PDF(Pubmed)
Abstract：
OBJECTIVE: Is there a difference in the time interval between the first and second live births among individuals with and without recurrent pregnancy loss (RPL)?
CONCLUSIONS: Primary RPL (two or more pregnancy losses before the first live birth) is associated with a shorter time interval between the first and second live births compared with individuals without RPL, but this association is reversed in patients with secondary RPL (RPL patients with no or one pregnancy loss before the first live birth).
BACKGROUND: There is limited information regarding the ability to have more than one child for patients with RPL. Previous studies have investigated the time to live birth and the live birth rate from the initial presentation to clinical providers. Most of the previous studies have included only patients treated at specialized RPL clinics and thus may be limited by selection bias, including patients with a more severe condition.
METHODS: We conducted a population-based retrospective cohort study of 184 241 participants who delivered in British Columbia, Canada, and had at least two recorded live births between 2000 and 2018. The aim was to study the differences in the time interval between the first and second live births and the prevalence of pregnancy complications in patients with and without RPL. Additionally, 198 319 individuals with their first live birth between 2000 and 2010 were studied to evaluate cumulative second live birth rates.
METHODS: Among individuals with at least two recorded live births between 2000 and 2018, 12 321 patients with RPL and 171 920 participants without RPL were included. RPL was defined as at least two pregnancy losses before 20 weeks gestation. Patients with primary RPL had at least two pregnancy losses occurring before the first live birth, while patients with secondary RPL had no or one pregnancy loss before the first live birth. We compared the time interval from the first to second live birth in patients with primary RPL, those with secondary RPL, and participants without RPL using generalized additive models to allow for a non-linear relationship between maternal age and time interval between first and second live births. We also compared prevalence of pregnancy complications at the first and second live births between the groups using non-parametric Kruskal-Wallis H test and Fisher\'s exact test for continuous and categorical variables, respectively. We assessed the cumulative second live birth rates in patients with primary RPL and those without RPL, among participants who had their first live birth between 2000 and 2010. Cox proportional hazards model was used to estimate and compare hazard ratios between the two groups using a stratified modelling approach.
RESULTS: The adjusted time interval between the first and second live births was the longest in patients with secondary RPL, followed by individuals without RPL, and the shortest time interval was observed in patients with primary RPL: 4.34 years (95% CI: 4.09-4.58), 3.20 years (95% CI: 3.00-3.40), and 3.05 years (95% CI: 2.79-3.32). A higher frequency of pregnancy losses was associated with an increased time interval between the first and second live births. The prevalence of pregnancy complications at the first and second live births, including gestational diabetes, hypertensive disorder of pregnancy, preterm birth, and multiple gestations was significantly higher in patients with primary RPL compared with those without RPL. The cumulative second live birth rate was significantly lower in patients with primary RPL compared with individuals without RPL.
CONCLUSIONS: This study may be limited by its retrospective nature. Although we adjusted for multiple potential confounders, there may be residual confounding due to a lack of information about pregnancy intentions and other factors, including unreported pregnancy losses.
CONCLUSIONS: The results of this study provide information that will help clinicians in the counselling of RPL patients who desire a second child.
BACKGROUND: This study was supported in part by a grant from the Canadian Institutes of Health Research (CIHR): Reference Number W11-179912. M.A.B. reports research grants from CIHR and Ferring Pharmaceutical. He is also on the advisory board for AbbVie, Pfizer, and Baxter. The other authors report no conflict of interest.
BACKGROUND: NCT04360564.
CONCLUSIONS: Primary RPL (two or more pregnancy losses before the first live birth) is associated with a shorter time interval between the first and second live births compared with individuals without RPL, but this association is reversed in patients with secondary RPL (RPL patients with no or one pregnancy loss before the first live birth).
BACKGROUND: There is limited information regarding the ability to have more than one child for patients with RPL. Previous studies have investigated the time to live birth and the live birth rate from the initial presentation to clinical providers. Most of the previous studies have included only patients treated at specialized RPL clinics and thus may be limited by selection bias, including patients with a more severe condition.
METHODS: We conducted a population-based retrospective cohort study of 184 241 participants who delivered in British Columbia, Canada, and had at least two recorded live births between 2000 and 2018. The aim was to study the differences in the time interval between the first and second live births and the prevalence of pregnancy complications in patients with and without RPL. Additionally, 198 319 individuals with their first live birth between 2000 and 2010 were studied to evaluate cumulative second live birth rates.
