Joneborg Ulrika, Eloranta Sandra, Johansson Anna L V, Marions Lena, Weibull Caroline E, Lambe Mats
Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska University Hospital/Institutet, Stockholm, Sweden.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Am J Obstet Gynecol. 2014 Dec;211(6):681.e1-7. doi: 10.1016/j.ajog.2014.06.030. Epub 2014 Jun 17.
The objective of the study was to investigate whether a history of hydatidiform mole (HM) is associated with an increased risk of adverse outcomes in subsequent pregnancies.
This was a nationwide cohort study with data from population-based registers. The study population consisted of all children registered in the Swedish Medical Birth Register 1973-2009 (n = 3,730,825). Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated for adverse maternal and offspring pregnancy outcomes by maternal history of HM prior to the delivery, with children to women with no maternal history of HM as the reference. Risk estimates were adjusted for maternal age at delivery and maternal country of birth.
A history of HM was not associated with an increased risk of adverse maternal outcomes in subsequent pregnancies (n = 5186). Women exposed to a molar pregnancy prior to the index birth were at an almost 25% increased risk of preterm birth (OR, 1.23; 95% CI, 1.06-1.43), whereas women with at least 1 birth between the HM and the index birth were at an increased risk of a large-for-gestational-age birth and stillbirth (OR, 1.35; 95% CI, 1.10-1.67 and OR, 1.81; 95% CI, 1.11-2.96, respectively). The risk of repeat mole was 0.4%.
Women with a history of HM are at no increased risk of adverse maternal outcomes in subsequent pregnancies but have an increased risk of large-for-gestational-age birth, stillbirth, and preterm birth. However, in absolute terms, the risk of subsequent adverse offspring outcomes is very low.
本研究旨在调查葡萄胎（HM）病史是否与后续妊娠不良结局风险增加相关。
这是一项基于全国人口登记数据的队列研究。研究人群包括1973 - 2009年瑞典医学出生登记册中登记的所有儿童（n = 3,730,825）。通过分娩前母亲的HM病史，以无HM病史母亲所生子女作为对照，估计不良孕产妇和子代妊娠结局的比值比（OR）及95%置信区间（CI）。风险估计值根据分娩时母亲年龄和母亲出生国家进行了调整。
HM病史与后续妊娠不良孕产妇结局风险增加无关（n = 5186）。在本次分娩前有葡萄胎妊娠史的女性早产风险增加近25%（OR，1.23；95%CI，1.06 - 1.43），而在HM与本次分娩之间至少有1次分娩的女性，大于胎龄儿出生和死产风险增加（OR分别为1.35；95%CI，1.10 - 1.67和OR，1.81；95%CI，1.11 - 2.96）。再次发生葡萄胎的风险为0.4%。
有HM病史的女性在后续妊娠中不良孕产妇结局风险并未增加，但大于胎龄儿出生、死产和早产风险增加。然而，从绝对数值来看，后续子代不良结局的风险非常低。
