Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, MedStar Washington Hospital Center, Washington, DC; the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, and the Department of Biostatistics and Epidemiology, MedStar Health Research Institute, Hyattsville, Maryland.
Obstet Gynecol. 2013 Dec;122(6):1184-95. doi: 10.1097/AOG.0000000000000017.
To delineate adverse obstetric and neonatal outcomes as well as indications for cesarean delivery by maternal age in a contemporaneous large national cohort.
This was a retrospective analysis of electronic medical records from 12 centers and 203,517 (30,673 women aged 35 years or older) women with singleton gestations stratified by maternal age. Logistic regression was performed to investigate maternal and neonatal outcomes for each maternal age strata (referent group, age 25.0-29.9 years), adjusting for race, parity, body mass index, insurance, pre-existing medical conditions, substance and tobacco use, and site. Documented indications for cesarean delivery were analyzed.
Neonates born to women aged 25.0-29.9 years had the lowest risk of birth weight less than 2,500 g (7.2%; P<.001), admission to neonatal intensive care unit (11.5%; P<.001), and perinatal mortality (0.7%; P<.001). Hypertensive disorders of pregnancy were higher in women aged 35 years or older (cumulative rate 8.5% compared with 7.8%; 25.0-29.9 years; P<.001). Previous uterine scar was the leading indication for cesarean delivery in women aged 25.0 years or older (36.9%; P<.001). For younger women, failure to progress or cephalopelvic disproportion (37.0% for those younger than age 20.0 years and 31.1% for those aged 20.0-24.9-years; P<.001) and nonreassuring fetal heart tracing (28.7% for those younger than 20.0 years and 21.2% for those aged 20.0-24.9-years; P<.001) predominated as indications. Truly elective cesarean delivery rate was 20.2% for women aged 45.0 years or older (adjusted odds ratio 1.85 [99% confidence interval 1.03-3.32] compared with the referent age group of 25.0-29.9 years).
Maternal and obstetric complications differed by maternal age, as did rates of elective cesarean delivery. Women aged 25.0-29.9 years had the lowest rate of serious neonatal morbidity.
: II.
在一个当代大型全国队列中，描绘产妇年龄对不良产科和新生儿结局以及剖宫产指征的影响。
这是对 12 个中心和 203517 名（30673 名年龄在 35 岁或以上的单胎孕妇）孕妇的电子病历进行的回顾性分析，按产妇年龄分层。采用 logistic 回归分析了每个产妇年龄组（参照组，年龄 25.0-29.9 岁）的产妇和新生儿结局，调整了种族、产次、体重指数、保险、既往疾病、药物和烟草使用以及地点等因素。分析了剖宫产的记录指征。
25.0-29.9 岁产妇分娩的新生儿出生体重低于 2500g 的风险最低（7.2%；P<.001），新生儿入住新生儿重症监护病房（11.5%；P<.001）和围产儿死亡率（0.7%；P<.001）最低。35 岁或以上产妇的妊娠高血压疾病发生率更高（累计发生率 8.5%比 7.8%；25.0-29.9 岁；P<.001）。对于年龄在 25 岁或以上的产妇，既往子宫瘢痕是剖宫产的主要指征（36.9%；P<.001）。对于年轻产妇，产程进展不良或头盆不称（20.0 岁以下产妇为 37.0%，20.0-24.9 岁产妇为 31.1%；P<.001）和胎儿胎心监护不良（20.0 岁以下产妇为 28.7%，20.0-24.9 岁产妇为 21.2%；P<.001）是主要的剖宫产指征。45 岁或以上产妇的真正选择性剖宫产率为 20.2%（调整后的优势比为 1.85[99%置信区间为 1.03-3.32]，与 25.0-29.9 岁参照年龄组相比）。
产妇年龄不同，产科并发症和选择性剖宫产率也不同。25.0-29.9 岁产妇的新生儿严重发病率最低。
II 级。
