Björkenstam Emma, Narusyte Jurgita, Alexanderson Kristina, Ropponen Annina, Kjeldgård Linnea, Svedberg Pia
Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden.
Finnish Institute of Occupational Health, Helsinki, Finland.
PLoS One. 2014 Jul 7;9(7):e101566. doi: 10.1371/journal.pone.0101566. eCollection 2014.
As the literature on long-term effects of childbirth on risk of morbidity or permanent work incapacity (DP) is limited, we aimed to study associations of childbirth with hospitalization and DP, adjusting for familial factors.
This cohort study included female twins, i.e. women with twin sister, born 1959-1990 in Sweden (n = 5 118). At least one in the twin pair had their first childbirth 1994-2009. Women were followed regarding all-cause and cause-specific (mental or musculoskeletal diagnoses) DP during year 2-5 after first delivery or equivalent. Associations between childbirth, hospitalization and DP were calculated as hazard ratios (HR) with 95% confidence intervals (CI).
Women who did not give birth had markedly higher number of DP days/year compared to those giving birth. Hospitalization after first childbirth was associated with a higher HR of DP. Those hospitalized at least once after their first childbirth had a three-fold DP risk (HR: 3.2; 95% CI 1.1-9.6), DP due to mental diagnoses (HR: 3.2; 1.2-8.8), and of DP due to musculoskeletal diagnoses (HR: 6.1; 1.6-22.9). Lower HRs in the discordant twin pair analyses indicated that familial factors may influence the studied associations.
Women who did not give birth had a much higher risk for DP than those who did. Among those who gave birth, the risk for DP was markedly higher among those with a previous hospitalization, and especially in women with repeated hospitalizations. The results indicate a health selection into giving birth as well as the importance of morbidity for DP.
由于关于分娩对发病风险或永久性工作能力丧失（DP）长期影响的文献有限，我们旨在研究分娩与住院治疗及DP之间的关联，并对家族因素进行校正。
这项队列研究纳入了1959年至1990年在瑞典出生的女性双胞胎（n = 5118），即有双胞胎姐妹的女性。双胞胎中至少有一人在1994年至2009年首次分娩。在首次分娩或同等情况后的第2至5年，对女性进行全因和特定病因（精神或肌肉骨骼诊断）DP的随访。分娩、住院治疗与DP之间的关联以风险比（HR）及95%置信区间（CI）计算。
未生育的女性每年的DP天数明显多于已生育的女性。首次分娩后住院与DP的HR较高相关。首次分娩后至少住院一次的女性患DP的风险增加两倍（HR：3.2；95%CI 1.1 - 9.6），因精神诊断导致的DP（HR：3.2；1.2 - 8.8），以及因肌肉骨骼诊断导致的DP（HR：6.1；1.6 - 22.9）。不一致双胞胎对分析中较低的HR表明家族因素可能影响所研究的关联。
未生育的女性患DP的风险比已生育的女性高得多。在已生育的女性中，既往有住院史的女性患DP的风险明显更高，尤其是多次住院的女性。结果表明存在健康因素影响生育选择以及发病情况对DP的重要性。
