Khoury M J, Erickson J D
Birth Defects and Genetic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia 30333.
Paediatr Perinat Epidemiol. 1993 Oct;7(4):404-16. doi: 10.1111/j.1365-3016.1993.tb00422.x.
Stillbirths and spontaneous abortuses have higher rates of birth defects than liveborn infants. The relationship between a woman's previous pregnancy loss and the risk of birth defects in the offspring has not been adequately examined, however. Using data from a population-based case-control study, we assessed whether one or more previous pregnancy loss was associated with increased birth defect risks. Case subjects were 4918 infants with serious births defects diagnosed in the first year of life and ascertained by the Metropolitan Atlanta Congenital Defects Program from 1968 to 1980. Control subjects were 3028 normal liveborn infants frequency-matched to case infants by race, hospital and period of birth. Among case and control infants whose mothers had already had at least one previous pregnancy, reported pregnancy losses (stillbirths and miscarriages) were associated with elevated risks of birth defects (odds ratios for one pregnancy loss of 1.24, two pregnancy losses of 1.49, and three or more pregnancy losses of 1.62, P < 0.0001 for trend). This association held after considering several potential confounders using logistic regression analysis. When specific defects were examined, many exhibited this association, notably hydrocephalus, and some cardiovascular, genital and limb defects. We estimate that the risk of serious birth defects increases from 2.5% for infants of women with no prior pregnancy loss to 4.2% for infants of women with three or more pregnancy losses. This finding has both clinical implications for pregnancy counselling and pathogenetic implications related to birth defect aetiology.
死产和自然流产的出生缺陷发生率高于活产婴儿。然而，女性既往流产与后代出生缺陷风险之间的关系尚未得到充分研究。利用一项基于人群的病例对照研究数据，我们评估了一次或多次既往流产是否与出生缺陷风险增加有关。病例组为1968年至1980年由大亚特兰大先天性缺陷项目确诊的4918例在出生后第一年被诊断出患有严重出生缺陷的婴儿。对照组为3028例正常活产婴儿，根据种族、医院和出生时期与病例组婴儿进行频率匹配。在母亲至少有过一次既往妊娠的病例组和对照组婴儿中，报告的流产（死产和流产）与出生缺陷风险升高有关（一次流产的比值比为1.24，两次流产为1.49，三次或更多次流产为1.62，趋势检验P<0.0001）。在使用逻辑回归分析考虑了几个潜在混杂因素后，这种关联依然存在。当检查特定缺陷时，许多缺陷都表现出这种关联，尤其是脑积水，以及一些心血管、生殖器和肢体缺陷。我们估计，既往无流产的女性所生婴儿严重出生缺陷的风险为2.5%，而有三次或更多次流产的女性所生婴儿的这一风险为4.2%。这一发现对妊娠咨询具有临床意义，对出生缺陷病因学也具有发病机制方面的意义。
