产妇年龄对新生儿不良结局影响的回顾性队列研究

doi:10.3969/j.issn.1673-5501.2019.04.006

摘要/Abstract

摘要： 目的探讨不同怀孕年龄单胎妊娠产妇和新生儿不良结局的关系。方法采用回顾性队列研究的方法,通过截取产科和新生儿科电子病例资料,获得2006年1月至2018年12月复旦大学附属妇产科医院住院单胎妊娠孕妇的社会人口学资料、孕产史及本次妊娠情况。按照分娩年龄不同将产妇分为低龄(<20岁)、适龄(~34岁)和高龄组(≥35岁)。分析各年龄组产妇相关特征的基线和妊娠的新生儿结局的发生率。组间比较采用χ²或Fisher精确检验。采用多自变量logistic回归模型,进行产妇亚组分析,以~34岁组为参考组,对<20、≥35岁组产妇,通过比值比(Crude OR)、调整比值比(Adjusted OR)和95％CI表示各产妇亚组相关的新生儿不良结局的风险。结果 2006至2014年高龄产妇比例6.9%~9.9%,2015、2016、2017和2018高龄产妇的比例分别为13.1%、13.8%、17.6%和19.6%。低龄组、高龄组在流动人口、初产妇、剖宫产比例方面与适龄组相比差异均有统计学意义(P均<0.001)。高龄组较适龄组胎产式为非头位者、不良孕产史、男性新生儿比例增加(P<0.05)。校正后低龄组和高龄组早产儿的发生率分别是适龄组的1.88倍(95%CI:1.34~2.65)和1.31倍(95%CI:1.21~1.42)。低龄组和高龄组中期早产儿的发生率分别是适龄组的2.83倍(95%CI:1.45~5.54)和1.34倍(95%CI:1.13~1.60),低龄组和高龄组晚期早产儿的发生率分别是适龄组的1.75倍(95%CI:1.22~2.51)和1.27倍(95%CI:1.17~1.36)。低龄组和高龄组低出生体重儿的发生率分别是适龄组的2.35倍(95%CI:1.66~3.33)和1.26倍(95%CI:1.16~1.37)。高龄组出生缺陷发生率是适龄组的1.39倍(95%CI:1.20~1.62)。结论与适龄组相比,高龄组和低龄组产妇增加了早产、中期早产儿、晚期早产儿和低出生体重的风险。对低龄产妇应加强流动人口的管理,定期产检。对高龄产妇,应预防出生缺陷的发生,积极处理妊娠期并发症,加强孕中后期监护,预防围生期感染。本研究结果有助于不同怀孕年龄产妇的产前咨询和管理。

