新生育政策下不同高龄段孕产妇安全性分析

张悦; 陈红波; 刘羽

doi:10.16766/j.cnki.issn.1674-4152.002947

新生育政策下不同高龄段孕产妇安全性分析

doi: 10.16766/j.cnki.issn.1674-4152.002947

张悦¹,
陈红波²,
刘羽^1, ,

1.
安徽医科大学附属妇幼保健院妇二科，安徽合肥 230031
2.
安徽医科大学附属妇幼保健院产一科

基金项目:

安徽省自然科学基金面上项目 2108085MH260

详细信息

通讯作者:
刘羽，E-mail：xiaoliuyu-079@163.com

中图分类号: R714.61 R714.25
计量
- 文章访问数: 258
- HTML全文浏览量: 82
- PDF下载量: 5
- 被引次数: 0
出版历程
- 收稿日期: 2022-03-07
- 网络出版日期: 2023-05-31

Analysis on the safety of different aged pregnant women under the new birth policy

ZHANG Yue¹,
CHEN Hongbo²,
LIU Yu^{1
, ,}

1.
Gynecology Department, Maternal and Child Health Hospital of Anhui Medical University, Hefei, Anhui 230031, China

摘要

摘要: 目的在我国生育政策发生改变及规范化管理高龄孕产妇背景下，探讨我院规范管理下高龄段孕产妇妊娠安全问题。方法选取2020年1—12月461例于安徽省妇幼保健医院分娩的单胎孕产妇。根据孕产妇年龄分为适龄组(20~34岁)184例，高龄组(35~39岁)147例，超高龄组(≥40岁)130例，分析高龄组与超高龄组孕产妇妊娠期并发症与妊娠结局。结果适龄组妊娠期糖尿病、胎膜早破、前置胎盘、剖宫产、流产、胎儿窘迫发生例数分别为38例、76例、3例、53例、13例、26例，高龄组妊娠期糖尿病、胎膜早破、前置胎盘、剖宫产、流产、胎儿窘迫发生例数分别为54例、44例、10例、84例、9例、9例，超高龄组妊娠期糖尿病、胎膜早破、前置胎盘、剖宫产、流产、胎儿窘迫发生例数分别为51例、4例、3例、46例、27例、11例。单因素分析显示，3组孕产妇妊娠期糖尿病、胎膜早破、前置胎盘、剖宫产、流产、胎儿窘迫比较差异有统计学意义，调整一般情况后，高龄组孕产妇剖宫产风险高于适龄组，超高龄组孕产妇流产风险高于适龄组。结论本研究发现高龄产妇剖宫产风险高于适龄产妇，超高龄孕产妇流产风险高于适龄孕产妇，其余妊娠期并发症及妊娠结局与年龄未呈相关性。规范管理可有效地保障高龄孕产妇的安全性。
- 超高龄产妇 /
- 流产 /
- 剖宫产
Abstract: Objective To discusses the pregnancy safety of different elderly pregnant women under the background of the change in birth policy and the standardized management of elderly pregnant women. Methods The clinical data of 461 singleton pregnant women in the Anhui Provincial Maternal and Child Health Hospital from January 2020 to December 2020 were collected. According to the maternal age, they were divided into age-appropriate maternity group (20-34 years old, 184 cases), the advanced maternal age group (35-39 years old, 147 cases) and very advanced maternal age group (more than 40 years, 130 cases). Pregnancy complications and outcomes were analyzed. Results The gestational diabetes mellitus, premature rupture of membranes, placenta praevia, caesarean section, miscarry, fetal distress were 38, 76, 3, 53, 13, 26 cases respectively in the age-appropriate maternity group, above those in the advanced maternal age group were 54, 44, 10, 84, 9, 9 cases respectively, and those in the very advanced maternal age group were 51, 4, 3, 46, 27, 11 cases respectively. Univariate analysis showed that gestational diabetes mellitus, premature rupture of membranes, placenta previa, cesarean section, abortion and fetal distress were statistically significant. After adjusting the general situation, the risk of cesarean section in the advanced maternal age group is higher than that in the age-appropriate maternity group, and the risk of abortion in the very advanced maternal age group is higher than that in the age-appropriate maternity group. Conclusion The risk of caesarean section in the advanced maternal age women was higher than that in pregnant women of appropriate age. The risk of abortion in the advanced maternal age women was higher than that in pregnant women of appropriate age. There is no age-related correlation between other complications and pregnancy outcomes. Standardized management effectively protects the safety of elderly pregnant women.
- Very advanced maternal age women /
- Miscarry /
- Cesarean

