双胎妊娠中母亲年龄和妊娠不良结局的关系

Association between maternal age and adverse pregnancy outcome in twin pregnancy

摘要:

目的 探讨双胎妊娠中母亲年龄和妊娠不良结局的关系。方法 回顾性纳入2006年1月至2016年6月住院分娩的双胎妊娠产妇2 363例的临床资料。按照产妇年龄不同分为 < 20岁（n=15）、20~24岁（n=158）、25~29岁（n=894）、30~34岁（n=936）、35~39岁（n=320）、≥ 40岁（n=40）6组。比较各年龄组产妇相关特征的基线，以及其妊娠不良结局（早产、出生缺陷、妊娠晚期死胎、小于胎龄儿）的发生率。采用广义估计方程，评估各年龄组妊娠不良结局发生的风险。结果 控制了居住地、是否初产妇、妊娠方式、孕产期相关疾病因素后，≥ 40岁组产妇的极早产儿和中期早产儿发生率分别是25~29岁组的2.60倍、1.99倍（P < 0.05）；20~24岁组极早产儿、晚期早产儿的发生率分别是25~29岁组的1.99倍、1.33倍（P < 0.05）； < 20岁、20~24岁、≥ 40岁组妊娠晚期死胎的发生率分别是25~29岁组的9.10倍、2.88倍、3.97倍（P < 0.05）； < 20岁、35~39岁组小于胎龄儿的发生率分别是25~29岁组的2.70倍、0.73倍（P < 0.05）。结论 双胎妊娠中， < 20岁的产妇发生小于胎龄儿和妊娠晚期死胎的风险较高，≥ 40岁的产妇发生极早产儿、中期早产儿和妊娠晚期死胎的风险较高，20~24岁产妇发生极早产儿、晚期早产儿和妊娠晚期死胎的风险较高。

Abstract:

Objective To study the association between maternal age and adverse pregnancy outcome in twin pregnancy. Methods The clinical data of 2 363 women with twin pregnancy from January 2006 to June 2016 were retrospectively reviewed. According to the age, the women were divided into six groups: < 20 years (n=15), 20-24 years (n=158), 25-29 years (n=894), 30-34 years (n=936), 35-39 years (n=320), and ≥ 40 years group (n=40). The above groups were compared in terms of related baseline features and incidence rates of adverse pregnancy outcomes (preterm birth, birth defect, stillbirth in late pregnancy and small-for-gestational-age birth). A generalized estimating equation was used to investigate the risk of adverse pregnancy outcomes in different age groups. Results After control for the factors including place of residence, primipara, pregnancy pattern, and gestational diseases, the incidence rates of very preterm birth and moderately preterm birth in the ≥ 40 years group were 2.60 and 1.99 times than those in the 25-29 years group respectively (P < 0.05). The incidence rates of very preterm birth and late preterm birth in the 20-24 years group were 1.99 and 1.33 times than those in the 25-29 years group respectively (P < 0.05). The incidence rates of stillbirth in late pregnancy in the < 20 years group, the 20-24 years group, and the ≥ 40 years group were 9.10, 2.88 and 3.97 times than those in the 25-29 years group respectively (P < 0.05). The incidence rates of small-for-gestational-age birth in the < 20 years group and the 35-39 years group were 2.70 and 0.73 times than those in the 25-29 years group respectively (P < 0.05). Conclusions In twin pregnancy, pregnant women, aged < 20 years, have a higher risk of smaller-for-gestational-age birth and stillbirth in late pregnancy, those aged ≥ 40 years have a higher risk of very preterm birth, moderately preterm birth and stillbirth in late pregnancy, and those aged 20-24 years have a higher risk of very preterm birth, late preterm birth and stillbirth in late pregnancy.