Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China.
JAMA Netw Open. 2022 Mar 1;5(3):e220944. doi: 10.1001/jamanetworkopen.2022.0944.
Gestational diabetes (GD) is one of the most common and important complications of pregnancy. Identifying pregnant women who are at high risk of GD is crucial for implementing early prevention and intervention.
To examine whether a history of spontaneous abortion (SAB) or induced abortion is associated with increased risk of GD in subsequent pregnancies.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study was conducted at a tertiary hospital in Shanghai, China. Pregnant women who received routine antenatal care between January 2014 and December 2019 were included. Data analysis was performed from December 2020 to June 2021.
Maternal history of abortion, including SAB and induced abortion, were extracted from medical records.
GD was diagnosed with a 75-g diagnostic oral glucose tolerance test. A multivariable-adjusted log-binomial analysis was used to estimate relative risks (RRs) and 95% CIs of GD associated with history of abortion.
Among the 102 259 included pregnant women (mean [SD] age, 29.8 [3.8] years), 14 579 (14.3%) experienced only SAB, 17 935 (17.5%) experienced only induced abortion, and 4017 (3.9%) experienced both SAB and induced abortion. A total of 12 153 GD cases were identified, and the prevalence of GD was 11.9% (12 153 of 102 259 women) in this cohort. Pregnant women who experienced only SAB (RR, 1.25; 95% CI, 1.18-1.31) or both SAB and induced abortion (RR, 1.15; 95% CI, 1.05-1.27) were at higher risk of developing GD. The association of SAB history with GD occurred in a number-dependent manner. Compared with pregnant women with no history of abortion, the RR for GD increased by 18% (RR, 1.18; 95% CI, 1.11-1.26) for pregnant women with 1 SAB, by 41% (RR, 1.41; 95% CI, 1.27-1.57) for those with 2 SABs, and by 43% (RR, 1.43; 95% CI, 1.22-1.67) for those more than 2 SABs. However, no association between history of induced abortion and GD was observed.
This study found that a history of SAB was associated with increased risk of GD in subsequent pregnancies. Further research is needed to clarify this association and explore the potential biological mechanisms underlying the association.
妊娠糖尿病（gestational diabetes，GD）是妊娠期间最常见和最重要的并发症之一。识别出患有 GD 风险较高的孕妇对于实施早期预防和干预至关重要。
探讨自然流产（spontaneous abortion，SAB）或人工流产史是否与随后妊娠中 GD 的风险增加相关。
设计、地点和参与者：这是一项在中国上海一家三级医院进行的回顾性队列研究。纳入 2014 年 1 月至 2019 年 12 月期间接受常规产前检查的孕妇。数据分析于 2020 年 12 月至 2021 年 6 月进行。
从病历中提取了母亲的流产史，包括 SAB 和人工流产。
通过 75g 口服葡萄糖耐量试验诊断 GD。使用多变量调整的对数二项式分析来估计与流产史相关的 GD 的相对风险（RR）和 95%置信区间（CI）。
在纳入的 102259 名孕妇（平均[标准差]年龄，29.8[3.8]岁）中，14579 名（14.3%）仅经历 SAB，17935 名（17.5%）仅经历人工流产，4017 名（3.9%）同时经历 SAB 和人工流产。共发现 12153 例 GD 病例，该队列中 GD 的患病率为 11.9%（12153 例/102259 例女性）。仅经历 SAB（RR，1.25；95%CI，1.18-1.31）或同时经历 SAB 和人工流产（RR，1.15；95%CI，1.05-1.27）的孕妇发生 GD 的风险更高。SAB 史与 GD 之间的关联呈数量依赖性。与无流产史的孕妇相比，有 1 次 SAB 的孕妇 GD 的 RR 增加 18%（RR，1.18；95%CI，1.11-1.26），有 2 次 SAB 的 RR 增加 41%（RR，1.41；95%CI，1.27-1.57），有 3 次或以上 SAB 的 RR 增加 43%（RR，1.43；95%CI，1.22-1.67）。然而，没有观察到人工流产史与 GD 之间的关联。
本研究发现 SAB 史与随后妊娠中 GD 的风险增加相关。需要进一步研究来阐明这种关联，并探讨关联背后的潜在生物学机制。
