Obstetrics & gynecology science

Korean Society of Obstetrics and Gynecology (대한산부인과학회)
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Pregnancy outcomes in women aged 35 and older

35세 이상 고령 산모의 산과적 예후

Park, Hee-Jin;Lee, Sook-Hwan;Cha, Dong-Hyun;Kim, In-Hyun;Jun, Hye-Sun;Lee, Kyoung-Jin;Song, Song-Ah;Park, Hey-Ri;Chung, Chang-Jo;Lee, Chung-No
박희진;이숙환;차동현;김인현;전혜선;이경진;송송아;박혜리;정창조;이정노

  • Published : 20061000
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Abstract

Objective: To estimate the effect of maternal age on obstetric outcomes, a retrospective analysis was done. Methods: Twenty six hundred and forty six women who delivered a singleton baby at our hospital from January 1, to December 31, 2004 were enrolled in this study. Subjects were divided into 3 age groups; 1) less than 35 years, 2) 35-39 years, and 3) 40 years and older. Chi-square test was used to assess the effect of age on obstetrics outcome. Then the odds ratio was calculated to represent clinically meaningful risk. Results: A total of 2646 women with complete data were available; 2245 (84.9%) less than 35 years of age; 350 (13.2%) 35-39 years; and 51 (1.9%) 40 years and older. Increasing age was significantly associated with chromosomal abnormalities (OR 3.9and 8.8 for ages 35-39 years and age 40 years and older, respectively), Preterm premature rupture of membranes (OR 1.3 and 3.2) and cesarean delivery (OR 2.0 and 5.5). Patients aged 35-39 years were at increased risk for placenta previa (OR 1.8) and congenital anomaly (OR 2.8) but these were not statistically significant. The rate of the preterm delivery was increased by age (OR 1.3 and 1.9 for ages 35-39 years and age 40 years and older, respectively) but it was not statistically significant (p=0.121). We did not find advanced maternal age to be associated with a statistically increased risk for preeclampsia, congenital anomaly, gestational diabetes, placenta abruption, low birth weight, macrosomia, neonatal morbidity (NICU admission), and perinatal loss. Conclusion: In conclusion, although the likelihood of adverse outcomes increases with maternal age, patients and obstetric care providers can be reassured that overall maternal and fetal outcomes are favorable in this patient population.

목적: 본 연구의 목적은 35세 이상이 고령 임신에서의 산과적 예후를 평가하기 위한 것이다. 연구 방법: 차병원에서 2004년 1월부터 2004년 12월까지 산전 진찰을 받고 분만한 산모를 대상으로 의무기록을 분석하는 후향적 연구를 시행하였다. 환자들은 산모의 나이에 따라 1) 35세 미만 2) 35-39세 3) 40세 이상으로 나누었고, 산모의 임신으로 인한 합병증 발생에 나이가 미치는 영향을 분석할 때는 35세 미만의 산모군을 대조군으로 하였으며 과거 임신력, 체지방 지수 (body mass index), 과거 내과적 병력, 임신 방법 등 영향을 미칠 수 있는 다양한 요인에 대하여 나이군 별로 분산 분석을 이용하여 비교하였다. 산과적 합병증의 발생 위험 비교는 카이제곱 검정법 (chi-square test)을 이용하였고 합병증의 비차비 (odds ratio)를 구하였다. 결과: 총 2646명의 산모 데이터를 분석하였고 35세 미만이 2,245명 (84.9%), 35세 이상-39세 이하가 350명 (13.2%), 40 세 이상의 산모는 51명 (1.9%) 이었다. 태아의 염색체 이상은 35세 이상의 산모에서 의미 있게 증가하였다 (OR 3.9; 35-39세, 8.8; 40세 이상). 자간전증 (preeclampsia)과 임신성 당뇨의 발생은 산모군간 차이가 없었다 (OR 1.2; 35-39세, 1.3; 40세 이상). 전치 태반 (OR 1.8)과 선천성 기형 (OR 2.8)은 35-39세 산모군에서만 다소 증가되었다. 태반 조기 박리 (placenta abruption)의 발생은 차이가 없었다. 조기 양막 파수 (preterm premature rupture of membranes: PPROM)는 나이가 증가할수록 위험도가 증가하였고 (OR 1.3; 35-39세, 3.2; 40세 이상: p=0.041), 조기 분만 (preterm delivery)도 증가하였으나 (OR 1.3;35-39세, 1.9; 40세 이상) 통계적으로 유의성은 없었다 (p=0.121). 저체중아 (low birth weight)와 거대아 (macrosomia)의 출산은 산모군 별로 통계적 의의가 없었으며 (p=0.899), 제왕 절개의 빈도는 산모의 나이가 증가함에 따라 현저하게 증가하였다 (OR 2.0; 35-39세, 5.5; 40세 이상). 신생아 중환자실 입원력은 산모군간 차이가 없었으며 (OR 0.9; 35-39세, 1.1; 40세 이상), 주산기 태아 사망은 35세 이상 산모군에서만 다소 증가하였으나 (OR 1.4) 통계적 의의는 없었다 (p=0.807). 결론: 결론적으로 산과적 합병증 중 태아의 염색체 이상과 제왕 절개 빈도, 조기 양막 파수의 위험도는 나이에 따라 증가하지만, 다른 산과적 합병증에 고령 임신이 미치는 영향은 크지 않다고 볼 수 있다.

