摘要目的 探讨乌鲁木齐市高龄产妇与妊娠合并症及妊娠结局之间的关系,为高龄产妇的母婴健康提供科学依据。方法 采用回顾性研究方法,分析2012年1月-2013年8月在乌鲁木齐市妇幼保健医院分娩的高龄产妇366人、正常年龄产妇1802人中不良妊娠结局及新生儿结局的差异。结果 ①一般情况:高龄产妇和正常年龄产妇民族构成差异有统计学意义( χ2=14.92,P=0.005);高龄产妇的孕前体重[(60.48±9.80)kg vs. (57.00±8.63)kg, t=6.87, P<0.001],BMI[(22.92±3.36)kg/m2vs. (21.63±3.01)kg/m2, t=5.12, P<0.001]均大于正常年龄产妇,但孕期增重却低于正常年龄产妇[(13.39±4.36) kg vs. (13.97±4.46)kg, t=2.29, P=0.022)];高龄产妇组经产妇比例大于正常年龄产妇(55.7% vs. 26.2%, χ2=123.75, P<0.001)。②妊娠合并症发生情况比较:高龄产妇与正常年龄产妇相比妊娠期糖尿病(21.6% vs. 13.0%, χ2=31.84, P<0.001)、子痫前期轻度及重度(16.4% vs. 10.9%;4.6% vs. 2.0%, χ2=18.71, P<0.001)发病率均较高;调整了民族、学历、孕前体重、孕期增重、孕次、产次之后高龄产妇与正常年龄产妇相比发生妊娠期糖尿病(调整 OR, AOR=2.108,95%CI:1.545~2.875)、轻度(AOR=1.573,95%CI:1.106~2.238)及重度子痫(AOR=2.510,95%CI:1.301~4.845)的危险性均变大。③妊娠结局比较:高龄产妇与正常年龄产妇相比早产(16.4% vs. 10.2%, χ2=11.90,P=0.001)、巨大儿(9.6% vs. 6.4%, χ2=4.78,P=0.029)、低出生体重儿(6.0% vs. 2.3%, χ2=14.38, P<0.001)、大于胎龄儿(17.8% vs. 11.7%, χ2=10.02,P=0.002)的发生率较高;调整了民族、学历、孕前体重、孕期增重、孕次、产次之后高龄产妇与正常年龄产妇相比早产(AOR=1.850,95%CI:1.306~2.620)、新生儿发生低出生体重儿(AOR=2.833,95%CI:1.558~5.151)和大于胎龄儿(AOR=1.420,95%CI:1.014~1.989)危险性均会增大。④分娩方式比较:高龄产妇组剖宫产率高于正常年龄产妇(51.6% vs. 41.9%, χ2=11.74,P=0.001);经产妇中高龄组剖宫产率高于正常年龄组(59.8% vs. 51.5%, χ2=3.97,P=0.046) 结论 控制相关影响因素后高龄产妇较正常年龄产妇发生妊娠合并症的风险会增大,其新生儿体重出现异常的风险也高于正常年龄产妇。
Abstract：Objective To investigate relationships between elderly parturient women and pregnancy complication and outcome in Urumqi, and provide scientific basis for the maternal and infant health. Methods A retrospective study was conducted to analyze the differences in adverse pregnancy outcomes and neonatal outcomes between 366 elderly parturient women and 1,802 normal age parturient women from Maternal and Child Health Hospital of Urumqi City from January 2012 to August 2013. Results The ethnic composition was significantly different in the elderly parturient women and normal age parturient women(P<0.05). The pre-pregnancy weight((60.48±9.80)kg vs. (57.00±8.63)kg, t=6.87, P<0.001) and body mass index(BMI)((22.92±3.36)kg/m2vs. (21.63±3.01)kg/m2, t=5.12, P<0.001)in the elderly parturient women were significantly higher than in the normal age parturient women, but the pregnancy weight gain was significantly lower((13.39±4.36) kg vs. (13.97±4.46)kg, t=2.29, P=0.022), the proportion of multipara was significantly larger(55.7% vs. 26.2%, χ2=123.75, P<0.001). For the incidence of pregnancy complications, compared with normal age parturient women, the elderly parturient women had a higher incidence of gestational diabetes mellitus(21.6% vs. 13.0%, χ2=31.84, P<0.001), mild and severe preeclampsia (16.4% vs. 10.9%;4.6% vs. 2.0%,χ2=18.71, P<0.001). After the ethnicity, education, pre-pregnancy weight, weight gain during pregnancy, pregnancy times and delivery times were adjusted, the risk of gestational diabetes(adjusted OR, AOR=2.108,95%CI:1.545-2.875), mild (AOR=1.573,95%CI:1.106-2.238)and severe(AOR=2.510,95%CI:1.301-4.845) preeclampsia in the elderly parturient women was greater when compared with the normal age parturient women. Comparison of pregnancy outcomes indicated that the incidence rates of preterm birth(16.4% vs.10.2%, χ2=11.90,P=0.001), giant infants(9.6% vs. 6.4%, χ2=4.78,P=0.029), low birth weight infants(6.0% vs 2.3%, χ2=14.38, P<0.001) andinfants with birth weight large for gestational age (LAG) (17.8% vs 11.7%, χ2=10.02,P=0.002) were higher in the elderly parturient women than in the normal age parturient women. After the ethnicity, education, pre-pregnancy weight, weight gain during pregnancy, pregnancy times and delivery times were adjusted, the risk of preterm birth (AOR=1.850, 95%CI:1.306-2.620), low birth weight infants(AOR=2.833,95%CI:1.558-5.151) and LAG (AOR=1.420,95%CI:1.014-1.989)in the elderly parturient women was greater when compared with the normal age parturient women. Regarding delivery modes, the cesarean section rate was higher in the elderly parturient group than in the normal age parturient group(51.6% vs. 41.9%, χ2=11.74,P=0.001). So was in the multipara(59.8% vs. 51.5%, χ2=3.97,P=0.046). Conclusions After the related influencing factors are controlled, the risk of pregnancy complication and abnormal neonatal birth weight is increased in the elderly parturient women than in the normal age parturient women.
姚雪梅, 丁桂凤. 产妇高龄对妊娠合并症及妊娠结局影响的研究[J]. 实用预防医学, 2017, 24(10): 1200-1203.
YAO Xue-mei, DING Gui-feng. Influence of advanced age on pregnancy complication and outcome. , 2017, 24(10): 1200-1203.
2017, Vol. 24 
