Debelo Bikila Tefera, Hunie Asratie Melaku, Solomon Abayneh Aklilu
Department of Midwifery, College of Medicine and Health Science, Ambo University, Ambo, Ethiopia.
Department of Women's and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Obstet Gynecol Int. 2020 Dec 24;2020:1875683. doi: 10.1155/2020/1875683. eCollection 2020.
Pregnancy at an advanced maternal age is defined as pregnancy at 35 years or older. Today, women postpone pregnancy due to different socioeconomic and personal reasons. However, there was limited evidence on fetal adverse outcomes' association with pregnancy at an advanced maternal age in Ethiopia and particularly in the study area. This study was aimed at assessing the effect of pregnancy at an advanced age on selected neonatal adverse pregnancy outcomes in Debre Markos Referral Hospital, Ethiopia, 2019.
Institution-based retrospective cohort study was conducted on 303 exposed (35 years and older) and 604 nonexposed (20-34 years old) immediate postpartum women who delivered at Debre Markos Referral Hospital after 28 weeks of gestation. All exposed women who fulfilled the inclusion criteria were sampled, and systematic random sampling was employed for those in the nonexposed group. The data were collected from 1st of July to 30th of December, 2019, by face-to-face interview and extraction from maternal chart using a structured questionnaire and data extraction checklist, respectively. Binary logistic regression (bivariate and multivariable) model was fitted, and wealth index was analyzed by principal component analysis. Adjusted relative risk with respect to 95% confidence interval was employed for the strength and directions of association between advanced maternal age and selected adverse pregnancy outcomes, respectively. -value of <0.05 was used to declare statistical significance.
The incidence of adverse neonatal outcomes including stillbirth, preterm birth, and low birth weight in the advanced maternal age group was 13.2%, 19.8%, and 16.5%, respectively. The incidence of stillbirth, preterm birth, and low birth weight in the nonexposed group was 3.1%, 8.4%, and 12.4%, respectively. The advanced maternal age group had three times the risk of stillbirth compared with the nonexposed group (ARR = 3.14 95% CI (1.30-7.00)). The advanced maternal age group had 2.66 times the risk of delivering preterm fetus (ARR = 2.66 95% CI (1.81-3.77)) compared with the younger counterparts. Low birth weight was not significantly associated with pregnancy at an advanced maternal age.
Fetal adverse outcomes including stillbirth and preterm birth were significantly associated with pregnancy at an advanced maternal age.
高龄孕产妇妊娠是指年龄在35岁及以上的妊娠。如今，女性因不同的社会经济和个人原因而推迟怀孕。然而，在埃塞俄比亚，尤其是在研究区域，关于高龄孕产妇妊娠与胎儿不良结局之间关联的证据有限。本研究旨在评估2019年埃塞俄比亚德布雷马科斯转诊医院高龄妊娠对选定的新生儿不良妊娠结局的影响。
对在德布雷马科斯转诊医院妊娠28周后分娩的303名暴露组（35岁及以上）和604名非暴露组（20 - 34岁）产后即刻妇女进行基于机构的回顾性队列研究。所有符合纳入标准的暴露组妇女均被纳入样本，非暴露组采用系统随机抽样。数据于2019年7月1日至12月31日收集，分别通过面对面访谈以及使用结构化问卷和数据提取清单从产妇病历中提取。采用二元逻辑回归（双变量和多变量）模型，并通过主成分分析对财富指数进行分析。分别采用调整后的相对风险及95%置信区间来评估高龄孕产妇与选定不良妊娠结局之间关联的强度和方向。P值<0.05表示具有统计学意义。
高龄孕产妇组中包括死产、早产和低出生体重在内的不良新生儿结局发生率分别为13.2%、19.8%和16.5%。非暴露组中死产、早产和低出生体重的发生率分别为3.1%、8.4%和12.4%。与非暴露组相比，高龄孕产妇组死产风险是其3倍（调整后相对风险=3.14，95%置信区间(1.30 - 7.00)）。与年轻组相比，高龄孕产妇组早产风险是其2.66倍（调整后相对风险= 2.66，95%置信区间(1.81 - 3.77)）。低出生体重与高龄孕产妇妊娠无显著关联。
包括死产和早产在内的胎儿不良结局与高龄孕产妇妊娠显著相关。