关键词: 不良结局, 怀孕年龄, 母亲, 新生儿

Abstract: Objective To investigate the association of maternal age and adverse neonatal outcomes in singleton pregnancies.Methods A retrospective cohort study was conducted to obtain the sociodemographic data, maternal history and pregnancy status of pregnant women in our hospital Obstetrics and Gyncology Hospital of Fudan University from January 2006 to December 2018 by reviewing obstetric and neonatal information. According to maternal age, the pregnant women were divided into three groups of low age group(<20 years old), appropriate age group (20-34 years old) and advanced age group (35 years of age or older). We analyzed the baseline maternal characteristics in all maternal age groups, prevalence of pregnancy outcomes in relation to the maternal age groups and the incidence of adverse neonatal outcomes. We analyzed the comparisons between groups using χ² or Fisher exact test. The association between each maternal age group and each adverse outcome was analyzed by a multivariate logistic regression model. At the same time, a subgroup analysis of maternal age was performed. The mothers aged 20-34 years as the reference group and the odds ratio (crude OR) and adjusted odds ratio (adjusted OR) and 95% confidence intervals (95%CI) were used to indicate the risk of neonatal adverse outcomes associated with subgroups.Results In recent years, the proportion of advanced maternal age in total pregnancy women has increased. From 2006 to 2014, the proportion of advanced age group in total pregnancy women 6.9%-9.9%, and the proportion of advanced age group in 2015, 2016, 2017 and 2018 was 13.1%, 13.8%, 17.6% and 19.6%, respectively. There were significant differences in the proportion of floating population, parturients and cesarean section between the low age group and the appropriate age group, the advanced age group and the appropriate age group as well (P all < 0.001). The non-cephalic birth type, abverse pregnancy history and the proportion of male newborns in advanced age group were higher than those in the appropriate age group (P < 0.05). After adjusting a variety of factors, the incidence of premature infants in low age group and advanced age group was 1.88 times (95%CI:1.34-2.65) and 1.31 times (95%CI:1.21-1.42) higher than that in the appropriate age group, respectively. The incidence of mid-term premature infants in the low age group and the advanced age group was 2.83 times (95%CI:1.45-5.54) and 1.34 times (95%CI:1.13-1.60) higher than that in the appropriate age group, respectively. The incidence of late premature infants in the low age group and the advanced age group was 1.75 times (95%CI:1.22-2.51) and 1.27 times (95%CI:1.17-1.36) higher than that in the appropriate age group, respectively. The incidence of low birth weight infants in the low age group and the advanced age group was 2.35 times (95%CI:1.66-3.33) and 1.26 times (95%CI:1.16-1.37) higher than that in the appropriate age group, respectively. The incidence of birth defects in the advanced age group was 1.39 times higher than that in the appropriate age group (95%CI:1.20-1.62).Conclusion The risk of preterm, moderate preterm, late preterm infants, low birth weight in both the low age group and the advanced age group were significantly higher than women aged 20-34 years, respectively. The management of floating population should be strengthened and prenatal examination should be carried out regularly. For the advanced age group, we should prevent the occurrence of birth defects, actively deal with complications during pregnancy, strengthen monitoring in the middle and late pregnancy, and prevent perinatal infection. The results of this study can contribute to the prenatal counseling and management of pregnant women of different gestational ages.

Key words: Adverse outcomes, Gestational ages, Mother, Newborns

杨旻, 汪吉梅. 产妇年龄对新生儿不良结局影响的回顾性队列研究[J]. 中国循证儿科杂志, 2019, 14(4): 276-281.

YANG Min, WANG Ji-mei. Retrospective cohort study of the effect of maternal age on adverse neonatal outcomes[J]. Chinese Journal of Evidence -Based Pediatric, 2019, 14(4): 276-281.

