出生时婴儿的性别与长期产妇死亡率。
Infant sex at birth and long-term maternal mortality.
机构信息
Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.
Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
出版信息
Paediatr Perinat Epidemiol. 2023 Mar;37(3):229-238. doi: 10.1111/ppe.12933. Epub 2023 Jan 5.
BACKGROUND
Maternal adaptations may vary by foetal sex. Whether male infants influence long-term mortality in mothers remains uncertain.
OBJECTIVE
The objective of the study was to examine whether male infants increase the risk of maternal mortality.
METHODS
This study included pregnant women enrolled at 12 US sites from 1959 to 1966 in the Collaborative Perinatal Project (CPP). Collaborative Perinatal Project records were linked to the National Death Index and the Social Security Master Death File to ascertain deaths until 2016. Foetal sex was determined by infant sex at birth, defined as the total number of male or female infants in pregnancies prior to or during enrolment in the CPP. In secondary analyses, exposure was defined as infant sex at the last CPP delivery. Outcomes included all-cause and underlying causes of mortality. We used Cox proportional hazards models weighted by the number of prior live births and stratified our models by parity and race/ethnicity.
RESULTS
Among 48,188 women, 50.8% had a male infant at their last registered CPP pregnancy and 39.0% had a recorded death after a mean follow-up of 47.8 years (SD 10.5 years). No linear association was found between the number of liveborn males and all-cause mortality (primipara women: HR 1.02, 95% CI 0.95, 1.09, multipara women, 1 prior live birth: HR 0.96, 95% CI 0.89, 1.03, multipara women, ≥2 prior live births: HR 0.97, 95% CI 0.85, 1.11). A similar trend was noted for cardiovascular- and cancer-related mortality. At the last delivery, women with a male infant did not have an increased risk of all-cause or cause-specific mortality compared to women with a female infant. These findings were consistent across racial/ethnic groups.
CONCLUSIONS
Women who give birth to male infants, regardless of number, are not at increased risk of all-cause and cause-specific mortality. These findings suggest that giving birth to male infants may not independently influence the long-term health of women.
背景
母体适应可能因胎儿性别而异。男性婴儿是否会增加母亲的长期死亡率尚不确定。
目的
本研究旨在探讨男性婴儿是否会增加产妇死亡的风险。
方法
本研究纳入了 1959 年至 1966 年期间在美国 12 个地点参加协作围产期项目（CPP）的孕妇。通过婴儿性别在出生时确定胎儿性别，定义为 CPP 之前或期间妊娠中男性或女性婴儿的总数。在二次分析中，暴露定义为最后一次 CPP 分娩时的婴儿性别。结局包括全因死亡率和根本死因死亡率。我们使用 Cox 比例风险模型，根据之前的活产数进行加权，并按产次和种族/民族分层模型。
结果
在 48188 名女性中，50.8%的人在最后一次 CPP 妊娠中有男性婴儿，39.0%的人在平均随访 47.8 年后（SD 10.5 年）记录到死亡。没有发现活产男性数量与全因死亡率之间存在线性关联（初产妇：HR 1.02，95%CI 0.95，1.09；经产妇女：有 1 次活产：HR 0.96，95%CI 0.89，1.03；经产妇女：有≥2 次活产：HR 0.97，95%CI 0.85，1.11）。心血管疾病和癌症相关死亡率也呈现出类似的趋势。在最后一次分娩时，与女性婴儿相比，男性婴儿的母亲全因和特定原因死亡率没有增加。这些发现在不同种族/民族群体中是一致的。
结论
无论数量多少，分娩男性婴儿的女性并不面临全因和特定原因死亡率增加的风险。这些发现表明，分娩男性婴儿可能不会独立影响女性的长期健康。
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