育龄女性人工流产史与妊娠等待时间的相关性研究

目的:探讨育龄女性人工流产史与妊娠等待时间(TTP)关系。方法:采用回顾性队列研究方法,将2013年1月-2017年12月参加深圳市孕前优生健康检查且符合条件的44672例育龄女性作为研究对象,以20608例既往有人工流产史者为暴露组(其中14762例有1次人工流产史,5846例有≥2次人工流产史),以24064例无人工流产史者为非暴露组。采用Kruskal-walls检验和χ2检验比较不同组间的基线特征,Kaplan-Meier法计算每个月经周期的累计妊娠率,使用Cox模型估计育龄女性人工流产史对TTP的影响。结果:既往无人工流产史的育龄女性12个月经周期的累计妊娠率为(32.6%),低于既往有1次(38.9%)和≥2次人工流产史(34.0%)者。对影响因素进行调整后,与无人工流产史的育龄女性相比,有1次和≥2次人工流产史的女性生育力分别升高19.0%(FOR=1.190,95%CI 1.147~1.234)和21.5%(FOR=1.215,95%CI 1.153~1.280)。结论:有人工流产史的育龄女性生育力较高,TTP未见延长。针对这一生育力较高的特定人群,应做好科学避孕指导工作,避免多次意外妊娠后反复实施人工流产术对其生殖健康产生不良影响。

Study on the association between the history of inducde abortion of reproductive-age women and their time to pregnancy

Objective:To explore the association between the history of inducde abortion of reproductive-age women and their time to pregnancy(TTP).Methods:A retrospective cohort study was conducted in 44672 eligible reproductive-age women who participated in the National Free Preconception Checkup Projects in Shenzhen from January 2013 to December 2017.A total of 20,608 women with a history of artificial abortion were selected in the exposed group(including 14,762 women with a history of one abortion and 5,846 women with a history of two or more abortions),while 24,064 women without history of abortion were selected in the non-exposed group.Theχ2 test was used to compare the baseline characteristics of women between the two groups,Kaplan-Meier method was used to calculate the cumulative pregnancy rate for each menstrual cycle,and Cox model was used to estimate the influence of artificial abortion history of reproductive-age women on their TTP.Results:The cumulative pregnancy rate in 12 menstrual cycles of reproductive-age women in the non-exposed group was 32.6%,which was significant lower than that(38.9%)of women with a history of one abortion or that(34.0%)of women with a history of more than once abortions.After adjusting the influencing factors,compared with reproductive-age women with no history of abortion,women with a history of one or more than once obortion had a increased fertility of 19.0%(FOR=1.190,95%CI:1.147-1.234)and 21.5%(FOR=1.215,95%CI:1.153-1.280),respectively.Conclusion:Reproductive-age women with a history of artificial abortion have higher fertility ablity and their TTP is not prolonged.In view of this specific population with higher fertility,scientific contraceptive guidance should be done to avoid the adverse effects of repeated induced abortions after multiple unplanned pregnancies on their reproductive health.