一次晚期流产史对后续妊娠结局的影响：一项超过 10 年的回顾性队列研究。

Impact of a previous late miscarriage on subsequent pregnancy outcomes: A retrospective cohort study over 10 years.

机构信息

Center for Reproductive Medicine, Shandong University, Jinan, Shandong, China.

Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, China.

出版信息

Int J Gynaecol Obstet. 2023 Nov;163(2):610-617. doi: 10.1002/ijgo.14862. Epub 2023 May 20.

DOI:10.1002/ijgo.14862

PMID:37208989

Abstract

OBJECTIVE

To explore the prognostic impact of a previous late miscarriage (LM) on the subsequent pregnancy outcomes of women with infertility.

METHOD

This retrospective cohort study included couples who had experienced LM following their first embryo transfer during an in vitro fertilization (IVF) cycle from January 2008 to December 2020. Subgroup analysis and binary logistic regression were performed to evaluate the associations between LM due to different causes and subsequent pregnancy outcomes.

RESULTS

A total of 1072 women who had experienced LM were included in this study, comprising 458, 146, 412, and 56 women with LM due to unexplained factors (unLM), fetal factors (feLM), cervical factors (ceLM; i.e. cervical incompetence), and trauma factors (trLM), respectively. Compared with the general IVF (gIVF) population, the early miscarriage rate was significantly higher in the unLM group (8.28% vs. 13.47%, adjusted odds ratio [OR] 1.60, 95% confidence interval [95% CI] 1.12-2.28; P = 0.01). Furthermore, women in the unLM and ceLM groups had a dramatically increased risk of recurrent LM (unLM: 4.24% vs. 9.43%, aOR 1.91, 95% CI 1.24-2.94; P = 0.003; ceLM: 4.24% vs.15.53%, aOR 2.68, 95% CI 1.82-3.95; P < 0.001) and consequently a reduced frequency of live birth (unLM: 49.96% vs. 43.01%, aOR 0.75, 95% CI 0.61-0.91; P = 0.004; ceLM: 49.96% vs. 38.59%, aOR 0.61, 95% CI 0.49-0.77; P < 0.001) compared with the gIVF population.

CONCLUSION

A previous LM due to an unexplained factor or cervical incompetence was significantly associated with a higher risk of miscarriage and a lower live birth rate after subsequent embryo transfer.

摘要

目的

探讨既往晚期流产（LM）对不孕妇女后续妊娠结局的影响。

方法

本回顾性队列研究纳入了 2008 年 1 月至 2020 年 12 月期间，在体外受精（IVF）周期中首次胚胎移植后发生 LM 的夫妇。通过亚组分析和二项逻辑回归评估了不同原因引起的 LM 与后续妊娠结局之间的关系。

结果

共有 1072 名发生 LM 的妇女纳入本研究，其中 458、146、412 和 56 名妇女分别因不明原因（unLM）、胎儿因素（feLM）、宫颈因素（ceLM，即宫颈机能不全）和创伤因素（trLM）导致 LM。与普通 IVF（gIVF）人群相比，unLM 组的早期流产率明显更高（8.28%比 13.47%，调整后优势比[OR] 1.60，95%置信区间[95%CI] 1.12-2.28；P=0.01）。此外，unLM 和 ceLM 组妇女再次发生 LM 的风险显著增加（unLM：4.24%比 9.43%，aOR 1.91，95%CI 1.24-2.94；P=0.003；ceLM：4.24%比 15.53%，aOR 2.68，95%CI 1.82-3.95；P<0.001），活产率降低（unLM：49.96%比 43.01%，aOR 0.75，95%CI 0.61-0.91；P=0.004；ceLM：49.96%比 38.59%，aOR 0.61，95%CI 0.49-0.77；P<0.001）。