Bianco A, Stone J, Lynch L, Lapinski R, Berkowitz G, Berkowitz R L
Department of Obstetrics, Gynecology, and Reproductive Science, Mount Sinai Medical Center, New York, New York, USA.
Obstet Gynecol. 1996 Jun;87(6):917-22. doi: 10.1016/0029-7844(96)00045-2.
To examine pregnancy outcome among women age 40 years and older.
A retrospective cohort study, including 1404 pregnant women at least 40 years of age and 6978 controls age 20-29 years, was conducted. The two groups were stratified, according to parity, to facilitate separate analysis. Associations between maternal age and pregnancy outcomes were assessed with the contingency chi 2 or two-tailed Fisher exact test. Multiple logistic regression was used to evaluate these associations and allowed for calculation of adjusted odds ratios (OR).
Older gravidas were more likely to develop gestational diabetes (nulliparas: OR 2.7, 95% confidence interval [CI] 1.9-3.7; multiparas: OR 3.8, 95% CI 2.7-5.4), preeclampsia (nulliparas: OR 1.8, 95% CI 1.3-2.6; multiparas: OR 1.9, 95% CI 1.2-2.9), and placenta previa (nulliparas: OR 13.0, 95% CI 4.8-35.0; multiparas: OR 6.4, 95% CI 2.6-15.6). Older women were also at increased risk for cesarean delivery (nulliparas: OR 3.1, 95% CI 2.6-3.7; multiparas: OR 3.3, 95% CI 2.6-4.1), operative vaginal delivery (nulliparas: OR 2.4, 95% CI 1.9-2.9; multiparas: OR 1.5, 95% CI 1.2-1.9), and induction of labor (nulliparas: OR 1.5, 95% CI 1.2-1.8; multiparas: OR 1.4, 95% CI 1.1-1.7). Older nulliparas had an increased incidence of abnormal labor patterns (OR 1.4, 95% CI 1.2-1.7), neonatal intensive care unit admissions (OR 1.6, 95% CI 1.2-2.2), and low 1-minute Apgar scores (OR 2.3, 95% CI 1.1-4.9). Older multiparas were more likely to experience fetal distress (OR 2.0, 95% CI 1.4-2.8), antepartum vaginal bleeding (OR 1.8, 95% CI 1.1-3.1), and preterm premature rupture of membranes (OR 1.7, 95% CI 1.1-2.9).
Although maternal morbidity was increased in the older gravidas, the overall neonatal outcome did not appear to be affected.
研究40岁及以上女性的妊娠结局。
开展一项回顾性队列研究，纳入1404名年龄至少40岁的孕妇以及6978名年龄在20 - 29岁的对照者。根据产次对两组进行分层，以便进行单独分析。采用列联卡方检验或双侧Fisher精确检验评估产妇年龄与妊娠结局之间的关联。使用多因素逻辑回归来评估这些关联，并计算调整后的优势比（OR）。
年龄较大的孕妇更易患妊娠期糖尿病（初产妇：OR 2.7，95%置信区间[CI] 1.9 - 3.7；经产妇：OR 3.8，95% CI 2.7 - 5.4）、先兆子痫（初产妇：OR 1.8，95% CI 1.3 - 2.6；经产妇：OR 1.9，95% CI 1.2 - 2.9）和前置胎盘（初产妇：OR 13.0，95% CI 4.8 - 35.0；经产妇：OR 6.4，95% CI 2.6 - 15.6）。年龄较大的女性剖宫产（初产妇：OR 3.1，95% CI 2.6 - 3.7；经产妇：OR 3.3，95% CI 2.6 - 4.1）、阴道助产（初产妇：OR 2.4，95% CI 1.9 - 2.9；经产妇：OR 1.5，95% CI 1.2 - 1.9）和引产（初产妇：OR 1.5，95% CI 1.2 - 1.8；经产妇：OR 1.4，95% CI 1.1 - 1.7）的风险也增加。年龄较大的初产妇异常产程（OR 1.4，95% CI 1.2 - 1.7）、新生儿重症监护病房收治（OR 1.6，95% CI 1.2 - 2.2）及1分钟Apgar评分低（OR 2.3，95% CI 1.1 - 4.9）的发生率增加。年龄较大的经产妇更易出现胎儿窘迫（OR 2.0，95% CI 1.4 - 2.8）、产前阴道出血（OR 1.8，95% CI 1.1 - 3.1）和胎膜早破（OR 1.7，95% CI 1.1 - 2.9）。
尽管年龄较大的孕妇母体发病率增加，但总体新生儿结局似乎未受影响。
