目的

探讨自然流产与所有原因和特定过早死亡（70岁之前死亡）的风险之间的关系。

设计

前瞻性队列研究。

场所：

美国护士的健康研究II（1993年至2017年）。

参加者：

101 681名曾经参加过“护士健康研究II”的女性护士。

主要结局指标

通过两年一次的问卷调查，了解妊娠中6个月龄内的自发流产发生情况。自发流产的发生情况与所有原因和特定原因导致的特定过早死亡的危险比和95％置信区间，均采用与时间相关的Cox比例危险模型进行估算。

结果

在24年的随访中，记录了2936例过早死亡，包括1346例癌症死亡和269例心血管疾病死亡。有和没有自然流产史的妇女的所有原因死亡率均相当（两组中每千人年1.24），但经历三次或以上自然流产的妇女（每千人1.47）和在24岁之前首次自然流产（每1000人年1.69）报告其自然流产的妇女死亡风险更高。随访期间，所有引起过早死亡的年龄调整后的危险比分别为1.02（95％CI0.94-1.11），1.39（1.03-1.86）和1.27（1.11-1.46）。在调整了混杂因素并更新了饮食和生活方式因素之后，随访期间过早死亡与自发流产的发生（HR1.19，95％CI1.08-1.30）有关。其中与复发性自然流产的关联性很强（与无流产相比，三次或以上自然流产的HR=1.59，95％CI 1.17-2.15;两次流产的HR1.23，95%CI 1.00-1.50;一次流产的HR：1.16，95%CI 1.05-1.28）；与自发流产发生在妇女的生育期早期关联也很强（相比于没有，≤23岁，HR：为1.32，95%CI 1.14至1.53；24-29岁 HR：1.16，95%CI 1.01-1.33；≥30岁HR1.12，95%CI0.98-1.28，）。当评估病因特异性死亡率时，自然流产与过早死亡的关联对于心血管疾病的死亡最为强烈（HR：1.48、95%CI:1.09至1.99）。自然流产与癌症过早死亡无关.

结论

自然流产与过早死亡，尤其是心血管疾病死亡的风险增加有关。

 

 

Objective To investigate the association of spontaneous abortion with the risk of all cause and cause specific premature mortality (death before the age of 70).

Design Prospective cohort study.

Setting The Nurses’ Health Study II (1993-2017), United States.

Participants 101 681 ever gravid female nurses participating in the Nurses’ Health Study II.

Main outcomes measures Lifetime occurrence of spontaneous abortion in pregnancies lasting less than 6 months, determined by biennial questionnaires. Hazard ratios and 95% confidence intervals for all cause and cause specific premature death according to the occurrence of spontaneous abortion, estimated with time dependent Cox proportional hazards models.

Results During 24 years of follow-up, 2936 premature deaths were recorded, including 1346 deaths from cancer and 269 from cardiovascular disease. Crude all cause mortality rates were comparable for women with and without a history of spontaneous abortion (1.24 per 1000 person years in both groups) but were higher for women experiencing three or more spontaneous abortions (1.47 per 1000 person years) and for women reporting their first spontaneous abortion before the age of 24 (1.69 per 1000 person years). The corresponding age adjusted hazard ratios for all cause premature death during follow-up were 1.02 (95% confidence interval 0.94 to 1.11), 1.39 (1.03 to 1.86), and 1.27 (1.11 to 1.46), respectively. After adjusting for confounding factors and updated dietary and lifestyle factors, the occurrence of spontaneous abortion was associated with a hazard ratio of 1.19 (95% confidence interval 1.08 to 1.30) for premature mortality during follow-up. The association was stronger for recurrent spontaneous abortions (hazard ratio 1.59, 95% confidence interval 1.17 to 2.15 for three or more spontaneous abortions; 1.23, 1.00 to 1.50 for two; and 1.16, 1.05 to 1.28 for one compared with none), and for spontaneous abortions occurring early in a woman’s reproductive life (1.32, 1.14 to 1.53 for age ≤23; 1.16, 1.01 to 1.33 for ages 24-29; and 1.12, 0.98 to 1.28 for age ≥30 compared with none). When cause specific mortality was evaluated, the association of spontaneous abortion with premature death was strongest for deaths from cardiovascular disease (1.48, 1.09 to 1.99). Spontaneous abortion was not related to premature death from cancer (1.08, 0.94 to 1.24).

Conclusions Spontaneous abortion was associated with an increased risk of premature mortality, particularly death from cardiovascular disease.