生育状况、分娩方式与长期妇科健康：澳大利亚妇女健康纵向研究队列中经产妇和未产妇的随访研究

Parity, mode of birth, and long-term gynecological health: A follow-up study of parous and nonparous women in the Australian Longitudinal Study on Women's Health cohort.

作者信息

Nohr Ellen A, Taastrøm Katja A, Kjeldsen Anne Cathrine M, Wu Chunsen, Pedersen Frank Henning, Brown Wendy J, Davis Deborah L

机构信息

Department of Clinical Research, Research Unit of Obstetrics and Gynaecology, University of Southern Denmark, Odense, Denmark.

Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark.

出版信息

Birth. 2024 Mar;51(1):198-208. doi: 10.1111/birt.12781. Epub 2023 Oct 17.

DOI:10.1111/birt.12781

PMID:37849409

Abstract

BACKGROUND

Although gynecological health issues are common and cause considerable distress, little is known about their causes. We examined how birth history is associated with urinary incontinence (UI), severe period pain, heavy periods, and endometriosis.

METHODS

We studied 7700 women in the Australian Longitudinal Study on Women's Health with an average follow-up of 10.9 years after their last birth. Surveys every third year provided information about birth history and gynecological health. Logistic regression was used to estimate how parity, mode of birth, and vaginal tears were associated with gynecological health issues. Presented results are adjusted odds ratios (OR) with 95% confidence intervals.

RESULTS

UI was reported by 16%, heavy periods by 31%, severe period pain by 28%, and endometriosis by 4%. Compared with women with two children, nonparous women had less UI (OR 0.35 [0.26-0.47]) but tended to have more endometriosis (OR 1.70 [0.97-2.96]). Also, women with only one child had less UI (OR 0.77 [0.61-0.98]), but more severe period pain (OR 1.24 [1.01-1.51]). Women with 4+ children had more heavy periods (OR 1.42 [1.07-1.88]). Compared with women with vaginal birth(s) only, women with only cesarean sections or vaginal birth after cesarean section had less UI (ORs 0.44 [0.34-0.58] and 0.55 [0.40-0.76]), but more endometriosis (ORs 1.91 [1.16-3.16] and 2.31 [1.25-4.28]) and heavy periods (ORs 1.21 [1.00-1.46] and 1.35 [1.06-1.72]). Vaginal tear(s) did not increase UI after accounting for parity and birth mode.

CONCLUSION

While women with vaginal childbirth(s) reported more urinary incontinence, they had less menstrual complaints and endometriosis.

摘要

背景

尽管妇科健康问题很常见且会造成相当大的困扰，但对其病因却知之甚少。我们研究了生育史与尿失禁（UI）、严重痛经、月经过多和子宫内膜异位症之间的关联。

方法

我们在澳大利亚女性健康纵向研究中对7700名女性进行了研究，自她们最后一次生育后平均随访10.9年。每三年进行一次调查，提供有关生育史和妇科健康的信息。采用逻辑回归来估计产次、分娩方式和阴道撕裂与妇科健康问题之间的关联。呈现的结果是调整后的优势比（OR）及95%置信区间。

结果

报告有尿失禁的女性占16%，月经过多的占31%，严重痛经的占28%，子宫内膜异位症的占4%。与有两个孩子的女性相比，未生育的女性尿失禁较少（OR 0.35 [0.26 - 0.47]），但子宫内膜异位症的发生率往往较高（OR 1.70 [0.97 - 2.96]）。此外，只有一个孩子的女性尿失禁较少（OR 0.77 [0.61 - 0.98]），但严重痛经较多（OR 1.24 [1.01 - 1.51]）。有4个及以上孩子的女性月经过多的情况较多（OR 1.42 [1.07 - 1.88]）。与仅经阴道分娩的女性相比，仅行剖宫产或剖宫产术后经阴道分娩的女性尿失禁较少（OR分别为0.44 [0.34 - 0.58]和0.55 [0.40 - 0.76]），但子宫内膜异位症（OR分别为1.91 [1.16 - 3.16]和2.31 [1.25 - 4.28]）和月经过多（OR分别为1.21 [1.00 - 1.46]和1.35 [1.06 - 1.72]）的发生率较高。在考虑产次和分娩方式后，阴道撕裂并未增加尿失禁的发生率。