Maternal age and severe maternal morbidity: A population-based retrospective cohort study.
Maternal age and severe maternal morbidity: A population-based retrospective cohort study.
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DOI：
10.1371/journal.pmed.1002307
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发表时间：
2017-05
期刊：
影响因子：
15.8
通讯作者：
Kramer MS
中科院分区：
文献类型：
--
作者：
Lisonkova S;Potts J;Muraca GM;Razaz N;Sabr Y;Chan WS;Kramer MS
2000年联合国千年发展目标之一是在15年内将孕产妇死亡率降低75%;然而，许多工业化国家没有迎接这一挑战。由于这些国家的平均产妇年龄继续上升，相关的可能危及生命的严重产妇发病率一直没有得到充分研究。我们的主要目标是检查孕产妇年龄与严重孕产妇发病率之间的关联。次要目的是比较这些相关性与不良胎儿/婴儿结局的相关性。这是一项基于人群的回顾性队列研究，包括2003年1月1日至2013年12月31日居住在美国华盛顿州的所有单胎分娩女性（n = 828，269）。我们比较了孕产妇死亡率/严重发病率的年龄特异性比率（例如，产科休克）和不利的胎儿/婴儿结果（例如，围产期死亡）。Logistic回归用于校正产次、体重指数、辅助受孕和其他潜在混杂因素。我们比较了粗比值比（OR）和调整后的OR（AOR）和风险差异及其95% CI。严重的孕产妇发病率显着较高的少女母亲比那些25-29岁（粗OR = 1.5，95%CI 1.5-1.6），并随母亲年龄超过39岁呈指数增加，从35-39岁女性的OR = 1.2（95% CI 1.2-1.3）至≥50岁女性的OR = 5.4（95% CI 2.4-12.5）。调整混杂因素后，青少年母亲中严重发病率的升高风险消失，但母亲败血症除外（AOR = 1.2，95%CI 1.1-1.4）。在≥35岁的母亲中，校正后的严重发病率，即羊水栓塞率，（AOR = 8.0，95% CI 2.7-23.7）和产科休克（AOR = 2.9，95% CI 1.3-6.6），母亲年龄≥40岁，肾衰竭（AOR = 15.9，95%CI 4.8-52.0）、产科干预并发症（AOR = 4.7，95%CI 2.3-9.5）和入住重症监护室（ICU）（AOR = 4.8，95%CI 2.0-11.9）。与25-29岁母亲相比，40-44岁母亲重度孕产妇发病率的校正风险差异为0.9%（95%CI 0.7%-1.2%），45-49岁母亲为1.6%（95%CI 0.7%-2.8%），≥50岁母亲为6.4%（95%CI 1.7%-18.2%）。胎儿和婴儿结局也观察到类似的相关性;未成年母亲的新生儿死亡率升高（AOR = 1.5，95%CI 1.2-1.7），而29岁以上的母亲死产风险较高。49岁以上妇女的严重孕产妇发病率高于其子女的死亡率/严重发病率。尽管样本量很大，但统计功效不足以检查产妇年龄与产妇死亡或非常罕见的严重发病率之间的关联。产妇年龄特异性严重发病率因结局而异。老年女性（≥40岁）的一些最严重、可能危及生命的疾病发生率显著升高，包括肾衰竭、休克、急性心脏病、产科干预的严重并发症和ICU入院。这些结果应该可以改善对考虑将分娩推迟到四十多岁的女性的咨询，并为她们的医疗保健提供者提供有用的信息。这一信息对于发达国家降低产妇死亡率和严重产妇发病率的预防战略也很有用。Sarka Lisonkova及其同事使用基于人口的数据，包括2003年至2013年居住在华盛顿州的所有单胎分娩妇女，计算了特定年龄的不良孕产妇和新生儿结局率。在高收入国家，产妇平均年龄继续上升。关于高龄产妇不良生育结果的研究主要集中在胎儿死亡和婴儿死亡率和发病率。尚不清楚老年妇女是否也面临着较高的严重孕产妇发病风险。我们研究了产妇死亡率和严重发病率的产妇年龄。潜在的危及生命的发病率，如肾功能衰竭，休克，羊水栓塞和心脏病的风险，在39岁以上的母亲中迅速增加。50岁以上妇女的严重孕产妇发病率可能高于其子女的死亡率/严重发病率。这些结果应该改善咨询妇女谁考虑推迟生育，直到他们的40多岁，并提供有用的信息，他们的医疗保健提供者。
One of the United Nations’ Millennium Development Goals of 2000 was to reduce maternal mortality by 75% in 15 y; however, this challenge was not met by many industrialized countries. As average maternal age continues to rise in these countries, associated potentially life-threatening severe maternal morbidity has been understudied. Our primary objective was to examine the associations between maternal age and severe maternal morbidities. The secondary objective was to compare these associations with those for adverse fetal/infant outcomes. This was a population-based retrospective cohort study, including all singleton births to women residing in Washington State, US, 1 January 2003–31 December 2013 (n = 828,269). We compared age-specific rates of maternal mortality/severe morbidity (e.g., obstetric shock) and adverse fetal/infant outcomes (e.g., perinatal death). Logistic regression was used to adjust for parity, body mass index, assisted conception, and other potential confounders. We compared crude odds ratios (ORs) and adjusted ORs (AORs) and risk differences and their 95% CIs. Severe maternal morbidity was significantly higher among teenage mothers than among those 25–29 y (crude OR = 1.5, 95% CI 