Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.
BJOG. 2024 Jan;131(2):175-188. doi: 10.1111/1471-0528.17623. Epub 2023 Jul 31.
To investigate the association between vaginal bleeding (VB) in pregnancy and women's mortality, using VB-unaffected pregnancies, terminations and miscarriages as comparators.
Observational cohort study.
Nationwide registries of Denmark linked at an individual level.
1 354 181 women and their 3 162 317 pregnancies (1979-2017), including 70 835 VB-affected pregnancies and comparators: 2 236 359 VB-unaffected pregnancies ending in childbirth; 589 697 terminations; and 265 426 miscarriages.
We followed pregnancies until the earliest date of woman's death, emigration or end of data.
All-cause and cause-specific mortality rates per 10 000 person-years (PY) and hazard ratios (HRs) with 95% confidence intervals (CIs) adjusted using Cox proportional hazards regression for age, calendar year, pre-existing chronic conditions and socio-economic factors.
There were 2320 deaths from any cause among women following VB-affected pregnancy (mortality rate 15.2, 95% CI 14.6-15.9 per 10 000 PY); 55 030 deaths following VB-unaffected pregnancy (mortality rate 12.7, 95% CI 12.6-12.8); 27 500 deaths following a termination (mortality rate 21.9, 95% CI 21.6-22.1), and 10 865 deaths following a miscarriage (mortality rate 19.2, 95% CI 18.8-19.6). For comparison of VB-affected versus VB-unaffected pregnancies, associations with all-cause (HR 1.14, 95% CI 1.09-1.19), natural causes (HR 1.15, 95% CI 1.09-1.22) and non-natural causes (HR 1.27, 95% CI 1.08-1.48) mortality were attenuated in a sensitivity analysis of pregnancies recorded in 1994-2017 (HR 1.00, 95% CI 0.90-1.12, HR 0.98, 95% CI 0.85-1.14 and HR 1.04, 95% CI 0.72-1.51, respectively). Contrasts with remaining comparators did not suggest increased risks of all-cause, natural or non-natural mortality causes.
We found no evidence of an increased risk of women's mortality following VB-affected versus VB-unaffected pregnancy, termination or miscarriage.
通过比较妊娠阴道出血（VB）和非 VB 妊娠、终止妊娠和自然流产，研究 VB 对妊娠女性死亡率的影响。
观察性队列研究。
丹麦全国性注册中心，个体层面数据相互关联。
1354181 名女性及其 3162317 次妊娠（1979-2017 年），包括 70835 次 VB 相关妊娠和对照组：2236359 次 VB 非相关妊娠分娩；589697 次终止妊娠；265426 次自然流产。
我们随访妊娠情况直至女性死亡、移民或数据截止日期。
每 10000 人年（PY）的全因死亡率和特定原因死亡率（PY）和风险比（HR），使用 Cox 比例风险回归校正年龄、日历年份、既往慢性疾病和社会经济因素。
VB 相关妊娠后有 2320 名女性死亡（死亡率 15.2，95%CI 14.6-15.9/10000PY）；VB 非相关妊娠后有 55030 名女性死亡（死亡率 12.7，95%CI 12.6-12.8/10000PY）；终止妊娠后有 27500 名女性死亡（死亡率 21.9，95%CI 21.6-22.1/10000PY）；自然流产后有 10865 名女性死亡（死亡率 19.2，95%CI 18.8-19.6/10000PY）。相比 VB 相关妊娠与 VB 非相关妊娠，全因（HR 1.14，95%CI 1.09-1.19）、自然原因（HR 1.15，95%CI 1.09-1.22）和非自然原因（HR 1.27，95%CI 1.08-1.48）的死亡率差异在仅纳入 1994-2017 年记录妊娠的敏感性分析中减弱（HR 1.00，95%CI 0.90-1.12，HR 0.98，95%CI 0.85-1.14，HR 1.04，95%CI 0.72-1.51）。与其余对照组相比，全因、自然或非自然死亡原因均未见风险增加。
我们未发现 VB 相关妊娠与 VB 非相关妊娠、终止妊娠或自然流产后女性死亡率增加的证据。
