超高龄经产妇妊娠并发症及妊娠结局的调查研究

Survey of Pregnancy Complications and Outcomes of the Multiparous Maternal with Extremely Advanced Age

目的:探讨超高龄经产妇围生期妊娠并发症及妊娠结局的特点,为临床上预防高龄经产妇围生期不良结局提供指导。方法:选取北京市朝阳区、海淀区6家助产机构2016年11月—2017年2月分娩的经产妇,按照产妇年龄分为超高龄经产妇组(≥40岁)198例、一般高龄经产妇组(35~39岁)1 110例、非高龄经产妇组(<35岁)1 645例,对其一般人口学资料、妊娠合并症和并发症及新生儿健康状况等进行横断面调查,比较不同组别产妇妊娠并发症和不良妊娠结局的差异。结果:①超高龄经产妇组和一般高龄经产妇组选择剖宫产的比例比非高龄经产妇组高,分别为27.3%,22.1%和16.8%,差异有统计学意义(均P ′<0.017)。超高龄经产妇组的分娩孕周比非高龄经产妇组小,差异有统计学意义(P ′<0.017)。②校正了孕期增重、分娩方式、胎数和分娩孕周等影响因素之后,超高龄经产妇组发生妊娠期高血压、妊娠期糖尿病、产后出血、多次(≥2次)流产的风险高于非高龄经产妇组,OR值分别为3.70,1.98,1.74,3.44,均有统计学意义(均P<0.05);发生甲状腺疾病(甲减、亚甲减或甲亢)的风险低于非高龄经产妇组(OR=0.40,P=0.032);胎盘相关疾病和危重症2组比较差异无统计学意义。一般高龄经产妇发生妊娠期高血压、妊娠期糖尿病、多次(≥2次)流产的风险高于非高龄经产妇组,OR值分别为1.92,1.57,1.76,均有统计学意义。③超高龄经产妇组新生儿转入新生儿重症监护病房(NICU)、发生新生儿呼吸窘迫综合征(NRDS)的风险高于非高龄经产妇组,OR值分别为2.11和4.28,有统计学意义。一般高龄经产妇组新生儿发生NRDS的风险高于非高龄经产妇组(OR=2.11),有统计学意义。结论:超高龄经产妇发生妊娠不良结局的风险高于非高龄经产妇,对有可能成为超高龄产妇的育龄妇女,孕前应充分评估身体健康状况,加强孕前健康管理,对已妊娠的超高龄经产妇应严格进行围生期的随访和管理,以减少不良妊娠结局的发生。

Objective:To explore the characteristics of perinatal complication and pregnancy outcome in elderly multipara, and to provide guidance for prevention of adverse perinatal outcomes in elderly multiparas. Methods: Six midwifery institutions from the Chaoyang and Haidian districts in Beijing were selected. All of multiparous maternal who were pregnant over 28 weeks and delivered in these six institutions from November 2016 to February 2017 were divided into three groups according to the age of maternal. There were 198 multiparas in super-advanced age group (≥ 40 years old), 1 110 cases in general advanced age group (35~39 years old) and 1 645 cases in non-advanced age group(<35 years old). This article makes a cross-sectional investigation on the general demographic data, pregnancy coexisted diseases and complications, and the health status of the newborn, and compares the differences of pregnancy complications and adverse pregnancy outcomes among different groups of women. Results:①The proportions of C-section in the super-advanced age group and the general advanced age group was higher than that in the non-advanced age group. It was 27.3%, 22.1%, and 16.8%, respectively, and the differences were statistically significant (all P ′<0.017). The gestational age of delivery in the super-advanced age group were smaller than that in the non-advanced age group (P ′<0.017).②After adjusting for factors such as weight gain during pregnancy, mode of delivery, number of foetuses and gestational age of delivery, the risk of gestational hypertension, gestational diabetes mellitus, postpartum hemorrhage and multiple (≥2) abortion in the super-advanced age group was higher than that in the non-advanced age group. The odds ratios (OR) were 3.70, 1.98, 1.74, 3.44, respectively (all P<0.05). The risk of thyroid diseases (including hypothyroidism, subhypothyroidism, and hyperthyroidism) was lower than that of non-advanced age group (OR=0.40, P=0.032). The risk of placental-related diseases and critically illnesses showed no statistically significant among the two groups. The risk of gestational hypertension, gestational diabetes, multiple (≥2) abortions in general advanced age group was higher than that in non-advanced age women, and their OR values were 1.92, 1.57, 1.76, respectively. The differences were statistically significant.③Compared with non-advanced age group, the risk of neonatal transferred to neonatal intensive care unit (NICU) and the risk of neonatal respiratory distress syndrome were higher in super-advanced age group. The OR values were 2.11 and 4.28, and the differences were statistically significant. The risk of neonatal respiratory distress syndrome in the general advanced age group was higher than that in the non-advanced age group (OR=2.11). The difference was statistically significant. Conclusions:The risk of adverse pregnancy outcomes in super-advanced age group is higher than that of nonelderly maternal. For women of childbearing age who are likely to become parturients of super-advanced age, their physical health should be fully evaluated before pregnancy, and health management before pregnancy should be strengthened. Perinatal follow-up and management should be carried out strictly for those who have become very parturients of super-advanced age, so as to reduce the occurrence of adverse pregnancy outcomes.