Ludford Isobel, Scheil Wendy, Tucker Graeme, Grivell Rosalie
Office of Public Health, Department for Health and Ageing, 11 Hindmarsh Square, Adelaide, SA 5000, Australia.
Aust N Z J Obstet Gynaecol. 2012 Jun;52(3):235-41. doi: 10.1111/j.1479-828X.2012.01442.x. Epub 2012 May 4.
Child bearing in the later reproductive years has become increasingly common in Australia with potential implications for clinical practice.
To examine pregnancy outcomes for nulliparous women of advanced maternal age with singleton pregnancies.
A retrospective population-based cohort study was conducted to compare the pregnancy outcomes for women aged 35-39 years and ≥40 years with women aged 25-29 years, analysing 34 695 records from the South Australian Perinatal Database between 1998 and 2008.
Pre-existing hypertension [relative risks (RR) 1.98 and 2.94 for women aged 35-39 years and ≥40 years, respectively], placenta praevia (RR 2.88 and 3.68), suspected intrauterine growth restriction (RR 1.33 and 1.77) and gestational diabetes (RR 1.97 and 2.53) increased with age. Women of advanced maternal age were more likely to have not laboured prior to birth (RR 2.19 and 3.28), be induced (RR 1.12 and 1.27) and have a breech presentation (RR 1.57 and 1.60). The likelihood of fetal distress increased with advancing maternal age (RR 1.15 and 1.24). Regression analyses revealed women of advanced maternal age were significantly more likely to have small for gestational age infants [adjusted odds ratios (AOR) 1.26 and 1.50], preterm birth (AOR 1.26 and 1.43), elective caesarean [relative risk ratios (RRR) 2.55 and 4.52], emergency caesarean (RRR 1.59 and 2.21) and experience a perinatal death (RRR 1.94 and 2.18).
The likelihood of pre-existing medical conditions, obstetric complications, adverse labour and birth outcomes and complications increased with advancing maternal age. Advanced maternal age was also independently associated with selected adverse pregnancy and infant outcomes.
在澳大利亚，晚育现象日益普遍，这可能对临床实践产生影响。
研究高龄初产妇单胎妊娠的妊娠结局。
开展一项基于人群的回顾性队列研究，比较35至39岁及40岁以上未生育女性与25至29岁女性的妊娠结局，分析了1998年至2008年南澳大利亚围产期数据库中的34695份记录。
既往高血压（35至39岁女性的相对风险为1.98，40岁及以上女性为2.94）、前置胎盘（相对风险为2.88和3.68）、疑似胎儿生长受限（相对风险为1.33和1.77）以及妊娠期糖尿病（相对风险为1.97和2.53）均随年龄增长而增加。高龄初产妇在分娩前未临产的可能性更大（相对风险为2.19和3.28），更有可能接受引产（相对风险为1.12和1.27）以及臀位分娩（相对风险为1.57和1.60）。胎儿窘迫的可能性也随产妇年龄增长而增加（相对风险为1.15和1.24）。回归分析显示，高龄初产妇更有可能生下小于胎龄儿[调整优势比为1.26和1.50]、早产[调整优势比为1.26和1.43]、选择性剖宫产[相对风险比为2.55和4.52]、急诊剖宫产（相对风险比为1.59和2.21）以及经历围产期死亡（相对风险比为1.94和2.18）。
既往疾病、产科并发症、不良分娩及出生结局和并发症的可能性随产妇年龄增长而增加。高龄产妇还与特定的不良妊娠和婴儿结局独立相关。
