Department of Obstetrics & Gynecology, Radboud University Medical Center, Nijmegen, the Netherlands.
Department of Obstetrics and Gynecology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Acta Obstet Gynecol Scand. 2020 Aug;99(8):1022-1030. doi: 10.1111/aogs.13828. Epub 2020 Apr 5.
There is an increase in women delivering ≥35 years of age. We analyzed the association between advanced maternal age and pregnancy outcomes in late- and postterm pregnancies.
A national cohort study was performed on obstetrical low-risk women using data from the Netherlands Perinatal Registry from 1999 to 2010. We included women ≥18 years of age with a singleton pregnancy at term. Women with a pregnancy complicated by congenital anomalies, hypertensive disorders or diabetes mellitus were excluded. Composite adverse perinatal outcome was defined as stillbirth, neonatal death, meconium aspiration syndrome, 5-minute Apgar score <7, neonatal intensive care unit admittance and sepsis. Composite adverse maternal outcome was defined as maternal death, placental abruption and postpartum hemorrhage of >1000 mL.
We stratified the women into three age groups: 18-34 (n = 1 321 366 [reference]); 35-39 (n = 286 717) and ≥40 (n = 40 909). Composite adverse perinatal outcome occurred in 1.6% in women aged 18-34, 1.7% in women aged 35-39 (relative risk [RR] 1.06, 95% confidence interval [95% CI] 1.03-1.08) and 2.2% in women aged ≥40 (RR 1.38, 95% CI 1.29-1.47), with 5-minute Apgar score <7 as the factor contributing most to the outcome. Composite adverse maternal outcome occurred in 4.6% in women aged 18-34, 5.0% in women aged 35-39 (RR 1.08, 95% CI 1.06-1.10) and 5.2% in women aged ≥40 (RR 1.14, 95% CI 1.09-1.19), with postpartum hemorrhage >1000 mL as the factor contributing most to the outcome. In all age categories, the risk of adverse pregnancy outcomes was higher for nulliparous than for multiparous women. The risk of adverse outcomes increased in both nulliparous and parous women with advancing gestational age. When adjusted for parity, onset of labor and gestational age, advanced maternal age is associated with an increase in both composite adverse perinatal and maternal outcomes.
The risk of adverse pregnancy outcome increases with advancing maternal age. Women aged ≥40 have an increased risk of adverse perinatal and maternal outcome when pregnancy goes beyond 41 weeks.
选择大于 35 岁的产妇数量有所增加。本研究分析了高龄产妇与晚期和过期妊娠不良妊娠结局的关系。
这是一项全国性队列研究，使用了荷兰围产期登记处 1999 年至 2010 年的数据，纳入了年龄大于 18 岁且足月单胎妊娠的低危孕妇。排除合并先天性畸形、高血压疾病或糖尿病的孕妇。复合不良围产儿结局定义为死胎、新生儿死亡、胎粪吸入综合征、5 分钟阿普加评分<7、新生儿重症监护病房入住和败血症。复合不良产妇结局定义为产妇死亡、胎盘早剥和产后出血>1000ml。
我们将孕妇分为三组：18-34 岁（n=1321366[参考]）；35-39 岁（n=286717）和≥40 岁（n=40909）。18-34 岁孕妇复合不良围产儿结局发生率为 1.6%，35-39 岁孕妇为 1.7%（相对风险[RR]1.06，95%置信区间[95%CI]1.03-1.08），≥40 岁孕妇为 2.2%（RR 1.38，95%CI 1.29-1.47），5 分钟阿普加评分<7 是导致该结果的主要因素。18-34 岁孕妇复合不良产妇结局发生率为 4.6%，35-39 岁孕妇为 5.0%（RR 1.08，95%CI 1.06-1.10），≥40 岁孕妇为 5.2%（RR 1.14，95%CI 1.09-1.19），产后出血>1000ml 是导致该结果的主要因素。在所有年龄组中，初产妇不良妊娠结局的风险高于经产妇。随着胎龄的增加，初产妇和经产妇不良妊娠结局的风险均增加。当调整产次、分娩开始和胎龄时，高龄产妇与复合不良围产儿和产妇结局的增加有关。
不良妊娠结局的风险随产妇年龄的增长而增加。≥40 岁的孕妇在妊娠超过 41 周时，不良围产儿和产妇结局的风险增加。
