首次临床流产的核型与后续妊娠结局的预测。
Karyotype of first clinical miscarriage and prognosis of subsequent pregnancy outcome.
机构信息
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford University, Sunnyvale CA, USA.
Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University, Sunnyvale CA, USA.
出版信息
Reprod Biomed Online. 2021 Jun;42(6):1196-1202. doi: 10.1016/j.rbmo.2021.03.021. Epub 2021 Apr 6.
RESEARCH QUESTION
Is the karyotype of the first clinical miscarriage in an infertile patient predictive of the outcome of the subsequent pregnancy?
DESIGN
Retrospective cohort study of infertile patients undergoing manual vacuum aspiration with chromosome testing at the time of the first (index) clinical miscarriage with a genetic diagnosis and a subsequent pregnancy. Patients treated at two academic-affiliated fertility centres from 1999 to 2018 were included; those using preimplantation genetic testing for aneuploidy were excluded. Main outcome was live birth in the subsequent pregnancy.
RESULTS
One hundred patients with euploid clinical miscarriage and 151 patients with aneuploid clinical miscarriage in the index pregnancy were included. Patients with euploid clinical miscarriage in the index pregnancy had a live birth rate of 63% in the subsequent pregnancy compared with 68% among patients with aneuploid clinical miscarriage (adjusted odds ratio [aOR] 0.75, 95% CI 0.47-1.39, P = 0.45, logistic regression model adjusting for age, parity, body mass index and mode of conception). In a multinomial logistic regression model with three outcomes (live birth, clinical miscarriage or biochemical miscarriage), euploid clinical miscarriage for the index pregnancy was associated with similar odds of clinical miscarriage in the subsequent pregnancy compared with aneuploid clinical miscarriage for the index pregnancy (32% versus 24%, respectively, aOR 1.49, 95% CI 0.83-2.70, P = 0.19). Euploid clinical miscarriage for the index pregnancy was not associated with likelihood of biochemical miscarriage in the subsequent pregnancy compared with aneuploid clinical miscarriage (5% versus 8%, respectively, aOR 0.46, 95% CI 0.14-1.55, P = 0.21).
CONCLUSION
Prognosis after a first clinical miscarriage among infertile patients is equally favourable among patients with euploid and aneuploid karyotype, and independent of the karyotype of the pregnancy loss.
研究问题
不孕患者首次临床流产的核型是否可预测随后妊娠的结局？
设计
对 1999 年至 2018 年在两家学术附属生育中心接受手动真空抽吸术并进行染色体检测的首次（索引）临床流产（有遗传诊断）且随后妊娠的不孕患者进行回顾性队列研究。排除使用胚胎植入前非整倍体检测的患者。主要结局为随后妊娠中的活产。
结果
100 例核型正常的临床流产患者和 151 例核型异常的临床流产患者纳入索引妊娠。核型正常的临床流产患者在随后妊娠中的活产率为 63%，而核型异常的临床流产患者为 68%（调整后的优势比[aOR]0.75，95%CI 0.47-1.39，P=0.45，logistic 回归模型调整了年龄、产次、体重指数和受孕方式）。在具有三个结局（活产、临床流产或生化妊娠）的多项逻辑回归模型中，索引妊娠的核型正常临床流产与索引妊娠的核型异常临床流产相比，随后妊娠中发生临床流产的可能性相似（分别为 32%和 24%，aOR 1.49，95%CI 0.83-2.70，P=0.19）。索引妊娠的核型正常临床流产与随后妊娠中生化妊娠的可能性无关，而核型异常临床流产（分别为 5%和 8%，aOR 0.46，95%CI 0.14-1.55，P=0.21）。
结论
不孕患者首次临床流产后，核型正常和核型异常患者的预后相似，与妊娠丢失的核型无关。
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