Leslie P W, Campbell K L, Little M A
Department of Anthropology, University of North Carolina, Chapel Hill 27599-3115.
Hum Biol. 1993 Apr;65(2):237-54.
There have been few investigations of intrauterine mortality in non-Western populations that have used techniques capable of detecting early pregnancy loss. We report here the initial results of a prospective study of fetal loss among the Turkana of northwest Kenya. Over 300 nomadic and settled women provided early morning urine samples for 3 consecutive days. Chorionic gonadotropin (hCG), a marker for pregnancy, and markers of ovarian cyclicity (LH, PdG) were determined with solid-phase enzyme immunoassays. Pregnancy was detected in 11% of nomadic women and in 22% of sedentary women of reproductive age. Follow-up surveys revealed that 45% of all pregnancies among settled women were lost; nearly 70% of pregnancies detected in the first trimester were lost. In contrast, none of the nomadic women experienced fetal loss. Because of the small sample sizes, these results must be interpreted cautiously. Nevertheless, even a conservative estimate of the fetal loss rate among the settled women is high compared with Western experience. Anthropometric data suggest that nutritional stress may contribute to the difference between the two populations. There is also some indication that risk of fetal loss in the settled population is associated with parity. The high rate of loss among the settled women along with the difference between the nomadic and settled samples supports the contentions that there may be substantial variation among populations in intrauterine mortality and that the contribution of fetal loss to fertility differences among populations may be more important than has been suspected.
在非西方人群中，很少有研究使用能够检测早期妊娠丢失的技术来调查宫内死亡率。我们在此报告肯尼亚西北部图尔卡纳人胎儿丢失前瞻性研究的初步结果。300多名游牧和定居妇女连续3天提供晨尿样本。使用固相酶免疫测定法测定妊娠标志物绒毛膜促性腺激素（hCG）以及卵巢周期性标志物（LH、PdG）。在育龄游牧妇女中，11%检测出怀孕；在育龄定居妇女中，22%检测出怀孕。随访调查显示，定居妇女中所有妊娠的45%丢失；在孕早期检测出的妊娠中，近70%丢失。相比之下，游牧妇女中没有出现胎儿丢失情况。由于样本量较小，这些结果必须谨慎解读。然而，即使对定居妇女胎儿丢失率进行保守估计，与西方的情况相比也很高。人体测量数据表明，营养压力可能是导致这两个人群差异的原因。也有一些迹象表明，定居人群中胎儿丢失的风险与产次有关。定居妇女的高丢失率以及游牧和定居样本之间的差异支持了以下观点：不同人群之间的宫内死亡率可能存在很大差异，并且胎儿丢失对人群生育率差异的影响可能比人们怀疑的更为重要。
