Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, Massachusetts.
Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, Massachusetts.
Fertil Steril. 2020 Mar;113(3):601-608.e1. doi: 10.1016/j.fertnstert.2019.10.027.
To estimate the association between physical activity and risk of subclinical and clinical pregnancy loss among women with a history of pregnancy loss.
Prospective cohort study as a secondary analysis of the Effects of Aspirin in Gestation and Reproduction randomized controlled trial of preconception-initiated low-dose aspirin among women with one or two prior pregnancy losses.
Four U.S. clinical centers, 2007-2011.
PATIENT(S): Women with confirmed pregnancy (n = 785) as determined from hCG testing in longitudinally collected biospecimens.
MAIN OUTCOME MEASURE(S): Subclinical loss of pregnancy detected only by hCG testing and clinically recognized loss.
RESULT(S): Among 785 women (mean [SD] age, 28.7 [4.6] years) with an hCG-confirmed pregnancy, 188 (23.9%) experienced pregnancy loss. In multivariable models adjusted for confounders, compared with the first tertile of physical activity (median = 7.7 metabolic equivalent of task hours/week), there was a roughly twofold higher risk of subclinical loss in the second (risk ratio = 2.06; 95% confidence interval, 1.03-4.14) and third tertiles (risk ratio = 1.92; 95% confidence interval, 0.94-3.90), with median metabolic equivalent of task hours/week of 27.8 and 95.7, respectively. No relations were observed between physical activity and clinically recognized loss.
CONCLUSION(S): Risk related to physical activity is different for pregnancy failure close to the time of implantation compared with that for later, clinical pregnancy loss. Higher physical activity levels were associated with an elevated risk of subclinical loss (i.e., pregnancies detected only by hCG, n = 55); however, no relationship was observed with clinically recognized loss. Further work is required to confirm these findings, assess generalizability to women without prior losses, and evaluate mechanisms.
Each participating center's Institutional Review Board approved the study, and participants provided written informed consent. The trial was registered on ClinicalTrials.gov (NCT00467363), and a Data Safety and Monitoring Board provided oversight.
评估有妊娠丢失史的女性身体活动与亚临床和临床妊娠丢失风险之间的关联。
作为一项对孕前起始低剂量阿司匹林治疗既往有一次或两次妊娠丢失的女性的 Effects of Aspirin in Gestation and Reproduction 随机对照试验的二次分析，前瞻性队列研究。
美国四个临床中心，2007-2011 年。
通过纵向采集的生物标本中 hCG 检测确定妊娠的女性（n=785）。
仅通过 hCG 检测检测到的亚临床妊娠丢失和临床公认的妊娠丢失。
在 785 名（平均[标准差]年龄 28.7[4.6]岁）hCG 确诊妊娠的女性中，有 188 名（23.9%）发生妊娠丢失。在调整混杂因素的多变量模型中，与身体活动的第一三分位（中位数=7.7 代谢当量小时/周）相比，第二（风险比=2.06；95%置信区间，1.03-4.14）和第三三分位（风险比=1.92；95%置信区间，0.94-3.90）的亚临床丢失风险大致高出两倍，中位代谢当量小时/周分别为 27.8 和 95.7。未观察到身体活动与临床公认的妊娠丢失之间存在关系。
与身体活动相关的风险在接近着床时间的妊娠失败与后期临床妊娠丢失之间有所不同。较高的身体活动水平与亚临床丢失风险增加相关（即仅通过 hCG 检测检测到的妊娠，n=55）；然而，与临床公认的妊娠丢失无关。需要进一步的工作来证实这些发现，评估对无既往妊娠丢失的女性的普遍性，并评估机制。
每个参与中心的机构审查委员会都批准了该研究，参与者提供了书面知情同意书。该试验在 ClinicalTrials.gov（NCT00467363）注册，数据安全和监测委员会提供监督。
