OHSU-PSU School of Public Health, Portland, Oregon, USA.
Oregon Health & Science University, Department of Obstetrics & Gynecology, Portland, Oregon, USA.
Int J Gynaecol Obstet. 2023 Aug;162(2):623-631. doi: 10.1002/ijgo.14707. Epub 2023 Feb 21.
To evaluate prenatal care utilization, low birth weight, and preterm birth among women aged 35 years and older in Mexico from 2008 to 2019.
We conducted a historical cohort study of all singleton live births in Mexico from 2008 to 2019. Outcomes were inadequate prenatal care, preterm birth, and low birth weight. We compared outcomes among women aged 35-39, 40-44, and 45-49 years with births to women aged 20-34 years. We used logistic regression to account for individual, health system, and contextual confounders.
We included a total of 19 526 922 births; 2 325 725 (11.9%) were to women aged 35 years and older. Women aged 45-49 years had the lowest levels of education, were more likely to be uninsured, and came from highly marginalized municipalities while those aged 35-39 years had the highest levels of education and insurance and came from the least marginalized municipalities. The odds of inadequate prenatal care (adjusted odds ratio [aOR] 1.12; 95% confidence interval [CI] 1.09-1.15), preterm birth (aOR 2.05; 95% CI 1.97-2.13), and low birth weight (aOR 2.03; 95% CI 1.95-2.12) were highest for women aged 45-49 years, compared with women aged 20-34 years. The odds of adverse perinatal outcomes increased progressively with age, but the odds of inadequate prenatal care (aOR 0.77; 95% CI 0.76-0.77) were lowest for women aged 35-39 years, when compared with women aged 20-34 years.
Women who deliver at 35 years and over are a heterogeneous group in Mexico. Being 35 years old and older is associated with increases in preterm birth and low birth weight neonates. Women who give birth between 45 and 49 years may be especially vulnerable.
评估 2008 年至 2019 年墨西哥 35 岁及以上妇女的产前保健利用情况、低出生体重和早产。
我们对 2008 年至 2019 年期间墨西哥所有单胎活产进行了历史队列研究。结局为产前保健不足、早产和低出生体重。我们比较了 35-39 岁、40-44 岁和 45-49 岁妇女与 20-34 岁妇女的结局。我们使用逻辑回归来考虑个体、卫生系统和背景混杂因素。
我们共纳入 19526922 例分娩；其中 2325725 例（11.9%）为 35 岁及以上妇女。45-49 岁年龄组的受教育程度最低，更有可能没有保险，且来自高度边缘化的市镇，而 35-39 岁年龄组的受教育程度和保险程度最高，且来自最不边缘化的市镇。产前保健不足的几率（调整后的优势比[aOR]1.12；95%置信区间[CI]1.09-1.15）、早产的几率（aOR 2.05；95% CI 1.97-2.13）和低出生体重的几率（aOR 2.03；95% CI 1.95-2.12）最高的是 45-49 岁年龄组，与 20-34 岁年龄组相比。随着年龄的增长，不良围产期结局的几率逐渐增加，但与 20-34 岁年龄组相比，35-39 岁年龄组的产前保健不足的几率（aOR 0.77；95% CI 0.76-0.77）最低。
在墨西哥，35 岁及以上分娩的妇女是一个异质性群体。35 岁及以上与早产和低体重新生儿的发生率增加有关。45-49 岁之间分娩的妇女可能尤其脆弱。
