【摘要】 目的:评估基于病因筛查的孕前干预方案对于改善复发性流产(RSA)患者再次妊娠结局的有效性和安全性。方法:2021年11月至2023年11月共入组286例RSA患者，根据入组时病因筛查结果，给予孕前干预治疗。治疗后第一次妊娠结局作为本次研究的终点。比较活产组与再次妊娠失败组的人口和基线特征，记录活产组的妊娠并发症和新生儿结局，分析病因筛查结果以及干预方案与再次妊娠结局的相关性。结果:患者均接受了孕前干预，治疗后再次妊娠活产率为69.76%;妊娠并发症发生率最高的是妊娠期糖尿病(35.35%),所有活产新生儿无严重不良结局。年龄、既往流产次数、婚姻情况和抗磷脂抗体异常是影响再次妊娠结局的高危因素(P≤0.05);孕前干预时长与自身抗体异常的RSA患者再次妊娠结局有关(P=0.034)。结论:对于RSA患者，特别是合并自身抗体异常者，基于病因筛查的孕前干预方案有助于改善再次妊娠结局，提高活产率，且不增加母婴并发症，临床应用安全有效。更多还原

【Abstract】 Objective:To evaluate the efficacy and safety of an etiology-based preconception intervention in improving pregnancy outcomes in patients with recurrent spontaneous abortion(RSA).Methods:From November 2021 to November 2023,a total of 286 patients with RSA were enrolled.Preconception intervention was administered based on the etiology identified at enrollment.The primary outcome was the first pregnancy outcome after treatment.Demographic and baseline characteristics were compared between the live birth group and the recurrent pregnancy loss group.Pregnancy complications and neonatal outcomes were recorded in the live birth group.The correlation between etiology, intervention strategies, and subsequent pregnancy outcomes was analyzed.Results:All patients in the cohort received preconception intervention, with a live birth rate of 69.76% after treatment.The most common pregnancy complication was gestational diabetes(35.35%).No severe adverse neonatal outcomes were observed.Advanced maternal age, previous miscarriage count, marital status, and antiphospholipid antibody abnormalities were identified as high-risk factors affecting pregnancy outcomes(P≤0.05).The duration of preconception intervention was significantly associated with pregnancy outcomes in RSA patients with autoantibody abnormalities(P=0.034).Conclusions:Etiology-based preconception intervention improves pregnancy outcomes and increases the live birth rate in RSA patients, particularly those with autoantibody abnormalities, without increasing maternal or neonatal complications.This approach is clinically safe and effective.更多还原