Carr Rebecca C, McKinney David N, Cherry Amy L, Defranco Emily A
Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH.
Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH..
Am J Obstet Gynecol MFM. 2022 Mar;4(2):100529. doi: 10.1016/j.ajogmf.2021.100529. Epub 2021 Nov 16.
The maternal age influences the risk of adverse pregnancy outcomes, including severe maternal morbidity. However, the leading drivers of severe maternal morbidity may differ between the maternal age groups.
To compare the contribution of different risk factors to the risk of severe maternal morbidity between various maternal age groups and estimate their population-attributable risks.
This was a retrospective, population-based cohort study of all US live births from 2012 to 2016 using birth certificate records. The demographic, medical, and pregnancy factors were compared between the 4 maternal age strata (<18 years, 18-34 years, 35-39 years, and ≥40 years). The primary outcome was composite severe maternal morbidity, defined as having maternal intensive care unit admission, eclampsia, unplanned hysterectomy, or a ruptured uterus. Multivariate logistic regression estimated the relative influence of the risk factors associated with severe maternal morbidity among the maternal age categories. Population-attributable fraction calculations assessed the contribution of the individual risk factors to overall severe maternal morbidity.
Of 19,473,910 births in the United States from 2012 to 2016, 80,553 (41 cases per 10,000 delivery hospitalizations) experienced severe maternal morbidity. The highest rates of severe maternal morbidity were observed at the extremes of maternal age: 45 per 10,000 at <18 years (risk ratio, 1.31; 95% confidence interval, [1.16-1.48]) and 73 per 10,000 (risk ratio, 2.02; 95% confidence interval, [1.96-2.09]) for ≥40 years. In all the age groups, preterm delivery, cesarean delivery, chronic hypertension, and preeclampsia were significantly associated with an increased adjusted relative risk of severe maternal morbidity. Cesarean delivery and preeclampsia increased the severe maternal morbidity risk among all the age groups and were more influential among the youngest mothers. The risk factors with the greatest population-attributable fractions were non-Hispanic Black race (5.4%), preeclampsia (10.9%), preterm delivery (29.4%), and cesarean delivery (38.1%). On the basis of these estimates, the births occurring in mothers at the extremes of maternal age (<18 and ≥35 years) contributed 4 severe maternal morbidity cases per 10,000 live births. Preterm birth and cesarean delivery contributed 12 and 15 cases of severe maternal morbidity per 10,000 live births, respectively.
Both adolescent and advanced-age pregnancies have an increased risk of severe maternal morbidity. However, there are age-specific differences in the drivers of severe maternal morbidity. This information may allow for better identification of those at a higher risk of severe maternal morbidity and may ultimately aid in patient counseling. KEY WORDS: adolescents, advanced-age pregnancy, maternal morbidity, population-attributable fraction.
产妇年龄会影响不良妊娠结局的风险，包括严重孕产妇发病。然而，不同年龄组产妇严重孕产妇发病的主要驱动因素可能有所不同。
比较不同风险因素对不同年龄组产妇严重孕产妇发病风险的贡献，并估计其人群归因风险。
这是一项基于人群的回顾性队列研究，使用出生证明记录，对2012年至2016年美国所有活产进行研究。比较了4个产妇年龄组（<18岁、18 - 34岁、35 - 39岁和≥40岁）的人口统计学、医学和妊娠因素。主要结局是综合严重孕产妇发病，定义为入住产妇重症监护病房、子痫、计划外子宫切除术或子宫破裂。多因素逻辑回归估计了不同年龄组产妇中与严重孕产妇发病相关的风险因素的相对影响。人群归因分数计算评估了个体风险因素对总体严重孕产妇发病的贡献。
2012年至2016年美国有19473910例分娩，其中80553例（每10000例分娩住院中有41例）发生严重孕产妇发病。严重孕产妇发病率最高出现在产妇年龄两端：<18岁时为每10000例中有45例（风险比，1.31；95%置信区间，[1.16 - 1.48]），≥40岁时为每10000例中有73例（风险比，2.02；95%置信区间，[1.96 - 2.09]）。在所有年龄组中，早产、剖宫产、慢性高血压和子痫前期与严重孕产妇发病的调整后相对风险增加显著相关。剖宫产和子痫前期增加了所有年龄组产妇的严重孕产妇发病风险，且对最年轻的母亲影响更大。人群归因分数最高的风险因素是非西班牙裔黑人种族（5.4%）、子痫前期（10.9%）、早产（29.4%）和剖宫产（38.1%）。根据这些估计，产妇年龄两端（<18岁和≥35岁）的母亲所生的每10000例活产中有4例严重孕产妇发病。早产和剖宫产分别导致每10000例活产中有12例和15例严重孕产妇发病。
青少年妊娠和高龄妊娠的严重孕产妇发病风险均增加。然而，严重孕产妇发病的驱动因素存在年龄特异性差异。这些信息可能有助于更好地识别严重孕产妇发病风险较高的人群，并最终有助于患者咨询。关键词：青少年、高龄妊娠、孕产妇发病、人群归因分数