METHODS: Among individuals with at least two recorded live births between 2000 and 2018, 12 321 patients with RPL and 171 920 participants without RPL were included. RPL was defined as at least two pregnancy losses before 20 weeks gestation. Patients with primary RPL had at least two pregnancy losses occurring before the first live birth, while patients with secondary RPL had no or one pregnancy loss before the first live birth. We compared the time interval from the first to second live birth in patients with primary RPL, those with secondary RPL, and participants without RPL using generalized additive models to allow for a non-linear relationship between maternal age and time interval between first and second live births. We also compared prevalence of pregnancy complications at the first and second live births between the groups using non-parametric Kruskal-Wallis H test and Fisher\'s exact test for continuous and categorical variables, respectively. We assessed the cumulative second live birth rates in patients with primary RPL and those without RPL, among participants who had their first live birth between 2000 and 2010. Cox proportional hazards model was used to estimate and compare hazard ratios between the two groups using a stratified modelling approach.
RESULTS: The adjusted time interval between the first and second live births was the longest in patients with secondary RPL, followed by individuals without RPL, and the shortest time interval was observed in patients with primary RPL: 4.34 years (95% CI: 4.09-4.58), 3.20 years (95% CI: 3.00-3.40), and 3.05 years (95% CI: 2.79-3.32). A higher frequency of pregnancy losses was associated with an increased time interval between the first and second live births. The prevalence of pregnancy complications at the first and second live births, including gestational diabetes, hypertensive disorder of pregnancy, preterm birth, and multiple gestations was significantly higher in patients with primary RPL compared with those without RPL. The cumulative second live birth rate was significantly lower in patients with primary RPL compared with individuals without RPL.
CONCLUSIONS: This study may be limited by its retrospective nature. Although we adjusted for multiple potential confounders, there may be residual confounding due to a lack of information about pregnancy intentions and other factors, including unreported pregnancy losses.
CONCLUSIONS: The results of this study provide information that will help clinicians in the counselling of RPL patients who desire a second child.
BACKGROUND: This study was supported in part by a grant from the Canadian Institutes of Health Research (CIHR): Reference Number W11-179912. M.A.B. reports research grants from CIHR and Ferring Pharmaceutical. He is also on the advisory board for AbbVie, Pfizer, and Baxter. The other authors report no conflict of interest.
