20 孕周前阴道出血的女性发生糖尿病和心血管疾病的风险：丹麦基于人群的队列研究。

Risk of diabetes and cardiovascular diseases in women with vaginal bleeding before 20 gestational weeks: Danish population-based cohort study.

机构信息

Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.

出版信息

Int J Epidemiol. 2023 Dec 25;52(6):1783-1794. doi: 10.1093/ije/dyad130.

DOI:10.1093/ije/dyad130

PMID:37758298

Abstract

BACKGROUND

Women's reproductive health is associated with cardiovascular morbidity. However, an association of vaginal bleeding (VB) in pregnancy with diabetes and cardiovascular outcomes has scarcely been investigated.

METHODS

We conducted a population-based cohort study in Denmark (1994-2018). Using nationwide registries, among 903 327 women we identified 1 901 725 pregnancies: 39 265 ended in childbirth and were affected by VB; 1 389 285 ended in childbirth and were unaffected by VB; 333 785 ended in a termination, and 139 390 ended in a miscarriage. The outcomes were diabetes types 1 and 2, hypertension, ischaemic heart disease including myocardial infarction, atrial fibrillation or flutter, heart failure and ischaemic and haemorrhagic stroke. We computed incidence rates and hazard ratios (HRs) with 95% confidence intervals (CIs) adjusted for age, calendar year of pregnancy end, morbidities and reproductive and socioeconomic factors, using inverse probability of treatment-weighted Cox proportional hazards regression.

RESULTS

In analyses of VB-affected vs VB-unaffected pregnancies, aHRs were 1.15 (1.03-1.28) for diabetes type 1, 1.19 (1.13-1.26) for diabetes type 2, 1.19 (1.14-1.25) for hypertension, 1.26 (1.16-1.37) for ischaemic heart disease, 1.21 (1.03-1.42) for myocardial infarction, 1.32 (1.14-1.51) for atrial fibrillation or flutter and 1.23 (0.99-1.52) for heart failure. aHRs were 1.41 (1.26-1.57) and 1.46 (1.23-1.72) for ischaemic and haemorrhagic stroke, respectively. When contrasting VB-affected pregnancies with terminations, aHRs were up to 1.3-fold increased for diabetes and hypertension; however, when contrasting VB-affected pregnancies with miscarriages, estimates were below or close to the null value.

CONCLUSIONS

Women's risks of diabetes and cardiovascular outcomes later in life were increased following VB-affected vs VB-unaffected pregnancy or termination, but not following VB-affected pregnancy vs miscarriage.

摘要

背景

女性的生殖健康与心血管发病率有关。然而，妊娠期间阴道出血（VB）与糖尿病和心血管结局的关系鲜有研究。

方法

我们在丹麦进行了一项基于人群的队列研究（1994-2018 年）。利用全国性登记处，我们在 903327 名女性中确定了 1901725 例妊娠：39265 例分娩并伴有 VB；1389285 例分娩且无 VB；333785 例妊娠终止且伴有 VB；139390 例妊娠终止且无 VB。结局为 1 型和 2 型糖尿病、高血压、包括心肌梗死在内的缺血性心脏病、心房颤动或扑动、心力衰竭以及缺血性和出血性中风。我们使用逆概率治疗加权 Cox 比例风险回归，根据年龄、妊娠结束的日历年份、合并症以及生殖和社会经济因素，计算发病率和危险比（HRs）及其 95%置信区间（CI）。

结果

在 VB 影响与 VB 无影响妊娠的分析中，1 型糖尿病的校正 HR 为 1.15（1.03-1.28），2 型糖尿病为 1.19（1.13-1.26），高血压为 1.19（1.14-1.25），缺血性心脏病为 1.26（1.16-1.37），心肌梗死为 1.21（1.03-1.42），心房颤动或扑动为 1.32（1.14-1.51），心力衰竭为 1.23（0.99-1.52）。缺血性和出血性中风的校正 HR 分别为 1.41（1.26-1.57）和 1.46（1.23-1.72）。与足月产相比，VB 影响妊娠与妊娠终止的校正 HR 最高增加了 1.3 倍；然而，与流产相比，VB 影响妊娠的估计值低于或接近零值。