初产妇单胎妊娠不良妊娠结局随孕产妇年龄变化的趋势：2011-2012 年中国多中心历史队列研究的联合分析点分析。
Changing trends of adverse pregnancy outcomes with maternal age in primipara with singleton birth: A join point analysis of a multicenter historical cohort study in China in 2011-2012.
机构信息
Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China.
出版信息
Acta Obstet Gynecol Scand. 2019 Aug;98(8):997-1003. doi: 10.1111/aogs.13595. Epub 2019 May 1.
INTRODUCTION
Adverse pregnancy outcomes are related to two opposite maternal factors, youth and aging. However, the change in trend of specific outcomes with childbearing age is unknown. The aim of this study was to investigate the changing trend of various maternal and neonatal outcomes with maternal age from 17 to 44 years.
MATERIAL AND METHODS
Data were extracted from the medical records from 2011-2012 of 39 public hospitals of 14 cities in China. The eligibility criteria were primiparity and singleton birth. Join point regression analysis was used to estimate the percent change per year of age (PCA) to explore the trends of adverse pregnancy outcomes with regard to maternal age and to identify the join point of maternal age when the trend was changed.
RESULTS
A total of 89 171 women were eligible for analysis. There were four categories of trend styles. Continuously increasing trends were linear for placenta previa (PCA, 0.1%), placenta implantation (PCA, 0.09%) and postpartum hemorrhage (PCA, 0.22%), and nonlinear for gestational diabetes mellitus with one join point of 23 years (PCA, 0.17% and 0.71%) and cesarean section with four join points of 25, 28, 31 and 36 years (PCA, 1.39%, 0.34%, 1.51%, 3.49% and 0.94%). Continuously decreasing trends were linear for intrahepatic cholestasis (PCA, -0.02%) and nonlinear for anemia with one join point of 28 years (PCA, -0.49% and -0.04%). The bidirective trends were downward to upward for preterm birth (PCA, -2.93%, -0.36% and 0.38%), hypertension in pregnancy (PCA, -0.09%, 0.47%), low birthweight (PCA 0.51% and 0.38%), low 1-minute Apgar score (PCA, -0.28% and 0.07%), low 5-minute Apgar score at (PCA, -0.10% and 0.06%) and neonatal intensive care unit admission (PCA, -1.92%, -0.07% and 0.12%) with a nadir age of 28 years. The bidirective trend was upward to downward for macrosomia (PCA, 0.39% and -0.11%), with a peak age of 30 years.
CONCLUSIONS
The changes in the trend of specific outcomes were different with maternal age, which means that youth, aging or both could affect the outcomes.
简介
不良妊娠结局与两种相反的母体因素有关，即年轻和衰老。然而，特定结局随生育年龄变化的趋势尚不清楚。本研究旨在探讨从 17 岁到 44 岁的不同母婴结局随产妇年龄的变化趋势。
材料与方法
数据来自中国 14 个城市的 39 家公立医院 2011-2012 年的病历。入选标准为初产妇和单胎妊娠。使用 Joinpoint 回归分析估计每年年龄的百分比变化（PCA），以探讨母婴年龄与不良妊娠结局的趋势，并确定母婴年龄变化的拐点。
结果
共有 89171 名妇女符合分析条件。有四种趋势类型。胎盘前置（PCA，0.1%）、胎盘植入（PCA，0.09%）和产后出血（PCA，0.22%）呈线性增长趋势，妊娠期糖尿病（PCA，0.17%和 0.71%）和剖宫产（PCA，1.39%、0.34%、1.51%、3.49%和 0.94%）呈非线性增长趋势，有一个拐点为 23 岁。持续下降的趋势为胆汁淤积性肝病（PCA，-0.02%）和贫血（PCA，-0.49%和-0.04%）呈非线性趋势，有一个拐点为 28 岁。早产（PCA，-2.93%、-0.36%和 0.38%）、妊娠高血压（PCA，-0.09%、0.47%）、低出生体重（PCA，0.51%和 0.38%）、1 分钟 Apgar 评分低（PCA，-0.28%和 0.07%）、5 分钟 Apgar 评分低（PCA，-0.10%和 0.06%）和新生儿重症监护病房入院率（PCA，-1.92%、-0.07%和 0.12%）呈下降至上升趋势，拐点为 28 岁。巨大儿（PCA，0.39%和-0.11%）呈上升至下降趋势，拐点为 30 岁。
结论
特定结局的趋势变化随产妇年龄的不同而不同，这意味着年轻、衰老或两者都可能影响结局。
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