Analysis of high-risk factors for pregnancy complications and adverse outcomes in advanced maternal age
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(x2=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(x2=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(x2=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(x2=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.
万方数据
维普
