上海交通大学学报（医学版）

上海交通大学学报(医学版) ›› 2021, Vol. 41 ›› Issue (11): 1485-1490.doi: 10.3969/j.issn.1674-8115.2021.11.012

• 论著 · 临床研究 • 上一篇    下一篇

高龄初产妇妊娠并发症和不良妊娠结局分析

曾金妹1(), 陈日玲2, 何洁云3, 梁东梅1, 练婷玉1, 尹明娟1, 饶佳为1, 倪进东1,4()   

  1. 1.广东医科大学公共卫生学院流行病与卫生统计学教研室，东莞 523808
    2.广东医科大学妇幼医学研究与出生缺陷防治重点实验室，佛山 528300
    3.广东医科大学附属顺德妇女儿童医院产科，佛山 528300
    4.广东医科大学精准公共卫生重点实验室，东莞 523808
  • 出版日期:2021-11-28 发布日期:2021-12-03
  • 通讯作者: 倪进东 E-mail:jinmeizeng1955@163.com;nijd-gw@gdmu.edu.cn
  • 作者简介:曾金妹(1995—)，女，硕士生；电子信箱：jinmeizeng1955@163.com。
  • 基金资助:
    广东医科大学高水平学科建设工程重大项目(4SG21001G)

Analysis of pregnancy complications and adverse pregnancy outcomes of elderly primiparas

Jin-mei ZENG1(), Ri-ling CHEN2, Jie-yun HE3, Dong-mei LIANG1, Ting-yu LIAN1, Ming-juan YIN1, Jia-wei RAO1, Jin-dong NI1,4()   

  1. 1.Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Medical University, Dongguan 523808, China
    2.Key Laboratory of Research in Maternal and Child Medicine and Birth Defects, Guangdong Medical University, Foshan 528300, China
    3.Department of Obstetrics, Shunde Women's and Children's Hospital Affiliated to Guangdong Medical University, Foshan 528300, China
    4.Key Laboratory of Precision Public Health, Guangdong Medical University, Dongguan 523808, China
  • Online:2021-11-28 Published:2021-12-03
  • Contact: Jin-dong NI E-mail:jinmeizeng1955@163.com;nijd-gw@gdmu.edu.cn
  • Supported by:
    Major Project of High-level Discipline Construction Project of Guangdong Medical University(4SG21001G)

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摘要：

目的·探讨高龄初产妇的妊娠并发症和不良妊娠结局，总结高龄初产妇的妊娠特点。方法·选择2017年1月—2018年12月在广东医科大学附属顺德妇女儿童医院住院分娩的全部高龄初产妇共300例组成高龄初产妇组，将同期于该院分娩第2胎的全部高龄经产妇共2 138例组成高龄经产妇组，按照出院日期随机抽取2 088例适龄初产妇、1 839例分娩第2胎的适龄经产妇组成适龄初产妇组、适龄经产妇组。单因素分析采用χ2检验和方差分析，多因素分析采用Logistic回归分析。比较分析4组产妇妊娠糖尿病、妊娠高血压、早产、产后出血等妊娠并发症和不良妊娠结局的差异。结果·以适龄经产妇组作为参照，通过多因素Logistic回归分析发现高龄初产妇组妊娠糖尿病（aOR=2.938，95%CI 2.240~3.853）、妊娠高血压（aOR=8.579，95%CI 3.082~23.887）、子痫（aOR=6.139，95%CI 2.400~15.985）、前置胎盘（aOR=3.642，95%CI 1.551~8.552）、羊水浑浊（aOR=4.318，95%CI 1.852~10.069）、早产（aOR=2.573，95%CI 1.710~3.871）、剖宫产（aOR=2.589，95%CI 1.988~3.373）、低出生体质量（aOR=3.317，95%CI 2.111~5.214）、新生儿窒息（aOR=8.175，95%CI 2.907~22.992）和呼吸窘迫综合征（aOR=10.936，95%CI 4.400~27.316）的发生风险最高。以适龄经产妇组作为参照，适龄初产妇组胎膜早破（aOR=1.635，95%CI 1.337~1.999）和羊水过多或过少（aOR=1.730，95%CI 1.317~2.271）的发生风险最高。以适龄经产妇组作为参照，高龄经产妇组发生盆腔粘连（aOR=1.754，95%CI 1.030~2.988）的风险最高，而适龄初产妇组发生盆腔粘连（aOR=0.148，95%CI 0.050~0.439）的风险最低。结论·高龄初产妇存在较高的妊娠糖尿病、妊娠高血压、子痫、前置胎盘、羊水浑浊、早产、剖宫产、低出生体质量、新生儿窒息和呼吸窘迫综合征风险。应重视高龄初产妇的围生期保健工作，使其接受规范化产前检查以提高其分娩质量。

