Davies M J, Rumbold A R, Whitrow M J, Willson K J, Scheil W K, Mol B W, Moore V M
1Robinson Institute,Discipline of Obstetrics and Gynaecology,The University of Adelaide,North Terrace, Adelaide,South Australia 5005,Australia.
3Epidemiology Branch,South Australian Department of Health,South Australia,Australia.
J Dev Orig Health Dis. 2016 Dec;7(6):678-684. doi: 10.1017/S2040174416000301. Epub 2016 Jul 4.
The study of very early pregnancy loss is impractical in the general population, but possible amongst infertility patients receiving carefully monitored treatments. We examined the association between fetal loss and the risk of birth defects in the surviving co-twin in a retrospective cohort study of infertility patients within an infertility clinic in South Australia from January 1986 to December 2002, linked to population registries for births, terminations and birth defects. The study population consisted of a total of 5683 births. Births from singleton pregnancies without loss were compared with survivors from (1) pregnancies with an empty fetal sac at 6-8 weeks after embryo transfer, (2) fetal loss subsequent to 8-week ultrasound and (3) multiple pregnancy continuing to birth. Odds ratios (OR) for birth defects were calculated with adjustment for confounders. Amongst infertility patients, the prevalence of birth defects was 7.9% for all twin pregnancies without fetal loss compared with 14.6% in pregnancies in which there had been an empty sac at ultrasound, and 11.6% for pregnancies with fetal loss after 6-8 weeks. Compared with singleton pregnancies without loss, the presence of an empty sac was associated with an increased risk of any defect (OR=1.90, 95% confidence intervals (CI)=1.09-3.30) and with multiple defects (OR=2.87, 95% CI=1.31-6.28). Twin pregnancies continuing to birth without loss were not associated with an overall increased prevalence of defects. We conclude that the observed loss of a co-twin by 6-8 weeks of pregnancy is related to the risk of major birth defects in the survivor.
在普通人群中研究极早期流产是不切实际的，但在接受精心监测治疗的不孕患者中则有可能。在一项对南澳大利亚一家不孕诊所1986年1月至2002年12月期间的不孕患者进行的回顾性队列研究中，我们研究了流产与存活的双胎之一出生缺陷风险之间的关联，该研究与出生、终止妊娠和出生缺陷的人口登记处相关联。研究人群包括总共5683例出生。将单胎妊娠无流产的出生情况与以下情况的幸存者进行比较：(1)胚胎移植后6 - 8周时孕囊为空的妊娠；(2)8周超声检查后发生的流产；(3)持续至分娩的多胎妊娠。计算出生缺陷的比值比(OR)并对混杂因素进行调整。在不孕患者中，所有无胎儿丢失的双胎妊娠出生缺陷患病率为7.9%，相比之下，超声检查时孕囊为空的妊娠患病率为14.6%，6 - 8周后发生胎儿丢失的妊娠患病率为11.6%。与无流产的单胎妊娠相比，孕囊为空与任何缺陷风险增加相关(OR = 1.90，95%置信区间(CI)=1.09 - 3.30)，与多种缺陷相关(OR = 2.87，95% CI = 1.31 - 6.28)。持续至分娩且无流产的双胎妊娠与总体缺陷患病率增加无关。我们得出结论，妊娠6 - 8周时观察到的双胎之一丢失与存活者发生主要出生缺陷的风险相关。
