Obstetrics & gynecology science

Korean Society of Obstetrics and Gynecology (대한산부인과학회)
권호 표지

Meta Analysis of Clinical Studies of Pregnancy and Delivery in Elderly Gravida

고령 산모의 임신 및 출산의 임상적 특성에 관한 메타분석

Choi, Jae-Ho;Han, Hyeon-Ju;Hwang, Jeong-Hye;Chung, Sung-Ro;Moon, Hyung;Park, Moon-ll;Cha, Kyung-Joon;Choi, Hang-Suk;Oh, Jae-Eung;Park, Young-Sun
최재호;한현주;황정혜;정성로;문형;박문일;차경준;최향석;오재응;박영선

  • Published : 20060200
⟨ Previous Next ⟩

Abstract

Objective: Our purpose was to identify the age-related inceased risks of the elderly gravida over 35 or 40 years at delivery by clarifying the effects of age and parity, their combination, and their interaction and the relationships of other complications. Methods: We have made meta analysis about general and clinical characteristics of elderly gravida over the aged 35 or 40 years, based on the 7 domestic theses since 1996 year at the department of Obstetrics and Gynecology. Results: The results were obtained as follows; In elderly gravida over the aged 35 or 40 years at delivery, maternal and neonatal outcomes were generally good, but in study group, there were a high incidence of gestational (preterm delivery, fetal presentation, pregnancy- induced hypertension, gestational diadetes, placenta previa, premature rupture of membranes) complications, uterine myoma during pregnancy and low birth weight in neonate after delivery. Conclusion: The increased risks of the elderly gravida over the aged 35 or 40 years at delivery may have been overshadowed by the previous focus on the elderly nullipara. In spite of high incidence of maternal morbidity, the overall maternal and neonatal outcomes were generally good. It is important to recognize what is more important in age-related pregnant-risks of the elderly gravida over the aged 35 or 40 years at delivery to appropriate counsel and manage this group of patients. This informations may be helpful for counsel in elderly gravida over the aged 35 or 40 years who are considering pregnancy.

목적: 35세 또는 40세 이상의 고령 산모에서 연령 및 연령과 관련된 산전 및 산후 합병증의 위험정도를 알아보고자 하였다. 연구 방법: 1996년 이후 국내에서 발표된 35세 또는 40세 이상의 고령 산모에 대한 7편의 연구문헌에 대해 메타 분석을 실시하였다. 결과: 35세 또는 40세 이상의 고령 산모에 있어서 출산 후 산모 및 신생아 상태는 전반적으로 양호하였다. 그러나, 연구군에서 대조군에 비해 임신 중에 임신 합병증 (조기분만, 태위, 임신성 고혈압, 임신성 당뇨병, 전치 태반, 조기 양막파수)과 자궁 근종, 출산 후 저체중아에 있어서 통계적으로 의의있게 높은 빈도를 보였다. 결론: 최근 35세 또는 40세 이상의 고령 산모의 증가는 이전부터의 고령 초산모에 대해서만의 관심에 의해 간과되었었다. 고령 산모의 높은 이환율에도 불구하고 전반적인 출산 후 산모 및 신생아 상태는 일반적으로 양호한 것으로 판단된다. 35세 및 40세 이상의 고령 산모에서 연령과 관련된 위험에 있어서 무엇이 중요한지를 인식하는 것이 이들에 대해 적절한 처치 및 관리를 위해 중요하다. 본 연구는 35세 및 40세 이상 고령 산모의 처치 및 관리를 위해 도움을 줄 수 있을 것으로 생각된다.

