高龄孕产妇妊娠期并发症及不良结局的高危因素分析

Analysis of high-risk factors for pregnancy complications and adverse outcomes in advanced maternal age

摘要

目的 探讨高龄孕产妇(AMA)妊娠期并发症及不良结局,为AMA的妊娠期保健和分娩期管理提供参考依据。方法 采用分层抽样的方法,选取2020年9月至2021年12月在厦门大学附属成功医院分娩的孕产妇420例为研究对象,其中AMA(年龄≥35岁)228例,适龄孕产妇(年龄<35岁)192例,按年龄将其分为≥40岁组57例,35~39岁组171例,<35岁组192例.回顾各组孕产妇的基本信息和临床资料,分析AMA妊娠期并发症及不良结局的相关危险因素。结果 不同年龄组的孕前体质量指数(BMI)、孕次、产次、流产次数比较差异均有统计学意义(F=23.800,H值分别为27.157、8.271、22.738;P<0.05).不同年龄组的辅助生殖技术(ART)后妊娠、妊娠期高血压疾病、妊娠期糖尿病、胎膜早破、子宫肌瘤、瘢痕子宫、不良孕产史、早产、前置胎盘、胎盘粘连、胎位异常的发生率比较差异均有统计学意义(χ²值分别为62.511、8.189、12.117、13.399、11.364、9.588、8.862、6.335、6.751、7.178、10.699,P<0.05).不同年龄组的剖宫产率及住院天数比较差异均有统计学意义(χ²=27.518,F=30.209;P<0.05).不同年龄组的胎儿窘迫、转新生儿重症监护室(NICU)的发生率比较差异均有统计学意义(χ²值分别为16.046、8.839,P<0.05).在不同年龄组的初产妇中,35~39岁组的剖宫产率最高,为34.50%(59/171);在不同年龄组的经产妇和子宫肌瘤剔除术后瘢痕子宫中,≥40岁组的剖宫产率都是最高,分别为12.28%(7/57)、50.00%(8/16);不同年龄组的初产妇、经产妇及子宫肌瘤剔除术后瘢痕子宫的剖宫产率比较差异均有统计学意义(χ²值分别为33.974、7.442、18.831,P<0.05).多因素Logistics回归分析显示,孕产妇年龄(OR=2.544,95%CI:1.567~4.131)、ART后妊娠(OR=3.348,95%CI:1.892~5.925)、妊娠期糖尿病(OR=2.447,95%CI:1.429~4.191)、妊娠期高血压疾病(OR=3.703,95%CI:1.607~8.532)、胎膜早破(OR=2.235,95%CI:1.348~3.707)、子宫肌瘤(OR=2.089,95%CI:1.033~4.225)、瘢痕子宫(OR=1.769,95%CI:1.010~3.100)均为母婴不良结局的危险因素(P<0.05)。结论 AMA行ART后妊娠较多,妊娠期高血压疾病、妊娠期糖尿病、胎膜早破、早产、前置胎盘、胎儿窘迫等疾病发生率较高,剖宫产率也随之增加.因此建议适龄生育,同时加强AMA的孕前宣教及孕产期管理,从而改善母婴结局.

Abstract

Objective To explore the pregnancy complications and adverse outcomes in advanced maternal age (AMA), and to provide a reference basis for pregnancy care and delivery management of AMA women. Methods From September 2020 to December 2021, a stratified sampling method was used to select 420 pregnant women delivered at Chenggong Hospital Affiliated to Xiamen University. Among them, 228 were AMA (age ≥35 years) and 192 were of appropriate maternal age (age <35 years). According to age, they were divided into three groups: 57 cases in the ≥40 years group, 171 cases in the 35-39 years group, and 192 cases in the <35 years group. The basic information and clinical data of the pregnant women in each group reviewed to analyze the related risk factors for pregnancy complications and adverse outcomes in AMA women. Results There were significant differences in pre-pregnancy body mass index (BMI), gravidities, parities and miscarriages among different age groups (F=23.800; H=27.157, 8.271, 22.738, respectively; P<0.05). There were significant differences in the incidence of pregnancy after assisted reproductive technology (ART), hypertensive disorders of pregnancy, gestational diabetes mellitus, premature rupture of membranes, uterine fibroids, cicatricial uterus, adverse pregnancy history, preterm birth, placenta previa, placenta adhesion and abnormal fetal position among different age groups (χ²=62.511, 8.189, 12.117, 13.399, 11.364, 9.588, 8.862, 6.335, 6.751, 7.178, 10.699, respectively, P<0.05). There were significant differences in the rate of cesarean section and hospitalization days among different age groups (χ²=27.518, F=30.209; P<0.05). There were significant differences in the incidence of fetal distress and conversion to neonatal intensive care unit (NICU) among different age groups (χ²=16.046, 8.839, P<0.05). Among the primiparous women in different age groups, the cesarean section rate was the highest in the 35-39 age group at 34.50% (59/171). Among the multiparous women and women with a scarred uterus after myomectomy in different age groups, the cesarean section rate was the highest in the ≥40 age group, at 12.28% (7/57) and 50.00% (8/16), respectively. There were significant differences in cesarean section rates among primiparous women, multiparous women, and women with a scarred uterus after myomectomy in different age groups (χ²=33.974, 7.442 and 18.831, respectively; P<0.05). Multivariate logistics regression analysis showed that maternal age (OR=2.544, 95%CI: 1.567-4.131), pregnancy after ART (OR=3.348, 95%CI: 1.892-5.925), gestational diabetes mellitus (OR=2.447, 95%CI: 1.429-4.191), hypertensive disorders of pregnancy (OR=3.703, 95%CI: 1.607-8.532), premature rupture of membranes (OR=2.235, 95%CI: 1.348-3.707), uterine fibroids (OR=2.089, 95%CI: 1.033-4.225) and scarred uterus (OR=1.769, 95%CI: 1.010-3.100) were all risk factors for adverse maternal and infant outcomes (P<0.05). Conclusion AMA patients have more pregnancies after ART, and the incidences of hypertensive disorders of pregnancy, gestational diabetes mellitus, premature rupture of membranes, preterm birth, placenta previa, and fetal distress are higher, and the cesarean section rate also increases accordingly. Therefore, it is suggested to encourage childbearing at an appropriate age and to strengthen pre-pregnancy education and prenatal management for AMA women to improve maternal and infant outcomes.

关键词

高龄孕产妇 / 不良结局 / 妊娠期并发症 / 影响因素

Key words

advanced maternal age / adverse outcomes / pregnancy complications / influencing factors

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基金资助

国家自然科学基金资助项目(81270718)

厦门市科技计划项目(3502Z20184066)