Sugai Shunya, Nishijima Koji, Haino Kazufumi, Yoshihara Kosuke
Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, Niigata, Japan.
Department of Obstetrics and Gynecology, Niigata University Medical and Dental Hospital, Niigata, Japan.
Am J Obstet Gynecol MFM. 2023 Apr;5(4):100885. doi: 10.1016/j.ajogmf.2023.100885. Epub 2023 Feb 4.
This study aimed to identify trends in pregnancy outcomes, especially delivery mode, among pregnant patients older than 45 years.
A literature search was performed using PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials for studies published between January 1, 2010, and June 30, 2022.
The primary outcomes were cesarean delivery and assisted delivery. The secondary outcomes were preeclampsia, gestational diabetes mellitus, placenta previa, placental abruption, postpartum hemorrhage, and preterm birth. The inclusion criteria were studies examining the relationship between older age pregnancy and pregnancy outcomes, studies that compared pregnancy outcomes at maternal age ≥45 years and <45 years, and at least one of the primary and secondary pregnancy outcomes were included.
Study screening was performed after duplicates were identified and removed. The quality of each study and publication bias were assessed. Forest plots and I statistics were calculated for each study outcome for each group. The main analysis was a random-effects analysis. The inverse variance method was used to integrate the results if studies had an adjusted analysis.
Among 4209 studies initially retrieved, 24 were included in this review. All studies were retrospective, observational studies. Pregnant patients aged ≥45 years had a significantly higher cesarean delivery rate (odds ratio, 2.87; 95% confidence interval, 2.50-3.30; I=97%) than those aged <45 years. However, the emergency cesarean delivery rate was lower in older pregnant patients (odds ratio, 0.61; 95% confidence interval, 0.47-0.79; I=79%). Pregnancy in older individuals was associated with a lower assisted delivery rate than pregnancy in younger individuals (odds ratio, 0.85; 95% confidence interval, 0.75-0.97; I=48%). Preeclampsia, gestational diabetes mellitus, placenta previa, placental abruption, postpartum hemorrhage, and preterm birth were more likely to occur in pregnant patients aged ≥45 years than in those aged <45 years. Adjusted pooled analyses showed trends similar to those in the unadjusted pooled analyses.
Adverse pregnancy outcomes, typically cesarean delivery, were more likely to occur in older (≥45 years) pregnant patients than in younger pregnant patients. However, the assisted delivery rate was lower in older pregnant patients.
本研究旨在确定45岁以上孕妇的妊娠结局趋势，尤其是分娩方式。
使用PubMed、科学网和Cochrane对照试验中央注册库对2010年1月1日至2022年6月30日期间发表的研究进行文献检索。
主要结局为剖宫产和助产。次要结局为子痫前期、妊娠期糖尿病、前置胎盘、胎盘早剥、产后出血和早产。纳入标准为研究年龄较大孕妇与妊娠结局之间的关系、比较母亲年龄≥45岁和<45岁时妊娠结局的研究，且纳入了至少一项主要和次要妊娠结局。
在识别并去除重复项后进行研究筛选。评估每项研究的质量和发表偏倚。计算每组每项研究结局的森林图和I统计量。主要分析为随机效应分析。如果研究进行了调整分析，则使用逆方差法整合结果。
在最初检索的4209项研究中，本综述纳入了24项。所有研究均为回顾性观察性研究。年龄≥45岁的孕妇剖宫产率显著高于年龄<45岁者（比值比，2.87；95%置信区间，2.50-3.30；I=97%）。然而，年龄较大的孕妇急诊剖宫产率较低（比值比，0.61；95%置信区间，0.47-0.79；I=79%）。与年轻孕妇相比，年龄较大孕妇的助产率较低（比值比，0.85；95%置信区间，0.75-0.97；I=48%）。年龄≥45岁的孕妇比年龄<45岁的孕妇更易发生子痫前期、妊娠期糖尿病、前置胎盘、胎盘早剥、产后出血和早产。调整后的汇总分析显示出与未调整汇总分析相似的趋势。
年龄较大（≥45岁）的孕妇比年轻孕妇更易出现不良妊娠结局，尤其是剖宫产。然而，年龄较大孕妇的助产率较低。
