Fox Nathan S, Rebarber Andrei, Dunham Samantha M, Saltzman Daniel H
Department of Obstetrics, Gynecology and Reproductive Science, Mount Sinai School of Medicine, New York, New York, USA.
J Matern Fetal Neonatal Med. 2009 Jul;22(7):593-6. doi: 10.1080/14767050902801819.
To investigate outcomes of twin gestations with advanced maternal age (AMA).
Historical cohort of twin gestations cared for by a maternal-fetal medicine faculty practice. Outcomes of patients with AMA (70) and non-AMA (75) were compared. AMA was defined as age > or =35. Analysis including mode of delivery, gestational age at delivery and overall complications was performed. Significance was determined using the chi-square test or the Student's t-test.
The Cesarean rate for AMA was significantly greater compared to non-AMA (80.0% vs. 54.7%; p = 0.001). The main reason for the increased rate was uterine dysfunction. The mean gestational age at delivery for AMA was significantly greater than for non-AMA (36.7 weeks vs. 35.4 weeks; p = 0.02). There were no differences in rates of other adverse outcomes including gestational hypertension, pre-eclampsia, gestational diabetes, suspected fetal growth restriction, preterm birth, low birth weight or low birth weight percentiles. This remained true when we compared the 32 women ages > or =40 years to 118 women ages <40 years.
Among twin pregnancies, AMA women are not at an increased risk of adverse pregnancy outcomes, aside from an increased rate of cesarean delivery.
探讨高龄孕妇（AMA）双胎妊娠的结局。
回顾性队列研究，纳入由母胎医学专科门诊诊治的双胎妊娠患者。比较AMA组（70例）和非AMA组（75例）的结局。AMA定义为年龄≥35岁。分析内容包括分娩方式、分娩孕周及总体并发症。采用卡方检验或学生t检验确定差异是否具有统计学意义。
AMA组剖宫产率显著高于非AMA组（80.0%对54.7%；p = 0.001）。剖宫产率增加的主要原因是子宫收缩乏力。AMA组分娩时的平均孕周显著长于非AMA组（36.7周对35.4周；p = 0.02）。包括妊娠期高血压、子痫前期、妊娠期糖尿病、疑似胎儿生长受限、早产、低出生体重或低出生体重百分位数在内的其他不良结局发生率无差异。当我们将32例年龄≥40岁的女性与118例年龄<40岁的女性进行比较时，情况依然如此。
在双胎妊娠中，除剖宫产率增加外，AMA女性不良妊娠结局的风险并未增加。
