Does Age at Menarche Differ Between Patients With Multiple Sclerosis and Healthy Controls?: An Updated Systematic Review and Meta-Analysis
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Abstract
Objective: Sex hormones play role in development of autoimmune diseases such as multiple sclerosis (MS). In our previous systematic review, we included three studies and reported the pooled odds ratio (OR) for increasing 1 year of age at menarche and risk of MS as 0.88. So, we designed this systematic review and meta-analysis to estimate the pooled mean age at menarche difference between women with MS and controls and also update the odds of developing MS by increasing age at menarche.
Materials and methods: We performed a comprehensive systematic search on PubMed, Scopus, EMBASE, and Web of Science on July 1st, 2023. Also, grey literature including conference abstracts and references of the references were investigated to find potentially relevant articles.
Results: A total 634 records were retrieved by systematic search. Also, one relevant record was identified from grey literature. After deduplication, 331 articles were remained for title/abstract screening and of those, 29 full-texts were evaluated. Finally, 15 studies were included in final analysis. The SMDs of age at menarche (control group – case group) ranged between -0.18 and 1.41. The pooled SMD of age at menarche (controls-cases) was 0.17 (95% CI: 0.09-0.25) (I2=85.1%, p<0.001). OR for age at menarche and risk of MS ranged between 0.8 and 1.76, and the pooled OR for increasing 1 year of age at menarche estimated as 0.92(95% CI: 0.89-0.94) (I2=41.6%, P=0.07).
Conclusion: The results of this systematic review show that the mean age at menarche is higher in controls than women with MS, and the risk of MS decreases by increasing age at menarche
2. Hanaei S, Sahraian MA, Mohammadifar M, Ramagopalan SV, Ghajarzadeh M. Effect of Vitamin D Supplements on Relapse Rate and Expanded Disability Status Scale (EDSS) in Multiple Sclerosis (MS): A Systematic Review and Meta-Analysis. Int J Prev Med. 2021;12:42.
3. Eskandari G, Ghajarzadeh M, Yekaninejad MS, Sahraian MA, Gorji R, Rajaei F, et al. Comparison of serum vitamin D level in multiple sclerosis patients, their siblings, and healthy controls. Iran J Neurol. 201;14(2):81-5.
4. Salpietro V., Polizzi A., Recca G. Ruggieri M. The role of puberty and adolescence in the pathobiology of pediatric multiple sclerosis. Mult Scler Demyelinating Disord. 2018;3:1-10.
5. Chitnis T. Role of puberty in multiple sclerosis risk and course. Clin Immunol. 2013;149(2):192-200.
6. Whitacre CC. Sex differences in autoimmune disease. Nat Immunol. 2001;2(9):777-80.
7. Lotter H, Altfeld M. Sex differences in immunity. Semin Immunopathol. 2019;41(2):133-135.
8. Confavreux C, Hutchinson M, Hours MM, Cortinovis-Tourniaire P, Moreau T. Rate of pregnancy-related relapse in multiple sclerosis. Pregnancy in Multiple Sclerosis Group. N Engl J Med. 1998;339(5):285-91.
9. Ghajarzadeh M, Mohammadi A, Shahraki Z, Sahraian MA, Mohammadifar M. Pregnancy History, Oral Contraceptive Pills Consumption (OCPs), and Risk of Multiple Sclerosis: A Systematic Review and Meta-Analysis. Int J Prev Med. 2022;13:89.
10. Azimi A, Hanaei S, Sahraian MA, Mohammadifar M, Ramagopalan SV, Ghajarzadeh M. Age at menarche and risk of multiple sclerosis (MS): a systematic review and meta-analysis. BMC Neurol. 2019;19(1):286.
11. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Int J Surg. 2021;88:105906.
12. Wells G, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. Newcastle-Ottawa quality assessment scale cohort studies. University of Ottawa. 2014.
13. Chitnis T, Graves J, Weinstock‐Guttman B, Belman A, Olsen C, Misra M, et al. Distinct effects of obesity and puberty on risk and age at onset of pediatric MS. Ann Clin Transl Neurol. 2016;3(12):897-907.
14. Gustavsen MW, Page CM, Moen SM, Bjølgerudl A, Berg-Hansen P, Nygaard GO, et al. Environmental exposures and the risk of multiple sclerosis investigated in a Norwegian case-control study. BMC Neurol. 2014;14:1-8.
15. Zeydan B, Atkinson EJ, Weis DM, Smith CY, Gazzuola Rocca L, Rocca WA, et al. Reproductive history and progressive multiple sclerosis risk in women. Brain Commun. 2020;2(2):fcaa185.
16. Ramagopalan S, Valdar W, Criscuoli M, DeLuca G, Dyment D, Orton SM, et al. Age of puberty and the risk of multiple sclerosis: a population based study. Eur J Neurol. 2009;16(3):342-7.
17. Rejali M, Hosseini SM, Tabaee MSK, Etemadifar M. Assessing the risk factors for multiple sclerosis in women of reproductive age suffering the disease in Isfahan Province. I Int J Prev Med. 2016;7.
18. Koch-Henriksen N, Sørensen PS. The changing demographic pattern of multiple sclerosis epidemiology. Lancet Neurol. 2010;9(5):520-32.
19. Molnarfi N, Schulze-Topphoff U, Weber MS, Patarroyo JC, Prod’homme T, Varrin-Doyer M, et al. MHC class II–dependent B cell APC function is required for induction of CNS autoimmunity independent of myelin-specific antibodies. J Exp Med. 2013;210(13):2921-37.
20. Lehmann-Horn K, Kinzel S, Weber MS. Deciphering the role of B cells in multiple sclerosis—towards specific targeting of pathogenic function. Int J Mol Sci. 2017;18(10):2048.
21. Shahraki Z, Rastkar M, Rastkar E, Mohammadifar M, Mohamadi A, Ghajarzadeh M. Impact of menopause on relapse rate and disability level in patients with multiple sclerosis (MS): a systematic review and meta-analysis. BMC Neurol. 2023;23(1):316.
22. Denney JM, Nelson EL, Wadhwa PD, Waters TP, Mathew L, Chung EK, Goldenberg RL, Culhane JF. Longitudinal modulation of immune system cytokine profile during pregnancy. Cytokine. 2011;53(2):170-7.
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| Issue | Vol 19, No 1 (March 2025) | |
| Section | Review Articles | |
| Keywords | ||
| Multiple Sclerosis Menarche Risk | ||
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