Departments of Obstetrics and Gynecology, The Edith Wolfson Medical Center, P.O Box 5, 58100, Holon, Israel.
Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
Arch Gynecol Obstet. 2020 Jun;301(6):1441-1447. doi: 10.1007/s00404-020-05562-x. Epub 2020 May 3.
Pregnancy at advanced maternal age (AMA) has become more common. There has been concern regarding the adverse effect deferring pregnancy might have on pregnancy outcomes. We aimed to prospectively study the effect of AMA on placental pathology.
A prospective case-control study was performed in a single university center. Placental histopathology, maternal demographics, labor characteristics, and neonatal outcomes of pregnancies with AMA were collected and compared to matched controls. We defined AMA as maternal age > 35 years at delivery. In attempt to isolate the effect of maternal age, we excluded cases complicated by preterm birth, hypertensive disorders, diabetes mellitus, small for gestational age, and congenital/genetic anomalies.
The study group included 110 AMA patients that were matched with controls. The groups did not differ in maternal demographics, but the AMA group had a higher rate of assisted reproductive technologies (ART) as compared to the control group (p < 0.001). Placentas in the AMA group were characterized by a higher rate of maternal vascular lesions (MVM) (39.1% vs. 24.5%, p = 0.003), but not fetal vascular malperfusion lesions (p = 0.576). In multivariable analysis maternal age was associated with placental MVM lesions independent of all other maternal demographics (aOR 1.18 95% CI 1.06-3.17). Neonatal outcomes did not significantly differ between the groups.
After excluding all background morbidities-AMA was associated with a higher rate of placental MVM lesions vs. controls. These findings suggest an independent effect of AMA on placental function. Large prospective trials are needed to study the clinical importance of these findings.
高龄产妇（AMA）妊娠越来越常见。人们担心推迟妊娠可能对妊娠结局产生不利影响。我们旨在前瞻性研究 AMA 对胎盘病理的影响。
在一家大学中心进行了一项前瞻性病例对照研究。收集并比较了 AMA 妊娠的胎盘组织病理学、产妇人口统计学、分娩特征和新生儿结局，并与匹配的对照组进行比较。我们将 AMA 定义为分娩时母亲年龄>35 岁。为了分离出母亲年龄的影响，我们排除了早产、高血压疾病、糖尿病、胎儿生长受限和先天性/遗传性异常等并发症的病例。
研究组包括 110 例 AMA 患者，与对照组相匹配。两组在产妇人口统计学方面没有差异，但 AMA 组的辅助生殖技术（ART）比例高于对照组（p<0.001）。与对照组相比，AMA 组胎盘的母体血管病变（MVM）发生率更高（39.1% vs. 24.5%，p=0.003），但胎儿血管灌注不良病变发生率无差异（p=0.576）。多变量分析显示，母亲年龄与胎盘 MVM 病变独立相关，与所有其他产妇人口统计学因素无关（aOR 1.18，95%CI 1.06-3.17）。两组新生儿结局无显著差异。
在排除所有背景疾病后，AMA 与胎盘 MVM 病变的发生率高于对照组相关。这些发现提示 AMA 对胎盘功能有独立影响。需要进行大型前瞻性试验来研究这些发现的临床重要性。