关键词: 高龄, 初产妇, 经产妇, 妊娠并发症, 不良妊娠结局

Abstract:

Objective·To explore the pregnancy complications and adverse pregnancy outcomes, and summarize the pregnancy characteristics of elderly primiparas.

Methods·A total of 300 elderly primiparas who delivered in Shunde Women's and Children's Hospital Affiliated to Guangdong Medical University from January 2017 to December 2018 were selected to form the elderly primipara group, and a total of 2 138 elderly multiparae who gave birth to their second child in the same period were selected to form the elderly multipara group. A total of 2 088 primiparas at the appropriate age were randomly selected according to the discharge date to form the appropriate age primipara group, and 1 839 multiparae at the appropriate age who gave birth to their second child were randomly selected to form the appropriate age multipara group. Univariate analysis was performed by χ2 test and analysis of variance, and multivariate analysis was performed by Logistic regression analysis. The differences among the four groups were compared and analyzed, including gestational diabetes mellitus, gestational hypertension, premature delivery, postpartum hemorrhage, and so on.

Results·Multivariate Logistic regression analysis showed that the elderly primiparas group had the highest risk of gestational diabetes mellitus (aOR=2.938, 95%CI 2.240?3.853), gestational hypertension (aOR=8.579, 95%CI 3.082?23.887), eclampsia (aOR=6.139, 95%CI 2.400?15.985), placenta previa (aOR=3.642; 95%CI 1.551?8.552), turbid amniotic fluid (aOR=4.318, 95%CI 1.852?10.069), premature delivery (aOR=2.573, 95%CI 1.710?3.871), cesarean section (aOR=2.589, 95%CI 1.988?3.373), low birth weight (aOR=3.317, 95%CI 2.111?5.214), neonatal asphyxia (aOR=8.175, 95%CI 2.907?22.992) and respiratory distress syndrome (aOR=10.936, 95%CI 4.400?27.316), compared with the appropriate age multiparae group. The appropriate age primipara group had highest risk of premature rupture of membranes (aOR=1.635, 95%CI 1.337?1.999) and hydramnios/oligohydramnios (aOR=1.730, 95%CI 1.317?2.271), compared with the appropriate age multipara group. The elderly multipara group had the highest risk of developing pelvic adhesions (aOR=1.754, 95%CI 1.030?2.988) compared with the appropriate age multipara group, whereas the appropriate age primipara group had the lowest risk of developing pelvic adhesions (aOR=0.148, 95%CI 0.050?0.439).

Conclusion·Elderly primiparas confer the highest risks of gestational diabetes mellitus, gestational hypertension, eclampsia, placenta previa, turbid amniotic fluid, premature delivery, cesarean section, low birth weight, neonatal asphyxia and respiratory distress syndrome. Attention should be paid to the perinatal care of elderly primiparas, so that they can receive standardized antenatal visits to improve the quality of their delivery.

Key words: advanced age, primipara, multipara, pregnancy complication, adverse pregnancy outcome

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