Institute of Reproductive and Child Health/National Health Commission Key Laboratory of Reproductive Health, Peking University Health Science Center, Beijing, China.
Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China.
J Glob Health. 2023 Dec 1;13:04161. doi: 10.7189/jogh.13.04161.
Although maternal age might affect pregnancy outcomes, it remains unclear whether this relationship is linear or curvilinear and if it differs between nulliparous and multiparous women. We aimed to characterize the relationship between maternal age and risks of pregnancy outcomes in a diverse sample of Chinese singleton pregnant women and to evaluate whether the relationship varied by parity.
We based this prospective multicenter cohort study on data from 18 495 singleton pregnant women who participated in the University Hospital Advanced Age Pregnant Cohort Study, conducted in eight Chinese public hospitals from 2016 to 2021. We used restricted cubic splines to model nonlinear relationships between maternal age continuum and adverse outcomes, and performed multivariable log-binomial regression to estimate the adjusted relative risk (RR) and 95% confidence interval (CI).
Among 18 495 singleton pregnant women (mean age 35.7, standard deviation (SD) = 4.2 years), maternal age was not related to postpartum hemorrhage or small for gestational age, but showed a positive, nonlinear relationship to gestational diabetes mellitus, hypertensive disorders of pregnancy, preeclampsia, placenta accreta spectrum, placenta previa, cesarean delivery, preterm birth, large for gestational age, macrosomia, and fetal congenital anomaly, with inflection points around 35.6-40.4 years. Compared to women younger than 35 years, older women had higher risks of adverse pregnancy outcomes, except for postpartum hemorrhage and small for gestational age. The risks of placenta accreta spectrum, placenta previa, large for gestational age, and macrosomia were highest for women aged 40-44 years, and risks of gestational diabetes mellitus, hypertensive disorders of pregnancy, preeclampsia, cesarean delivery, preterm birth and congenital anomaly were highest for those aged ≥45 years. Most risks were more pronounced in nulliparous than multiparous women (P for interaction <0.02).
Delayed childbirth was related to increased risks of adverse pregnancy outcomes, especially for nulliparous women. Appropriate childbearing age, generally before 35 years, is recommended for optimising pregnancy outcomes.
虽然产妇年龄可能会影响妊娠结局，但目前尚不清楚这种关系是线性的还是曲线的，以及它是否在初产妇和经产妇之间存在差异。我们旨在描述中国单胎孕妇中产妇年龄与妊娠结局风险之间的关系，并评估这种关系是否因产次而异。
我们基于 2016 年至 2021 年期间在 8 家中国公立医院参加高龄孕妇队列研究的 18495 名单胎孕妇的前瞻性多中心队列研究数据。我们使用限制立方样条来模拟产妇年龄连续体与不良结局之间的非线性关系，并使用多变量对数二项式回归来估计调整后的相对风险（RR）和 95%置信区间（CI）。
在 18495 名单胎孕妇中（平均年龄 35.7 岁，标准差 4.2 岁），产妇年龄与产后出血或小于胎龄儿无关，但与妊娠期糖尿病、妊娠高血压疾病、子痫前期、胎盘植入谱、前置胎盘、剖宫产、早产、大于胎龄儿、巨大儿和胎儿先天性异常呈正相关，非线性关系，拐点在 35.6-40.4 岁左右。与年龄小于 35 岁的女性相比，年龄较大的女性发生不良妊娠结局的风险更高，除了产后出血和小于胎龄儿。胎盘植入谱、前置胎盘、大于胎龄儿和巨大儿的风险在 40-44 岁的女性中最高，妊娠期糖尿病、妊娠高血压疾病、子痫前期、剖宫产、早产和先天性异常的风险在年龄≥45 岁的女性中最高。与经产妇相比，大多数风险在初产妇中更为明显（P 交互<0.02）。
延迟分娩与不良妊娠结局风险增加有关，尤其是对于初产妇。建议适当的生育年龄，一般在 35 岁之前，以优化妊娠结局。
