Department of Health Sciences, San Paolo Hospital Medical School, Università degli Studi di Milano, Milano, Italy.
Integrated System for Health, Social Assistance and Welfare - Directorate for Social Statistics and Population Census, ISTAT - Italian Statistical Institute, Rome, Italy.
J Matern Fetal Neonatal Med. 2022 Nov;35(21):4137-4141. doi: 10.1080/14767058.2020.1847075. Epub 2020 Nov 23.
In recent decades, the trend for women is to delay childbearing. However, worldwide, advanced maternal age is an independent risk factor for stillbirth, as well as advanced gestational age. National data are not available about stillbirths in the Italian population. We explored whether, at term of pregnancy, advanced maternal age is associated with an increased risk of stillbirth in Italy. We speculate that a policy of induction of labor at term of pregnancy in older mothers may significantly reduce the stillbirth.
Data provided by Italian Ministry of Health and National Statistical Institute were used to identify all singleton deliveries ≥22 weeks of gestation during a four years study period. We evaluated the outcome of pregnancy (livebirths or stillbirths) and we stratified data by gestational age and by maternal age at delivery. The hazard risk and the relative risk of stillbirth were calculated.
The overall stillbirth rate was 3.4 per 1000, with a total of 6451 cases of stillbirths in the four years study period. Overall, the risk of stillbirth increases at term of pregnancy in all maternal age groups, especially in older mothers. A total of 674 stillbirths occurred in women aged 40 years or older and 24.2% of them ( = 163) occurred at term of pregnancy. Among women aged 40 years and above, 7.3% of stillbirths (49/674) occurred beyond 39 weeks of gestation. The hazard risk doubles from 39 to 40 weeks, from 0.60 per 1000 ongoing pregnancies to 1.16 per 1000 ongoing pregnancies; the relative risk at 40 weeks of gestation was the highest in the older mothers and was 5.17 (95% CI 3.16-8.46).
The effect of maternal age on birth outcomes is a relevant aspect in Italy. If the association between maternal age and stillbirth is supposed to be part of the pathophysiology of fetal death, our data indicate that induction of labor before 40 weeks of gestation in women aged 40 years old or older might prevent overall 7.3% of stillbirths for induction at 39 weeks, 13% of stillbirths for induction at 38 weeks. To reduce potentially preventable stillbirths, caregivers should perform a specific risk assessment for each pregnant woman. The impact of maternal age should be seriously considered, and an individualized approach should be planned at term of pregnancy in older mothers, including the possibility of a slightly anticipation of induction of labor if spontaneously undelivered.
近几十年来，女性的生育年龄呈推迟趋势。然而，在全球范围内，高龄产妇是导致死胎的独立危险因素，同时也是导致过期妊娠的独立危险因素。意大利的人口中并没有关于死产的数据。我们探讨了在意大利，妊娠末期高龄产妇是否与死产风险增加相关。我们推测，在妊娠末期对高龄产妇实施引产可能会显著降低死产率。
我们使用意大利卫生部和国家统计局提供的数据，确定了四年研究期间所有 22 周以上的单胎分娩。我们评估了妊娠结局（活产或死产），并根据孕龄和产妇分娩时的年龄进行了分层。计算了死产的危险比和相对风险。
总的死产率为每 1000 例活产 3.4 例，在四年的研究期间共有 6451 例死产。总的来说，所有产妇年龄组在妊娠末期的死产风险都在增加，尤其是高龄产妇。共有 674 例死产发生在 40 岁及以上的妇女中，其中 24.2%（163 例）发生在妊娠末期。在 40 岁及以上的妇女中，有 7.3%（49/674）的死产发生在 39 周以后。从 39 周到 40 周，危险比增加一倍，从每 1000 例活产中 0.60 例增加到每 1000 例活产中 1.16 例；在高龄产妇中，40 周的相对风险最高，为 5.17（95%CI 3.16-8.46）。
产妇年龄对分娩结局的影响是意大利的一个重要方面。如果产妇年龄与死产之间的关联被认为是胎儿死亡的病理生理学的一部分，那么我们的数据表明，对 40 岁及以上的妇女在 40 周之前实施引产可能会预防 39 周时的所有 7.3%的死产、38 周时的 13%的死产。为了降低潜在可预防的死产，医务人员应针对每位孕妇进行特定的风险评估。应认真考虑产妇年龄的影响，并为妊娠末期的高龄产妇制定个体化的方案，包括在未自发分娩时稍微提前引产的可能性。
