药物及手术流产史与早产关联的出生队列研究

目的 探讨既往药物及手术流产史与早产的关联。方法 参与马鞍山市优生优育队列的3 474名孕妇于孕14周前收集一般人口学资料、既往药物及手术流产史资料，以单胎活产儿3 256人为分析样本。根据是否有药物及手术流产史以及流产次数进行分组，采用logistic回归分析既往药物及手术流产史对随后妊娠早产发生率的影响。结果 早产发生率为4.12%（n=134），自发性早产发生率为2.49%（n=81）。控制可能的混杂因素后，有过1次药物流产史（RR=2.00，95%CI：1.04～3.85）或2次及以上药物流产史（RR=3.58，95%CI：1.04～12.30）会增加总早产发生风险，药物流产史（RR=2.51，95%CI：1.23～5.15）亦会增加自发性早产风险。有过1次手术流产史（RR=0.67，95%CI：0.42～1.01）或2次及以上手术流产史（RR=0.97，95%CI：0.51～1.85）与总早产或自发性早产（RR=0.72，95%CI：0.43～1.22）关联无统计学意义。结论 既往药物流产史是早产或自发性早产的独立危险因素。

Previous medical or surgical abortions and subsequent risk of preterm birth: a birth cohort study

Objective To understand the association between medical abortion (MA) or surgical abortion (SA) and the risk of preterm birth (PTB) in subsequent pregnancy. Methods The prospective cohort study was conducted in Ma''anshan, Anhui province. The information about demographic characteristics and previous MA or SA of 3 474 pregnant women were collected before 14 gestational weeks. Logistic regression analysis was conducted to compare the rates of preterm birth based on the history of previous MA or SA, and 3 256 live births were included in the analysis. Results The PTB rate and spontaneous preterm birth (sPTB) rate were 4.12%(n=134) and 2.49%(n=81) respectively. Previous MA was associated with an increased risk of total PTB (RR=2.00, 95%CI: 1.04-3.85 for one MA and RR=3.58, 95%CI: 1.04-12.30 for two or more MAs) and sPTB (RR=2.51, 95%CI: 1.23-5.15). The risk of PTB in women with one SA (RR=0.67, 95%CI: 0.42-1.01) or more SA (RR=0.97, 95%CI: 0.51-1.85) did not differ significantly compared with the women with no history of SA. Conclusion This study suggests that medical abortion could increase the risk of PTB or sPTB.