Subfertility and risk of later life maternal cardiovascular disease
Subfertility and risk of later life maternal cardiovascular disease
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DOI：
10.1093/humrep/der400
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发表时间：
2012-02-01
影响因子：
6.1
通讯作者：
Ingelsson, Erik
中科院分区：
文献类型：
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作者：
Parikh, Nisha I.;Cnattingius, Sven;Ingelsson, Erik
背景：不孕不育与心血管疾病(CVD)有共同的途径，包括多囊卵巢综合征、肥胖和甲状腺疾病。与两次怀孕的妇女相比，以前怀孕0-1次的妇女发生心血管疾病的风险更高。目前尚不确定最终生育的妇女中的不孕史是否是心血管疾病的危险因素。方法：在瑞典医学出生登记处(n=863 324)中有自我报告不孕史的瑞典妇女(n=863 324)，我们在不同的模型中使用COX比例风险模型对年龄、出生年份、最高收入、教育、出生国家、高血压、糖尿病、早产、小于胎龄(SGA)、吸烟和BMI进行调整后，将不孕史与心血管疾病风险联系起来。在其他分析中，我们排除了有：(I)妊娠相关或非妊娠相关的高血压和/或糖尿病；以及(Ii)早产和/或SGA婴儿的妇女。结果：在最终生育的未分娩妇女中(1983年至2005年，平均随访时间11.9年；0-23年和9 906 621人年)，报告&>=5年亚生育的妇女患心血管疾病的风险比0年增加(风险比1.19，95%可信区间1.02-1.39)。与0年相比，有1-2年或3-4年不孕症的女性患心血管疾病的风险没有显著增加。BMI的核算并没有改变结果。排除患有高血压和/或糖尿病的妇女的相关性减弱，而排除早产和/或SGA出生的妇女并没有改变研究结果。结论：即使考虑到心血管危险因素和不良妊娠结局，最终生育的妇女中的不孕不育也是心血管疾病的危险因素。未来的研究应该探索这种联系背后的机制。
BACKGROUND: Subfertility shares common pathways with cardiovascular disease (CVD), including polycystic ovarian syndrome, obesity and thyroid disorders. Women with prior 0-1 pregnancies are at an increased risk of incident CVD when compared with women with two pregnancies. It is uncertain whether history of subfertility among women eventually giving birth is a risk factor for CVD.METHODS: Among Swedish women with self-reported data on subfertility in the Swedish Medical Birth Register (n = 863 324), we used Cox proportional hazards models to relate a history of subfertility to CVD risk after adjustment for age, birth year, highest income, education, birth country, hypertension, diabetes, preterm birth, small for gestational age (SGA), smoking and for BMI in separate models. In additional analyses, we excluded women with: (i) pregnancy-related or non-pregnancy-related hypertension and/or diabetes; and (ii) preterm births and/or SGA babies.RESULTS: Among nulliparous women eventually having a childbirth (between 1983 and 2005, the median follow-up time 11.9; 0-23 years and 9 906 621 person-years of follow-up), there was an increased risk of CVD among women reporting >= 5 years of subfertility versus 0 years (hazard ratio 1.19, 95% confidence interval 1.02-1.39). There were not significantly elevated CVD risks for women with 1-2 or 3-4 years of subfertility versus 0 years. Accounting for BMI did not change results. Excluding women with hypertension and/or diabetes attenuated associations, whereas exclusion of women with preterm and/or SGA births did not change findings.CONCLUSIONS: Subfertility among women eventually having a childbirth is a risk factor for CVD even upon accounting for cardiovascular risk factors and adverse pregnancy outcomes. Future studies should explore the mechanisms underlying this association.