美国哈佛大学公共卫生学院Jorge E Chavarro团队研究了自然流产与全因和原因特异性早死的相关性。2021年3月24日，该研究发表在《英国医学杂志》上。
为了探讨自然流产与全因和特异性原因早死（70岁以前死亡）风险的相关性，研究组在美国进行了一项前瞻性队列研究。1993年至2017年，研究组招募了101 681名曾经怀孕的女护士，通过两年一次的问卷调查，确定6个月以下妊娠的终生自然流产发生率。根据自然流产的发生率，用时间相关Cox比例风险模型估计全因和特异性原因早死的风险比。
在24年的随访中，研究组共记录到2936例过早死亡，其中1346例死于癌症，269例死于心血管疾病。有和无自然流产史女性的粗全因死亡率相当（两组均为1.24/1000人-年），但有三次及以上自然流产史的女性（1.47/1000人-年）和24岁前报告首次自然流产的女性（1.69/1000人-年）的粗全因死亡率较高。随访期间全因早死的相应年龄校正风险比分别为1.02、1.39和1.27。
在校正混杂因素和更新饮食和生活方式因素后，自然流产的发生与随访期间过早死亡的风险比为1.19。复发性自然流产与早死的相关性更强，其中三次及以上自然流产的风险比为1.59，两次流产的风险比为1.23，一次流产的风险比为1.16。女性生育早期发生自然流产也与早死相关，其中年龄≤23岁者为1.32，24~29岁者为1.16，年龄≥30岁者为1.12。在评估特异性原因死亡率时，自然流产与早死的相关性在心血管疾病死亡中最强（1.48）。自然流产与癌症原因早死无关（1.08）。
研究结果表明，自然流产与早死，尤其是心血管疾病死亡的风险增加有关。
附：英文原文
Title: Association of spontaneous abortion with all cause and cause specific premature mortality: prospective cohort study
Author: Yi-Xin Wang, Lidia Mínguez-Alarcón, Audrey J Gaskins, Stacey A Missmer, Janet W Rich-Edwards, JoAnn E Manson, An Pan, Jorge E Chavarro
Issue&Volume: 2021/03/24
Abstract:
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 101681 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.
DOI: 10.1136/bmj.n530
Source: https://www.bmj.com/content/372/bmj.n530
BMJ-British Medical Journal:《英国医学杂志》，创刊于1840年。隶属于BMJ出版集团，最新IF：93.333
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本期文章：《英国医学杂志》：Online/在线发表