HTML全文

表 1 3组孕产妇一般情况比较(例)

Table 1. Comparison of maternity general conditions in three groups(cases)

组别	例数	辅助生殖		瘢痕子宫		流产史		初产妇
组别	例数	否	是	否	是	否	是	否	是
适龄组	184	164	20	170	14	125	59	42	142
高龄组	147	121	26	90	57^a	49	98^a	122	25^a
超高龄组	130	119	11^b	99	31^ab	34	96^a	126	4^ab
χ²值		6.050		46.379		65.811		216.559
P值		0.049		＜0.001		＜0.001		＜0.001
注：与适龄组比较，^aP<0.017；与高龄组比较，^bP<0.017。

下载: 导出CSV

表 2 3组孕产妇妊娠期并发症情况比较(例)

Table 2. Comparison of maternity complications during pregnancy in three groups(cases)

组别	例数	GDM		妊娠期高血压		子痫前期		肝内胆汁淤积症		前置胎盘		胎盘植入		胎盘早剥		胎膜早破
组别	例数	否	是	否	是	否	是	否	是	否	是	否	是	否	是	否	是
适龄组	184	146	38	178	6	179	5	180	4	181	3	183	1	177	7	108	76
高龄组	147	93	54^a	143	4	141	6	143	4	137	10^a	146	1	143	4	103	44^a
超高龄组	130	79	51^a	123	7	119	11	126	4	127	3^a	127	3	129	1	126	4^a
χ²值		15.583		1.535		5.755		0.257		10.575		2.539		2.780		57.625
P值		<0.001		0.464		0.056		0.879		0.027		0.281		0.249		0.034
注：与适龄组比较，^aP<0.017。

下载: 导出CSV

表 3 3组孕产妇妊娠结局比较(例)

Table 3. Comparison of maternity pregnancy outcomes in three groups

组别	例数	早产		巨大儿		胎儿窘迫		胎儿畸形		剖宫产		产后出血		流产
组别	例数	否	是	否	是	否	是	否	是	否	是	否	是	否	是
适龄组	184	167	17	162	22	158	26	180	4	131	53	173	11	171	13
高龄组	147	134	13	121	26	138	9^a	142	5	63	84^a	141	6	138	9^a
超高龄组	130	120	10	114	16	119	11	121	9	84	46^a	126	4	103	27^a
χ²值		0.238		2.620		6.297		4.725		28.820		1.586		19.675
P值		0.888		0.270		0.043		0.094		0.000		0.452		0.000
注：与适龄组比较，^aP<0.017。

下载: 导出CSV

表 4 变量赋值情况

Table 4. Variable assignment

变量	赋值方法
因变量
辅助生殖	否=0，是=1
瘢痕子宫	否=0，是=1
流产史	否=0，是=1
初产妇	否=0，是=1
GDM	否=0，是=1
前置胎盘	否=0，是=1
胎膜早破	否=0，是=1
胎儿窘迫	否=0，是=1
剖宫产	否=0，是=1
流产	否=0，是=1
自变量
组别	适龄组=0，高龄组=1，超高龄组=2

下载: 导出CSV

表 5 3组孕产妇妊娠期并发症及妊娠结局二元logistic分析

Table 5. Binary logistic analysis of pregnancy complications and outcomes of pregnant women in three groups

