Physical activity and incidence of subclinical and clinical pregnancy loss: a secondary analysis in the Effects of Aspirin in Gestation and Reproduction randomized trial

In this longitudinal study, higher levels of physical activity are related to increased risk of subclinical loss but not clinical pregnancy loss.

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Volume 113, Issue 3, Pages 601–608.e1

Authors:

Lindsey M. Russo, M.S., Brian W. Whitcomb, Ph.D., Joshua R. Freeman, M.S., Sunni L. Mumford, Ph.D., Lindsey A. Sjaarda, Ph.D., Neil J. Perkins, Ph.D., Karen C. Schliep, Ph.D., Jagteshwar Grewal, Ph.D., Robert M. Silver, M.D., Enrique F. Schisterman, Ph.D.

Abstract:

Objective

To estimate the association between physical activity and risk of subclinical and clinical pregnancy loss among women with a history of pregnancy loss.

Design

Prospective cohort study as a secondary analysis of the Effects of Aspirin in Gestation and Reproduction randomized controlled trial of preconception-initiated low-dose aspirin among women with one or two prior pregnancy losses.

Setting

Four U.S. clinical centers, 2007–2011.

Patient(s)

Women with confirmed pregnancy (n = 785) as determined from hCG testing in longitudinally collected biospecimens.

Main Outcome Measure(s)

Subclinical loss of pregnancy detected only by hCG testing and clinically recognized loss.

Result(s)

Among 785 women (mean [SD] age, 28.7 [4.6] years) with an hCG-confirmed pregnancy, 188 (23.9%) experienced pregnancy loss. In multivariable models adjusted for confounders, compared with the first tertile of physical activity (median = 7.7 metabolic equivalent of task hours/week), there was a roughly twofold higher risk of subclinical loss in the second (risk ratio = 2.06; 95% confidence interval, 1.03–4.14) and third tertiles (risk ratio = 1.92; 95% confidence interval, 0.94–3.90), with median metabolic equivalent of task hours/week of 27.8 and 95.7, respectively. No relations were observed between physical activity and clinically recognized loss.

Conclusion(s)

Risk related to physical activity is different for pregnancy failure close to the time of implantation compared with that for later, clinical pregnancy loss. Higher physical activity levels were associated with an elevated risk of subclinical loss (i.e., pregnancies detected only by hCG, n = 55); however, no relationship was observed with clinically recognized loss. Further work is required to confirm these findings, assess generalizability to women without prior losses, and evaluate mechanisms.

Ethical approval

Each participating center’s Institutional Review Board approved the study, and participants provided written informed consent. The trial was registered on ClinicalTrials.gov (NCT00467363), and a Data Safety and Monitoring Board provided oversight.



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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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