Objective

To identify, besides maternal age and the number of previous pregnancy losses, additional characteristics of couples with unexplained recurrent pregnancy loss (RPL) that improve the prediction of an ongoing pregnancy.

Design

Hospital-based cohort study in couples who visited specialized RPL units of two academic centers between 2012 and 2020.

Setting

Two academic centers in the Netherlands.

Patients

Clinical data from 526 couples with unexplained RPL were used in this study.

Intervention(s)

None.

Main Outcome Measures

The final model to estimate the chance of a subsequent ongoing pregnancy was determined using a backward selection process and internally validated using bootstrapping. Model performance was assessed in terms of calibration and discrimination (area under the receiver operating characteristic curve).

Results

Subsequent ongoing pregnancy was achieved in 345 of 526 couples (66%). The number of previous pregnancy losses, maternal age, paternal age, maternal body mass index, paternal body mass index, maternal smoking status, and previous in vitro fertilization/intracytoplasmic sperm injection treatment were predictive of the outcome. The optimism-corrected area under the receiver operating characteristic curve was 0.63 compared with 0.57 when using only the number of previous pregnancy losses and maternal age.

Conclusions

The identification of additional predictors of a subsequent ongoing pregnancy after RPL, including male characteristics, is significant for both clinicians and couples with RPL. At the same time, we showed that the predictive ability of the current model is still limited and more research is warranted to develop a model that can be used in clinical practice.

中文翻译：

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更准确地预测不明原因反复流产夫妇的未来妊娠结局：将双方都考虑在内

客观的

除了母亲年龄和既往流产次数外，还要确定无法解释的复发性流产 (RPL) 夫妇的其他特征，这些特征可以提高对持续妊娠的预测。

设计

在 2012 年至 2020 年期间访问两个学术中心的专业 RPL 单位的夫妇中进行的基于医院的队列研究。

环境

荷兰的两个学术中心。

耐心

本研究使用了来自 526 对原因不明的 RPL 夫妇的临床数据。

干预措施

没有。

主要观察指标

估计随后持续怀孕机会的最终模型是使用反向选择过程确定的，并使用自举进行内部验证。根据校准和区分（接收器操作特征曲线下的面积）评估模型性能。

结果

526 对夫妇中有 345 对（66%）实现了随后的持续妊娠。既往流产次数、母亲年龄、父亲年龄、母亲体重指数、父亲体重指数、母亲吸烟状况和先前体外受精/胞浆内精子注射治疗可预测结果。受试者工作特征曲线下的乐观校正面积为 0.63，而仅使用既往流产次数和产妇年龄时为 0.57。

结论

确定 RPL 后继续妊娠的其他预测因素，包括男性特征，对临床医生和 RPL 夫妇都具有重要意义。同时，我们表明当前模型的预测能力仍然有限，需要更多的研究来开发可用于临床实践的模型。