Dongguan Maternal and Child Health Care Hospital, No.99 Zhenxing Road, Dongcheng District, Dongguan City, 523112, Guangdong Province, China.
Arch Gynecol Obstet. 2022 Feb;305(2):349-358. doi: 10.1007/s00404-021-06158-9. Epub 2021 Jul 30.
To explore whether a history of IUD use could increase the risk of subsequent preterm birth.
We performed a cohort study of 24,496 multipara aged 19-48 years in Dongguan City. Each subject was followed up for 1 year, and 12,508 women obtained pregnancy outcomes. They were divided into 2 groups: 2130 subjects with IUD use history (exposure group), and 10,378 subjects without IUD use history (control group). The exposure group will remove the IUD before pregnancy. The primary outcomes were preterm birth (less than 37 weeks of gestation) and early preterm birth (less than 34 weeks of gestation). We used log-binomial regression to estimate adjusted risk ratios (aRR) of preterm birth and early preterm birth for women with a history of IUD. According to the different adjusted baseline data, three regression models were established, and the propensity matching score method was also used to verify the stability of the results.
The delivery rate of women with IUD history was 51.24%, and that of women without IUD was 51.03% ( = 0.063, P = 0.802). Six hundred and eighty-five women had preterm birth (5.48%, 95% CI 5.08-5.88) and 133 women had early preterm birth (1.06%, 95% CI 0.83-1.24). Compared with the control group, the incidence of preterm birth and early preterm birth in the exposure group were significantly lower. The results are stable in all four models. Subgroup analysis also supported the result. This study also found that the longer the women used IUD before pregnancy, the younger the age of first using IUD, and the shorter the time from condom removal to pregnancy, the lower the incidence of premature birth.
The women with a history of IUD use are less likely to have premature birth after the IUD is removed. More prospective studies are needed to confirm it.
探讨宫内节育器（IUD）使用史是否会增加随后早产的风险。
我们对东莞市 24496 名 19-48 岁的经产妇进行了队列研究。每位受试者随访 1 年，12508 名女性获得妊娠结局。她们被分为两组：2130 名有 IUD 使用史的受试者（暴露组）和 10378 名无 IUD 使用史的受试者（对照组）。暴露组将在怀孕前取出 IUD。主要结局是早产（不足 37 周）和早期早产（不足 34 周）。我们使用对数二项回归估计有 IUD 使用史的女性早产和早期早产的调整风险比（aRR）。根据不同的调整基线数据，建立了三个回归模型，并使用倾向评分匹配法验证结果的稳定性。
有 IUD 史的女性分娩率为 51.24%，无 IUD 史的女性为 51.03%（=0.063，P=0.802）。685 名女性发生早产（5.48%，95%CI 5.08-5.88），133 名女性发生早期早产（1.06%，95%CI 0.83-1.24）。与对照组相比，暴露组的早产和早期早产发生率明显较低。四个模型的结果均稳定。亚组分析也支持这一结果。本研究还发现，女性在怀孕前使用 IUD 的时间越长、首次使用 IUD 的年龄越小、从避孕套去除到怀孕的时间越短，早产的发生率越低。
取出 IUD 后，有 IUD 使用史的女性发生早产的可能性较低。需要更多的前瞻性研究来证实这一点。
