孕产妇高龄与不良妊娠及分娩结局的关系

Association between advanced maternal age and adverse pregnancy and delivery outcomes

目的分析孕产妇高龄对不良妊娠及分娩结局的影响,为促进围产保健管理工作提供建议。方法收集2016年11月1日—2016年12月31日在北京市海淀区3家医院住院分娩的2 335例产妇资料,包括人口学信息、产科相关合并症及并发症、新生儿基本状况等。根据产妇的分娩年龄分为<35岁组、35～39岁组和≥40岁组,探讨孕产妇高龄与多种不良妊娠及分娩结局之间的关系。结果 2 335例产妇的平均分娩年龄为(32.5±4.1)岁,高龄孕产妇的比例为30.6%。3组产妇中,孕前超重和肥胖、IVF-ET、瘢痕子宫、妊娠期糖尿病、妊娠期高血压疾病、前置胎盘、剖宫产及新生儿转NICU的发生率均随产妇分娩年龄的增加而上升。校正混杂因素后,与<35岁组产妇比较,35～39岁组和≥40岁组产妇妊娠期糖尿病的发生风险分别增加0.89倍、2.12倍,妊娠期高血压疾病的发生风险分别增加0.55倍、1.12倍,剖宫产的发生风险分别增加0.64倍、0.52倍。此外,≥40岁组产妇分娩的新生儿转NICU的风险也高于<35岁组产妇。结论生育政策调整后,高龄孕产妇比例明显上升,其发生多种不良妊娠及分娩结局的风险增加,应加强高龄孕产妇的围产保健管理,保障母婴安全。

Objective To analyze the associations between advanced maternal age and adverse pregnancy and delivery outcomes,and to promote perinatal health care management. Methods A total of 2 335 pregnant women were collected from November 1,to December 31 in 2016 from 3 hospitals in Haidian District of Beijing. Information included demographic characteristics,obstetric related comorbidities and complications,and neonatal basic conditions was recorded.Delivery age was categorized three groups,including aged 〈35 years,aged 35-39 years and aged ≥ 40 years,and associations between advanced maternal age and a variety of adverse pregnancy and delivery outcomes was compared.Results The average age of delivery for 2 335 pregnant women was（ 32. 5 ± 4. 1） years. The proportion of advanced maternal age was 30. 6%. The incidence of maternal complication and adverse outcome increased with maternal age increase,including overweight and obesity,IVF-ET,scar uterus,gestational diabetes mellitus,hypertensive disorders complicating pregnancy,placenta previa,cesarean section and neonates transferred into neonatal ICU. Compared with 〈35 years age group,the risk of gestational diabetes mellitus in 35-39 years group and ≥40 years group increased by 0. 89 times and 2. 12 times,respectively. The risk of hypertensive disorders complicating pregnancy increased by 0. 55 times and1. 12 times,respectively. The risk of cesarean section increased by 0. 64 times and 0. 52 times,compared to 〈35 years group after adjusting confounding factors. Conclusion After new fertility policy put into effect,the proportion of women with advanced maternal age increased significantly and the risk of multiple adverse pregnancy and delivery outcomes increased at the same time. Strengthen the perinatal health care management for women with advanced maternal was needed to ensure the health of mothers and infants.