高龄孕产妇的妊娠结局与孕检的关系

Relationship of pregnancy outcomeswith pregnancy examination among olderparturient women

目的 探讨高龄孕产妇的临床特征、妊娠结局,以及孕早检、孕检次数对高龄孕产妇妊娠结局的影响。方法 收集户籍和分娩均在南宁市六城区的108 734例孕产妇的临床和妊娠结局资料,按照年龄划分为适龄组(年龄20~34岁)和高龄组(年龄≥35岁)。结果 高龄孕产妇孕早检和孕检次数≥5的比例显著低于适龄组,而孕次≥3次、经产、剖宫产史、人工或自然流产≥3次、辅助生殖技术受孕、多胎、孕期接触可疑致畸物质、重度高危妊娠的比例显著高于适龄组(均P <0.01)。高龄孕产妇分娩孕周<37、低出生体质量、极低出生体质量、足月小样儿、胎儿生长受限、巨大儿、5 min Apgar <7、剖宫产、出生缺陷、死胎的发生率显著高于适龄组(均P <0.01)。多因素logistic回归显示,孕早检和孕检次数≥5是高龄孕产妇分娩孕周<37、低出生体质量、胎儿生长受限、5 min Apgar <7、剖宫产、死胎等不良妊娠结局的保护因素(均P <0.05)。结论 高龄孕产妇容易出现不良妊娠结局,而孕期规范检查能降低高龄孕产妇不良妊娠结局发生风险。

Objective To explore the clinical characteristics and pregnancy outcomes in older parturientwomen,and study the influence of examination at first trimester and number of prenatal visits on pregnancy outcomes among them.Methods A total of 108 734 parturient women from six urban districts of Nanning with both household registration and delivery registered in Nanning were recruited and allocated to the control group(aged 20 ~34 years)and the older group(aged ≥ 35 years).The data of clinical characteristics and pregnancy outcomes were collected and retrospectively analyzed.Results The rate of the women who took the examination at first trimester andprenatal visits ≥ 5 times in the control group was significantly lower than that in the older group(P < 0.01).The rates of those with the history of pregnancy ≥ 3 times,multiparity orcesarean section,spontaneous or induced abortion ≥ 3 times,assisted reproductive technology,multiple pregnancy,exposure to suspected teratogenic substances,or severe high-risk pregnancy in the older group were significantly higher than those of the control group(all P < 0.01).The incidence rates of deliverywith < 37w gestation,lowbirth weight,extremely low birth weight,full-term underweight,fetal growth restriction,macrosomia,Apgar scores below 7 at 5 min,cesarean section,birth defects and stillbirthin the oldergroup were significantly higher than those in the control(all P < 0.01).BymultivariateLogistic regression,the examination at first trimester and prenatal visits ≥ 5 times were the protective factors of adverse pregnancy outcomes of elder parturient women such as delivery with < 37 w gestation,low birth weight,fetal growth restriction,Apgar scores below 7 at 5 min,cesarean section and stillbirth(all P < 0.05).Conclusion Older parturient women are prone to adverse pregnancy outcomes,and fulfilled standard antenatal care may decrease the risk of adverse pregnancy outcomes among them.