Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.
Department of Pediatrics, Mikkeli Central Hospital, Mikkeli, Finland.
BMC Pregnancy Childbirth. 2023 Apr 4;23(1):228. doi: 10.1186/s12884-023-05539-z.
There is a paucity of information regarding the association between traumatic brain injuries (TBIs) and subsequent multifetal gestations. Since TBIs are known to negatively affect the neuroendocrine system, we hypothesized that the functions of the whole reproductive system might be disturbed as a result. The aim of this study is to determine the association between previous TBIs and the risk of multifetal gestations using nationwide registers.
In this retrospective register-based cohort study, data from the National Medical Birth Register (MBR) were combined with data from the Care Register for Health Care. All fertile-aged women (15-49 years) who had sustained a TBI before pregnancy were included in the patient group. Women with prior fractures of the upper extremity, pelvis, and lower extremity were included in the control group. A logistic regression model was used to assess the risk for multifetal gestation after TBI. Odds ratios (ORs) and adjusted odds ratios (aOR) with 95% confidence intervals (CIs) between the groups were compared. The model was adjusted by maternal age and maternal BMI during pregnancy and previous births. The risk for multifetal gestations were evaluated during different periods following the injury (0-3 years, 3-6 years, 6-9 years, and 9 + years).
A total of 14 153 pregnancies occurred after the mother had sustained a TBI, and 23 216 pregnancies occurred after the mother had sustained fractures of the upper extremity, pelvis, or lower extremity. Of these, 201 (1.4%) women had multifetal gestations after TBI and 331 (1.4%) women had multifetal gestations after fractures of the upper extremity, pelvis, or lower extremity. Interestingly, the total odds of multifetal gestations were not higher after TBI when compared to fractures of the upper extremity, pelvis, and lower extremity (aOR 1.04, CI 0.86-1.24). The odds were highest at 6-9 years (aOR 1.54, 1.03-2.29) and lowest at 0-3 years (aOR 0.84, CI 0.59-1.18).
The risk for multifetal gestations after TBIs was not higher than after the other traumas included in this study. Our results provide good baseline information on the effects of TBIs on the risk for multifetal gestations, but further research is required on this topic.
关于创伤性脑损伤（TBI）与随后的多胎妊娠之间的关联，信息十分匮乏。由于 TBI 已知会对神经内分泌系统产生负面影响，我们假设整个生殖系统的功能可能会受到干扰。本研究旨在通过全国性登记册确定先前 TBI 与多胎妊娠风险之间的关联。
在这项回顾性基于登记的队列研究中，将国家围产儿登记册（MBR）的数据与来自医疗保健登记册的数据相结合。所有在妊娠前发生过 TBI 的育龄妇女（15-49 岁）均被纳入患者组。上肢、骨盆和下肢骨折的妇女被纳入对照组。使用逻辑回归模型评估 TBI 后多胎妊娠的风险。比较两组之间的比值比（OR）和调整后的比值比（aOR）及 95%置信区间（CI）。该模型通过产妇年龄和妊娠期间的 BMI 以及既往分娩进行了调整。评估了受伤后不同时期（0-3 年、3-6 年、6-9 年和 9+年）多胎妊娠的风险。
共有 14153 例妊娠发生在母亲发生 TBI 之后，23216 例妊娠发生在母亲发生上肢、骨盆或下肢骨折之后。其中，201 例（1.4%）妇女在 TBI 后发生多胎妊娠，331 例（1.4%）妇女在上肢、骨盆或下肢骨折后发生多胎妊娠。有趣的是，与上肢、骨盆和下肢骨折相比，TBI 后多胎妊娠的总几率并没有更高（aOR 1.04，CI 0.86-1.24）。6-9 年时的几率最高（aOR 1.54，CI 1.03-2.29），0-3 年时的几率最低（aOR 0.84，CI 0.59-1.18）。
TBI 后多胎妊娠的风险并不高于本研究纳入的其他创伤。我们的结果为 TBI 对多胎妊娠风险的影响提供了良好的基线信息，但需要进一步研究这一课题。
