Department of Women's and Children's Health, Division of Reproductive Health Care, the Department of Medicine Solna, Clinical Epidemiology Unit, the Department of Clinical Science, Intervention and Technology, Division of Pediatrics, Karolinska Institutet, Stockholm; and the Center for Clinical Research Dalarna, Falun, Sweden.
Obstet Gynecol. 2015 Aug;126(2):355-362. doi: 10.1097/AOG.0000000000000947.
To investigate the association between advanced maternal age and stillbirth risks in first, second, third, and fourth births or more.
A population-based registry study including all women aged 25 years and older with singleton pregnancies at 28 weeks of gestation and later gave birth in Sweden from 1990 to 2011; 1,804,442 pregnancies were analyzed. In each parity group, the risk of stillbirth at age 30-34 years, 35-39 years, and 40 years and older compared with age 25-29 years was investigated by logistic regression analyses adjusted for sociodemographic factors, smoking, body mass index, history of stillbirth, and interdelivery interval. Also, two low-risk groups were investigated: women with a high level of education and nonsmoking women of normal weight.
Stillbirth rates increased by maternal age: 25-29 years 0.27%; 30-34 years 0.31%; 35-39 years 0.40%; and 40 years or older 0.53%. Stillbirth risk increased by maternal age in first births. Compared with age 25-29 years, this increase was approximately 25% at 30-34 years and doubled at age 35 years. In second, third, and fourth birth or more, stillbirth risk increased with maternal age in women with a low and middle level of education, but not in women with high education. In nonsmokers of normal weight, the risk in second births increased from age 35 years or older and in third births or more from age 30 years or older.
Advanced maternal age is an independent risk factor for stillbirth in nulliparous women. This age-related risk is reduced or eliminated in parous women, possibly as a result of physiologic adaptations during the first pregnancy.
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探讨初产妇、经产妇中母亲年龄较大与死胎风险的关系。
这是一项基于人群的注册研究，纳入了 1990 年至 2011 年在瑞典 28 孕周及以上单胎妊娠且年龄≥25 岁的所有孕妇，共 1804442 例妊娠。在每个产次组中，采用 logistic 回归分析调整了社会人口因素、吸烟、体质量指数、死胎史和产次间隔，比较了 30-34 岁、35-39 岁和 40 岁及以上与 25-29 岁年龄组的死胎风险。还调查了两个低风险组：高学历组和不吸烟且体质量正常的女性。
死胎率随母亲年龄增加而升高：25-29 岁为 0.27%；30-34 岁为 0.31%；35-39 岁为 0.40%；40 岁及以上为 0.53%。初产妇的死胎风险随母亲年龄增加而增加，与 25-29 岁年龄组相比，30-34 岁时增加约 25%，35 岁时增加一倍。在经产妇中，低学历和中等学历的女性死胎风险随母亲年龄增加而增加，但高学历女性则不然。在不吸烟且体质量正常的女性中，第二产次的风险从 35 岁及以上开始增加，第三产次及以上的风险从 30 岁及以上开始增加。
母亲年龄较大是初产妇死胎的独立危险因素。这种与年龄相关的风险在经产妇中降低或消除，可能是由于第一次妊娠时的生理适应。
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