参考文献

[1]Heffner LJ. Advanced maternal age-how old is too old? N Engl J Med, 2004, 351(19): 1927-1929
[2]CDC. Vitalstats. [www. cdc. gov/nchs/vitalstats. htm]
[3]WHO/Europe. European Health for All database (HFA-DB). July 2013. [www. euro. who. int/en/what-we-do/data-and-evidence/databases/european-health-for-all-database-hfa-db2]
[4]Fraser AM, Brockert JE, Ward RH. Association of young maternal age with adverse reproductive outcomes. N Engl J Med, 1995, 332(17): 1113-1117
[5]Chen XK, Wen SW, Fleming N, et al. Teenage pregnancy and adverse birth outcomes: a large population based retrospective cohort study. Int J Epidemiol, 2007, 36(2): 368-373
[6]National Health and Family Planning Commission of the People’ Republic of China. Briefing on the implementation of the “two child policy”. http: //news. xinhuanet. com/2017-03/11/c_1120609715. htm (2017)
[7]MacDorman MF, Kirmeyer SE, Wilson EC. Fetal and perinatal mortality, United States, 2006. Natl Vital Stat Rep, 2012, 60(8): 1-22
[8]Boulet SL, Kirby RS, Reefhuis J, et al. Assisted Reproductive Technology and Birth Defects Among Liveborn Infants in Florida, Massachusetts, and Michigan, 2000-2010. JAMA Pediatr, 2016, 170(6): e154934
[9]Wang Y, Tanbo T, Abyholm T, et al. The impact of advanced maternal age and parity on obstetric and perinatal outcomes in singleton gestations. Arch Gynecol Obstet, 2011, 284(1): 31-37
[10]Hsieh TT, Liou JD, Hsu JJ, et al. Advanced maternal age and adverse perinatal outcomes in an Asian population. Eur J Obstet Gynecol Reprod Biol, 2010, 148(1): 21-26
[11]Kenny LC, Lavender T, McNamee R, et al. Advanced maternal age and adverse pregnancy outcome: evidence from a large contemporary cohort. PLoS ONE, 2013, 8(2): e56583
[12]Laopaiboon M, Lumbiganon P, Intarut N, et al. Advanced maternal age and pregnancy outcomes: a multicountry assessment. BJOG, 2014, 121(Suppl 1): 49-56
[13]Felice ME, Feinstein RA, Fisher MM, et al. Adolescent pregnancy current trends and issues: 1998. Pediatrics, 1999, 103(2): 516-520
[14]Carolan MC, Davey MA, Biro M, et al. Very advanced maternal age and morbidity in Victoria, Australia: a population based study. BMC Pregnancy Childbirth, 2013, 13: 80
[15]Yogev Y, Melamed N, Bardin R, et al. Pregnancy outcome at extremely advanced maternal age. Am J Obstet Gynecol, 2010, 203(6): 558. e1-7
[16]Bayrampour H, Heaman M. Advanced maternal age and the risk of cesarean birth: a systematic review. Birth, 2010, 37(3): 219-226
[17]Callaway LK, Lust K, McIntyre HD. Pregnancy outcomes in women of very advanced maternal age. Aust N Z J Obstet Gynaecol, 2005, 45(1): 12-16
[18]Delbaere I, Verstraelen H, Goetgeluk S, et al. Pregnancy outcome in primiparae of advanced maternal age. Eur J Obstet Gynecol Reprod Biol, 2007, 135(1): 41-46
[19]Ludford I, Scheil W, Tucker G, et al. Pregnancy outcomes for nulliparous women of advanced maternal age in South Australia, 1998-2008. Aust N Z J Obstet Gynaecol, 2012, 52(3): 235-241
[20]Sunderam S, Kissin DM, Crawford SB, et al. Assisted Reproductive Technology Surveillance-United States, 2012. MMWR Surveill Summ, 2015, 64(6): 1-29
[21]Tanbo T, Dale PO, Lunde O, et al. Obstetric outcome in singleton pregnancies after assisted reproduction. Obstet Gynecol, 1995, 86(2): 188-912
[22]Bukulmez O, Deren O. Perinatal outcome in adolescent pregnancies: a case-control study from a Turkish University hospital. Eur J Obstet Gynecol Reprod Biol, 2000, 88(2): 207-212
[23]Salihu HM, Wilson RE, Alio AP, et al. Advanced maternal age and risk of antepartum and intrapartum stillbirth. J Obstet Gynaecol Res, 2008, 34(5): 843-850
[24]Lisonkova S, Pare E, Joseph K. Does advanced maternal age confer a survival advantage to infants born at early gestation? BMC Pregnancy Childbirth, 2013, 13: 87
[25]Fretts RC, Schmittdiel J, McLean FH, et al. Increased maternal age and the risk of fetal death. N Engl J Med, 1995, 333(15): 953-957
[26]Csermely G, Susánszky é, Czeizel AE. Association of young and advanced age of pregnant women with the risk of isolated congenital abnormalities in Hungary-a population-based case-matched control study. J Matern Fetal Neonatal Med, 2015, 28(4): 436-442
[27]Frederiksen LE, Ernst A, Brix N, et al. Risk of Adverse Pregnancy Outcomes at Advanced Maternal Age. Obstet Gynecol, 2018, 131(3): 457-463
[28]Gill SK, Broussard C, Devine O, et al. Association between maternal age and birth defects of unknown etiology: United States, 1997-2007. Birth Defects Res A Clin Mol Teratol, 2012, 94(12): 1010-1018