Magnus Maria C, Ferreira Diana D S, Borges Maria Carolina, Tilling Kate, Lawlor Deborah A, Fraser Abigail
Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, 0213, Norway.
MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.
Wellcome Open Res. 2021 Feb 12;5:205. doi: 10.12688/wellcomeopenres.16245.2. eCollection 2020.
Several studies have found that women who are overweight or obese have an increased risk of miscarriage. There is also some evidence of associations of other aspects of cardiometabolic health, including blood pressure and lipids, with miscarriage risk, although these have not been examined to the same extent as body-mass index (BMI). Our objective was to investigate the risk of miscarriage according to pre-pregnancy cardiometabolic health. We examined pre-pregnancy levels of BMI, blood pressure, fasting insulin and metabolites profile at age 18 and risk of miscarriage by age 24. The study included adult female offspring in the Avon Longitudinal Study of Parents and Children with a pregnancy between 18 and 24 years of age (n=434 for BMI and blood pressure; n=265 for metabolites). We used log-binomial regression to calculate adjusted associations between cardiometabolic health measures and miscarriage. The overall risk of miscarriage was 22%. The adjusted relative risks for miscarriage were 0.96 (95% CI: 0.92-1.00) for BMI (per unit increase), 0.98 (0.96-1.00) for systolic blood pressure, and 1.00 (0.97-1.04) for diastolic blood pressure (per 1 mmHg increase). Total cholesterol, total lipids and phospholipids in HDL-cholesterol were associated with increased likelihood of miscarriage, but none of the p-values for the metabolites were below the corrected threshold for multiple testing (p-value ≤0.003). Our findings indicate no strong evidence to support a relationship between pre-pregnancy cardiometabolic health and risk of miscarriage in young, healthy women who became pregnant before age 24. Future studies are necessary that are able to evaluate this question in samples with a wider age range.
多项研究发现，超重或肥胖的女性流产风险增加。也有一些证据表明，包括血压和血脂在内的心脏代谢健康的其他方面与流产风险有关，尽管这些方面的研究程度不及体重指数（BMI）。我们的目标是根据孕前心脏代谢健康状况调查流产风险。我们研究了18岁时的孕前BMI、血压、空腹胰岛素和代谢物谱水平，以及24岁时的流产风险。该研究纳入了雅芳亲子纵向研究中的成年女性后代，她们在18至24岁之间怀孕（BMI和血压研究样本量为434例；代谢物研究样本量为265例）。我们使用对数二项回归来计算心脏代谢健康指标与流产之间的校正关联。流产的总体风险为22%。BMI（每单位增加）的流产校正相对风险为0.96（95%CI：0.92-1.00），收缩压为0.98（0.96-1.00），舒张压（每升高1 mmHg）为1.00（0.97-1.04）。总胆固醇、总脂质和高密度脂蛋白胆固醇中的磷脂与流产可能性增加有关，但代谢物的p值均未低于多重检验的校正阈值（p值≤0.003）。我们的研究结果表明，没有强有力的证据支持24岁前怀孕的年轻健康女性孕前心脏代谢健康与流产风险之间存在关联。未来有必要开展研究，以便能够在更广泛年龄范围的样本中评估这个问题。
