2015—2019年温州市高龄产妇特征及妊娠结局变化趋势

doi:10.3969/j.issn.2095-9400.2021.04.007

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摘要目的：分析高龄产妇的妊娠特征以及不良妊娠结局的变化特点，为进一步改进母婴保健工作方法和管理模式、保障母婴安全提供科学依据。方法：采用回顾性调查分析法，依托温州市妇幼保健信息管理平台中孕产妇保健信息系统，收集2015—2019年在温州市助产机构分娩的年龄≥20岁的产妇资料，分高龄组（年龄≥35岁）和适龄组（20～34岁）。采用χ2检验和趋势χ2检验分析高龄与适龄产妇的人口学特征、妊娠合并症、并发症和不良妊娠结局发生率变化趋势及差异。结果：2015—2019年温州市分娩产妇共536 456人，其中高龄产妇为56 637人（占10.56%），年龄≥40岁的高龄产妇共8 787人（占15.51%），最大年龄为55岁。2015—2019年温州市高龄产妇占产妇总数的比例呈现上升趋势（χ2趋势=1 225.00，P＜0.001），二胎及以上产妇数中高龄产妇占比呈现先下降后上升趋势（χ2趋势=21.64，P＜0.001）。高龄产妇的非初胎比例、剖宫产比例均高于适龄组，产检次数、文化程度、职业构成在两组分布差异均有统计学意义（均P＜0.001）。高龄与适龄产妇的妊娠期合并症（妊娠期糖尿病、子痫前期）和并发症（产后出血、胎膜早破）的发生率均呈逐年增加趋势（P＜0.01），但是高龄产妇的早产、巨大儿和低出生体质量的发生率未显示逐年增加或降低的变化趋势（P＞0.05）。高龄产妇2015—2019年合计的妊娠并发症、合并症和不良妊娠结局的发生率均高于适龄组（P＜0.001）。结论：2015—2019年高龄产妇的妊娠期糖尿病和胎膜早破发生率明显增加，且不良妊娠结局的发生率明显高于适龄产妇，需要妇幼保健及产科重点关注。

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	叶傲霜
	林颖
	包佳佳
	杨新军

关键词 ：高龄产妇, 妊娠并发症, 不良妊娠结局

Abstract：Objective: To analyze the pregnancy characteristics and adverse pregnancy outcomes in elderly pregnant women, and to provide scientific basis for improving the working method and management mode of maternal and child health care to ensure the safety of mothers and infants. Methods:Retrospective analysis was made of the data of pregnant women aged ≥20 years who gave birth in Wenzhou midwifery institutions from 2015 to 2019, based on the related information collected from the Information Management Platform of Wenzhou Maternal and Child Health Center, and they were divided as the senior-age group (aged ≥35 years) and the right-age group (aged 20-34 years). Cochran-Mantel-Haenszel χ2 test and crosstabs χ2 test was used to analyze the linear trend in the incidence of adverse pregnancy outcomes and differences in demographics and pregnancy complications/comorbidity. Results: A total of 536 456 women gave birth in Wenzhou between 2015 and 2019, of whom 56 637 (10.56%) were elderly and 8 787 (15.51%) were aged ≥40 years old, with a maximum age of 55 years. Between 2015 and 2019, the proportion of elderly pregnant women in Wenzhou showed an upward trend (χ2trend=1 225.00, P<0.001), and the proportion of elderly pregnant women in parity ≥2 showed an upward trend (χ2trend=21.64, P<0.001). The proportion of non-first births, non-births, caesarean sections, education of junior high school and below were all higher in the senior-age group than those in the right-age group (P<0.001 in all comparisons). The incidence of gestational complications (GDM, pre-eclampsia) and complications (postpartum haemorrhage, premature fetal membrane breakage) in both groups showed an annually increasing trend (P<0.01), but the incidence of preterm birth, macrosomia and low birth weight in the senior-age pregnant women did not show an annual increasing or decreasing trend (P>0.05). The incidence of pregnancy complications and adverse pregnancy outcomes in the senior-age pregnant women was higher than the right-age group in 2015-2019 (P<0.001). Conclusion: The incidence of gestational diabetes and premature fetal membrane break-up among elderly pregnant women increased significantly from 2015 to 2019, and the incidence of adverse pregnancy outcomes in elderly pregnant women was higher than the right-age pregnant women. Therefore, obstetric doctors and health workers in the Maternal and Child Health Center need to pay more attention to the elderly pregnant women.

Key words： elderly puerpera pregnancy complications adverse pregnancy outcomes

收稿日期: 2020-09-21

通讯作者: 杨新军，教授，Email：xjyang@wmu.edu.cn。 E-mail: xjyang@wmu.edu.cn

作者简介: 叶傲霜，副主任医师，Email：752019677@qq.com。

链接本文:

https://xb.wmu.edu.cn/CN/10.3969/j.issn.2095-9400.2021.04.007 或 https://xb.wmu.edu.cn/CN/Y2021/V51/I4/292

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