Risk factors and model construction for subsequent pregnancy failure in patients with unexplained recurrent spontaneous abortion
Zhu Hua
Zhang Jiaying
Zhang Yunqiang
Jiang Ting
Yang Yan
Lu Yinghao
Chen Lanyu
Abstract：Objective To explore risk factors for subsequent pregnancy failure in patients with unexplained recurrent spontane-ous abortion(URSA)and construct a risk prediction model to guide clinical management.Methods A total of 230 URSA pa-tients admitted to the Obstetrics & Gynecology Hospital of Fudan University from March 2021 to February 2024 were enrolled and allocated to a pregnancy success group(n=72)and a pregnancy failure group(n=158)based on subsequent pregnancy outcomes.Multivariate stepwise logistic regression was used to identify risk factors,and a nomogram prediction model was constructed.The predictive value of the model was evaluated using receiver operating characteristic(ROC)curve analysis.Re-sults The pregnancy failure group had higher proportions of age ≥35 years,cervical insufficiency,positive anticardiolipin an-tibodies,and positive antisperm antibodies;larger gestational weeks at consultation;more prior abortions;lower human chori-onic gonadotropin(HCG),progesterone,and estradiol levels;and higher pulsatility index(PI),resistance index(RI),and systolic/diastolic velocity ratio(S/D)compared to the success group,with statistical significance(P＜0.05).Multivariate a-nalysis identified age ≥35 years(OR=2.044,95％CI:1.428-2.926),multiple prior abortions(OR=2.787,95％CI:1.825-4.256),positive anticardiolipin antibodies(OR=2.259,95％CI:1.533-3.330),reduced HCG(OR=0.400,95％CI:0.257-0.622),elevated RI(OR=2.370,95％CI:1.608-3.494),and elevated S/D(OR=2.751,95％CI:1.756-4.310)as independent risk factors for pregnancy failure(P＜0.05).The nomogram model demonstrated a concord-ance index(C-index)of 0.879(95％CI:0.826-0.932)for predicting URSA patients.ROC analysis showed an AUC of 0.861(95％CI:0.808-0.914),with specificity of 67.69％and sensitivity of 92.14％.Conclusion Key risk factors for sub-sequent pregnancy failure in URSA patients include advanced maternal age(≥35 years),multiple prior abortions,positive an-ticardiolipin antibodies,reduced HCG levels,elevated RI,and increased S/D.The nomogram model based on these factors ex-hibits high predictive accuracy for pregnancy failure among these individuals.
Keywords：Unexplained recurrent spontaneous abortionPregnancy outcomeRisk factorsNomogramPrediction model
Publication Date：2025-02-20
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：7( 79-85 )