Advanced maternal age and adverse perinatal outcome
Advanced maternal age and adverse perinatal outcome
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DOI：
10.1097/01.aog.0000140682.63746.be
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发表时间：
2004-10-01
影响因子：
7.2
通讯作者：
Milsom, I
中科院分区：
文献类型：
--
作者：
Jacobsson, B;Ladfors, L;Milsom, I
目的：研究孕妇年龄对40~44岁和45岁以上孕妇围产儿结局和产科结局的影响，并估计不良结局是否与合并疾病和妊娠并发症有关。方法：对1987~2001年间分娩的40~44岁和45岁以上孕妇和20~29岁产妇进行全国前瞻性、基于人群的队列研究。调整后的优势比(OR)是在对重大畸形、母体既往疾病和吸烟进行调整后计算的。主要观察指标为围产儿死亡率、胎儿宫内死亡、新生儿死亡、早产和先兆子痫。结果：15年间共分娩1 566 313例(20~29岁876 361例，40~44岁31 662例，大于或等于45岁1 205例)。45岁及以上、40-44岁和20-29岁的围产儿死亡率分别为1.4%、1.0%和0.5%。45岁及以上女性围产儿死亡率的调整后OR为2.4(95%可信区间1.5-4.0)，而40-44岁女性为1.7(950/(CI 1.5-1.9))。45岁及以上女性宫内死亡的调整OR为3.8(95%CI 2.2-6.4)，而40-44岁女性为2.1(95%CI 1.8-2.4)。早产、妊娠期糖尿病和先兆性惊厥在40-44岁和45岁或以上的女性中更常见。与无合并疾病或妊娠并发症的妇女相比，合并疾病或妊娠并发症的妇女围产儿死亡率增加，但没有证据表明这些因素随着年龄的增加而变得更加重要。结论：围产儿死亡率、胎儿宫内死亡和新生儿死亡随年龄增加而增加。合并疾病和妊娠并发症也随着年龄的增加而增加，但这并不能完全解释观察到的围产儿死亡率随年龄的增加。(C)2004年，由TLE美国妇产科医师学会提供。
OBJECTIVE: The aim of this study was to investigate the influence of maternal age on perinatal and obstetric outcome in women aged 40-44 years and those 45 years or older and to estimate whether adverse outcome was related to intercurrent illness and pregnancy complications.METHODS: National prospective, population-based, cohort study in women aged 40-44 years and those 45 years or older and in a control group of women aged 20-29 years who delivered during the period 1987-2001. Adjusted odds ratios (OR) were calculated after adjustments for significant malformations, maternal pre-existing diseases, and smoking. Main outcome measures were perinatal mortality, intrauterine fetal death, neonatal death, preterm birth, and preeclampsia.RESULTS: During the 15-year period, there were 1,566,313 deliveries (876,361 women were 20-29 years of age, 31,662 were 40-44 years, and 1,205 were greater than or equal to 45 years). Perinatal mortality was 1.4%, 1.0%, and 0.5% in women 45 years or older, 40-44, and 20-29 years, respectively. Adjusted OR for perinatal mortality was 2.4 (95% confidence interval [CI] 1.5- 4.0) in women aged 45 years or older, compared With 1.7 (950/( CI 1.5-1.9) in women 40-44 years. Adjusted OR for intrauterine fetal death was 3.8 (95% CI 2.2-6.4) in women aged 45 years or older, compared with 2.1 (95% CI 1.8 -2.4) in women 40 - 44 years. Preterm birth, gestational diabetes, and preedampsia were more common among women 40-44 years of age and those 45 years or older. Perinatal mortality was increased in women with intercurrent illness or pregnancy complications compared with women without these conditions, but there was no evidence that these factors became more important with increasing age.CONCLUSION: Perinatal mortality, intrauterine fetal death, and neonatal death increased with age. There was also an increase in intercurrent illnesses and pregnancy complications with increasing age, but this did not entirely explain the observed increase in perinatal mortality with age. ((C) 2004 by Tle American College of Obstetricians and Gynecologists.).