产妇年龄与剖宫产和妊娠期糖尿病及子痫前期-子痫的关系:一项回顾性分析  

The relationship between advanced maternal age and cesarean section and gestational diabetes mellitus and preeclampsia-edampsia: a retrospective analysis

作　　者：李薇 朱怡冰[2,3] 缪崇 李海波[2,3] 徐立波 白猛[5] 高海艳 曹华 LI Wei;ZHU Yi-bing;LIAO Cong;LI Hai-zheng;XU Li-bo;BAI Meng;GAO Hai-yan;CAO Hua(Fujian Maternity Hospital,Fuzhou,Fujian 35000l,China)

机构地区：[1]福建省妇产医院出生队列研究室,福建福州1350001 [2]福建省妇幼保健院出生队列研究室 [3]福建医科大学妇儿临床医学院 [4]福建省妇幼保健院计算机技术科 [5]福建省妇产医院信息中心 [6]福建省妇幼保健院福建省妇儿重大疾病研究重点实验室 [7]福建省儿童医院心脏外科

出　　处：《中国预防医学杂志》2022年第12期924-929,共6页Chinese Preventive Medicine

基　　金：福建省财政厅卫生健康省级专项补助资金[闽财指(2019)827号]。

摘　　要：目的 探讨高龄产妇与剖宫产、妊娠期糖尿病(gestational diabetes mellitus, GDM)和子痫前期-子痫之间的关系。方法 选择2017年1月—2019年12月在福建省妇幼保健院分娩的产妇(年龄≥18岁),按照产妇年龄分为4组:18~<35岁(参照组)、35~<40岁、40~<45岁、≥45岁(超高龄组),采用多因素logistic回归校正潜在混杂因素分析各年龄组不良妊娠结局发生的风险。结果 根据纳入排除标准,最终共纳入49 953例产妇。孕前身体质量指数(body mass index, BMI)、孕期增重、产次和受孕方式在不同年龄组间差异有统计学意义(P<0.01)。高龄与剖宫产、GDM和子痫前期-子痫发生风险成正相关(P<0.05)。与18~<35岁组相比,超高龄组的剖宫产、GDM及子痫前期-子痫的发生率分别为66.18%、41.18%和10.29%。与18~<35岁组相比,发生风险增加1.78、1.90和3.15倍(剖宫产,OR=2.78,95%CI:1.67~4.65,P<0.01;GDM,OR=2.90,95%CI=1.74~4.83,P<0.01;子痫前期-子痫(OR=4.15,95%CI=1.67~10.31,P=0.002)。分层分析显示,超高龄与GDM的发生在自然受孕组中更为密切,而与剖宫产的发生在初产妇中有更强的关联性(交互作用P<0.01)。结论 超高龄产妇(≥45岁)与剖宫产、GDM和子痫前期-子痫的风险增加有关。而且分娩年龄与不良妊娠结局的关系可能受产次和受孕方式的影响。Objective To explore the relationship between advanced maternal age and cesarean section,gestational diabetes mellitus(GDM) and preeclampsia-eclampsia.Methods Pregnant women(maternal age≥18 years old) who delivered babies in Fujian Maternity and Child Health Hospital from January 2017 to December 2019 were retrospectively recruited and divided into 4 groups based on maternal age:18-<35(control group),35-<40,40-<45 and ≥45(very advanced maternal age group).Multivariate logistic regression model was used to analyze the risk of adverse pregnancy outcomes in each group after adjusting the potential confounding factors.Results According to the inclusion and exclusion criteria,a total of 49 953pregnant women were finally included in the study.There were significant differences in pre-pregnancy body mass index(BMI),weight gain during pregnancy,parity and conception method among women in different age groups(P<0.01).Advanced maternal age was positively associated with the risk of cesarean section,GDM and preeclampsia-eclampsia(P<0.05).The incidences of cesarean section,GDM and preeclampsiaeclampsia were 66.18%,41.18% and 10.29% in women with very advanced maternal age,the risks were1.78,1.90 and 3.15 times higher compared to those in control group(cesarean section:OR=2.78,95%CI:1.67-4.65,P<0.01;GDM:OR=2.90,95%CI=1.74-4.83,P <0.01;preeclampsia-eclampsia:OR=4.15,95%CI=1.67-10.31,P=0.002).Stratified analysis showed that the effect of very advanced maternal age on increased risk of GDM was significantly greater in women with natural conception(P=0.002),while the effect of very advanced maternal age on increased risk of cesarean section was significantly greater among primiparous women(P<0.01).Conclusions Very advanced maternal age(≥45 years old) is related to greater risk of cesarean section,GDM and preeclampsia-eclampsia.The magnitude of the influence of maternal age also differs by conception method and by parity.

关 键 词：高龄产妇 剖宫产 妊娠期糖尿病 子痫前期-子痫 

分 类 号：R173[医药卫生—妇幼卫生保健]