Department of Urology, Stanford University School of Medicine, Stanford, CA 94305-5118, USA.
Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA 94305-5118, USA.
Hum Reprod. 2021 Feb 18;36(3):785-793. doi: 10.1093/humrep/deaa332.
Is preconception paternal health associated with pregnancy loss?
Poor preconception paternal health is associated with a higher risk of pregnancy loss as confirmed in sensitivity analyses accounting for maternal age and health.
Preconception paternal health can negatively impact perinatal outcomes.
STUDY DESIGN, SIZE, DURATION: Retrospective cohort study of US insurance claims database from 2009 to 2016 covering 958 804 pregnancies.
PARTICIPANTS/MATERIALS, SETTING, METHODS: US insurance claims database including women, men and pregnancies within the USA between 2007 and 2016. Paternal preconception health status (e.g. metabolic syndrome diagnoses (MetS), Charlson comorbidity index (CCI) and individual chronic disease diagnoses) was examined in relation to pregnancy loss (e.g. ectopic pregnancy, miscarriage and stillbirth).
In all, 958 804 pregnancies were analyzed. The average paternal age was 35.3 years (SD 5.3) and maternal age was 33.1 years (SD 4.4). Twenty-two percent of all pregnancies ended in a loss. After adjusting for maternal factors, the risk of pregnancy loss increased with increasing paternal comorbidity. For example, compared to men with no components of MetS, the risk of pregnancy loss increased for men with one (relative risk (RR) 1.10, 95% CI 1.09-1.12), two (RR 1.15, 95% CI 1.13-1.17) or three or more (RR 1.19, 95% CI 1.14-1.24) components. Specifically, less healthy men had a higher risk of siring a pregnancy ending in spontaneous abortion, stillbirth and ectopic pregnancies. Similar patterns remained with other measures of paternal health (e.g. CCI, chronic diseases, etc.). When stratifying by maternal age as well as maternal health, a similar pattern of increasing pregnancy loss risk for men with 1, 2 or 3+ MetS was observed. A statistically significant but weak association between timing of pregnancy loss and paternal health was found.
LIMITATIONS, REASONS FOR CAUTION: Retrospective study design covering only employer insured individuals may limit generalizability.
Optimization of a father's health may improve pregnancy outcomes.
STUDY FUNDING/COMPETING INTERESTS: National Institutes of Health National Center for Advancing Translational Science Clinical and Translational Science Award (UL1 TR001085). M.L.E. is an advisor for Sandstone Diagnostics, Dadi, Hannah and Underdog. No other competing interests were declared.
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准父亲的健康状况与妊娠丢失有关吗？
在考虑了母亲年龄和健康状况的敏感性分析中，较差的准父亲健康状况与妊娠丢失风险增加相关。
准父亲的健康状况可能会对围产期结局产生负面影响。
研究设计、规模和持续时间：这是一项回顾性队列研究，使用了美国保险索赔数据库，涵盖了 2009 年至 2016 年的 958804 例妊娠。
参与者/材料、地点和方法：该研究纳入了美国 2007 年至 2016 年间的女性、男性及其妊娠的美国保险索赔数据库。研究人员检查了准父亲的健康状况（如代谢综合征诊断（MetS）、Charlson 合并症指数（CCI）和个体慢性病诊断）与妊娠丢失（如异位妊娠、流产和死产）之间的关系。
共分析了 958804 例妊娠。准父亲的平均年龄为 35.3 岁（标准差 5.3），母亲的平均年龄为 33.1 岁（标准差 4.4）。22%的妊娠以流产告终。在调整了母亲因素后，随着准父亲合并症的增加，妊娠丢失的风险增加。例如，与没有任何 MetS 成分的男性相比，有一个（相对风险（RR）1.10，95%可信区间（CI）1.09-1.12）、两个（RR 1.15，95% CI 1.13-1.17）或三个或更多（RR 1.19，95% CI 1.14-1.24）成分的男性，妊娠丢失的风险增加。具体而言，健康状况较差的男性生育的妊娠更有可能自然流产、死产和异位妊娠。其他衡量准父亲健康状况的指标（如 CCI、慢性病等）也存在类似的模式。当按母亲年龄和母亲健康状况分层时，也观察到有 1、2 或 3+ MetS 的男性妊娠丢失风险增加的类似模式。还发现了妊娠丢失时间与准父亲健康状况之间存在统计学意义但较弱的关联。
回顾性研究设计仅涵盖雇主投保个体，可能限制了研究结果的普遍性。
优化父亲的健康状况可能会改善妊娠结局。
研究资助/利益冲突：美国国立卫生研究院国家推进转化科学临床和转化科学奖（UL1 TR001085）。M.L.E. 是 Sandstone Diagnostics、Dadi、Hannah 和 Underdog 的顾问。没有其他利益冲突。
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