Hahn Kristen A, Hatch Elizabeth E, Rothman Kenneth J, Mikkelsen Ellen M, Brogly Susan B, Sørensen Henrik T, Riis Anders H, Wise Lauren A
Department of Epidemiology, Boston University School of Public Health, Boston, MA.
Paediatr Perinat Epidemiol. 2014 Sep;28(5):412-23. doi: 10.1111/ppe.12142.
Several studies indicate that female obesity increases the risk of spontaneous abortion (SAB). Central adiposity, height, and location of typical weight gain have not been examined as risk factors for SAB.
We examined the associations between selected anthropometric factors and risk of SAB among 5132 women enrolled in a Danish Internet-based prospective cohort study of pregnancy planners. We used Cox proportional hazards regression models, with gestational weeks as the time scale, to compute hazard ratios (HRs) of SAB and 95% confidence intervals (CIs).
After adjustment for potential confounders, the HRs for SAB among underweight (body mass index (BMI, kg/m(2) ) <20), overweight (BMI: 25-29) and obese (BMI ≥30) women were 1.00 [95% CI: 0.81, 1.24], 0.90 [95% CI: 0.73, 1.09] and 1.23 [95% CI: 0.98, 1.54], respectively, compared with normal weight women (BMI 20-24). The association between obesity and SAB was stronger for early SAB (<8 weeks gestation); HR: 1.34 95% CI: 1.01, 1.77. The HR for height ≥174 cm vs. <166 cm was 0.81 [95% CI: 0.66, 1.00]. Increased waist-to-hip ratio (WHR) was inversely associated with risk of SAB (HR: 0.81; 95% CI: 0.63, 1.05). Waist circumference and location of typical weight gain were not appreciably associated with SAB risk.
This study confirms previous studies that have shown a small positive association between obesity and SAB risk. Our results suggest that obesity is a stronger risk factor for early pregnancy losses, and that small stature and low WHR are associated with an increased risk of SAB.
多项研究表明，女性肥胖会增加自然流产（SAB）的风险。中心性肥胖、身高以及典型体重增加部位尚未作为SAB的风险因素进行研究。
我们在一项针对丹麦怀孕计划者的基于互联网的前瞻性队列研究中，对5132名女性进行了选定人体测量因素与SAB风险之间的关联研究。我们使用Cox比例风险回归模型，以孕周作为时间尺度，计算SAB的风险比（HR）和95%置信区间（CI）。
在对潜在混杂因素进行调整后，体重过轻（体重指数（BMI，kg/m²）<20）、超重（BMI：25 - 29）和肥胖（BMI≥30）女性SAB的HR分别为1.00 [95% CI：0.81, 1.24]、0.90 [95% CI：0.73, 1.09]和1.23 [95% CI：0.98, 1.54]，与正常体重女性（BMI 20 - 24）相比。肥胖与早期SAB（妊娠<8周）之间的关联更强；HR：1.34 95% CI：1.01, 1.77。身高≥174 cm与<166 cm相比的HR为0.81 [95% CI：0.66, 1.00]。腰臀比（WHR）增加与SAB风险呈负相关（HR：0.81；95% CI：0.63, 1.05）。腰围和典型体重增加部位与SAB风险无明显关联。
本研究证实了先前的研究，即肥胖与SAB风险之间存在微弱的正相关。我们的结果表明，肥胖是早期妊娠丢失的更强风险因素，身材矮小和低WHR与SAB风险增加有关。
