School of Nursing and Midwifery, St. Alban's Campus, Victoria University, Melbourne 8001, Australia.
Midwifery. 2013 May;29(5):479-89. doi: 10.1016/j.midw.2012.04.001. Epub 2012 Nov 16.
to examine the evidence in relation to very advanced maternal age (≥45 years) and maternal and perinatal outcomes in high-income countries.
this review was conducted against a background of increasing fertility options for women aged ≥=45 years and rising birth rates among this group of women.
established health databases including SCOPUS, MEDLINE, CINAHL, EMBASE and Maternity and Infant Care were searched for journal papers, published 2001-2011, that examined very advanced maternal age (VAMA) and maternal and perinatal outcomes. Further searches were based on references found in located articles. Keywords included a search term for maternal age ≥45 years (very advanced maternal age, pregnancy aged 45 years and older) and a search term for maternal complications (caesarian section, hypertension, pre-eclampsia, gestational diabetes) and/or adverse perinatal outcome (preterm birth, low birth weight, small for gestational age, stillbirth, perinatal death). Of 164 retrieved publications, 10 met inclusion criteria.
data were extracted and organised under the following headings: maternal age ≥45 years; maternal characteristics such as parity and use of artificial reproductive technology (ART); and pre-existing maternal conditions, such as diabetes and hypertension. Additional headings included: gestational conditions, such as pre-eclampsia and gestational diabetes (GDM); and perinatal outcomes, including fetal/infant demise; gestational age and weight. Study quality was assessed by using the Critical Appraisal Skills Programme (CASP) guidelines.
this review produced three main findings: (1) increased rates of stillbirth, perinatal death, preterm birth and low birth weight among women ≥45 years; (2) increased rates of pre-existing hypertension and pregnancy complications such as GDM, gestational hypertension (GH), pre-eclampsia and interventions such as caesarian section; and (3) a trend of favourable outcomes, even at extremely advanced maternal age (50-65 years), for healthy women who had been screened to exclude pre-existing disease.
although there is strong evidence of an association between very advanced maternal age and adverse maternal and perinatal outcomes, the absolute rate of stillbirth/perinatal death remains low, at less than 10 per 1000 births in most high-income countries. Therefore, although women in this age group encounter greater pregnancy risk, most will achieve a successful pregnancy outcome. Best outcomes appear to be linked to pre-existing maternal health, and pregnancy care at tertiary centres may also contribute. This information should be used to counsel women aged ≥45 years who are contemplating pregnancy.
研究高收入国家中非常高龄产妇（≥45 岁）和母婴围生期结局的证据。
本综述是在越来越多的 45 岁及以上女性生育选择以及该年龄段女性出生率上升的背景下进行的。
在 SCOPUS、MEDLINE、CINAHL、EMBASE 和母婴护理等既定健康数据库中，搜索了 2001-2011 年期间发表的研究非常高龄产妇（VAMA）和母婴围生期结局的期刊论文。进一步的搜索是基于已定位文章中的参考文献进行的。关键词包括一个搜索条件是母亲年龄≥45 岁（非常高龄产妇、怀孕年龄 45 岁及以上）和一个搜索条件是母亲并发症（剖腹产、高血压、先兆子痫、妊娠糖尿病）和/或不良围生期结局（早产、低出生体重、小于胎龄儿、死胎、围生期死亡）。在检索到的 164 篇出版物中，有 10 篇符合纳入标准。
数据根据以下标题进行提取和组织：母亲年龄≥45 岁；母亲特征，如产次和使用辅助生殖技术（ART）；以及现有的母亲疾病，如糖尿病和高血压。其他标题包括：妊娠情况，如先兆子痫和妊娠糖尿病（GDM）；以及围生期结局，包括胎儿/婴儿死亡；胎龄和体重。使用批判性评估技能计划（CASP）指南评估研究质量。
本综述产生了三个主要发现：（1）45 岁及以上妇女中死胎、围生期死亡、早产和低出生体重的发生率增加；（2）现有高血压和妊娠并发症（如 GDM、妊娠高血压（GH）、先兆子痫）以及剖腹产等干预措施的发生率增加；（3）对于经过筛选排除现有疾病的健康妇女，即使在非常高龄产妇（50-65 岁）时，也有良好的结局趋势。
尽管有强有力的证据表明非常高龄产妇与母婴不良结局之间存在关联，但在大多数高收入国家，死胎/围生期死亡的绝对发生率仍然较低，不到每 1000 例分娩中有 10 例。因此，尽管该年龄组的妇女面临更大的妊娠风险，但大多数妇女将实现成功的妊娠结局。最佳结局似乎与现有母亲健康有关，在三级中心进行妊娠护理也可能有贡献。这些信息应该用于咨询考虑怀孕的 45 岁及以上妇女。
