Department of Nutrition, Harvard T H Chan School of Public Health, 655 Huntington Avenue, Boston, MA 02115, USA.
Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
BMJ. 2021 Mar 24;372:n530. doi: 10.1136/bmj.n530.
To investigate the association of spontaneous abortion with the risk of all cause and cause specific premature mortality (death before the age of 70).
Prospective cohort study.
The Nurses' Health Study II (1993-2017), United States.
101 681 ever gravid female nurses participating in the Nurses' Health Study II.
Lifetime occurrence of spontaneous abortion in pregnancies lasting less than 6 months, determined by biennial questionnaires. Hazard ratios and 95% confidence intervals for all cause and cause specific premature death according to the occurrence of spontaneous abortion, estimated with time dependent Cox proportional hazards models.
During 24 years of follow-up, 2936 premature deaths were recorded, including 1346 deaths from cancer and 269 from cardiovascular disease. Crude all cause mortality rates were comparable for women with and without a history of spontaneous abortion (1.24 per 1000 person years in both groups) but were higher for women experiencing three or more spontaneous abortions (1.47 per 1000 person years) and for women reporting their first spontaneous abortion before the age of 24 (1.69 per 1000 person years). The corresponding age adjusted hazard ratios for all cause premature death during follow-up were 1.02 (95% confidence interval 0.94 to 1.11), 1.39 (1.03 to 1.86), and 1.27 (1.11 to 1.46), respectively. After adjusting for confounding factors and updated dietary and lifestyle factors, the occurrence of spontaneous abortion was associated with a hazard ratio of 1.19 (95% confidence interval 1.08 to 1.30) for premature mortality during follow-up. The association was stronger for recurrent spontaneous abortions (hazard ratio 1.59, 95% confidence interval 1.17 to 2.15 for three or more spontaneous abortions; 1.23, 1.00 to 1.50 for two; and 1.16, 1.05 to 1.28 for one compared with none), and for spontaneous abortions occurring early in a woman's reproductive life (1.32, 1.14 to 1.53 for age ≤23; 1.16, 1.01 to 1.33 for ages 24-29; and 1.12, 0.98 to 1.28 for age ≥30 compared with none). When cause specific mortality was evaluated, the association of spontaneous abortion with premature death was strongest for deaths from cardiovascular disease (1.48, 1.09 to 1.99). Spontaneous abortion was not related to premature death from cancer (1.08, 0.94 to 1.24).
Spontaneous abortion was associated with an increased risk of premature mortality, particularly death from cardiovascular disease.
探讨自然流产与全因和特定病因过早死亡（70 岁前死亡）风险的关系。
前瞻性队列研究。
美国护士健康研究 II（1993-2017 年）。
参与护士健康研究 II 的 101681 名曾妊娠的女性护士。
通过每两年一次的问卷确定妊娠持续时间不到 6 个月的自然流产的终生发生情况。根据自然流产的发生情况，使用时间依赖性 Cox 比例风险模型估计全因和特定病因过早死亡的风险比和 95%置信区间。
在 24 年的随访期间，记录了 2936 例过早死亡，其中 1346 例死于癌症，269 例死于心血管疾病。无自然流产史和有自然流产史的女性粗全因死亡率相当（两组均为每 1000 人年 1.24 人），但经历过 3 次或更多次自然流产的女性（每 1000 人年 1.47 人）和报告首次自然流产发生在 24 岁之前的女性（每 1000 人年 1.69 人）的死亡率更高。随访期间全因过早死亡的相应年龄调整风险比分别为 1.02（95%置信区间 0.94 至 1.11）、1.39（1.03 至 1.86）和 1.27（1.11 至 1.46）。在校正混杂因素和更新的饮食及生活方式因素后，自然流产与随访期间过早死亡的风险比为 1.19（95%置信区间 1.08 至 1.30）相关。复发性自然流产（3 次或以上自然流产的风险比为 1.59，95%置信区间为 1.17 至 2.15；2 次为 1.23，95%置信区间为 1.00 至 1.50；1 次为 1.16，95%置信区间为 1.05 至 1.28，均与无自然流产史相比）和早期发生的自然流产（≤23 岁的风险比为 1.32，95%置信区间为 1.14 至 1.53；24-29 岁为 1.16，95%置信区间为 1.01 至 1.33；≥30 岁为 1.12，95%置信区间为 0.98 至 1.28，均与无自然流产史相比）与过早死亡的相关性更强。当评估特定病因死亡率时，自然流产与心血管疾病过早死亡（1.48，1.09 至 1.99）的相关性最强。自然流产与癌症相关的过早死亡（1.08，0.94 至 1.24）无关。
自然流产与过早死亡风险增加相关，尤其是与心血管疾病相关的过早死亡。
