Egeland Grace M, Tell Grethe S, Næss Øyvind, Igland Jannicke, Klungsøyr Kari
Department of Global Public Health and Primary Care, Norwegian Institute of Public Health, & Professor, University of Bergen, Bergen, Norway.
Institute of Health and Society, University of Oslo, Oslo, Norway.
BMJ Open. 2017 Aug 11;7(8):e017034. doi: 10.1136/bmjopen-2017-017034.
To evaluate whether family history of disease and pregravid lifestyle and cardiovascular risk factors are associated with subsequent stillbirth delivery.
Prepregnancy cohort study.
Cohort Norway regional health surveys (1994-2003) linked to Medical Birth Registry of Norway for deliveries through 2012.
13 497 singleton births ( 22 weeks gestation) in 8478 women.
Risk of stillbirth evaluated by Poisson regression.
Mean (SD) length of follow-up was 5.5 (3.5) years. In analyses adjusting for baseline age and length of follow-up, ≥3 hours of baseline past-year vigorous physical activity per week (resulting in shortness of breath/sweating) was associated with increased risk of stillbirth compared with <1 hour/week of vigorous activity (incidence rate ratio, IRR 2.46; 95% CI 1.23 to 4.90). In contrast, baseline past-year light physical activity of ≥3 hours per week associated with reduced risk of stillbirth compared with <3 hours of light physical activity per week (IRR 0.53; 95% CI 0.30 to 0.93). A family history of stroke associated with increased risk of stillbirth delivery (IRR 2.53; 95% CI 1.06 to 6.01). Because overweight/obese women may experience shortness of breath and sweating with less physical exertion than normal weight women, a sensitivity analysis was conducted limited to women with a normal BMI ( 18.5 and <25 kg/m). Vigorous activity of ≥3 hours per week (IRR of 4.50; 95% CI 1.72 to 11.79) and a family history of stroke (IRR of 3.81; 95% CI 1.31 to 11.07) were more strongly related to stillbirth risk among women with a normal BMI than that observed for all women combined. Established risk factors also associated with stillbirth risk.
The study identified physical activity and family history of stroke as potential new risk factors for stillbirth delivery.
评估疾病家族史、孕前生活方式及心血管危险因素是否与随后的死产分娩相关。
孕前队列研究。
挪威队列地区健康调查（1994 - 2003年）与挪威医疗出生登记处相链接，以获取截至2012年的分娩信息。
8478名女性中的13497例单胎分娩（妊娠22周）。
通过泊松回归评估死产风险。
平均（标准差）随访时间为5.5（3.5）年。在对基线年龄和随访时间进行调整的分析中，与每周剧烈体力活动<1小时相比，基线时过去一年每周剧烈体力活动≥3小时（导致呼吸急促/出汗）与死产风险增加相关（发病率比，IRR 2.46；95%CI 1.23至4.90）。相比之下，与每周轻度体力活动<3小时相比，基线时过去一年每周轻度体力活动≥3小时与死产风险降低相关（IRR 0.53；95%CI 0.30至0.93）。中风家族史与死产分娩风险增加相关（IRR 2.53；95%CI 1.06至6.01）。由于超重/肥胖女性比正常体重女性在较少体力消耗时就可能出现呼吸急促和出汗，因此进行了一项敏感性分析，仅限于BMI正常（18.5且<25kg/m²）的女性。与所有女性合并分析相比，BMI正常的女性中，每周剧烈活动≥3小时（IRR为4.50；95%CI 1.72至11.79）和中风家族史（IRR为3.81；95%CI 1.31至11.07）与死产风险的相关性更强。已确定的危险因素也与死产风险相关。
该研究确定体力活动和中风家族史是死产分娩的潜在新危险因素。
