Unit on Reproductive and Regenerative Medicine, Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, USA.
Fertil Steril. 2013 Mar 1;99(3):790-5. doi: 10.1016/j.fertnstert.2012.11.013. Epub 2012 Dec 1.
To assess in utero exposures and the odds of an endometriosis diagnosis.
Matched cohort design.
Fourteen participating clinical centers in geographically defined areas in Utah and California.
PATIENT(S): Operative cohort comprised 473 women undergoing laparoscopy/laparotomy, and an age- and residence-matched population cohort comprising 127 women undergoing pelvic magnetic resonance imaging (MRI), 2007-2009.
INTERVENTION(S): None.
MAIN OUTCOME MEASURE(S): Women completed standardized interviews before surgery or MRI regarding in utero exposures: mothers' lifestyle during the index pregnancy, and the index woman's gestation and birth size. Endometriosis was defined as visually confirmed disease in the operative cohort, and MRI visualized disease in the population cohort. The odds of an endometriosis diagnosis and corresponding 95% confidence intervals (CI) were estimated for each exposure by cohort using logistic regression and adjusting for current smoking, age at menarche, body mass index, and study site.
RESULT(S): Endometriosis was diagnosed in 41% and 11% of women in the operative and population cohorts, respectively. In the primary analysis, adjust odds ratios (AORs) were elevated for maternal vitamin usage (1.27; 95% CI, 0.85-1.91), maternal cigarette smoking (1.16; 95% CI = 0.61-2.24), and low birth weight (1.1; 95% CI, 0.92-1.32). Reduced odds were observed for maternal usage of caffeine (0.99; 95% CI, 0.64-1.54), alcohol (0.82; 95% CI, 0.35-1.94), paternal cigarette smoking (0.72; 95% CI, 0.43-1.19), and preterm delivery (0.98; 95% CI, 0.47-2.03). Sensitivity analyses mostly upheld the primary results except for a decreased AOR for preterm birth (0.41; 95% CI, 0.18-0.94) when restricting to visualized and histologically confirmed endometriosis in the operative cohort.
CONCLUSION(S): In utero exposures were not statistically significantly associated with the odds of an endometriosis diagnosis in either cohort.
评估宫内暴露与子宫内膜异位症诊断的几率。
匹配队列设计。
在犹他州和加利福尼亚州的地理定义区域内的 14 个参与临床中心。
手术队列包括 473 名接受腹腔镜/剖腹手术的女性，以及年龄和居住地相匹配的人群队列中的 127 名接受盆腔磁共振成像（MRI）的女性，时间为 2007-2009 年。
无。
女性在手术前或 MRI 前完成了关于宫内暴露的标准化访谈：母亲在指数妊娠期间的生活方式，以及指数女性的妊娠和出生大小。在手术队列中，将通过肉眼确认疾病来定义子宫内膜异位症，在人群队列中通过 MRI 可视化疾病来定义。通过逻辑回归，根据当前吸烟状况、初潮年龄、体重指数和研究地点，对每个暴露因素在队列中进行子宫内膜异位症诊断的几率和相应的 95%置信区间（CI）进行估计。
手术和人群队列中分别有 41%和 11%的女性被诊断为子宫内膜异位症。在主要分析中，母体维生素使用（1.27；95%CI，0.85-1.91）、母体吸烟（1.16；95%CI=0.61-2.24）和低出生体重（1.1；95%CI，0.92-1.32）的调整比值比（AOR）升高。母体咖啡因使用（0.99；95%CI，0.64-1.54）、酒精使用（0.82；95%CI，0.35-1.94）、父亲吸烟（0.72；95%CI，0.43-1.19）和早产（0.98；95%CI，0.47-2.03）的几率降低。除了在手术队列中限制为可视化和组织学证实的子宫内膜异位症时，早产的 AOR 降低（0.41；95%CI，0.18-0.94）外，敏感性分析大多支持主要结果。
在两个队列中，宫内暴露与子宫内膜异位症诊断的几率均无统计学显著关联。
