Division of Cardiology, Queen's Medical Center, John A. Burns School of Medicine, 1301 Punchbowl Street, Honolulu, HI 96813, USA.
Hum Reprod. 2012 Feb;27(2):568-75. doi: 10.1093/humrep/der400. Epub 2011 Nov 30.
BACKGROUND: Subfertility shares common pathways with cardiovascular disease (CVD), including polycystic ovarian syndrome, obesity and thyroid disorders. Women with prior 0-1 pregnancies are at an increased risk of incident CVD when compared with women with two pregnancies. It is uncertain whether history of subfertility among women eventually giving birth is a risk factor for CVD. METHODS: Among Swedish women with self-reported data on subfertility in the Swedish Medical Birth Register (n = 863 324), we used Cox proportional hazards models to relate a history of subfertility to CVD risk after adjustment for age, birth year, highest income, education, birth country, hypertension, diabetes, preterm birth, small for gestational age (SGA), smoking and for BMI in separate models. In additional analyses, we excluded women with: (i) pregnancy-related or non-pregnancy-related hypertension and/or diabetes; and (ii) preterm births and/or SGA babies. RESULTS: Among nulliparous women eventually having a childbirth (between 1983 and 2005, the median follow-up time 11.9; 0-23 years and 9 906 621 person-years of follow-up), there was an increased risk of CVD among women reporting ≥ 5 years of subfertility versus 0 years (hazard ratio 1.19, 95% confidence interval 1.02-1.39). There were not significantly elevated CVD risks for women with 1-2 or 3-4 years of subfertility versus 0 years. Accounting for BMI did not change results. Excluding women with hypertension and/or diabetes attenuated associations, whereas exclusion of women with preterm and/or SGA births did not change findings. CONCLUSIONS Subfertility among women eventually having a childbirth is a risk factor for CVD even upon accounting for cardiovascular risk factors and adverse pregnancy outcomes. Future studies should explore the mechanisms underlying this association.
背景:不孕与心血管疾病(CVD)有共同的发病途径,包括多囊卵巢综合征、肥胖和甲状腺疾病。与有两次妊娠的女性相比,有 0-1 次妊娠的女性发生 CVD 的风险增加。然而,最终生育的女性不孕史是否是 CVD 的一个危险因素尚不确定。
方法:在瑞典生育登记处(Swedish Medical Birth Register)中,我们对有不孕史的瑞典女性(n=863324)进行了 Cox 比例风险模型分析,将不孕史与 CVD 风险相关联,同时调整了年龄、出生年份、最高收入、教育程度、出生国家、高血压、糖尿病、早产、小于胎龄儿(SGA)、吸烟和 BMI 等因素。在进一步的分析中,我们排除了以下女性:(i)妊娠相关或非妊娠相关的高血压和/或糖尿病;(ii)早产和/或 SGA 婴儿。
结果:在最终生育的初产妇中(1983 年至 2005 年之间,中位随访时间为 11.9 年;0-23 年,随访人数为 9906621 人年),与不孕 0 年的女性相比,不孕≥5 年的女性 CVD 发病风险增加(风险比 1.19,95%置信区间 1.02-1.39)。不孕 1-2 年或 3-4 年的女性与不孕 0 年的女性相比,CVD 发病风险并未显著升高。考虑 BMI 后结果并未改变。排除高血压和/或糖尿病患者会削弱相关性,而排除早产和/或 SGA 出生的患者则不会改变研究结果。结论:在考虑了心血管危险因素和不良妊娠结局后,最终生育的女性不孕史是 CVD 的一个危险因素。未来的研究应该探索这种关联的潜在机制。
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