Department of Urology, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA 94305-5118, USA.
Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA.
BMJ. 2018 Oct 31;363:k4372. doi: 10.1136/bmj.k4372.
To evaluate the impact of advanced paternal age on maternal and perinatal outcomes in the United States.
Retrospective, population based cohort study.
US.
40 529 905 documented live births between 2007 and 2016.
Primary perinatal outcomes were gestational age, birth weight, Apgar score at five minutes, admission to a neonatal intensive care unit, need for postpartum antibiotics, and seizures. Primary maternal outcomes were gestational diabetes and pre-eclampsia. Secondary outcome was the number of preventable perinatal events.
Higher paternal age was associated with an increased risk of premature birth, low birth weight, and low Apgar score. After adjustment for maternal age, infants born to fathers aged 45 years or older had 14% higher odds of premature birth (odds ratio 1.14, 95% confidence interval 1.13 to 1.15), independent of gestational age, and 18% higher odds of seizures (1.18, 0.97 to 1.44) compared with infants of fathers aged 25 to 34 years. The odds of gestational diabetes was 34% higher (1.34, 1.29 to 1.38) in mothers with the oldest partners. 13.2% (95% confidence interval 12.5% to 13.9%) of premature births and 18.2% (17.5% to 18.9%) of gestational diabetes in births associated with older fathers were estimated to be attributable to advanced paternal age.
Advanced paternal age is associated with negative effects on both mothers and offspring. Given the relatively low prevalence of advanced paternal age in the US, population level impacts are currently modest. Nevertheless, as advanced paternal age has doubled in the US over the past generation, further investigation is warranted of the impact on birth outcomes and public health.
评估美国高龄父亲对母婴围产结局的影响。
回顾性、基于人群的队列研究。
美国。
2007 年至 2016 年间记录的 40529905 例活产。
主要围产结局为胎龄、出生体重、5 分钟时的阿普加评分、新生儿重症监护病房收治、产后抗生素使用和癫痫发作。主要母婴结局为妊娠期糖尿病和子痫前期。次要结局为可预防围产事件的数量。
较高的父亲年龄与早产、低出生体重和低阿普加评分的风险增加有关。在调整母亲年龄后，父亲年龄 45 岁或以上的婴儿早产的可能性增加 14%（优势比 1.14，95%置信区间 1.13 至 1.15），与胎龄无关，且癫痫发作的可能性增加 18%（1.18，0.97 至 1.44），与 25 至 34 岁父亲的婴儿相比。与年龄最大的伴侣生育的母亲患妊娠期糖尿病的风险增加 34%（1.34，1.29 至 1.38）。估计与高龄父亲相关的早产（13.2%，95%置信区间 12.5%至 13.9%）和妊娠期糖尿病（18.2%，17.5%至 18.9%）中有 13.2%可归因于高龄父亲。
高龄父亲与母婴双方的不良后果相关。鉴于美国高龄父亲的相对低流行率，目前人群水平的影响是适度的。尽管如此，由于美国高龄父亲在过去一代人中增加了一倍，进一步调查高龄父亲对生育结局和公共卫生的影响是有必要的。
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