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Title: [Clinic characteristics of women with advanced maternal age and perinatal outcomes].
Author: Chen Y, Zheng XL, Wu SW, Zhang WY.
Journal: Zhonghua Fu Chan Ke Za Zhi; 2017 Aug 25; 52(8):508-513. PubMed ID: 28851166.
Abstract:
Objective: To explore the association between maternal age and perinatal outcomes. Methods: Totally, 3 151 women with advanced maternal age and 6 098 women younger than 35 years old who delivered in Beijing Obstetrics and Gynecology Hospital in 2016 were recruited. Their clinic characteristics and perinatal outcomes were collected to divide into 3 groups based on delivery age, Group 1 (aged 35-39 years, 2 683 cases), Group 2 (aged ≥40 years, 366 cases) and the control group (aged<35 years, 6 098 cases). The association between maternal age and adverse perinatal outcomes were analyzed, including hypertensive disorder complicating pregnancy, gestational diabetes mellitus (GDM), preterm birth and postpartum hemorrhage. Results: The rate of cesarean section history (27.39%, 33.61%, 5.53%) or previous myomectomy history (2.80%, 5.46%, 0.72%) were compared between the advanced maternal age groups and the control group, and the differences were statistically significant (P<0.05). The percentage of prepregnancy overweight and obesity (29.67%, 27.05%, 18.47%), complicated with myoma (14.83%,19.95%, 5.64%) were compared among the three groups, and the differences were statistically significant (P<0.05). The percentage of pregnancy through assisted reproductive technology (9.84%, 15.03%, 3.12%) also had statistically significant differences (P<0.05). The incidence of fetal chromosomal abnormalities (1.23%, 3.01%, 0.36%) and fetal malformations (1.94%, 4.37%, 0.48%) increased with the maternal age, with statistically significant differences (P<0.01). The mobidity of hypertensive disorders (9.84%, 13.11%, 9.23%), pregestational diabetes mellitus (1.83%, 2.19%, 0.72%), gestational diabetes mellitus (22.70%, 28.42%, 14.87%), premature rupture of membranes (25.57%, 19.40%, 31.42%), placenta previa (2.05%, 2.46%, 0.92%), preterm birth(8.35%, 11.20%, 5.51%), postpartum hemorrhage (25.11%, 18.31%, 20.27%) and forceps delivery (5.42%, 2.33%, 5.71%) were compared, and the differences were statistically significant (P<0.05). The cesarean section rate in primipara (45.42%, 75.74%, 21.33%) and multipara (51.46%, 61.54%, 30.95%) had statistically significant difference (P<0.05). The proportion of macrosomia (10.80%, 8.85%, 7.96%) and neonates transferred into neonatal ICU (9.63%, 11.48%, 5.21%) in term neonates had statistically significant difference (P<0.05). Conclusions: Women with advanced maternal age increase after new family planning policy put into effect, so do the risk of adverse perinatal outcomes. Attention and interventions should be made to cope with the occurrence of adverse perinatal outcomes. 目的： 研究高龄孕产妇的临床特点，及年龄与多种不良妊娠结局的关系。 方法： 收集2016年1月1日至12月31日在首都医科大学附属北京妇产医院分娩的3 151例高龄（分娩年龄≥35岁）产妇及同期分娩的6 098例非高龄产妇的临床资料及妊娠结局。剔除信息不全者，根据产妇的分娩年龄，分为高龄1组（35~39岁，2 683例）、高龄2组（≥40岁，366例）及对照组（<35岁，6 098例）共3组，对3组产妇的临床资料进行对照分析，探索孕产妇年龄与妊娠期高血压疾病、妊娠期糖尿病、早产等多种妊娠风险之间的关系。 结果： 高龄1组、高龄2组和对照组产妇中，既往因剖宫产史（分别为27.39%、33.61%、5.53%）或既往子宫肌瘤剔除术史（2.80%、5.46%、0.72%）所造成瘢痕子宫者的比例分别比较，差异均有统计学意义（P均<0.05）。3组产妇中，孕前超重及肥胖者（分别为29.67%、27.05%、18.47%）、妊娠合并子宫肌瘤者（14.83%、19.95%、5.64%）的比例分别比较，差异均有统计学意义（P均<0.05）；通过辅助生殖技术受孕者（9.84%、15.03%、3.12%）也随年龄增加而呈现上升趋势（P<0.05）。3组产妇中，胎儿染色体异常（1.23%、3.01%、0.36%）及胎儿畸形（1.94%、4.37%、0.48%）的发生率，分别比较，差异均有统计学意义（P均<0.01）；妊娠期高血压疾病（9.84%、13.11%、9.23%）、糖尿病合并妊娠（1.83%、2.19%、0.72%）、妊娠期糖尿病（22.70%、28.42%、14.87%）、胎膜早破（25.57%、19.40%、31.42%）、前置胎盘（2.05%、2.46%、0.92%）、早产（8.35%、11.20%、5.51%）、产后出血（25.11%、18.31%、20.27%）及手术助娩（5.42%、2.33%、5.71%）的发生率分别比较，差异均有统计学意义（P均<0.05）。3组产妇中，初产妇的剖宫产率（45.42%、75.74%、21.33%）及经产妇的剖宫产率（51.46%、61.54%、30.95%）分别比较，差异均有统计学意义（P均<0.05）。3组产妇中，足月新生儿中巨大儿的发生率（10.80%、8.85%、7.96%）及新生儿转新生儿ICU率（9.63%、11.48%、5.21%）分别比较，差异均有统计学意义（P均<0.05）。 结论： "二孩"政策调整后，高龄孕产妇的比例上升，其妊娠不良结局的相关风险增加，应加强高龄孕产妇妊娠的管理，对妊娠期并发症及合并症尽早进行预防及干预。.

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