{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T10:14:18Z","timestamp":1779185658948,"version":"3.51.4"},"reference-count":36,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2019,9,10]],"date-time":"2019-09-10T00:00:00Z","timestamp":1568073600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To explore the relation between famine exposure in early life and subsequent pregnancy loss, including stillbirth, and spontaneous abortion in adulthood.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>A population\u2010based, partly ecological study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting and population<\/jats:title><jats:p>Individual data of 58\u00a0601 females born around the time of the Great Chinese Famine in 1959\u20131961.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Associations between the famine exposure in early life and pregnancy loss (stillbirth and spontaneous abortion) in adulthood were analysed using negative binomial regression, with the non\u2010exposure group as reference, adjusting for region, highest education, monthly income, alcohol consumption, tobacco use, <jats:styled-content style=\"fixed-case\">body mass index<\/jats:styled-content> in 25\u2010year\u2010olds and metabolic equivalent. Further analyses were stratified by rural versus urban region.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main outcome measures<\/jats:title><jats:p>Continuous variables of times of stillbirths and spontaneous abortions were used according to the individual self\u2010reported reproductive history.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>No association was found between famine exposure and spontaneous abortion. In contrast, females experiencing the famine during their prenatal period (incidence rate ratio\u00a0=\u00a01.15, 95% CI 1.00\u20131.33) or infant period (<jats:styled-content style=\"fixed-case\">incidence rate ratio<\/jats:styled-content>\u00a0=\u00a01.27, 95% CI 1.12\u20131.44) were more likely to report stillbirth in later adult life. Such an association appeared stronger in women living in rural regions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Early life exposure of famine was associated with an increased risk of stillbirth but not spontaneous abortion in adulthood. The strength of such an association appeared stronger in rural areas. Given the high potential for unmeasured confounding, these associations must be interpreted with caution. Regarding the potential implication that undernutrition in the fetal period is related to reproductive outcome in adulthood, fetal nutritional supply may play an important role in human reproduction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p>Exposure to famine in early life was associated with increased pregnancy loss in adulthood.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.15908","type":"journal-article","created":{"date-parts":[[2019,8,24]],"date-time":"2019-08-24T09:59:16Z","timestamp":1566640756000},"page":"39-45","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Early life famine exposure to the Great Chinese Famine in 1959\u20131961 and subsequent pregnancy loss: a population\u2010based study"],"prefix":"10.1111","volume":"127","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2180-0122","authenticated-orcid":false,"given":"H","family":"Zhang","sequence":"first","affiliation":[{"name":"School of Public Health Peking University Health Science Center Beijing China"},{"name":"Department of Population, Family and Reproductive Health Johns Hopkins Bloomberg School of Public Health Baltimore MD USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8521-5630","authenticated-orcid":false,"given":"X","family":"Qu","sequence":"additional","affiliation":[{"name":"School of Public Health Peking University Health Science Center Beijing China"},{"name":"Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7933-0667","authenticated-orcid":false,"given":"H","family":"Wang","sequence":"additional","affiliation":[{"name":"Institute for Medical Humanities Peking University Health Science Centre Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5444-186X","authenticated-orcid":false,"given":"K","family":"Tang","sequence":"additional","affiliation":[{"name":"Research Centre for Public Health Tsinghua University Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,9,10]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1257\/jep.25.3.153"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(15)00279-X"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2011.04.005"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1301817110"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.87.12.1962"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/den274"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1086\/380584"},{"key":"e_1_2_6_9_1","first-page":"89","article-title":"The great famine in China, 1959\u20101961: causes, distribution and interpretation","volume":"33","author":"Hong M","year":"2015","journal-title":"J Guizhou Univ (Social Sci)"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.2307\/1973026"},{"key":"e_1_2_6_11_1","volume-title":"1949\u20101959 Report of the Damage Caused by Disaster in China","author":"National Bureau of Statistics of China; 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