母亲年龄增加与胎儿死亡风险

Increased maternal age and the risk of fetal death.

作者信息

Fretts R C, Schmittdiel J, McLean F H, Usher R H, Goldman M B

机构信息

Department of Obstetrics and Gynecology, Beth Israel Hospital, Boston, MA 02215, USA.

出版信息

N Engl J Med. 1995 Oct 12;333(15):953-7. doi: 10.1056/NEJM199510123331501.

DOI:10.1056/NEJM199510123331501

PMID:7666913

Abstract

BACKGROUND

Although the fetal death rate has declined over the past 30 years among women of all ages, it is unknown whether particular characteristics of the mother, such as age, still affect the risk of fetal death. We undertook a study to determine whether older age, having a first child (nulliparity), or other characteristics of the mother are risk factors for fetal death.

METHODS

We used data from the McGill Obstetrical Neonatal Database to evaluate risk factors for fetal death among all deliveries at the Royal Victoria Hospital in Montreal (n = 94,346) from 1961 through 1993. Data were available for two time periods (1961 through 1974 and 1978 through 1993); data for 1975 through 1977 have not been entered into the data base and were therefore not included. Using logistic regression, we estimated the effect of specific maternal characteristics and complications of pregnancy on the risk of fetal death.

RESULTS

The fetal death rate decreased significantly from 11.5 per 1000 total births (including live births and stillbirths) in the 1960s to 3.2 per 1000 in 1990 through 1993 (P < 0.001). Between these periods, the average maternal age at delivery increased from 27 to 30 years (P < 0.001), and the frequency of the diagnosis of diabetes and hypertension during pregnancy increased fivefold (P < 0.001). Nevertheless, after we controlled for these and other maternal characteristics, women 35 years of age or older continued to have a significantly higher rate of fetal death than their younger counterparts (odds ratio for women 35 to 39 years of age as compared with women < 30 years of age, 1.9; 95 percent confidence interval, 1.3 to 2.7; for those 40 or older, 2.4; 95 percent confidence interval, 1.3 to 4.5).

CONCLUSIONS

Changes in maternal health and obstetrical practice have resulted in a 70 percent decline in the rate of fetal death among pregnant women of all ages since the 1960s. Advancing maternal age, however, continues to be a risk factor for fetal death.

摘要

背景

尽管在过去30年里所有年龄段女性的胎儿死亡率都有所下降，但尚不清楚母亲的某些特征，如年龄，是否仍会影响胎儿死亡风险。我们开展了一项研究，以确定高龄、初产（未生育）或母亲的其他特征是否为胎儿死亡的风险因素。

方法

我们使用了麦吉尔产科新生儿数据库的数据，评估1961年至1993年蒙特利尔皇家维多利亚医院所有分娩（n = 94,346）中胎儿死亡的风险因素。数据有两个时间段（1961年至1974年和1978年至1993年）；1975年至1977年的数据未录入数据库，因此未纳入。使用逻辑回归，我们估计了特定母亲特征和妊娠并发症对胎儿死亡风险的影响。

结果

胎儿死亡率从20世纪60年代每1000例总出生数（包括活产和死产）中的11.5例显著下降至1990年至1993年的每1000例3.2例（P < 0.001）。在这些时间段之间，分娩时的平均母亲年龄从27岁增加到30岁（P < 0.001），孕期糖尿病和高血压的诊断频率增加了五倍（P < 0.001）。然而，在我们对这些及其他母亲特征进行控制后，35岁及以上的女性胎儿死亡率仍显著高于年轻女性（35至39岁女性与<30岁女性相比的优势比为1.9；95%置信区间为1.3至2.7；40岁及以上女性为2.4；95%置信区间为1.3至4.5）。