Hamada Rintaro, Hasegawa Akihiro, Maeda Yuto, Suemitsu Tokumasa, Matsuoka Tomona, Matsui Hitoshi, Takahashi Ken, Ito Yuki, Kamide Taizan, Samura Osamu, Okamoto Aikou
Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Nishi-Shinbashi 3-19-18, Minato-Ku, Tokyo, 105-8471, Japan.
Department of Public Health, Institute of Science Tokyo, M&D Tower 16 F, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan.
BMC Pregnancy Childbirth. 2025 Jul 3;25(1):711. doi: 10.1186/s12884-025-07827-2.
Advanced maternal age (AMA), defined as pregnancy in people aged ≥ 35 years, is associated with an increased risk of adverse perinatal outcomes. Although the outcomes of AMA pregnancies have been reported, detailed information on the specific outcomes in pregnant individuals aged ≥ 45 years, particularly those reaching full term, remains limited. Therefore, this study aimed to investigate the perinatal outcomes of full-term pregnant individuals aged ≥ 45 years.
We conducted a retrospective cohort study involving full-term pregnant individuals aged ≥ 35 years who attempted vaginal delivery at our facility between January 2019 and December 2023. Participants were categorized into the AMA (35-39 years, n = 947), moderate AMA (40-44 years, n = 387), and very AMA (≥ 45 years, n = 34) groups. The primary outcomes included maternal outcomes, such as intrapartum cesarean delivery (CD) rate and indications, blood loss, and additional interventions (e.g., uterine artery embolization [UAE]). Secondary outcomes included neonatal outcomes such as birth weight, Apgar score, umbilical artery pH, need for respiratory support, and neonatal intensive care unit (NICU) admission within 24 h of birth.
The intrapartum CD rate increased significantly with age (AMA: 17.0%, moderate AMA: 27.1%, very AMA: 35.3%; p < 0.01). However, more than half of the deliveries were vaginal, even in the very AMA group. No significant differences in intrapartum CD indications were found between the groups. The amount of blood loss was significantly higher in the moderate AMA group than in the other groups (p < 0.001). UAE and cesarean hysterectomy incidences showed no significant differences across the groups (p = 0.52 and p = 0.78, respectively). Regarding neonatal outcomes, no significant differences in birth weight were observed, along with low Apgar score, low umbilical artery pH, need for respiratory support, or NICU admission within 24 h of birth between the groups (p = 0.61, p = 0.62, p = 0.52, p = 1.00, and p = 0.44, respectively).
Although the risk of intrapartum CD increases in pregnant individuals aged ≥ 45 years, those delivering at full term have neonatal outcomes similar to those of younger AMA pregnancies. Importantly, nearly two-thirds of this cohort achieved vaginal delivery. This information may be helpful for consultations with pregnant individuals aged ≥ 45 years in the clinical setting.
高龄孕产妇（AMA）定义为年龄≥35岁的孕妇，其围产期不良结局风险增加。尽管已有AMA妊娠结局的报道，但关于年龄≥45岁孕妇的具体结局，尤其是足月分娩者的详细信息仍然有限。因此，本研究旨在调查年龄≥45岁的足月孕妇的围产期结局。
我们进行了一项回顾性队列研究，纳入了2019年1月至2023年12月期间在我院尝试经阴道分娩的年龄≥35岁的足月孕妇。参与者被分为AMA组（35 - 39岁，n = 947）、中度AMA组（40 - 44岁，n = 387）和极重度AMA组（≥45岁，n = 34）。主要结局包括孕产妇结局，如产时剖宫产（CD）率及指征、失血量和额外干预措施（如子宫动脉栓塞术[UAE]）。次要结局包括新生儿结局，如出生体重、阿氏评分、脐动脉pH值、呼吸支持需求以及出生后24小时内入住新生儿重症监护病房（NICU）的情况。
产时CD率随年龄显著增加（AMA组：17.0%，中度AMA组：27.1%，极重度AMA组：35.3%；p < 0.01）。然而，即使在极重度AMA组，超过一半的分娩为经阴道分娩。各组间产时CD指征无显著差异。中度AMA组的失血量显著高于其他组（p < 0.001）。UAE和剖宫产子宫切除术的发生率在各组间无显著差异（分别为p = 0.52和p = 0.78）。关于新生儿结局，各组间出生体重、低阿氏评分、低脐动脉pH值、呼吸支持需求或出生后24小时内入住NICU情况均无显著差异（分别为p = 0.61、p = 0.62、p = 0.52、p = 1.00和p = 0.44）。
尽管年龄≥45岁的孕妇产时CD风险增加，但足月分娩者的新生儿结局与年轻AMA妊娠者相似。重要的是，该队列中近三分之二实现了经阴道分娩。这些信息可能有助于在临床环境中与年龄≥45岁的孕妇进行咨询。
