The correlation between early pregnancy loss and maternal age is well-documented. As maternal age increases, anti-Mullerian hormone (AMH), a biomarker of ovarian reserve, decreases. There is evidence that AMH levels may be predictive of pregnancy outcomes independent of age. Low AMH values have been associated with increased risk of miscarriages , but data are conflicting and limited to analysis in specific populations, such as the infertile or older population. The relationship between high AMH and miscarriages is also unclear and limited by small sample sizes. A large cohort study in a more general population is necessary to understand this association and provide another counseling tool.
To compare risk of miscarriage in females with low AMH (<0.5 ng/mL) and high AMH (2.5–5.99 ng/mL and 6–20 ng/mL) levels with females with normal AMH values (0.5–2.49 ng/mL) in a general U.S. commercially insured population.
以美国有商业保险的人群为研究对象，比较低AMH值（<0.5 ng/mL）和高AMH值（2.5–5.99 ng/mL和6–20 ng/mL）与正常AMH值（0.5–2.49 ng/mL）女性的流产风险。
Materials and Methods
We used OptumLabs® Data Warehouse, a longitudinal, real-world data asset with de-identified administrative claims data (7), between 1/1/2005 – 6/31/2019. Using a validated approach to identifying pregnancy episodes, outcomes, and start dates in an administrative dataset using ICD, CPT, HCPCS, and LOINC codes (8), we restricted to pregnancies resulting in a live birth or a miscarriage with a start date no more than six months after an AMH test was performed. Females with cancer were excluded. Multivariable linear regression analyses were performed to assess the impact of AMH on the risk of spontaneous miscarriage adjusting for race, age, smoking, and obesity while also testing for interaction between age and AMH categories. Measures of association were expressed in adjusted risk ratios (aRR) and 95% confidence intervals.
We identified 10,708 females who had AMH testing performed shortly before a pregnancy that would result in either a live birth or a miscarriage. There were 11,057 live births and 456 miscarriages identified. The geometric mean AMH among females who had a miscarriage was 1.45 ng/mL (95% CI: 1.22, 1.71) compared to the mean AMH among females with a live birth (2.16 ng/mL, 95% CI: 2.11, 2.22). In adjusted analysis, females with an AMH value less than 0.5 ng/mL were at 63% higher risk of experiencing a miscarriage (aRR 1.63, 95% CI: 1.22-2.17) compared to females with AMH values between 0.5 and 2.49 ng/mL. There were no differences in risk of miscarriage in females with AMH values between 2.5 and 5.99 ng/mL (aRR 0.94, 95% CI 0.75-1.18) or between 6 and 20 ng/mL (aRR 0.93, 95% CI: 0.69-1.24) compared to the reference group. Interaction terms between age and AMH were not significant.
纳入的10708名女性在妊娠前不久进行了AMH检测，其中11057例活产和456例流产。流产和活产女性AMH的几何均数分别为1.45ng/mL（95%CI：1.22，1.71）和2.16ng/mL（95%CI:2.11，2.22）。AMH值小于0.5 ng/mL（低AMH）的女性流产风险比正常AMH值（0.5–2.49 ng/mL）的女性高63%（aRR 1.63，95%CI:1.22-2.17）；AMH值在2.5–5.99 ng/mL和6–20 ng/mL的女性流产风险无差异（aRR 0.94，95%CI 0.75-1.18和aRR 0.93，95%可CI：0.69-1.24）。年龄与AMH之间的交互作用不显著。
The use of an administrative dataset consisting of a large population further supports evidence that low AMH levels are related to more miscarriages. This association did not differ by age. This study demonstrates that low AMH is a marker of reduced fecundity in a more general population.
文章来源：LOW ANTI-MULLERIAN HORMONE LEVELS ARE ASSOCIATED WITH MISCARRIAGE IN A GENERAL FEMALE POPULATION Zhou, Beth et al.Fertility and Sterility, Volume 118, Issue 5, e20