单胎妊娠中母亲年龄与胎儿死亡风险：美国，1995 - 2000年
Maternal age and risk of fetal death in singleton gestations: USA, 1995-2000.
作者信息
Canterino J C, Ananth C V, Smulian J, Harrigan J T, Vintzileos A M
机构信息
Department of Obstetrics, Gynecology and Reproductive Sciences, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School/Robert Wood Johnson University Hospital, New Brunswick, USA.
出版信息
J Matern Fetal Neonatal Med. 2004 Mar;15(3):193-7. doi: 10.1080/14767050410001668301.
OBJECTIVE
To determine the magnitude of risk for fetal death among singleton pregnancies in relation to maternal age, and to compare the risks with other common indications for fetal testing.
STUDY DESIGN
We performed a retrospective cohort analysis of singleton births delivered between 1995 and 2000 using the US linked birth/infant death data. Gestational age at < 24 weeks and fetuses with anomalies were excluded. Fetal death rates at > or = 24 and > or = 32 weeks were calculated among women aged 15-19, 20-24, 25-29, 30-34, 35-39, 40-44 and 45-49 years, as well as for other common indications for testing: chronic and pregnancy-induced hypertension, diabetes and small-for-gestational age (SGA). The association between maternal age and fetal deaths was derived after adjusting for potential confounders through multivariable logistic regression models. Relative risks (RR) and 95% confidence intervals (CI) were derived from these models after adjusting for the effects of gravidity, race, marital status, prenatal care, education, smoking and placental abruption.
RESULTS
Among the 21,610,873 singleton births delivered at > or = 24 weeks, fetal deaths occurred in 58,580 (2.7 per 1000). Births to young (15-19 years) and older (> or = 35 years) women comprised 12.6% and 11.4%, respectively. Compared with women aged 20-24 years, young women did not experience an increased risk of fetal death. However, increasing rates of fetal death at > or = 24 and at > or = 32 weeks were seen with increasing maternal age. The RR for fetal death at > or = 24 and at > or = 32 weeks among women 35-39 years were 1.21 and 1.31, respectively, while the RRs were 1.62 and 1.67 among women aged 40-44 years. Women 45-49 years were 2.40-fold (95% CI 1.77, 3.27) and 2.38-fold (95% CI 1.64, 3.46) as likely to deliver a stillborn fetus at > or = 24 weeks and > or = 32 weeks, respectively. RRs for fetal death at > or = 24 and > or = 32 weeks for hypertensive disease, diabetes, and SGA ranged between 1.46 and 4.95.
CONCLUSION
Fetal deaths are increased among older women (> or = 35 years). Fetal testing in women of advanced maternal age may be beneficial.
目的
确定单胎妊娠中与母亲年龄相关的胎儿死亡风险程度，并将该风险与其他常见的胎儿检测指征的风险进行比较。
研究设计
我们使用美国出生/婴儿死亡关联数据，对1995年至2000年间分娩的单胎进行了回顾性队列分析。排除孕周小于24周的胎儿和有异常的胎儿。计算了年龄在15 - 19岁、20 - 24岁、25 - 29岁、30 - 34岁、35 - 39岁、40 - 44岁和45 - 49岁的女性在孕24周及以上和孕32周及以上时的胎儿死亡率，以及其他常见检测指征（慢性高血压和妊娠高血压、糖尿病和小于胎龄儿）的胎儿死亡率。通过多变量逻辑回归模型对潜在混杂因素进行调整后，得出母亲年龄与胎儿死亡之间的关联。在调整了妊娠次数、种族、婚姻状况、产前护理、教育程度、吸烟和胎盘早剥的影响后，从这些模型中得出相对风险（RR）和95%置信区间（CI）。
结果
在孕24周及以上分娩的21,610,873例单胎中，有58,580例（每1000例中有2.7例）发生胎儿死亡。年轻（15 - 19岁）和年长（35岁及以上）女性分娩的比例分别为12.6%和11.4%。与20 - 24岁的女性相比，年轻女性胎儿死亡风险并未增加。然而，随着母亲年龄的增加，孕24周及以上和孕及以上32周的胎儿死亡发生率上升。35 - 39岁女性在孕24周及以上和孕32周及以上时胎儿死亡的RR分别为1.21和1.31，而40 - 44岁女性的RR分别为1.62和1.67。45 - 在孕24周及以上和孕32周及以上时，49岁的女性分娩死产胎儿的可能性分别是2.40倍（95% CI 1.77, 3.27）和2.38倍（95% CI 1.64, 3.46）。高血压疾病、糖尿病和小于胎龄儿在孕24周及以上和孕32周及以上时胎儿死亡的RR在1.46至4.95之间。
结论
年长女性（35岁及以上）胎儿死亡增加。对高龄孕妇进行胎儿检测可能有益。
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