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生育能力低下与晚年发生母亲心血管疾病的风险。

Subfertility and risk of later life maternal cardiovascular disease.

机构信息

Division of Cardiology, Queen's Medical Center, John A. Burns School of Medicine, 1301 Punchbowl Street, Honolulu, HI 96813, USA.

出版信息

Hum Reprod. 2012 Feb;27(2):568-75. doi: 10.1093/humrep/der400. Epub 2011 Nov 30.


DOI:10.1093/humrep/der400
PMID:22131387
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3283089/
Abstract

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.

摘要

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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引用本文的文献

[1]
Preconception thyroid function in relation to pregnancy lipids among women attending a fertility center.

Thyroid Res. 2025-7-1

[2]
Longitudinal Measures of Cardiovascular Risk Factors Are Associated with Subfertility in the Coronary Artery Risk Development in Young Adults (CARDIA) Study.

medRxiv. 2025-1-9

[3]
Mixtures of Urinary Phenol and Phthalate Metabolite Concentrations in Relation to Serum Lipid Levels among Pregnant Women: Results from the EARTH Study.

Toxics. 2024-8-7

[4]
Association between parities and duration of breastfeeding and the severity of coronary artery disease in women above 30 years old age (A pilot study).

Caspian J Intern Med. 2024

[5]
Cardiovascular disease risk factors and infertility: multivariable analyses and one-sample Mendelian randomization analyses in the Trøndelag Health Study.

Hum Reprod Open. 2024-5-24

[6]
Update on sex specific risk factors in cardiovascular disease.

Front Cardiovasc Med. 2024-2-6

[7]
The association of Life's Simple 7 and infertility among U.S. women.

Front Endocrinol (Lausanne). 2024

[8]
History of Infertility and Midlife Cardiovascular Health in Female Individuals.

JAMA Netw Open. 2024-1-2

[9]
Assisted reproductive technology: what are the cardiovascular risks for women?

Expert Rev Cardiovasc Ther. 2023

[10]
Position Statement on Ischemic Heart Disease - Women-Centered Health Care - 2023.

Arq Bras Cardiol. 2023-8-4

本文引用的文献

[1]
Menstrual irregularity and cardiovascular mortality.

J Clin Endocrinol Metab. 2010-10-27

[2]
Parity and risk of later-life maternal cardiovascular disease.

Am Heart J. 2010-2

[3]
Neuroimmune mechanisms of cytokine-induced depression: current theories and novel treatment strategies.

Neurobiol Dis. 2009-11-26

[4]
Depression and risk of sudden cardiac death and coronary heart disease in women: results from the Nurses' Health Study.

J Am Coll Cardiol. 2009-3-17

[5]
Depressive symptoms, health behaviors, and risk of cardiovascular events in patients with coronary heart disease.

JAMA. 2008-11-26

[6]
Thrombophilia risk factors are associated with intrauterine foetal death and pregnancy-related venous thromboembolism.

Scand J Clin Lab Invest. 2009

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Fertil Steril. 2009-2

[8]
Fibrinolytic defects and recurrent miscarriage: a systematic review and meta-analysis.

Obstet Gynecol. 2007-5

[9]
International estimates of infertility prevalence and treatment-seeking: potential need and demand for infertility medical care.

Hum Reprod. 2007-6

[10]
Definite involuntary childlessness: associations between coping, social support and psychological distress.

Hum Reprod. 2007-1

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