Grotegut Chad A, Chisholm Christian A, Johnson Lauren N C, Brown Haywood L, Heine R Phillips, James Andra H
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina, United States of America.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, Virginia, United States of America.
PLoS One. 2014 Apr 25;9(4):e96237. doi: 10.1371/journal.pone.0096237. eCollection 2014.
The number of women aged 45 and older who become pregnant is increasing. The objective of this study was to estimate the risk of medical and obstetric complications among women aged 45 and older.
The Nationwide Inpatient Sample was used to identify pregnant woman during admission for delivery. Deliveries were identified using International Classification of Diseases, Ninth Revision (ICD-9-CM) codes. Using ICD-9-CM codes, pre-existing medical conditions and medical and obstetric complications were identified in women at the time of delivery and were compared for women aged 45 years and older to women under age 35. Outcomes among women aged 35-44 were also compared to women under age 35 to determine if women in this group demonstrated intermediate risk between the older and younger groups. Logistic regression analyses were used to calculate odds ratios with 95% confidence intervals for pre-existing medical conditions and medical and obstetric complications for both older groups relative to women under 35. Multivariable logistic regression analyses were also developed for outcomes at delivery among older women, while controlling for pre-existing medical conditions, multiple gestation, and insurance status, to determine the effect of age on the studied outcomes.
Women aged 45 and older had higher adjusted odds for death, transfusion, myocardial infarction/ischemia, cardiac arrest, acute heart failure, pulmonary embolism, deep vein thrombosis, acute renal failure, cesarean delivery, gestational diabetes, fetal demise, fetal chromosomal anomaly, and placenta previa compared to women under 35.
Pregnant women aged 45 and older experience significantly more medical and obstetric complications and are more likely to die at the time of a delivery than women under age 35, though the absolute risks are low and these events are rare. Further research is needed to determine what associated factors among pregnant women aged 45 and older may contribute to these findings.
45岁及以上怀孕的女性数量正在增加。本研究的目的是评估45岁及以上女性发生医学和产科并发症的风险。
使用全国住院患者样本确定分娩入院期间的孕妇。通过国际疾病分类第九版（ICD-9-CM）编码识别分娩情况。利用ICD-9-CM编码，确定分娩时女性的既往病史以及医学和产科并发症，并将45岁及以上的女性与35岁以下的女性进行比较。还将35 - 44岁女性的结果与35岁以下女性进行比较，以确定该组女性是否表现出介于年龄较大和较小两组之间的中等风险。采用逻辑回归分析计算两个年龄较大组相对于35岁以下女性的既往病史以及医学和产科并发症的比值比及95%置信区间。还针对年龄较大女性的分娩结局开展多变量逻辑回归分析，同时控制既往病史、多胎妊娠和保险状况，以确定年龄对所研究结局的影响。
与35岁以下女性相比，45岁及以上女性在死亡、输血、心肌梗死/缺血、心脏骤停、急性心力衰竭、肺栓塞、深静脉血栓形成、急性肾衰竭、剖宫产、妊娠期糖尿病、胎儿死亡、胎儿染色体异常和前置胎盘方面的校正比值更高。
45岁及以上的孕妇发生的医学和产科并发症明显更多，且在分娩时死亡的可能性比35岁以下的女性更大，尽管绝对风险较低且这些事件很少见。需要进一步研究以确定45岁及以上孕妇中的哪些相关因素可能导致这些结果。