变量	自变量	B	SE	Wald χ²	P值	OR值	95% CI
GDM	高龄组	0.306	0.315	0.942	0.331	1.358	0.733~7.515
	超高龄组	0.429	0.338	1.612	0.204	1.535	0.792~2.975
前置胎盘	高龄组	0.380	0.808	0.222	0.638	1.463	0.300~7.124
	超高龄组	-0.520	0.955	0.222	0.638	1.463	0.300~7.124
胎膜早破	高龄组	-0.200	0.295	0.459	0.498	0.819	0.459~1.461
	超高龄组	-0.237	0.329	0.521	0.471	0.789	0.414~1.502
胎儿窘迫	高龄组	-0.565	0.488	1.341	0.247	0.568	0.218~1.479
	超高龄组	-0.414	0.520	0.635	0.426	0.661	0.238~1.831
剖宫产	高龄组	1.224	0.338	13.136	＜0.001	3.399	1.754~6.588
	超高龄组	0.689	0.388	3.149	0.076	1.992	0.930~4.264
流产	高龄组	0.165	0.552	0.090	0.764	1.180	0.400~23.481
	超高龄组	1.560	0.546	8.165	0.004	4.761	1.632~13.885
注：以适龄组为参照。

下载: 导出CSV

参考文献(18)

