极高龄妇女助孕的产科风险与伦理

Obstetric outcomes and ethical problems among women with very advanced maternal age undergoing assisted reproductive technology

随着女性年龄的增长,体外受精(IVF)成功率下降。即使通过辅助生殖技术(ART)助孕成功获得妊娠,妊娠合并症、并发症以及分娩并发症的发病风险增加,围产儿发病率和死亡率高。高龄是不良妊娠结局的独立危险因素。尤其对于极高龄女性,有循证医学高级别的证据均证实极高龄会显著增加妊娠期并发症、严重的母体并发症和胎儿/新生儿不良结局的发病风险,严重影响母婴健康,同时极高龄妇女生育也存在一系列伦理学问题。极高龄女性只有在经过严格的医学评估排除健康隐患后,方可考虑给予助孕,如年龄超过52岁,应拒绝给予ART助孕。

Advanced maternal age (AMA) was an independent risk factor that affect pregnancy outcome. With the increase of maternal age, the success rate of IVF declined. Even though AMA women conceived with assisted reproductive technology (ART), the risks for obstetric and perinatal complications significantly increased, accompanied by an increased risk of perinatal morbidity and mortality. Especially to the women with very advanced maternal age (VAMA), there was high-quality evidence verified VAMA significantly increased the risk of pregnancy complication, severe maternal complication and adverse fetal/neonatal outcomes, which seriously affected maternal and child health. Meanwhile, a series of ethical issues related to infertility treatments to women with VAMA still existed. ART could be provided to VAMA women after a thorough medical evaluation to eliminate health risks. If women over the age of 52 years, ART should be discouraged.