Fang Tingfeng, Ji Xiaohui, Su Ziyang, Zhang Ao, Zhu Liqiong, Tang Jing, Mai Zhuoyao, Lin Haiyan, Ouyang Nengyong, Chen Hui
Department of Obstetrics & Gynecology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
Guangdong Provincial Clinical Research Center for Obstetrical and Gynecological Diseases, Guangzhou, China.
BMC Pregnancy Childbirth. 2024 Dec 19;24(1):827. doi: 10.1186/s12884-024-07048-z.
The treatment for recurrent pregnancy loss (RPL) has been addressed in international guidelines. However, limited studies have investigated the risk factors associated with pregnancy and live birth outcomes in patients with RPL after treatment. The objective of this study was to offer a comprehensive assessment of the risk factors for pregnancy loss in patients with a history of RPL following therapeutic interventions.
This retrospective cohort study involved 431 women in early pregnancy with a history of RPL who experienced treatment at the Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, between June 2018 and June 2020. The main outcome measures were the ongoing pregnancy ≥ 12 weeks and the live birth outcomes. Univariate and multivariate logistic regression analyses were conducted to identify the risk factors for pregnancy loss < 12 weeks and live birth outcomes.
Patient's age and the prevalence of uterine malformations were significantly different between the patients with and without ongoing pregnancy ≥ 12 weeks (32.64 ± 5.08 vs. 31.54 ± 4.34, P = 0.026; 34.70% vs. 24.60%, P = 0.035). The risk of pregnancy loss < 12 weeks was significantly increased with age and those with uterine abnormalities (adjusted OR: 1.48 [95% CI: 1.05 to 2.07], P = 0.025; adjusted OR:1.78 [95% CI 1.11 to 2.79], P = 0.016). The risk of non-live birth was significantly increased in couples with parental karyotype abnormalities (adjusted OR: 0.08 [95% CI 0.01 to 0.76], P = 0.029). No statistically significant differences were found between the patients with and without ongoing pregnancy ≥ 12 weeks and live birth regarding number of miscarriages, BMI, thyroid stimulating hormone, thyroid peroxidase antibody, thyroglobulin antibody, homa insulin-resistance, parental karyotype abnormality, B lymphocyte, NK cells, antinuclear antibody, antithrombin III activity, platelet aggregation function, anticardiolipin antibody, lupus anticoagulant, homocysteine, protein C, protein S, anti-β2 glycoprotein antibody, anti-phosphatidylserine and thromboelastograms.
In patients with RPL after treatment, age and uterine anomalies were identified as risk factors linked to pregnancy loss < 12 weeks, while parental karyotype abnormalities were recognized as an independent risk factor affecting live birth outcomes.
Not applicable.
国际指南中已提及复发性流产（RPL）的治疗方法。然而，针对接受治疗后的RPL患者，与妊娠及活产结局相关的危险因素的研究较少。本研究的目的是全面评估接受治疗性干预后有RPL病史患者的流产危险因素。
这项回顾性队列研究纳入了2018年6月至2020年6月期间在中山大学孙逸仙纪念医院妇产科接受治疗的431例有RPL病史的早孕女性。主要观察指标为持续妊娠≥12周和活产结局。进行单因素和多因素逻辑回归分析，以确定妊娠<12周流产和活产结局的危险因素。
妊娠≥12周和未妊娠的患者之间，患者年龄和子宫畸形患病率存在显著差异（32.64±5.08 vs. 31.54±4.34，P = 0.026；34.70% vs. 24.60%，P = 0.035）。妊娠<12周的流产风险随年龄和子宫异常情况显著增加（调整后的OR：1.48 [95% CI：1.05至2.07]，P = 0.025；调整后的OR：1.78 [95% CI 1.11至2.79]，P = 0.016）。父母核型异常的夫妇中，非活产风险显著增加（调整后的OR：0.08 [95% CI 0.01至0.76]，P = 0.029）。妊娠≥12周和未妊娠的患者之间，以及活产患者与未活产患者之间，在流产次数、BMI、促甲状腺激素、甲状腺过氧化物酶抗体、甲状腺球蛋白抗体、稳态模型胰岛素抵抗、父母核型异常、B淋巴细胞、NK细胞、抗核抗体、抗凝血酶III活性、血小板聚集功能、抗心磷脂抗体、狼疮抗凝物、同型半胱氨酸、蛋白C、蛋白S、抗β2糖蛋白抗体、抗磷脂酰丝氨酸和血栓弹力图方面，未发现统计学显著差异。
在接受治疗后的RPL患者中，年龄和子宫异常被确定为与妊娠<12周流产相关的危险因素，而父母核型异常被认为是影响活产结局的独立危险因素。
不适用。
