Curtin School of Population Health, Curtin University, Perth, Western Australia, Australia.
School of Public Health, University of Adelaide, Adelaide, South Australia, Australia.
BJOG. 2022 Oct;129(11):1853-1861. doi: 10.1111/1471-0528.17223. Epub 2022 Jun 1.
To investigate whether intervening miscarriages and induced abortions impact the associations between interpregnancy interval after a live birth and adverse pregnancy outcomes.
Population-based cohort study.
Norway.
A total of 165 617 births to 143 916 women between 2008 and 2016.
We estimated adjusted relative risks for adverse pregnancy outcomes using log-binomial regression, first ignoring miscarriages and induced abortions in the interpregnancy interval estimation (conventional interpregnancy interval estimates) and subsequently accounting for intervening miscarriages or induced abortions (correct interpregnancy interval estimates). We then calculated the ratio of the two relative risks (ratio of ratios, RoR) as a measure of the difference.
The proportion of short interpregnancy interval (<6 months) was 4.0% in the conventional interpregnancy interval estimate and slightly increased to 4.6% in the correct interpregnancy interval estimate. For interpregnancy interval <6 months, compared with 18-23 months, the RoR was 0.97 for preterm birth (PTB) (95% confidence interval [CI] 0.83-1.13), 0.97 for spontaneous PTB ( 95% CI 0.80-1.19), 1.00 for small-for-gestational age ( 95% CI 0.86-1.14), 1.00 for large-for-gestational age (95% CI 0.90-1.10) and 0.99 for pre-eclampsia (95% CI 0.71-1.37). Similarly, conventional and correct interpregnancy intervals yielded associations of similar magnitude between long interpregnancy interval (≥60 months) and the pregnancy outcomes evaluated.
Not considering intervening pregnancy loss due to miscarriages or induced abortions, results in negligible difference in the associations between short and long interpregnancy intervals and adverse pregnancy outcomes.
Not considering pregnancy loss in interpregnancy interval estimation resulted no meaningful differences in observed risks of adverse pregnancy outcomes.
探讨干预性流产和人工流产是否会影响活产后的妊娠间隔与不良妊娠结局之间的关联。
基于人群的队列研究。
挪威。
2008 年至 2016 年期间，143916 名妇女的 165617 例活产。
采用对数二项式回归估计不良妊娠结局的校正相对风险，首先忽略妊娠间隔内的流产和人工流产（常规妊娠间隔估计），然后考虑到介入性流产或人工流产（正确的妊娠间隔估计）。然后计算这两个相对风险的比值（比值比，RoR）作为差异的衡量标准。
常规妊娠间隔估计中，短妊娠间隔（<6 个月）的比例为 4.0%，在正确的妊娠间隔估计中略增至 4.6%。对于妊娠间隔<6 个月，与 18-23 个月相比，早产（PTB）的 RoR 为 0.97（95%置信区间[CI]为 0.83-1.13），自发性早产（PTB）的 RoR 为 0.97（95% CI 为 0.80-1.19），小于胎龄儿（SGA）的 RoR 为 1.00（95% CI 为 0.86-1.14），大于胎龄儿（LGA）的 RoR 为 1.00（95% CI 为 0.90-1.10），子痫前期的 RoR 为 0.99（95% CI 为 0.71-1.37）。同样，常规和正确的妊娠间隔对长妊娠间隔（≥60 个月）与评估的妊娠结局之间的关联产生了相似程度的关联。
不考虑流产或人工流产引起的妊娠丢失，在短妊娠间隔和长妊娠间隔与不良妊娠结局之间的关联中，结果没有明显差异。
在妊娠间隔估计中不考虑妊娠丢失，观察到的不良妊娠结局风险没有明显差异。
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