1.5–1.6) and increased exponentially with maternal age over 39 y, from OR = 1.2 (95% CI 1.2–1.3) among women aged 35–39 y to OR = 5.4 (95% CI 2.4–12.5) among women aged ≥50 y. The elevated risk of severe morbidity among teen mothers disappeared after adjustment for confounders, except for maternal sepsis (AOR = 1.2, 95% CI 1.1–1.4). Adjusted rates of severe morbidity remained increased among mothers ≥35 y, namely, the rates of amniotic fluid embolism (AOR = 8.0, 95% CI 2.7–23.7) and obstetric shock (AOR = 2.9, 95% CI 1.3–6.6) among mothers ≥40 y, and renal failure (AOR = 15.9, 95% CI 4.8–52.0), complications of obstetric interventions (AOR = 4.7, 95% CI 2.3–9.5), and intensive care unit (ICU) admission (AOR = 4.8, 95% CI 2.0–11.9) among those 45–49 y. The adjusted risk difference in severe maternal morbidity compared to mothers 25–29 y was 0.9% (95% CI 0.7%–1.2%) for mothers 40–44 y, 1.6% (95% CI 0.7%–2.8%) for mothers 45–49 y, and 6.4% for mothers ≥50 y (95% CI 1.7%–18.2%). Similar associations were observed for fetal and infant outcomes; neonatal mortality was elevated in teen mothers (AOR = 1.5, 95% CI 1.2–1.7), while mothers over 29 y had higher risk of stillbirth. The rate of severe maternal morbidity among women over 49 y was higher than the rate of mortality/serious morbidity of their offspring. Despite the large sample size, statistical power was insufficient to examine the association between maternal age and maternal death or very rare severe morbidities. Maternal age-specific incidence of severe morbidity varied by outcome. Older women (≥40 y) had significantly elevated rates of some of the most severe, potentially life-threatening morbidities, including renal failure, shock, acute cardiac morbidity, serious complications of obstetric interventions, and ICU admission. These results should improve counselling to women who contemplate delaying childbirth until their forties and provide useful information to their health care providers. This information is also useful for preventive strategies to lower maternal mortality and severe maternal morbidity in developed countries. Using population-based data including all singleton births to women residing in Washington State 2003 to 2013, Sarka Lisonkova and colleagues calculated age-specific rates of adverse maternal and neonate outcomes. Average maternal age continues to rise in high-income countries. Research on adverse birth outcomes at advanced maternal age is mainly focused on fetal death and infant mortality and morbidity. It is not known whether older women are also at higher risk of severe maternal morbidity. We examined maternal mortality and severe morbidity by maternal age. The risk of potentially life-threatening morbidity, such as renal failure, shock, amniotic fluid embolism, and cardiac morbidity, increases rapidly among mothers over 39 years old. The rate of severe maternal morbidity among women over 50 years old may be higher than the rate of mortality/serious morbidity of their offspring. These results should improve counselling to women who contemplate delaying childbirth until their forties and provide useful information to their health care providers.