BACKGROUND: NCT04360564.
摘要：
目的：有和没有反复妊娠丢失（RPL）的个体在第一和第二活产之间的时间间隔是否有差异？
结论：与没有RPL的个体相比，原发性RPL（第一次活产前两次或更多的妊娠丢失）与第一和第二活产之间的时间间隔较短有关，但这种关联在继发性RPL患者(首次活产前无妊娠或有一次妊娠丢失的RPL患者)中逆转.
背景：关于RPL患者生育一个以上孩子的能力的信息有限。以前的研究已经调查了活产的时间和活产率，从最初的介绍到临床提供者。大多数以前的研究仅包括在专门的RPL诊所接受治疗的患者，因此可能受到选择偏倚的限制。包括病情更严重的患者。
方法：我们对在不列颠哥伦比亚省分娩的184.241名参与者进行了一项基于人群的回顾性队列研究，加拿大,在2000年至2018年期间，至少有2例记录了活产。目的是研究有和没有RPL的患者的第一和第二活产之间的时间间隔以及妊娠并发症的患病率的差异。此外,研究了2000年至2010年间首次活产的198.319人，以评估累积的第二次活产率。
方法：在2000年至2018年期间至少有两名活产记录的个体中，包括12.321名RPL患者和171.920名无RPL的参与者。RPL定义为在妊娠20周前至少两次妊娠丢失。原发性RPL患者在第一次活产前至少有两次妊娠丢失，而继发性RPL患者在首次活产前没有或有一次妊娠丢失。我们比较了原发性RPL患者从第一次活产到第二次活产的时间间隔，那些具有二级RPL的，和没有RPL的参与者使用广义累加模型，以允许产妇年龄与第一和第二活产之间的时间间隔之间的非线性关系。我们还使用非参数Kruskal-WallisH检验和Fisher精确检验对连续和分类变量比较了两组之间第一次和第二次活产妊娠并发症的患病率。分别。我们评估了原发性RPL患者和无RPL患者的累积第二活产率。在2000年至2010年间首次活产的参与者中。Cox比例风险模型用于使用分层建模方法估计和比较两组之间的风险比。
结果：在继发性RPL患者中，第一次和第二次活产之间的调整时间间隔最长，其次是没有RPL的人，在原发性RPL患者中观察到的最短时间间隔为4.34年（95％CI：4.09-4.58），3.20年（95%CI：3.00-3.40），和3.05年（95%CI：2.79-3.32）。妊娠丢失的频率较高与第一和第二活产之间的时间间隔增加有关。第一个和第二个活产的妊娠并发症的患病率，包括妊娠期糖尿病,妊娠高血压疾病，早产,与没有RPL的患者相比，原发性RPL的多胎妊娠明显更高。与没有RPL的个体相比，原发性RPL患者的累积第二次活产率显着降低。
结论：本研究可能受到回顾性性质的限制。尽管我们调整了多种潜在的混杂因素，由于缺乏有关怀孕意向和其他因素的信息，可能存在残留的混杂因素，包括未报告的妊娠损失。
结论：这项研究的结果提供的信息将有助于临床医生为希望二胎的RPL患者提供咨询。
背景：这项研究部分得到了加拿大卫生研究院（CIHR）的资助：参考号W11-179912。M.A.B.报告CIHR和FerringPharmaceutical的研究资助。他也是AbbVie的顾问委员会成员,辉瑞,还有巴克斯特.其他作者报告没有利益冲突。
背景：NCT04360564。
结论：与没有RPL的个体相比，原发性RPL（第一次活产前两次或更多的妊娠丢失）与第一和第二活产之间的时间间隔较短有关，但这种关联在继发性RPL患者(首次活产前无妊娠或有一次妊娠丢失的RPL患者)中逆转.
背景：关于RPL患者生育一个以上孩子的能力的信息有限。以前的研究已经调查了活产的时间和活产率，从最初的介绍到临床提供者。大多数以前的研究仅包括在专门的RPL诊所接受治疗的患者，因此可能受到选择偏倚的限制。包括病情更严重的患者。
方法：我们对在不列颠哥伦比亚省分娩的184.241名参与者进行了一项基于人群的回顾性队列研究，加拿大,在2000年至2018年期间，至少有2例记录了活产。目的是研究有和没有RPL的患者的第一和第二活产之间的时间间隔以及妊娠并发症的患病率的差异。此外,研究了2000年至2010年间首次活产的198.319人，以评估累积的第二次活产率。
方法：在2000年至2018年期间至少有两名活产记录的个体中，包括12.321名RPL患者和171.920名无RPL的参与者。RPL定义为在妊娠20周前至少两次妊娠丢失。原发性RPL患者在第一次活产前至少有两次妊娠丢失，而继发性RPL患者在首次活产前没有或有一次妊娠丢失。我们比较了原发性RPL患者从第一次活产到第二次活产的时间间隔，那些具有二级RPL的，和没有RPL的参与者使用广义累加模型，以允许产妇年龄与第一和第二活产之间的时间间隔之间的非线性关系。我们还使用非参数Kruskal-WallisH检验和Fisher精确检验对连续和分类变量比较了两组之间第一次和第二次活产妊娠并发症的患病率。分别。我们评估了原发性RPL患者和无RPL患者的累积第二活产率。在2000年至2010年间首次活产的参与者中。Cox比例风险模型用于使用分层建模方法估计和比较两组之间的风险比。
结果：在继发性RPL患者中，第一次和第二次活产之间的调整时间间隔最长，其次是没有RPL的人，在原发性RPL患者中观察到的最短时间间隔为4.34年（95％CI：4.09-4.58），3.20年（95%CI：3.00-3.40），和3.05年（95%CI：2.79-3.32）。妊娠丢失的频率较高与第一和第二活产之间的时间间隔增加有关。第一个和第二个活产的妊娠并发症的患病率，包括妊娠期糖尿病,妊娠高血压疾病，早产,与没有RPL的患者相比，原发性RPL的多胎妊娠明显更高。与没有RPL的个体相比，原发性RPL患者的累积第二次活产率显着降低。
结论：本研究可能受到回顾性性质的限制。尽管我们调整了多种潜在的混杂因素，由于缺乏有关怀孕意向和其他因素的信息，可能存在残留的混杂因素，包括未报告的妊娠损失。
结论：这项研究的结果提供的信息将有助于临床医生为希望二胎的RPL患者提供咨询。
背景：这项研究部分得到了加拿大卫生研究院（CIHR）的资助：参考号W11-179912。M.A.B.报告CIHR和FerringPharmaceutical的研究资助。他也是AbbVie的顾问委员会成员,辉瑞,还有巴克斯特.其他作者报告没有利益冲突。
背景：NCT04360564。