Keywords

References

  1. 통계청. 인구동태조사 2004
  2. Edge V, Laros R. Pregnancy outcome in nulliparous women aged 35 or older. Am J Obstet Gynecol 1993; 168: 1881-5 https://doi.org/10.1016/0002-9378(93)90706-O
  3. Bobrowski R, Bottoms S. Underappreciated risks of the elderly multipara. Am J Obstet Gynecol 1995; 172: 1764-70 https://doi.org/10.1016/0002-9378(95)91409-9
  4. Bianco A, Stone J, Lynch L, Lapinski R, Berkowitz G, Berkowitz R. Pregnancy outcome at age 40 and older. Obstet Gynecol 1996; 87: 917-22 https://doi.org/10.1016/0029-7844(96)00045-2
  5. Berkowitz GS, Skovron ML, Lapinski RH. Delayed childbearing and the outcome of pregnancy. N Engl J Med 1990; 322: 659-64 https://doi.org/10.1056/NEJM199003083221004
  6. Cnattingius S, Forman M, Michele R. Delayed childbearing and risk of adverse perinatal outcome. JAMA 1992; 268: 886-90 https://doi.org/10.1001/jama.268.7.886
  7. Prysak M, Lorenz R, Kisly A. Pregnancy outcome in nulliparous women 35 years and older. Obstet Gynecol 1995; 85: 65-70 https://doi.org/10.1016/0029-7844(94)00330-G
  8. Seoud M, Nassar AH, Usta IM, Melhem Z, Kazma A, Khalil AM. Impact of advanced maternal age on pregnancy outcome. Am J Perinatol 2002; 19: 1-7 https://doi.org/10.1055/s-2002-20175
  9. Vercellini P, Zuliani G, Rognoni MT, Trespidi L, Oldani S, Cardinale A. Pregnancy at forty and over: a case control study. Eur J Obstet Gynecol Reprod Biol 1993; 48: 191-5 https://doi.org/10.1016/0028-2243(93)90087-S
  10. Ales K, Druzin M, Santibi D. Impact of advanced maternal age on the outcome of pregnancy. Surg Gynecol Obstet 1990; 171: 209-16 aged 35 or older. Am J Obstet Gynecol 1993; 168: 1881-2 https://doi.org/10.1016/0002-9378(93)90706-O
  11. Gilbert WM, Nesbitt TS, Danielsen B. Childbearing beyond age 40: pregnancy outcome in 24,032 cases. Obstet Gynecol 1999; 93: 9-14 https://doi.org/10.1016/S0029-7844(98)00382-2
  12. Jacobsson B, Ladfors L, Milson I. Advanced maternal age and adverse perinatal outcome. Obstet Gynecol 2004; 104: 727-33 https://doi.org/10.1097/01.AOG.0000140682.63746.be
  13. Goldman CJ, Fergal D, Malone, Vvidaver J, Robert H. Impact of Maternal Age on Obstetric Outcome. Obstet Gynecol 2005; 105: 983-90 https://doi.org/10.1097/01.AOG.0000158118.75532.51
  14. Wilson RD, Kendrick V, Wittmann BK, McGillivray B. Spontaneous abortion and pregnancy outcome after normal first-trimaster ultrasound examination. Obstet Gynecol 1986; 67: 352-5
  15. Hook EB. Rates of chromosome abnormalities at different maternal ages. Obstet Gynecol 1981; 58: 282-5
