Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Womens Health Issues. 2021 Jan-Feb;31(1):40-48. doi: 10.1016/j.whi.2020.08.008. Epub 2020 Sep 19.
Advanced maternal age (AMA) has been linked to both higher risk of adverse birth outcomes and higher levels of comorbidities. It is unclear if adverse outcomes are higher for older healthy women. This study examined the association between AMA and adverse birth outcomes among women with and without preexisting and pregnancy-related health conditions.
Analysis of data for 14,933 singleton births between 2004 and 2015 from the population-based Maryland Pregnancy Risk Assessment Monitoring System was conducted, comparing women aged 20-34 years and 35 years and older. Multivariable logistic regression estimated the difference in odds of preterm birth (PTB) and low birthweight (LBW) by age group among women with and without health conditions. The analysis of women without health conditions was stratified by parity.
Among women without health conditions, AMA was associated with higher odds of PTB regardless of birthweight, LBW regardless of term, LBW term births, and LBW PTBs; stratified analysis showed higher risk of these outcomes among both older primiparas and multiparas. Compared with younger women with hypertensive disorders, older women with similar health conditions had higher odds of PTB regardless of birthweight. Older women with asthma had higher odds of LBW term births.
AMA is associated with adverse birth outcomes among women with and without health conditions compared with younger women with similar health status. Improved screening and management of health conditions during pregnancy is needed for older women, regardless of parity.
高龄产妇（AMA）与不良母婴结局风险增加以及合并症水平升高有关。高龄健康女性的不良结局是否更高尚不清楚。本研究考察了有无既往和妊娠相关健康状况的女性中，AMA 与不良母婴结局之间的关联。
分析了 2004 年至 2015 年马里兰州基于人群的妊娠风险评估监测系统中 14933 例单胎妊娠的数据，比较了年龄在 20-34 岁和 35 岁及以上的女性。多变量逻辑回归估计了有无健康状况的女性中，年龄组间早产（PTB）和低出生体重（LBW）的几率差异。无健康状况的女性按产次进行分层分析。
在无健康状况的女性中，无论出生体重如何，AMA 均与较高的 PTB 几率相关；无论足月与否，LBW、LBW 足月出生和 LBW PTB 几率均较高；分层分析显示，高龄初产妇和经产妇均有更高的发生这些结局的风险。与患有高血压疾病的年轻女性相比，有相似健康状况的高龄女性，无论出生体重如何，PTB 的几率均较高。患有哮喘的高龄女性，LBW 足月出生的几率较高。
与健康状况相似的年轻女性相比，有和无健康状况的女性 AMA 与不良母婴结局有关。无论产次如何，都需要对高龄女性进行健康状况的改善筛查和妊娠管理。
