复发性流产女性后续妊娠围产期不良结局风险是否更高？

Study question

研究问题

Are women with recurrent pregnancy loss (RPL) at higher risk of adverse perinatal outcomes in a subsequent pregnancy?

复发性流产（RPL）的妇女后续妊娠围产期不良结局风险是否更高？

Summary answer

答案摘要

Women with a history of RPL have significant higher odds of adverse perinatal outcomes in a subsequent pregnancy.

有复发性妊娠流产史的妇女在再次妊娠时出现不良围产期结果的几率明显较高。

What is known already

已知信息

Studies have suggested that RPL women may have higher risks for obstetrical and perinatal complications such as hypertensive disorders, placental abruption, placenta accreta spectrum disorders, preterm delivery, and perinatal death in a subsequent pregnancy compared to those without an RPL history. However, the existing body of research presents a conflicting narrative, thus highlighting the need for a comprehensive understanding of the implications of RPL on pregnancy outcomes.

研究表明，与无RPL病史的妇女相比，RPL妇女在后续妊娠中发生产科和围产期并发症的风险较高，如高血压疾病、胎盘早剥、胎盘植入性疾病、早产和围产期死亡等。然而，现有的研究结论相互矛盾，因此强调需要全面了解 RPL对妊娠结局的影响。

Study design, size, duration

研究设计、规模和持续时间

A systematic review and meta-analysis was conducted. MEDLINE, EMBASE, Google Scholar and Cochrane databases were searched from inception until July 2023 for studies on RPL and adverse perinatal outcomes. Data was extracted by two independent reviewers.

进行了系统回顾和meta分析。在 MEDLINE、EMBASE、Google Scholar 和 Cochrane 数据库中检索了从开始到 2023 年 7 月期间有关 RPL 和不良围产期结局的研究。数据由两名独立审稿人提取。

Participants/materials, setting, methods

参与者/材料、环境、方法

DerSimonian and Laird random effect meta-analyses were performed to pool effect estimates. Results were presented as odd ratios with their respective 95% confidence intervals. Subgroup analyses were conducted for those with unexplained RPL and by number of pregnancy losses. Sensitivity analysis using only high-quality studies and influence analysis were performed. The Newcastle-Ottawa Scale was used to assess for risk of bias.

进行了 DerSimonian 和 Laird 随机效应meta分析，以集合效应评价。结果以比值比及其各自的 95% 可信区间表示。对原因不明的 RPL 以及流产次数进行了亚组分析。仅使用高质量研究进行灵敏度分析，并进行了影响因素分析。采用Newcastle-Ottawa表用于评估偏倚风险。

Main results and the role of chance

主要结果和偶然性的作用

The systematic search yielded 8,915 records, of which 42 studies (n = 5,619,124) were included in our meta-analysis. Women with RPL had higher odds of pre-eclampsia (OR 1.19; 95% CI, 1.03-1.37), pregnancy-induced hypertension (OR 1.24; 95% CI, 1.03-1.48), gestational diabetes (OR 1.76; 95% CI, 1.28-2.44), cesarean delivery (OR 1.65, 95% CI, 1.47-1.85), placental abruption (OR 1.57; 95% CI, 1.37-1.81), placenta previa (OR 1.93; 95% CI, 1.59-2.35; 7 studies), placenta accreta (OR 4.42; 95% CI, 3.09-6.33), preterm birth (OR 1.79; 95% CI, 1.65-1.93), very preterm birth (OR 2.58; 95% CI, 2.08-3.18), small for gestational age (OR 1.31; 95% CI, 1.15-1.78), congenital anomalies (OR 1.25; 95% CI, 1.02-1.53), stillbirth (OR 1.25; 95% CI, 1.04-1.51) and perinatal death (OR 2.04; 95% CI, 1.58-2.71) compared to women without a history of RPL. There was no association with aneuploidy.

系统搜索共获得 8,915 条记录，其中 42 项研究（n =5,619,124）被纳入我们的meta分析。与无PRL患者相比，患有 RPL 的妇女患先兆子痫（OR 1.19；95% CI，1.03-1.37）、妊娠高血压（OR 1.24; 95% CI, 1.03-1.48）、妊娠糖尿病（OR 1.76；95% CI，1.28-2.44）、剖宫产（OR1.65，95% CI，1.47-1.85），胎盘早剥（OR 1.57；95% CI，1.37-1.81）、前置胎盘（OR 1.93；95% CI，1.59-2.35；7 项研究）、胎盘植入(OR 4.42; 95% CI, 3.09-6.33), 早产 (OR 1.79; 95% CI, 1.65-1.93)、极早产（OR 2.58；95% CI，2.08-3.18）、小于孕龄儿(OR 1.31; 95% CI, 1.15-1.78), 先天性畸形 (OR 1.25; 95% CI, 1.02-1.53）、死产（OR 1.25；95% CI，1.04-1.51）和围产期死亡（OR 2.04；95%CI，1.58-2.71）几率更高。与非整倍体无关。

Limitations, reasons for caution

局限性，需谨慎的原因

Significant inter-study heterogeneity and inconsistent adjustment for confounders was noted across included studies.

研究间存在显著异质性，对混杂因素的调整不一致。

Wider implications of the findings

研究结果的广泛影响

RPL patients are at higher odds of adverse perinatal outcomes in a subsequent pregnancy, and therefore require additional counselling and monitoring in said pregnancy. There is an urgent need for further prospective research clarifying the relationship between RPL and perinatal outcomes.

RPL患者在后续妊娠中出现不良围产期结果的几率更高，因此，在怀孕期间需要额外的咨询和监测。迫切需要进一步的前瞻性研究，阐明 RPL 与围产期结局之间的关系。

参考文献：

I Letourneau, K Zitour, J Candeliere, M Hick, C  Q Wu, P-431 Perinatal outcomes after recurrent pregnancy loss: a systematic review and meta-analysis, Human Reproduction, Volume 39, Issue Supplement_1, July 2024, deae108.106, https://doi.org/10.1093/humrep/deae108.106