Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Oxford, UK.
BJOG. 2017 Jul;124(8):1225-1233. doi: 10.1111/1471-0528.14216. Epub 2016 Jul 13.
This study aimed to examine the factors associated with maternal mortality among women aged ≥35 years.
Unmatched population based case-control study.
United Kingdom.
Between 2009 and 2012, 105 cases of maternal deaths aged ≥35 years were extracted from the surveillance database of the MBRRACE-UK confidential enquiries into maternal deaths in the UK. In addition, 766 controls aged ≥35 years were identified from the UK Obstetric Surveillance System (2005-2012).
Risk factors known to be associated with maternal mortality and morbidity and for which data were available were examined for their association with maternal mortality among women ≥35 years using logistic regression analysis.
Odds ratios and 95% confidence intervals associated with maternal death.
Five factors were found to be significantly associated with increased odds of death among women aged ≥35 years: smoking during pregnancy (adjusted odds ratio (aOR) 2.06, 95% CI 1.13-3.75), inadequate use of antenatal care (aOR 23.62, 95% CI 8.79-63.45), medical co-morbidities (aOR 5.92, 95% CI 3.56-9.86) and previous pregnancy problems (aOR 2.06, 95% CI 1.23-3.45). The odds associated with death increased by 12% per year increase in age (aOR 1.12, 95% CI 1.02-1.22).
Age was associated with maternal mortality even after adjusting for other known risk factors. Importantly, this study showed an association between maternal mortality and smoking among women aged 35 years or older. It emphasises the importance of public health action to reduce smoking levels and address trends in rising maternal age.
Smoking is a risk factor for maternal death for those aged over 35 years.
本研究旨在探讨≥35 岁妇女孕产妇死亡的相关因素。
基于人群的非匹配病例对照研究。
英国。
2009 年至 2012 年期间，从英国母婴围产儿死亡率监测数据库（MBRRACE-UK）中提取了 105 例≥35 岁的孕产妇死亡病例。此外，从英国产科监测系统（2005-2012 年）中确定了 766 例≥35 岁的对照。
对于已知与孕产妇发病率和死亡率相关且数据可用的危险因素，采用 logistic 回归分析方法，检验其与≥35 岁妇女孕产妇死亡的相关性。
与孕产妇死亡相关的比值比及其 95%置信区间。
有五个因素被发现与≥35 岁妇女死亡风险增加显著相关：孕期吸烟（调整后比值比[aOR] 2.06，95%CI 1.13-3.75）、产前保健不足（aOR 23.62，95%CI 8.79-63.45）、合并内科疾病（aOR 5.92，95%CI 3.56-9.86）和既往妊娠问题（aOR 2.06，95%CI 1.23-3.45）。年龄每增加 1 岁，死亡风险增加 12%（aOR 1.12，95%CI 1.02-1.22）。
即使在调整了其他已知危险因素后，年龄仍与孕产妇死亡率相关。重要的是，本研究显示了≥35 岁妇女的孕产妇死亡与吸烟之间的关联。这强调了采取公共卫生行动降低吸烟水平和应对产妇年龄上升趋势的重要性。
对于年龄超过 35 岁的女性，吸烟是导致孕产妇死亡的一个风险因素。
