Recurrent Pregnancy Loss Unit, Capital Region, Copenhagen University Hospital, Rigshospitalet, Fertility Clinic 4071, 2100 Copenhagen Ø, and Hvidovre Hospital, 2650 Hvidovre, Denmark.
Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen N, Denmark.
Hum Reprod. 2021 Mar 18;36(4):1065-1073. doi: 10.1093/humrep/deaa326.
Does the sequence of prior pregnancy events (pregnancy losses, live births, ectopic pregnancies, molar pregnancy and still birth), obstetric complications and maternal age affect chance of live birth in the next pregnancy and are prior events predictive for the outcome?
The sequence of pregnancy outcomes is significantly associated with chance of live birth; however, pregnancy history and age are insufficient to predict the outcome of an individual woman's next pregnancy.
Adverse pregnancy outcomes decrease the chance of live birth in the next pregnancy, whereas the impact of prior live births is less clear.
STUDY DESIGN, SIZE, DURATION: Nationwide, registry-based cohort study of 1 285 230 women with a total of 2 722 441 pregnancies from 1977 to 2017.
PARTICIPANTS/MATERIALS, SETTING, METHODS: All women living in Denmark in the study period with at least one pregnancy in either the Danish Medical Birth Registry or the Danish National Patient Registry. Data were analysed using logistic regression with a robust covariance model to account for women with more than one pregnancy. Model discrimination and calibration were ascertained using 20% of the women in the cohort randomly selected as an internal validation set.
Obstetric complications, still birth, ectopic pregnancies and pregnancy losses had a negative effect on the chance of live birth in the next pregnancy. Consecutive, identical pregnancy outcomes (pregnancy losses, live births or ectopic pregnancies) immediately preceding the next pregnancy had a larger impact than the total number of any outcome. Model discrimination was modest (C-index = 0.60, positive predictive value = 0.45), but the models were well calibrated.
LIMITATIONS, REASONS FOR CAUTION: While prior pregnancy outcomes and their sequence significantly influenced the chance of live birth, the discriminative abilities of the predictive models demonstrate clearly that pregnancy history and maternal age are insufficient to reliably predict the outcome of a given pregnancy.
Prior pregnancy history has a significant impact on the chance of live birth in the next pregnancy. However, the results emphasize that only taking age and number of losses into account does not predict if a pregnancy will end as a live birth or not. A better understanding of biological determinants for pregnancy outcomes is urgently needed.
STUDY FUNDING/COMPETING INTEREST(S): The work was supported by the Novo Nordisk Foundation, Ole Kirk Foundation and Rigshospitalet's Research Foundation. The authors have no financial relationships that could appear to have influenced the work.
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先前妊娠事件（妊娠丢失、活产、异位妊娠、葡萄胎和死产）、产科并发症和产妇年龄的顺序是否会影响下一次妊娠的活产机会，先前的事件是否可以预测结局？
妊娠结局的顺序与活产机会显著相关；然而，妊娠史和年龄不足以预测个体女性下一次妊娠的结局。
不良妊娠结局会降低下一次妊娠的活产机会，而先前活产的影响则不太清楚。
研究设计、规模、持续时间：这是一项全国范围内基于登记的队列研究，纳入了 1977 年至 2017 年间至少有一次妊娠的 1285230 名丹麦女性，共涉及 2722441 次妊娠。
参与者/材料、设置、方法：所有在研究期间居住在丹麦的女性，这些女性的至少一次妊娠都记录在丹麦医学出生登记处或丹麦国家患者登记处。使用逻辑回归和稳健协方差模型进行分析，以考虑到有多次妊娠的女性。使用队列中随机选择的 20%的女性作为内部验证集来确定模型的区分度和校准度。
产科并发症、死产、异位妊娠和妊娠丢失对下一次妊娠的活产机会有负面影响。紧接着的、相同的妊娠结局（妊娠丢失、活产或异位妊娠）在前次妊娠后立即发生，其影响大于任何结局的总数。模型的区分度适中（C 指数=0.60，阳性预测值=0.45），但模型校准良好。
局限性、谨慎的原因：虽然先前的妊娠结局及其顺序显著影响活产机会，但预测模型的区分能力清楚地表明，妊娠史和产妇年龄不足以可靠地预测特定妊娠的结局。
先前的妊娠史对下一次妊娠的活产机会有重大影响。然而，结果强调，仅考虑年龄和丢失次数并不能预测妊娠是否会以活产结束。迫切需要更好地了解妊娠结局的生物学决定因素。
研究资金/竞争利益：这项工作得到了诺和诺德基金会、Ole Kirk 基金会和 Rigshospitalet 研究基金会的支持。作者没有任何可能影响工作的财务关系。
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