[1]	LAOPAIBOON M, LUMBIGANON P, INTARUT N, et al. Advanced maternal age and pregnancy outcomes: a multicountry assessment[J]. BJOG, 2014, 121(Suppl 1): 49-56. http://www.onacademic.com/detail/journal_1000039360347210_89e9.html
[2]	中华人民共和国国家卫生和计划生育委员会. 国家卫生计生委关于加强母婴安全保障工作的通知[J]. 中华人民共和国国家卫生和计划生育委员会公报, 2017(7): 11-18. https://www.cnki.com.cn/Article/CJFDTOTAL-WSGB201707008.htm National Health Commission of the People's Republic of China. Notice of National Health and Family Planning Comission on Strengthening Maternal and Infant Safety Guarantee[J]. Gazette of the National Health and Family Planning Commission of People's Republic of China, 2017(7): 11-18. https://www.cnki.com.cn/Article/CJFDTOTAL-WSGB201707008.htm
[3]	谢幸, 孔北华, 段涛. 妇产科学[M]. 9版. 北京: 人民卫生出版社, 2018. XIE X, KONG B H, DUAN T. Obstetrics and gynecology[M]. 9th edition. Beijing: People's Medical Publishing House, 2018.
[4]	中华医学会妇产科学分会产科学组. 孕前和孕期保健指南(2018)[J]. 中华妇产科杂志, 2018, 53(1): 7-13. doi: 10.3760/cma.j.issn.0529-567x.2018.01.003 Obstetrics Group, Society of Obstetrics and gynecology, Chinese Medical Association. Guide to Prenatal and prenatal care(2018)[J]. Chinese Journal of Obstetrics and Gynecology, 2018, 53(1): 7-13. doi: 10.3760/cma.j.issn.0529-567x.2018.01.003
[5]	LI Z Y, CHENG Y J, WANG D Y, et al. Incidence rate of type 2 diabetes mellitus after gestational diabetes of mellitus: a systematic review and meta-analysis of 170, 139 women[J]. J Diabetes Res, 2020, 2020: 3076463. DOI: 10.1155/2020/3076463.
[6]	刘铭忆, 马秀华. 妊娠期糖尿病妇女产后转归及随访的研究进展[J]. 中华全科医学, 2022, 20(1): 109-112, 116. doi: 10.16766/j.cnki.issn.1674-4152.002289 LIU M Y, MA X H. Advance in research on postpartum outcome and follow-up of women with gestational diabetes mellitus[J]. Chinese Journal of General Practice, 2022, 20(1): 109-112, 116. doi: 10.16766/j.cnki.issn.1674-4152.002289
[7]	PLOWS J F, STANLEY J L, BAKER P N, et al. The pathophysiology of gestational diabetes mellitus[J]. Int J Mol Sci, 2018, 19(11): 3342. doi: 10.3390/ijms19113342
[8]	OPPONG S A, TORTO M, BEYUO T. Risk factors and pregnancy outcome in women aged over 40 years at Korle-Bu Teaching Hospital in Accra, Ghana[J]. Int J Gynaecol Obstet, 2020, 149(1): 56-60. doi: 10.1002/ijgo.13087
[9]	SALIM N A, SATTI I. Risk factors of placenta previa with maternal and neonatal outcome at Dongola/Sudan[J]. J Family Med Prim Care, 2021, 10(3): 1215-1217. doi: 10.4103/jfmpc.jfmpc_2111_20
[10]	ROUSTAEI Z, VEHVILÄINEN-JULKUNEN K, TUOMAINEN T P, et al. The effect of advanced maternal age on maternal and neonatal outcomes of placenta previa: a register-based cohort study[J]. Eur J Obstet Gynecol Reprod Biol, 2018, 227: 1-7. doi: 10.1016/j.ejogrb.2018.05.025
[11]	王杰, 尤子善, 蒋立, 等. 426例胎膜早破患者高危因素及围产结局分析[J]. 中国妇幼保健, 2019, 34(17): 3927-3930. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB201917018.htm WANG J, YOU Z S, JIANG L. Investigation and analysis on high－risk factors and perinatal outcomes of 426 patients with premature rupture of membranes[J]. Maternal and Child Health Care of China, 2019, 34(17): 3927-3930. https://www.cnki.com.cn/Article/CJFDTOTAL-ZFYB201917018.htm
[12]	BOUVIER D, FOREST J C, BLANCHON L, et al. Risk factors and outcomes of preterm premature rupture of membranes in a cohort of 6 968 pregnant women prospectively recruited[J]. J Clin Med, 2019, 8(11): 1987. doi: 10.3390/jcm8111987
[13]	辛桂艳. 高龄产妇妊娠的危险因素分析[J]. 中国医药指南, 2019, 17(6): 48. https://www.cnki.com.cn/Article/CJFDTOTAL-YYXK201906041.htm XIN G Y. Risk factors of pregnancy in advanced maternal age[J]. Guide of China Medicine, 2019, 17(6): 48. https://www.cnki.com.cn/Article/CJFDTOTAL-YYXK201906041.htm
[14]	SANDALL J, TRIBE R M, AVERY L, et al. Short-term and long-term effects of caesarean section on the health of women and children[J]. Lancet, 2018, 392(10155): 1349-1357. http://www.sciencedirect.com/science/article/pii/S0140673618319305
[15]	RYDAHL E, DECLERCQ E, JUHL M, et al. Cesarean section on a rise-Does advanced maternal age explain the increase? A population register-based study[J]. PLoS One, 2019, 14(1): e0210655. DOI: 10.1371/journal.pone.0210655.
[16]	VOLGSTEN H, JANSSON C, SVANBERG A S, et al. Longitudinal study of emotional experiences, grief and depressive symptoms in women and men after miscarriage[J]. Midwifery, 2018, 64: 23-28.
[17]	FREDERIKSEN L E, ERNST A, BRIX N, et al. Risk of adverse pregnancy outcomes at advanced maternal age[J]. Obstet Gynecol, 2018, 131(3): 457-463. http://www.nature.com/articles/s41598-018-29889-3
[18]	MIKWAR M, MACFARLANE A J, MARCHETTI F. Mechanisms of oocyte aneuploidy associated with advanced maternal age[J]. Mutat Res Rev Mutat Res, 2020, 785: 108320. DOI: 10.1016/j.mrrev.2020.108320.