Thompson James A
College of Veterinary Medicine and Biomedical Science, Texas A&M University, USA.
Acta Sci Paediatr. 2020 Oct;3(10):58-69. doi: 10.31080/aspe.2020.03.0312. Epub 2020 Sep 29.
Men and women, in the United States, are having children at considerably older ages. This changing demographic has been associated with multiple neonatal adverse birth outcomes that are currently considered to constitute a major public health crisis. The objective of this study was to evaluate the risk of parent age on birth defects and to provide results that can serve as a starting point for more specific mediation modeling. The modeling estimated the effects of parent age on birth defects controlling for confounding between maternal and paternal age and separated the mediating effect of chromosomal disorders, including Down syndrome.
Data containing approximately 15,000,000 birth records were obtained from the United States Natality database for the years 2014 to 2018. A Bayesian modeling approach was used to estimate adjusted risks of parent ages both unadjusted and adjusted for the other parent's age and for the mediational effect of chromosomal disorders, including Down syndrome.
Increasing maternal age was associated with increased risks for hypospadias and cyanotic congenital heart disease. Increasing maternal and paternal ages were associated with decreasing risks for gastroschisis. For limb reduction defect, cleft lip and all defects combined, the risk of maternal age was U-shaped with the lowest risks observed at approximately age 35y. Paternal age was not associated with an increase in the birth prevalence of birth defects.
Advancing maternal age was associated with increased birth prevalence of hypospadias and cyanotic congenital heart disease and associated with a lower birth prevalence for gastroschisis. Both older and younger maternal ages were related to limb reduction defect and cleft lip. Advancing paternal age was not associated with an increased birth prevalence of birth defects but was associated with a decreased birth prevalence of gastroschisis.
在美国，男性和女性生育子女的年龄大幅提高。这种人口结构的变化与多种新生儿不良出生结局相关，目前这些不良结局被视为重大的公共卫生危机。本研究的目的是评估父母年龄对出生缺陷的风险，并提供可作为更具体中介模型起点的结果。该模型估计了父母年龄对出生缺陷的影响，控制了父母年龄之间的混杂因素，并分离了包括唐氏综合征在内的染色体疾病的中介作用。
从美国2014年至2018年出生数据库中获取了包含约1500万条出生记录的数据。采用贝叶斯建模方法来估计未调整以及调整了另一方父母年龄和染色体疾病（包括唐氏综合征）中介作用后的父母年龄调整风险。
母亲年龄增加与尿道下裂和青紫型先天性心脏病风险增加相关。母亲和父亲年龄增加与腹裂风险降低相关。对于肢体短小缺陷、唇裂以及所有缺陷综合来看，母亲年龄的风险呈U形，在约35岁时风险最低。父亲年龄与出生缺陷的出生患病率增加无关。
母亲年龄增长与尿道下裂和青紫型先天性心脏病的出生患病率增加相关，与腹裂的出生患病率降低相关。母亲年龄偏大和偏小均与肢体短小缺陷和唇裂有关。父亲年龄增长与出生缺陷的出生患病率增加无关，但与腹裂的出生患病率降低有关。
