Lean Samantha C, Derricott Hayley, Jones Rebecca L, Heazell Alexander E P
Maternal and Fetal Health Research Centre, Division of Developmental Biology and Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.
St. Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom.
PLoS One. 2017 Oct 17;12(10):e0186287. doi: 10.1371/journal.pone.0186287. eCollection 2017.
Advanced maternal age (AMA; ≥35 years) is an increasing trend and is reported to be associated with various pregnancy complications.
To determine the risk of stillbirth and other adverse pregnancy outcomes in women of AMA.
Embase, Medline (Ovid), Cochrane Database of Systematic Reviews, ClinicalTrials.gov, LILACS and conference proceedings were searched from ≥2000.
Cohort and case-control studies reporting data on one or more co-primary outcomes (stillbirth or fetal growth restriction (FGR)) and/or secondary outcomes in mothers ≥35 years and <35 years.
The effect of age on pregnancy outcome was investigated by random effects meta-analysis and meta-regression. Stillbirth rates were correlated to rates of maternal diabetes, obesity, hypertension and use of assisted reproductive therapies (ART).
Out of 1940 identified titles; 63 cohort studies and 12 case-control studies were included in the meta-analysis. AMA increased the risk of stillbirth (OR 1.75, 95%CI 1.62 to 1.89) with a population attributable risk of 4.7%. Similar trends were seen for risks of FGR, neonatal death, NICU unit admission restriction and GDM. The relationship between AMA and stillbirth was not related to maternal morbidity or ART.
Stillbirth risk increases with increasing maternal age. This is not wholly explained by maternal co-morbidities and use of ART. We propose that placental dysfunction may mediate adverse pregnancy outcome in AMA. Further prospective studies are needed to directly test this hypothesis.
高龄孕产妇（年龄≥35岁）呈上升趋势，据报道与多种妊娠并发症相关。
确定高龄孕产妇死产及其他不良妊娠结局的风险。
检索了自2000年起的Embase、Medline（Ovid）、Cochrane系统评价数据库、ClinicalTrials.gov、LILACS及会议论文集。
队列研究和病例对照研究，报告年龄≥35岁和＜35岁母亲的一项或多项共同主要结局（死产或胎儿生长受限（FGR））和/或次要结局的数据。
采用随机效应荟萃分析和荟萃回归研究年龄对妊娠结局的影响。死产率与孕产妇糖尿病、肥胖、高血压及辅助生殖技术（ART）的使用情况相关。
在1940篇检索到的文献中，63项队列研究和12项病例对照研究纳入荟萃分析。高龄孕产妇增加了死产风险（比值比1.75，95%置信区间1.62至1.89），人群归因风险为4.7%。胎儿生长受限、新生儿死亡、新生儿重症监护病房收治受限及妊娠期糖尿病的风险也呈现类似趋势。高龄孕产妇与死产之间的关系与孕产妇发病率或辅助生殖技术无关。
死产风险随孕产妇年龄增加而升高。这不能完全由孕产妇合并症和辅助生殖技术的使用来解释。我们认为胎盘功能障碍可能介导了高龄孕产妇的不良妊娠结局。需要进一步的前瞻性研究来直接验证这一假设。
