Risk of Adverse Pregnancy Outcomes at Advanced Maternal Age
Risk of Adverse Pregnancy Outcomes at Advanced Maternal Age
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DOI：
10.1097/aog.0000000000002504
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发表时间：
2018-03-01
影响因子：
7.2
通讯作者：
Ekelund, Charlotte Kvist
中科院分区：
文献类型：
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作者：
Frederiksen, Line Elmerdahl;Ernst, Andreas;Ekelund, Charlotte Kvist
目的：研究高龄孕妇与特定不良妊娠结局风险之间的可能关系。方法：该研究使用了丹麦全国范围内369,516例单胎妊娠的队列，从怀孕11-14周到分娩或终止妊娠。将35岁及以上孕妇分为35-39岁和40岁及以上两个高龄孕妇，并与20-34岁孕妇进行比较。不良妊娠结局包括染色体异常、先天畸形、流产、死产和孕34周前出生。采用多变量Logistic回归分析研究高龄孕妇与不良妊娠结局之间的关系。结果：在40岁及以上的孕妇中，10.82%的孕妇经历了一个或多个选定的不良妊娠结局，而20-34岁的孕妇的这一比例为5.46%(优势比[OR]2.02，99.8%可信区间1.78-2.29)。40岁及以上孕妇与20~34岁孕妇相比，染色体异常(3.83%vs 0.56%，OR 7.44[CI 5.93~9.34])、流产(1.68%vs 0.42%，OR 3.10[CI 2.19~4.38])、孕34周前出生(2.01%vs 1.21%，OR 1.66[CI 1.23~2.24])风险增加。风险预测图表显示，高龄、使用辅助生殖技术、未分娩、孕期吸烟和肥胖增加了不良妊娠结局的绝对预测风险。结论：40岁以上的女性染色体异常、流产和孕34周前出生的风险高于年轻女性，应进行相应的监测。没有观察到死产和其他先天性畸形的风险增加。有几个因素会增加不良妊娠结局的风险，但高龄产妇在总风险得分中所占比例很高。
OBJECTIVE: To study the possible associations between advanced maternal age and risk of selected adverse pregnancy outcomes.METHODS: The study used a nationwide cohort of 369,516 singleton pregnancies in Denmark followed from 11-14 weeks of gestation to delivery or termination of pregnancy. Pregnant women aged 35 years or older were divided into two advanced maternal age groups, 35-39 years and 40 years or older, and compared with pregnant women aged 20-34 years. Adverse pregnancy outcomes were chromosomal abnormalities, congenital malformations, miscarriage, stillbirth, and birth before 34 weeks of gestation. Multivariable logistic regression analyses were performed to investigate associations between advanced maternal age and adverse pregnancy outcomes. Furthermore, a risk prediction model for a composite adverse pregnancy outcome was made with prespecified predicting factors.RESULTS: Among the pregnant women aged 40 years or older, 10.82% experienced one or more of the selected adverse pregnancy outcomes compared with 5.46% of pregnant women aged 20-34 years (odds ratio [OR] 2.02, 99.8% CI 1.78-2.29). When pregnant women 40 years or older were compared with women aged 20-34 years, they had a higher risk of chromosomal abnormalities (3.83% vs 0.56%, OR 7.44 [CI 5.93-9.34]), miscarriage (1.68% vs 0.42%, OR 3.10 [CI 2.19-4.38]), and birth before 34 weeks of gestation (2.01% vs 1.21%, OR 1.66 [CI 1.23-2.24]), but no increased risk of congenital malformations and stillbirth. The risk prediction chart showed that advanced maternal age, use of assisted reproductive technology, nulliparous pregnancy, smoking during pregnancy, and obesity increased the absolute predictive risk of an adverse pregnancy outcome.CONCLUSION: Women older than 40 years have a higher risk of chromosomal abnormalities, miscarriage, and birth before 34 weeks of gestation than younger women and should be monitored accordingly. No increased risk was observed for stillbirth and other congenital malformations. Several factors increase the risk of adverse pregnancy outcomes, but advanced maternal age drives a high proportion of the total risk score.