Keywords

References

  1. Kessler I, Lancet M, Borenstein R, et al. The problem of the older primipara. Obstet Gynecol 1980; 56: 2
  2. Berkowitz GS, Skovron ML, Lapinsk PH, Berkowitz RL. Delayed childbearing and the outcome of pregnancy. N Engl J Med 1990; 322: 659-64 https://doi.org/10.1056/NEJM199003083221004
  3. 김성금, 박치희, 이미영, 이경희, 장미경, 홍희선. 고령 산모의 임신예후에 관한 고찰사. 대한산부회지 1994; 137: 1967
  4. Bobrowski RA, Bottoms SF. Underappreciated risks of the elderly multipara. Am J Obstet Gynecol 1995; 172: 1764 https://doi.org/10.1016/0002-9378(95)91409-9
  5. Peto, R. (1987), Who do we need systematic overviews of randomized trials-, Statistics in Medicine 6; pp. 233-40 https://doi.org/10.1002/sim.4780060306
  6. Berlin, J.A., Laird, N.H., Sacks, H.S. and Chalmers, T.C. (1989), A comparison of statistical methods for combining event rates from clinical trials. Statistics in Medicine 8; pp. 141-51 https://doi.org/10.1002/sim.4780080202
  7. Toohey JS, Keegan KA, Morgan MA. The 'dangerous multipara'; fact or fiction? Am J Obstet Gynecol 1988; 95: 230
  8. Nortman D. Parental age as a factor in pregnancy outcome and child development. Report on Population/Family Planning 1974; 16
  9. Milner M, Barry-Kinsetta C, Unwin A. The inpact of maternal age on pregnancy and its outcome. Int J Obstet Gynecol 1992; 38: 281-6 https://doi.org/10.1016/0020-7292(92)91019-K
  10. 이종학. 노령 초산부에 관한 임상통계학적 고찰. 대한산부회지 Vol. 30. No. 2. February 1987
  11. Kirz DS, Dorchester W, Freeman RK. Advanced maternal age: the mature gravida. Am J Obstet Gynecol 1985; 152: 7
  12. 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. Naeye RL. Maternal age, obstetric complications and the outcome of pregnancy. Obstet Gynecol 1983; 61: 210-6
  14. Hains CJ, Michaol S, Denis HY, et al. Neonatal outcome and its relationship with maternal age. Aust NZ J Obstet Gynecol 1991; 31: 209 https://doi.org/10.1111/j.1479-828X.1991.tb02782.x
  15. Stein A. Pregnancy in gravida over age 35 years. Nurse Midwife 1983; 28: 107-27
  16. Blickstein I, Lancer M, Kessler J. Re-evaluation of the obstetrical risk for the older primipara. Int J Obstet Gynecol 1987; 25: 107-12 https://doi.org/10.1016/0020-7292(87)90003-8
  17. Lev-Toaff AS, Coleman BG, Arger PH. Leiomyomas in pregnancy: Sonographic study. Radiology 1987; 164: 375
  18. Winer-Muran HT, Muram D, Gillerson MS. Uterine myomas in pregnancy. J Assoc Can Radiol 1984; 35: 168
  19. Rice JP, Kay HH, Mahony BS. The clinical significance of uterine leiomyomas in pregnancy. Am J Obstet Gynecol 1989; 160: 1212 https://doi.org/10.1016/0002-9378(89)90194-4
  20. 이영규, 이회민, 신무철, 최기욱, 김삼봉, 양만용, 홍기연. 노령 산모에 관한 임상 통계학적조사. 대한산부회지 1995; 38: 582
  21. Michael B, Aldous and Bruce M. Maternal age at first childbirth and risk of low birth weight and preterm delivery in Washington state. JAMA 1993; 270: 2574 https://doi.org/10.1001/jama.270.21.2574
  22. Spellacy WN, Miller SJ, Wineger A. Pregnancy after 40 years of age. Obstet Gynecol 1986; 68: 452-4
  23. Lehman DK and Chiasm J. Pregnancy outcome in medically complicated and uncomplicated patients aged 40 years or older. Am J Obstet Gynecol 1987; 157: 738
  24. Jolly M, Sebire N, Harris J, Robinson S, Regan L. Pregnancy and obstetrics. The risks associated with pregnancy in women aged 35 years or older. Human Reprod 2000; 14: 2433
  25. Addashek JA, Alam M, Peaceman et al. Factor contributing to the increased cesarean birth rate in older parturient women. Am J Obstet Gynecol 1993; 169: 936 https://doi.org/10.1016/0002-9378(93)90030-M
  26. Gordon D, Milberg J. Advanced maternal age as a risk factor for cesarean delivery. Obstet Gynecol 1991; 77: 493-7
  27. 신중석, 이순곤, 김주영, 조태호. 노령초산부에 관한 임상통계 학적 고찰. 대한산부회지 1983; 26: 365
  28. Tuck SM, Yudkin PL, Turnbull AC. Pregnancy outcome in elderly primigravida with and without a history of infertility. Br J Obstet Gynecol 1988; 95: 230-7 https://doi.org/10.1111/j.1471-0528.1988.tb06862.x
  29. Wilson RD, Kendrick V, Wittmann BK, McGillivray B. Spontaneous abortion and pregnancy outcome after normal first-trimester ultrasound examination. Obstet Gynecol 1986; 67: 352
  30. Cunningham FG, Leveno KJ. Childbearing among older women-the message is cautiously optimistic. N Eng J Med 1995; 333: 1002 https://doi.org/10.1056/NEJM199510123331511
  31. Prysak M, Lorenz RP, Kisly A. Pregnancy outcome in nulliparous women 35years and older. Obstet Gynecol 1995; 85: 65 https://doi.org/10.1016/0029-7844(94)00330-G