School of Public Health, Peking University Health Science Center, Beijing, China.
Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
BJOG. 2020 Jan;127(1):39-45. doi: 10.1111/1471-0528.15908. Epub 2019 Sep 10.
To explore the relation between famine exposure in early life and subsequent pregnancy loss, including stillbirth, and spontaneous abortion in adulthood.
A population-based, partly ecological study.
Individual data of 58 601 females born around the time of the Great Chinese Famine in 1959-1961.
Associations between the famine exposure in early life and pregnancy loss (stillbirth and spontaneous abortion) in adulthood were analysed using negative binomial regression, with the non-exposure group as reference, adjusting for region, highest education, monthly income, alcohol consumption, tobacco use, body mass index in 25-year-olds and metabolic equivalent. Further analyses were stratified by rural versus urban region.
Continuous variables of times of stillbirths and spontaneous abortions were used according to the individual self-reported reproductive history.
No association was found between famine exposure and spontaneous abortion. In contrast, females experiencing the famine during their prenatal period (incidence rate ratio = 1.15, 95% CI 1.00-1.33) or infant period (incidence rate ratio = 1.27, 95% CI 1.12-1.44) were more likely to report stillbirth in later adult life. Such an association appeared stronger in women living in rural regions.
Early life exposure of famine was associated with an increased risk of stillbirth but not spontaneous abortion in adulthood. The strength of such an association appeared stronger in rural areas. Given the high potential for unmeasured confounding, these associations must be interpreted with caution. Regarding the potential implication that undernutrition in the fetal period is related to reproductive outcome in adulthood, fetal nutritional supply may play an important role in human reproduction.
Exposure to famine in early life was associated with increased pregnancy loss in adulthood.
探讨生命早期饥荒暴露与随后的妊娠丢失（包括死产和自然流产）之间的关系。
基于人群的部分生态研究。
1959-1961 年大饥荒时期出生的 58601 名女性个体数据。
采用负二项回归分析生命早期饥荒暴露与成年后妊娠丢失（死产和自然流产）之间的关联，以非暴露组为参照，调整了地区、最高教育程度、月收入、饮酒、吸烟、25 岁时的体重指数和代谢当量。进一步按城乡地区进行分层分析。
根据个体自我报告的生殖史，使用连续变量记录死产和自然流产的次数。
未发现饥荒暴露与自然流产之间存在关联。相反，在胎儿期（发病率比=1.15，95%可信区间 1.00-1.33）或婴儿期（发病率比=1.27，95%可信区间 1.12-1.44）经历饥荒的女性更有可能在成年后报告死产。这种关联在农村地区的女性中更为明显。
生命早期暴露于饥荒与成年后死产风险增加有关，但与自然流产无关。这种关联在农村地区更为明显。鉴于存在未测量的混杂因素的高可能性，必须谨慎解释这些关联。关于胎儿期营养不良与成年生殖结局之间存在潜在关联的问题，胎儿营养供应可能在人类生殖中发挥重要作用。
生命早期的饥荒暴露与成年后的妊娠丢失增加有关。
