{"id":57,"title":"Assessing mediation of sexual orientation disparities in miscarriage by age at pregnancy, gravidity, and use of medically assisted reproduction in four national cohorts","title_zh":"性取向与流产差异：妊娠年龄、孕次及医学辅助生殖的中介作用——四项全国队列分析","url":"https://pubmed.ncbi.nlm.nih.gov/42986205","doi":"10.1093/aje/kwag290","pmid":"42986205","journal":"Am J Epidemiol","kind":"paper","lang":"en","published_at":"2026-11-05T00:00:00+00:00","fetched_at":"2026-11-08T03:43:52+00:00","authors":["Chakraborty P","Reynolds CA","Berzansky I","Chavarro JE","Obedin-Maliver J","Everett B","Haneuse S","Charlton BM"],"primary_topic":"art-clinical","topics":[{"slug":"art-clinical","score":4.0,"hits":["assisted reproduction"]},{"slug":"early-pregnancy","score":4.0,"hits":["miscarriage"]}],"topic_score":4.0,"preference_score":0.0,"preference_labels":[],"llm_score":77.0,"final_score":77.0,"score_dims":{"novelty":78,"rigor":85,"impact":70,"relevance":75,"translation":60},"recommend_reason":"研究以多队列和中介分析量化性少数人群流产差异的可解释因素，方法严谨、结论清晰，对理解MAR使用与流产差异的边界有参考价值；但属于生殖健康公平议题，对ART实验室直接操作价值有限。","keywords":["性取向差异","流产","医学辅助生殖","中介分析","队列研究","生殖健康公平"],"selected":1,"story_id":61,"llm_provider":"deepseek","llm_model":"deepseek-flash","llm_effort":"low","source_key":"pubmed-art","source_name":"PubMed · 辅助生殖临床","source_tier":1,"mention_count":1,"has_interpretation":false,"journal_key":null,"journal_tier":"unknown","journal_if":null,"is_mock":false,"summary_zh":"该研究利用四个全国队列（NHS2/3、GUTS、Add Health），采用随机干预中介效应分析，评估性取向对流产的影响是否由妊娠年龄、孕次和医学辅助生殖（MAR）使用所中介。结果显示，性少数个体的妊娠更易以流产告终；年龄仅弱中介（中介比例12%，95%CI 5%-19%），孕次（2%，95%CI -1%-6%）和MAR使用（-1%，95%CI -4%-3%）基本不中介。结论提示，性取向相关的流产差异仅小部分由年龄解释，孕次与MAR使用不解释该差异，结构因素可能更值得关注。","summary":"Recent research has documented a higher miscarriage risk among sexual minority individuals than heterosexual individuals. These disparities may be partly mediated by age at pregnancy, gravidity, and use of medically assisted reproduction (MAR). We used data from four cohorts (Nurses' Health Study 2 and 3, Growing Up Today Study, and National Longitudinal Study of Adolescent to Adult Health) to estimate randomized interventional analogues of mediational direct and indirect effects of sexual orientation on miscarriage (pure natural direct effects [rPNDE], total natural indirect effects [rTNIE], and proportions mediated [rPM]). We found that pregnancies to sexual minority individuals were more likely to end in a miscarriage than those to heterosexual individuals. We found weak mediation of this effect by age (rPNDE: 1.23, 95% confidence interval [CI]: 1.15-1.32; rTNIE: 1.02, 95% CI: 1.01-1.03; rPM: 12%, 95% CI: 5%-19%), but not gravidity (rPM: 2%, 95% CI: -1%-6%) and MAR use (rPM: -1%, 95% CI: -4%-3%). While these factors impact miscarriage risk, our findings suggest that sexual orientation disparities in miscarriage are only minimally explained by age, and not explained by gravidity and use of MAR, contributing to the understanding of the role of pregnancy-related factors vs. structural factors in sexual orientation disparities in miscarriage.","interpretation_basis":null,"fulltext_status":null,"interpretation":null,"fulltext":{"available":false,"status":null,"reason":"尚未抓取全文（未入选、分数未达阈值，或还没跑 fulltext 步骤）","pmcid":null,"license":null,"chars":0,"source":null,"fetched_at":null}}