Previous miscarriage and the subsequent risk of preterm birth in Scotland, 1980-2008: a historical cohort study.
Previous miscarriage and the subsequent risk of preterm birth in Scotland, 1980-2008: a historical cohort study.
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DOI：
10.1111/1471-0528.13276
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发表时间：
2015-10
期刊：
影响因子：
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通讯作者：
Smith G
中科院分区：
文献类型：
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作者：
Oliver-Williams C;Fleming M;Wood AM;Smith G
确定以往流产与早产风险之间的关系在1980-2008年期间是否发生了变化，并确定这种关系是否因早产的原因而不同。相关联的出生数据库。所有苏格兰国民健康保险制度的医院。1980至2008年间，共有732至719名未分娩妇女首次活产。风险评估采用Logistic回归分析。早产，按原因细分(自发的、诊断为先兆子痫的引产或未诊断为先兆子痫的引产)和严重程度[极端(妊娠24-28周)、中度(妊娠29-32周)和轻度(妊娠33-36周)]。与之前的研究一致，既往流产与全原因早产风险的增加有关(调整后的优势比，AOR为1.26；95%的可信区间，95%的可信区间为1.22-1.29)。这源于与所有亚型的关联。与极早产的相关性最强(AOR为1.73；95%的CI为1.57-1.90)。风险随着流产次数的增加而增加。有三次或三次以上流产的妇女发生全因早产的风险最大(AOR为2.14；95%的可信区间为1.93-2.38)，与极端早产的关联最强(AOR为3.87；95%的可信区间为2.85-5.26)。从1980年到2008年，流产和早产之间的联系强度有所下降。这是因为在没有诊断出先兆子痫的情况下，自然早产和诱生早产的相关性减弱。在苏格兰，在1980-2008年间，既往流产史与早产风险之间的关联有所下降。我们推测，通过减少宫颈损伤，处理不完全终止妊娠的方法的改变可能解释了这一趋势。
To determine whether the relationship between previous miscarriage and risk of preterm birth changed over the period 1980–2008, and to determine whether the pattern varied according to the cause of the preterm birth. Linked birth databases. All Scottish NHS hospitals. A total of 732 719 nulliparous women with a first live birth between 1980 and 2008. Risk was estimated using logistic regression. Preterm birth, subdivided by cause (spontaneous, induced with a diagnosis of pre-eclampsia, or induced without a diagnosis of pre-eclampsia) and severity [extreme (24–28 weeks of gestation), moderate (29–32 weeks of gestation), and mild (33–36 weeks of gestation)]. Consistent with previous studies, previous miscarriage was associated with an increased risk of all-cause preterm birth (adjusted odds ratio, aOR 1.26; 95% confidence interval, 95% CI 1.22–1.29). This arose from associations with all subtypes. The strongest association was found with extreme preterm birth (aOR 1.73; 95% CI 1.57–1.90). Risk increased with the number of miscarriages. Women with three or more miscarriages had the greatest risk of all-cause preterm birth (aOR 2.14; 95% CI 1.93–2.38), and the strongest association was with extreme preterm birth (aOR 3.87; 95% CI 2.85–5.26). The strength of the association between miscarriage and preterm birth decreased from 1980 to 2008. This was because of weakening associations with spontaneous preterm birth and induced preterm birth without a diagnosis of pre-eclampsia. The association between a prior history of miscarriage and the risk of preterm birth declined in Scotland over the period 1980–2008. We speculate that changes in the methods of managing incomplete termination of pregnancy might explain the trend, through reduced cervical damage.