  16. Naeye R. Maternal age, obstetric complications, and the outcome of pregnancy. Obstet Gynecol 1983; 61: 210-16
  17. Crawford BS, Davis J, Harrigill K. Uterine artery atherosclerotic disease: histologic features and clinical correlation. Obstet Gynecol 1997; 90: 210-5 https://doi.org/10.1016/S0029-7844(97)00225-1
  18. Ananth CV, Wilcox AJ. Placental abruption and perinatal mortality in the United States. Am J Epidemiol 2001; 153: 332 https://doi.org/10.1093/aje/153.4.332
  19. Lehmann DK, Chism J. Pregnancy outcome in medically complicated and uncomplicated patients aged 40 years and older. Am J Obstet Gynecol 1987; 157: 738-42 https://doi.org/10.1016/S0002-9378(87)80041-8
  20. Spellacy WN, Miller SJ, Winegar A. Pregnancy after 40 years of age. Obstet Gynecol 1986; 68: 452-4
  21. Yasin SY, Beydoun SN. Pregnancy outcome at greater than or equal to 20 weeks' gestation in women in their 40s: a case-control study. J Reprod Med 1988; 33: 209-13
  22. Fretts RC, Schmittdiel J, McLean FH, Usher RH, Goldman MB. Increased maternal age and risk of fetal death. N Engl J Med 1995; 333: 953-7 https://doi.org/10.1056/NEJM199510123331501
  23. Bell J, Campbell D, Graham W, Penney G, Ryan M, Hall M. Can obstetric complications explain the high levels of obstetric interventions and maternity service use among older women? A retrospective analysis of routinely collected data. BJOG 2001; 108: 910-8 https://doi.org/10.1111/j.1471-0528.2001.00214.x
  24. Dulitzki M, Soriano D, Schiff E, Chetrit A, Mashiach S, Seidman DS. Effect of very advanced maternal age on pregnancy outcome and rate of cesarean delivery. Obstet Gynecol 1998; 92: 935-9 https://doi.org/10.1016/S0029-7844(98)00335-4
  25. Martel M, Wacholder S, Lippman A, Brohan J, Hamilton E. Maternal age and primary cesarean section rates: a multivariate analysis. Am J Obstet Gynecol 1987; 156: 305-8 https://doi.org/10.1016/0002-9378(87)90273-0
  26. Cohen W, Newman L, Friedman E. Risk of labor abnormalities with advancing maternal age. Obstet Gynecol 1980; 55: 414-6
  27. Peipert JF, Bracken MB. Maternal age: an independent risk factor for cesarean delivery. Obstet Gynecol 1993; 81: 200-5
  28. Bell J, Campbell D, Graham W, Penney G, Ryan M, Hall M. Do obstetric complications explain high caesarean section rates among women over 30? A retrospective analysis. BMJ 2001; 322: 894-5 https://doi.org/10.1136/bmj.322.7291.894
  29. Ezra Y, McParland P, Farine D. High delivery intervention rates in nulliparous women over age 35. Eur J Obstet Gynecol Reprod Biol 1995; 62: 203-7 https://doi.org/10.1016/0301-2115(95)02201-H