Abortion, changed paternity, and risk of preeclampsia in nulliparous women.
Abortion, changed paternity, and risk of preeclampsia in nulliparous women.
复制标题
未产妇的流产、父亲身份变更和先兆子痫的风险。
DOI：
10.1093/aje/kwg101
复制
发表时间：
2003
影响因子：
5
通讯作者：
Sibai,BahaM
中科院分区：
文献类型：
--
作者：
Saftlas,AudreyF;Levine,RichardJ;Klebanoff,MarkA;Martz,KarenL;Ewell,MarianG;Morris,CynthiaD;Sibai,BahaM
先前的分娩赋予对先兆子痫的强保护作用，而先前的堕胎赋予较弱的保护作用。在随后的怀孕中改变伴侣的经产妇女似乎失去了前一次分娩的保护作用。这项研究（钙用于先兆子痫预防试验，1992-1995年）探讨了以前流产过的未经产妇女在更换伴侣后是否也失去了以前怀孕的保护作用。在这项大型补钙预防先兆子痫临床试验的参与者中进行了队列分析。受试者未经产，既往妊娠一次或更少，妊娠20周后分娩，并在5-21周时接受有关既往妊娠和亲子关系的采访。无流产史的妇女作为Logistic回归分析的参照组。有流产史的妇女与同一伴侣再次怀孕，患先兆子痫的风险接近一半（调整后的比值比= 0.54，95%置信区间：0.31，0.97）。相比之下，与新伴侣一起怀孕的有堕胎史的妇女与没有堕胎史的妇女有相同的先兆子痫风险（调整后的比值比= 1.03，95%置信区间：0.72，1.47）。因此，以前堕胎的保护作用只在与同一伴侣再次怀孕的妇女中起作用。提出了一种基于免疫的病因学机制，即长期暴露于前一次妊娠的胎儿抗原可在随后的同一父亲妊娠中预防先兆子痫。
A prior birth confers a strong protective effect against preeclampsia, whereas a prior abortion confers a weaker protective effect. Parous women who change partners in a subsequent pregnancy appear to lose the protective effect of a prior birth. This study (Calcium for Preeclampsia Prevention Trial, 1992–1995) examines whether nulliparous women with a prior abortion who change partners also lose the protective effect of the prior pregnancy. A cohort analysis was conducted among participants in this large clinical trial of calcium supplementation to prevent preeclampsia. Subjects were nulliparous, had one prior pregnancy or less, delivered after 20 weeks’ gestation, and were interviewed at 5–21 weeks about prior pregnancies and paternity. Women without a history of abortion served as the reference group in logistic regression analyses. Women with a history of abortion who conceived again with the same partner had nearly half the risk of preeclampsia (adjusted odds ratio = 0.54, 95 percent confidence interval: 0.31, 0.97). In contrast, women with an abortion history who conceived with a new partner had the same risk of preeclampsia as women without a history of abortion (adjusted odds ratio = 1.03, 95 percent confidence interval: 0.72, 1.47). Thus, the protective effect of a prior abortion operated only among women who conceived again with the same partner. An immune-based etiologic mechanism is proposed, whereby prolonged exposure to fetal antigens from a previous pregnancy protects against preeclampsia in a subsequent pregnancy with the same father.