Schimmel Michael S, Bromiker Ruben, Hammerman Cathy, Chertman Lila, Ioscovich Alexander, Granovsky-Grisaru Sorina, Samueloff Arnon, Elstein Deborah
Department of Neonatology, Shaare Zedek Medical Center, Affiliated with the Hebrew University, Hadassah Medical School, Jerusalem, Israel.
Arch Gynecol Obstet. 2015 Apr;291(4):793-8. doi: 10.1007/s00404-014-3469-0. Epub 2014 Sep 17.
Delayed childbearing is increasingly common; hence, concerns emerge regarding potential for additional risks of delivery at advanced maternal age (AMA; ≥35 years). In this study, we sought to assess impact of AMA and parity on maternal and perinatal outcomes.
In this retrospective single-center study (July 2005 to October 2011), we compared spontaneously-conceived singleton births of AMA mothers with spontaneously-conceived singletons of mothers aged 24-27 years. Maternal outcomes: incidence of diabetes, hypertension, and emergency cesarean sections (ECS). Neonatal outcomes: prematurity, birth weight, incidence of small or large for gestational age infants (SGA/LGA, respectively), low birth weight (LBW), and 5'-Apgar scores. Sub-groupings of maternal age were 35-38, 39-42, or 43-47 years; prematurity as <34 or <37 weeks; AMA parity as primiparous, 2-5 births, 6-9 births, or ≥10 births. Binary logistic regression was used for multivariate analyses.
Of 24,579 eligible women, 11,243 were AMA (14.0% total singleton births) and 13,336 were aged 24-27 years (16.7% total singleton births) at delivery. There were no maternal or perinatal deaths. Incidence of maternal hypertension and diabetes was significantly greater in AMA, especially oldest AMA. AMA including primiparous had significantly more ECS than younger including primiparous controls, respectively, and were more likely to deliver LGA neonates. Primiparous AMA women did not have increased incidence of LGA babies but significantly increased incidence of SGA infants.
AMA, especially primiparous, has more adverse maternal and neonatal outcomes than younger women; however, these did not include mortality. Consistent antenatal care may explain this.
晚育现象日益普遍，因此，对于高龄产妇（AMA；≥35岁）分娩时潜在额外风险的担忧随之而来。在本研究中，我们试图评估高龄产妇和产次对孕产妇及围产期结局的影响。
在这项回顾性单中心研究（2005年7月至2011年10月）中，我们将高龄产妇自然受孕的单胎分娩与年龄在24 - 27岁的产妇自然受孕的单胎分娩进行了比较。孕产妇结局：糖尿病、高血压和急诊剖宫产（ECS）的发生率。新生儿结局：早产、出生体重、小于胎龄儿或大于胎龄儿（分别为SGA/LGA）的发生率、低出生体重（LBW）以及5分钟阿氏评分。孕产妇年龄的亚组为35 - 38岁、39 - 42岁或43 - 47岁；早产定义为<34周或<37周；高龄产妇产次分为初产妇、2 - 5次分娩、6 - 9次分娩或≥10次分娩。采用二元逻辑回归进行多变量分析。
在24,579名符合条件的女性中，11,243名是高龄产妇（占单胎分娩总数的14.0%），13,336名在分娩时年龄为24 - 27岁（占单胎分娩总数的16.7%）。没有孕产妇或围产期死亡病例。高龄产妇中孕产妇高血压和糖尿病的发生率显著更高，尤其是年龄最大的高龄产妇。包括初产妇在内的高龄产妇急诊剖宫产的比例分别显著高于包括初产妇在内的年轻对照组，且更有可能分娩出大于胎龄儿。初产妇高龄产妇中大于胎龄儿的发生率没有增加，但小于胎龄儿的发生率显著增加。
高龄产妇，尤其是初产妇，比年轻女性有更多不良的孕产妇和新生儿结局；然而，这些结局不包括死亡率。持续的产前护理可能对此做出了解释。
