Associations between Smoking, Intrauterine Device Uptake, and Ectopic Pregnancy: A Meta Analysis

Ridha Rossela Yanuari, Eti Poncorini Pamungkasari, Vitri Widyaningsih


Background: Ectopic pregnancy is an import­ant cause of maternal morbidity and mortality, estimated to occur in approximately 1-2% of pregnancies worldwide. Smoking and history of using intrauterine devices are risk factors for ectopic pregnancy. This study aims to estimate the magnitude of the relationship between smoking and a history of using intrauterine devices on the incidence of ectopic pregnancy based on a number of previous primary studies.

Subjects and Method: This study is a syste­matic review and meta-analysis. The articles used in this study were obtained from several databases, including: PubMed, Google Scholar, and Science Direct which were published from 2000-2020. The inclusion criteria used are full text articles with Case Control design. The keywords used to search for articles were as follows: smoking AND "ectopic pregnancy" AND multivariate; "use of intrauterine device" AND "ectopic pregnancy" AND multivariate; smoking OR cigarette AND “use of intrauterine device” AND “ectopic pregnancy” OR “tubal pregnancy” AND multivariate. Articles were collected using PRISMA flow diagrams and analyzed using the Review Manager 5.3.

Results: A meta-analysis of 7 articles showed that women of reproductive age who smoked had a 2.20 times risk of ectopic pregnancy compared to women of reproductive age who did not smoke (aOR= 2.20; 95% CI= 1.45 to 3.34; p= 0.002). A meta-analysis of 9 articles showed that women of reproductive age with a history of using intrauterine devices had a 2.28 times risk of ectopic pregnancy compared to women of reproductive age who did not use intrauterine devices (aOR= 2.28; 95% CI= 1.74 to 2.98; p<0.001).

Conclusion: Smoking and a history of using intrauterine devices increase the risk of ectopic pregnancy.

Keywords: smoking, intrauterine contracep­tives, ectopic pregnancy, meta-analysis

Correspondence: Ridha Rossela Yanuari. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: Mobile: 085747311182

Journal of Maternal and Child Health (2021), 06(04): 388-399

Full Text:



Anorlu RI, Oluwole Abudu OO, Adebajo S (2005). Risk factors for ectopic pregnancy in Lagos, Nigeria. Acta Obstet Gynecol Scand, 84(2): 184-188.

Bouyer J, Rachou E, Germain E, Pouly J, Fernandez H, Coste J, Pouly J (2000). Risk factors for extrauterine pregnancy in women using an intrauterine device. Fertility And Sterility.74(5), 899-908.

Bouyer J, Coste J, Shojaei T, Pouly J, Fer-nandez H, Gerbaud L, Job-Spira N (2003). Risk factors for ectopic pregnancy: a comprehensive analysis based on a large case-control, population-based study in France. Am J Epidemiol. 185(94): 185-194.

CEBMa (2014). Critical Appraisal for Case Control Study. Amsterdam.

Demirdag E, Guler I, Abay S, Erdem M, Erdem A (2016). The impact of expectant management, systemic methotrexate and surgery on subsequent preg-nancy outcomes in tubal ectopic pregnancy. Ir J Med Sci. 186(2): 387–392.

Karaer A, Avsar FA, Batioglu S (2006). Risk factors for ectopic pregnancy: a case-control study. Aust N Z J Obstet Gynaecol. 46(6), 521-527.

Kashanian M, Baradaran HR, Mousavi SS, Sheikhansari N, Bararpour F (2016). Risk factors in ectopic pregnancy and differences between adults and adolescents is consanguinity import-nt. J Obstet Gynaecol. 36(7): 935–939.

Lewis SL, Bucher L, Heitkemper MM, Harding MM, Kwong L, Roberts D (2017). Medical-Surgical Nursing: Assesment of Management of Clinical Problems (5th ed.). Elsevier Mosby.

Li C, Zhao W, Meng C, Cao S, Ping H, Qin G, Cao S, Xi X, Zhu Q, Li X, Zhang J (2014). Contraceptive Use and the Risk of Ectopic Pregnancy: A Multi-Center Case Control Study. Plos One, 9(12).

Li C, Zhao W, Zhu Q, Cao S, Ping H, Xi X, Qin G, Yan M, Zhang D, Qiu J, Zhang J (2015). Risk factors for ectopic preg-nancy: a multicenter case-control study. BMC Pregnancy Childbirth, 1–9.

Mindjah YAA, Essiben F, Foumane P, Dohbit JS, Mboudou ET (2018). Risk factors for ectopic pregnancy in a population of Cameroonian women. PlosOne,13(12).

Moini A, Hosseini R, Jahangiri N, Shiva M, Akhoond MR (2014). Risk factors for ectopic pregnancy: A case–control study. J Res Med Sci, 19(9), 844–849.

Murti B (2018). Prinsip dan Metode Riset Epidemiologi. Surakarta: Universitas Sebelas Maret.

Orazulike NC, Konje JC (2013). Diagnosis and management of ectopic preg-nancy. BMC Women’s Health, 9(4), 373–385.

Parashi S, Moukhah S, Ashrafi M (2014). Main risk factors for Ectopic Pregnancy: A Case-control study in a sample of Iranian Women. Int J Fertil Steril, 8(2), 147–154.

Patil M (2012). Ectopic pregnancy after infertility treatment. J Hum Reprod Sci, 5(2): 154–165.

Sivalingam VN, Duncan WC, Kirk E, Shephard LA, Horne AW (2011). Diagnosis and management of ectopic pregnancy. J Fam Plann Reprod Health Care, 37(4): 231–240.


  • There are currently no refbacks.