Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD.
Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD.
Ann Epidemiol. 2019 Jun;34:40-44. doi: 10.1016/j.annepidem.2019.04.002. Epub 2019 Apr 11.
To determine whether family history of cardiovascular disease (CVD) is a risk factor for pregnancy loss, given potential shared etiology, including vascular mechanisms involved in reproduction and placentation.
In a prospective study, first-degree family histories were self-reported before pregnancy among women with 1-2 previous losses. Women were followed for up to 6 menstrual cycles while attempting pregnancy and through pregnancy. Pregnancies were ascertained by urinary human chorionic gonadotropin and confirmed by ultrasound. Risk ratios and 95% confidence intervals for pregnancy loss were estimated using weighted Poisson regression models with robust standard errors adjusted for covariates including prepregnancy body mass index and sociodemographics.
Of 1228 women enrolled, 742 had a clinically confirmed pregnancy, and of these, 18% experienced a clinical pregnancy loss. Forty six percent of women reported family history of CVD, diabetes, hypertension, or hypercholesterolemia/dyslipidemia. Family history of CVD was not associated with the risk of pregnancy loss overall (1.01; 95% confidence interval: 0.64, 1.59) or among women with 2 previous losses (1.05; 0.51, 2.17). Family history of hypertension was also not associated with pregnancy loss (0.98; 0.65, 1.46).
Family history of CVD is not providing additional information helpful in determining the risk of subsequent pregnancy loss in an at-risk group.
鉴于心血管疾病（CVD）家族史可能存在共同的发病机制，包括涉及生殖和胎盘形成的血管机制，确定其是否为妊娠丢失的危险因素。
在一项前瞻性研究中，在有 1-2 次既往流产史的女性妊娠前，通过自我报告的方式报告一级亲属的 CVD 病史。这些女性在尝试妊娠和妊娠期间，最多随访 6 个月经周期。通过尿人绒毛膜促性腺激素检测并通过超声确认妊娠。使用加权泊松回归模型估计妊娠丢失的风险比和 95%置信区间，并采用稳健标准误差进行调整，调整的协变量包括孕前体重指数和社会人口统计学因素。
在纳入的 1228 名女性中，742 名女性有临床确认的妊娠，其中 18%经历了临床妊娠丢失。46%的女性报告有 CVD、糖尿病、高血压或高胆固醇血症/血脂异常的家族史。总体而言，CVD 家族史与妊娠丢失的风险无关（1.01；95%置信区间：0.64，1.59），或与有 2 次既往流产史的女性无关（1.05；0.51，2.17）。高血压家族史也与妊娠丢失无关（0.98；0.65，1.46）。
CVD 家族史并不能提供额外的有用信息，有助于确定高危人群中随后妊娠丢失的风险。
