Trying to Conceive After an Early Pregnancy Loss: An Assessment on How Long Couples Should Wait.
Trying to Conceive After an Early Pregnancy Loss: An Assessment on How Long Couples Should Wait.
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DOI：
10.1097/aog.0000000000001159
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发表时间：
2016-02
影响因子：
7.2
通讯作者：
Schisterman EF
中科院分区：
文献类型：
--
作者：
Schliep KC;Mitchell EM;Mumford SL;Radin RG;Zarek SM;Sjaarda L;Schisterman EF
比较妊娠丢失日期间隔不同的夫妇与随后尝试受孕的夫妇之间的怀孕和活产时间。在阿司匹林对妊娠和生殖的影响的二次分析试验中，纳入了1083名年龄在18-40岁、有1-2次早期丢失、最后一次怀孕结局为非异位或非磨牙丢失的妇女。参与者被积极跟踪长达六个月经周期，对于怀孕的妇女，直到怀孕结果。我们计算的间隔时间为尝试受孕的开始日期减去妊娠丢失日期。怀孕时间被定义为开始尝试怀孕，直到下一次怀孕。离散COX模型考虑了左截断和右截尾，估计了根据年龄、种族、体重指数、教育程度和亚生育水平进行调整的受精率优势比(OR)。虽然在随机化之前评估了间隔时间，因此认为与治疗分配无关，但考虑到先前证明小剂量阿司匹林可以预测怀孕时间，对治疗的额外调整进行了评估。间隔0-3个月的夫妇(n=765[76.7%])与间隔3个月的夫妇(n=233[23.4%])相比，更有可能实现活产(53.2%比36.1%)，而且怀孕至活产的时间显著缩短(中位数(IQR)5个周期，调整后受精性OR：1.71[95%CI：1.30，2.25])。此外，调整小剂量阿司匹林治疗并没有明显改变估计。我们的研究支持这样一种假设，即没有生理学证据表明在早期流产后推迟怀孕尝试。
To compare time to pregnancy and live birth among couples with varying intervals of pregnancy loss date to subsequent trying to conceive date. In this secondary analysis of the Effects of Aspirin in Gestation and Reproduction trial, 1,083 women, aged 18–40 years with 1–2 prior early losses and whose last pregnancy outcome was a non-ectopic or non-molar loss, were included. Participants were actively followed for up to six menstrual cycles, and for women achieving pregnancy, until pregnancy outcome. We calculated intervals as start of trying to conceive date minus pregnancy loss date. Time to pregnancy was defined as start of trying to conceive until subsequent conception. Discrete Cox models, accounting for left truncation and right censoring, estimated fecundability odds ratios (OR) adjusting for age, race, BMI, education, and subfertility. While intervals were assessed prior to randomization and thus reasoned to have no relation with treatment assignment, additional adjustment for treatment was evaluated given that low-dose aspirin was previously shown to be predictive of time to pregnancy. Couples with a 0–3 month (n=765 [76.7%]) versus >3 month (n=233 [23.4%]) interval were more likely to achieve a live birth (53.2% versus 36.1%) with a significantly shorter time to pregnancy leading to live birth (median (IQR) 5 cycles, adjusted fecundability OR: 1.71 [95% CI: 1.30, 2.25]). Additionally adjusting for low-dose aspirin treatment did not appreciably alter estimates. Our study supports the hypothesis that there is no physiological evidence for delaying pregnancy attempt after an early loss.