背景:母体风险因素如自身免疫性疾病(AD)和亚甲基四氢叶酸还原酶(MTHFR)基因多态性增加了妊娠损失率(PLs)。
目的:评估AD和MTHFR多态性患者孕周前(gw)22的单例PLs。
方法:完全,243名妇女中的1108例单胎妊娠被分类为:1)33名AD患者中的148例妊娠,2)66例MTHFR多态性患者的316例妊娠,3)144例AD+MTHFR多态性患者中的644例妊娠。PLs分为亚组:a)化学妊娠(CP),b)枯萎卵(BO),c)gw每一项10,d)gw11-14e)gw15-22,f)异位妊娠(EP),g)滋养细胞疾病(TD)。使用Beksac产科指数(BOI)比较产科历史:[活着的孩子数量(π/10)]/gravida。
结果:gw22之前的PL率为39.2%(58/148),33.2%(105/316),AD为36.3%(234/644),MTHFR,和AD+MTHFR组,分别(p=0.421)。产前筛查期胎儿丢失率(CP+BO+gw10胎儿丢失+EP+TD)为84.8%,75.9%,在AD中占77.8%,MTHFR,和AD+MTHFR,分别(p=0.264)。重力4与具有重力5的那些在BOI上有统计学上的显着差异(p<0.001)。
结论:患有AD和/或MTHFR多态性的单胎妊娠中,gw22前的PL率为35.8%。妊娠患者的临床发现似乎更复杂。
BACKGROUND: The rates of pregnancy losses (PLs) are increased by maternal risk factors such as autoimmune disorders (AD) and methylenetetrahydrofolate reductase (MTHFR) gene polymorphisms.
OBJECTIVE: To evaluate singleton PLs before gestational week (gw) 22 among patients with AD and MTHFR polymorphisms.
METHODS: Totally, 1108 singleton pregnancies in 243 women were categorized as: 1) 148 pregnancies in 33 patients with AD, 2) 316 pregnancies in 66 patients with MTHFR polymorphisms, 3) 644 pregnancies in 144 patients with AD +MTHFR polymorphisms. PLs were classified into subgroups: a) Chemical Pregnancy(CP), b) Blighted Ovum(BO), c) gw ⩽ 10, d) gw11-14 e) gw15-22, f) Ectopic Pregnancy(EP), g) Trophoblastic Disease(TD). Obstetric histories were compared using Beksac Obstetrics Index (BOI): [number of living child + (π/10)]/gravida.
RESULTS: PL rates before gw22 were 39.2% (58/148), 33.2% (105/316), and 36.3% (234/644) in AD, MTHFR, and AD +MTHFR groups, respectively (p= 0.421). The rate of Pre-Prenatal Screening Period fetal losses (CP + BO + gw ⩽ 10 fetal losses + EP + TD) were 84.8%, 75.9%, and 77.8% in AD, MTHFR, and AD +MTHFR, respectively (p= 0.264). Gravidity ⩽ 4 versus those with gravidity ⩾ 5 had statistically significant differences in BOI (p< 0.001).
CONCLUSIONS: PL rate before gw22 among singleton pregnancies with AD and/or MTHFR polymorphisms was 35.8%. The clinical findings seem to be more complicated in patients with gravidity ⩾ 5.