterm delivery rates (OR 0.78; 95% CI 0.34 to 1.76; p = 0.55). Conclusions This meta‐analysis, based on data from cohort studies with moderate certainty of evidence, indicates that removing an IUD after pregnancy diagnosis may reduce the odds of miscarriage and bleeding during gestation. However, further high‐quality research is needed to evaluate outcomes in pregnancies associated with hormonal IUDs, as well as critical factors such as gestational age at diagnosis, timing of IUD removal, and the position of the gestational sac relative to the device. |
| format | Article |
| id | doaj-art-ee856d304a524f51a58ecfbd731ff14c |
| institution | OA Journals |
| issn | 0001-6349 1600-0412 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Wiley |
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| series | Acta Obstetricia et Gynecologica Scandinavica |
| spelling | doaj-art-ee856d304a524f51a58ecfbd731ff14c2025-08-20T02:36:31ZengWileyActa Obstetricia et Gynecologica Scandinavica0001-63491600-04122025-05-01104580481410.1111/aogs.15061Retained versus removed copper intrauterine device during pregnancy: An updated systematic review and meta‐analysisGabriela Oliveira Gonçalves Molino0Ana Clara Felix de Farias Santos1Maírla Marina Ferreira Dias2Ana Gabriela Alves Pereira3Nicole dos Santos Pimenta4Pedro Henrique Costa Matos da Silva5Department of Medicine Federal University of Health Sciences of Porto Alegre (UFCSPA) Porto Alegre BrazilDepartment of Pharmacology City University of São Paulo (UNICID) São Paulo BrazilDepartment of Medicine Federal University of Campina Grande (UFCG) Campina Grande BrazilDepartment of Medicine State University of São Paulo (UNESP) Botucatu BrazilDepartment of Medicine Federal University of the State of do Rio de Janeiro (UNIRIO) Rio de Janeiro BrazilDepartment of Gynecology and Obstetrics Federal University of Goiás (UFG) Goiânia BrazilAbstract Introduction Intrauterine devices (IUDs) are highly effective contraceptives. Despite their effectiveness, pregnancies can occur during IUD use, and the management of such cases, particularly when the pregnancy is desired, remains controversial. Material and Methods We conducted a systematic review and meta‐analysis to evaluate outcomes in women who unintentionally conceived while using IUDs and chose to continue their pregnancies. We searched PubMed, Embase, and Cochrane databases to identify studies comparing women who removed their IUD after pregnancy discovery to those who retained it. The primary outcomes assessed were miscarriage, bleeding during pregnancy, and preterm delivery. Secondary outcomes included cesarean delivery, chorioamnionitis, congenital malformations, intrauterine growth restriction, preterm premature rupture of membranes, and stillbirth. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for the binary outcomes using random‐effects models to account for variability across studies. The certainty of evidence was measured using the Grading of Recommendations Assessment, Development, and Evaluation approach. Results From 3719 records, 4 cohorts were included. Among the 693 pregnant women analyzed, 402 had their IUD removed, while 291 retained the device. The analysis focused on copper IUDs, with most studies reporting removal during the first trimester and after ultrasound evaluation, although gaps in standardized reporting practices and removal methods were noted. Significant benefits were observed for the IUD‐removed group, including reduced incidences of bleeding during gestation (OR 0.42; 95% CI 0.24 to 0.73; p < 0.01. Moderate certainty of evidence), and miscarriage (OR 0.29; 95% CI 0.17 to 0.48; p < 0.01. Moderate certainty of evidence). There was no significant difference in preterm delivery rates (OR 0.78; 95% CI 0.34 to 1.76; p = 0.55). Conclusions This meta‐analysis, based on data from cohort studies with moderate certainty of evidence, indicates that removing an IUD after pregnancy diagnosis may reduce the odds of miscarriage and bleeding during gestation. However, further high‐quality research is needed to evaluate outcomes in pregnancies associated with hormonal IUDs, as well as critical factors such as gestational age at diagnosis, timing of IUD removal, and the position of the gestational sac relative to the device.https://doi.org/10.1111/aogs.15061birthcontraceptioncopper intrauterine devicematernal‐fetal medicinepregnancyprenatal care |
| spellingShingle | Gabriela Oliveira Gonçalves Molino Ana Clara Felix de Farias Santos Maírla Marina Ferreira Dias Ana Gabriela Alves Pereira Nicole dos Santos Pimenta Pedro Henrique Costa Matos da Silva Retained versus removed copper intrauterine device during pregnancy: An updated systematic review and meta‐analysis Acta Obstetricia et Gynecologica Scandinavica birth contraception copper intrauterine device maternal‐fetal medicine pregnancy prenatal care |
| title | Retained versus removed copper intrauterine device during pregnancy: An updated systematic review and meta‐analysis |
| title_full | Retained versus removed copper intrauterine device during pregnancy: An updated systematic review and meta‐analysis |
| title_fullStr | Retained versus removed copper intrauterine device during pregnancy: An updated systematic review and meta‐analysis |
| title_full_unstemmed | Retained versus removed copper intrauterine device during pregnancy: An updated systematic review and meta‐analysis |
| title_short | Retained versus removed copper intrauterine device during pregnancy: An updated systematic review and meta‐analysis |
| title_sort | retained versus removed copper intrauterine device during pregnancy an updated systematic review and meta analysis |
| topic | birth contraception copper intrauterine device maternal‐fetal medicine pregnancy prenatal care |
| url | https://doi.org/10.1111/aogs.15061 |
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