Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway.
MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom.
PLoS Med. 2021 May 10;18(5):e1003603. doi: 10.1371/journal.pmed.1003603. eCollection 2021 May.
Increased risk of miscarriage has been reported for women with specific chronic health conditions. A broader investigation of chronic diseases and miscarriage risk may uncover patterns across categories of illness. The objective of this study was to study the risk of miscarriage according to various preexisting chronic diseases.
We conducted a registry-based study. Registered pregnancies (n = 593,009) in Norway between 2010 and 2016 were identified through 3 national health registries (birth register, general practitioner data, and patient registries). Six broad categories of illness were identified, comprising 25 chronic diseases defined by diagnostic codes used in general practitioner and patient registries. We required that the diseases were diagnosed before the pregnancy of interest. Miscarriage risk according to underlying chronic diseases was estimated as odds ratios (ORs) using generalized estimating equations adjusting for woman's age. The mean age of women at the start of pregnancy was 29.7 years (SD 5.6 years). We observed an increased risk of miscarriage among women with cardiometabolic diseases (OR 1.25, 95% CI 1.20 to 1.31; p-value <0.001). Within this category, risks were elevated for all conditions: atherosclerosis (2.22; 1.42 to 3.49; p-value <0.001), hypertensive disorders (1.19; 1.13 to 1.26; p-value <0.001), and type 2 diabetes (1.38; 1.26 to 1.51; p-value <0.001). Among other categories of disease, risks were elevated for hypoparathyroidism (2.58; 1.35 to 4.92; p-value 0.004), Cushing syndrome (1.97; 1.06 to 3.65; p-value 0.03), Crohn's disease (OR 1.31; 95% CI: 1.18 to 1.45; p-value 0.001), and endometriosis (1.22; 1.15 to 1.29; p-value <0.001). Findings were largely unchanged after mutual adjustment. Limitations of this study include our inability to adjust for measures of socioeconomic position or lifestyle characteristics, in addition to the rareness of some of the conditions providing limited power.
In this registry study, we found that, although risk of miscarriage was largely unaffected by maternal chronic diseases, risk of miscarriage was associated with conditions related to cardiometabolic health. This finding is consistent with emerging evidence linking cardiovascular risk factors to pregnancy complications.
有研究报道称，患有某些特定慢性疾病的女性流产风险增加。更广泛地研究慢性疾病与流产风险之间的关系，可能会揭示出不同疾病类别之间的模式。本研究的目的是研究不同的慢性疾病与流产风险之间的关系。
我们进行了一项基于登记的研究。通过 3 个国家健康登记处（出生登记处、全科医生数据和患者登记处），确定了 2010 年至 2016 年期间挪威的注册妊娠（n=593009）。确定了 6 大类疾病，包括 25 种由全科医生和患者登记处使用的诊断代码定义的慢性疾病。我们要求这些疾病在相关妊娠前被诊断出来。使用广义估计方程调整女性年龄后，根据潜在的慢性疾病估计流产风险的比值比（OR）。妊娠开始时女性的平均年龄为 29.7 岁（SD 5.6 岁）。我们发现患有心脏代谢疾病的女性流产风险增加（OR 1.25，95%CI 1.20 至 1.31；p<0.001）。在这一类别中，所有疾病的风险都升高：动脉粥样硬化（2.22，1.42 至 3.49；p<0.001）、高血压疾病（1.19，1.13 至 1.26；p<0.001）和 2 型糖尿病（1.38，1.26 至 1.51；p<0.001）。在其他疾病类别中，甲状旁腺功能减退症（2.58，1.35 至 4.92；p=0.004）、库欣综合征（1.97，1.06 至 3.65；p=0.03）、克罗恩病（OR 1.31，95%CI：1.18 至 1.45；p=0.001）和子宫内膜异位症（1.22，1.15 至 1.29；p<0.001）的风险也升高。在相互调整后，结果基本保持不变。本研究的局限性包括我们无法调整社会经济地位或生活方式特征的措施，以及某些疾病的罕见性，这些疾病的罕见性限制了研究的效力。
在这项登记研究中，我们发现，尽管流产的风险在很大程度上不受母体慢性疾病的影响，但流产的风险与心脏代谢健康相关的疾病有关。这一发现与将心血管危险因素与妊娠并发症联系起来的新证据一致。
