Analysis On The Safety Of Elderly Pregnant Women Under The New Birth Policy

Objective:To investigate the safety of Advanced maternal age(AMA)under the new birth policy by comparing pregnancy complications and outcomes in different age groups.Methods:The subjects of the study will be singleton pregnant women who have received regular antenatal care and who will be working at the Hefei Maternal and Child Health Hospital from January 2020 to December 2021.A total of 1024 cases were included in the study,including 545 cases in the age-appropriate group,313 cases in the 35-39 age group(AMA)and 166 cases in the 40+ age group(Very advanced maternal age,VAMA).Outcomes included general clinical data,pregnancy complications,perinatal outcomes,postpartum haemorrhage(PPH)and mode of delivery.The χ2 test was used to compare three groups.Comparison between groups was performed when P<0.05;binary logistic regression analysis was performed for univariate analysis of pregnancy complications,perinatal outcomes,PPH and mode of delivery when P<0.05.Confounding factors were controlled to analyse the influence of age on pregnancy complications,perinatal outcomes,PPH and mode of delivery.Results:1.The age-appropriate group and the AMA group:(1)univariate analysis: No statistically significant variations in gestational diabetes mellitus(GDM),gestational hypertension(GH),preeclampsia(PE),intrahepatic cholestasis of pregnancy(ICP),abnormal amniotic fluid volume,placental implantation,placental abruption(PA),premature rupture of membranes(PROM),spontaneous abortion,preterm delivery,macrocephaly,fetal malformation and PPH incidence were observed between the age-appropriate group and the AMA group.Statistically significant variations in placenta previa(PP),fetal distress and caesarean section(CS)incidence were observed between the age-appropriate group and the AMA group.The incidence of PP was lower in the age-appropriate group than in the AMA group.The incidence of fetal distress was higher in the age-appropriate group than in the AMA group.The incidence of CS was lower in the age-appropriate group than in the AMA group.(2)Binary Logistic regression analysis: There was no significant difference in the risk of GDM,PE,spontaneous abortion,fetal distress and fetal malformation between the age-appropriate group and the AMA group.The risk of PP in pregnant women aged 35-39 years was 7,500 times higher than in those aged 20-34 years,and the difference was statistically significant.The risk of CS in pregnant women aged 35-39 years was 1.890 times higher than in those aged 20-34 years,and the difference was statistically significant.2.The age-appropriate group and the VAMA group:(1)univariate analysis:There was no statistically significant difference in rates of GH,ICP,anomalies in amnion size,PP,placental implantation,PA,PROM,premature birth,macrocephaly,PPH,fetal distress,CS in age-matched group compared with VAMA group.GDM occurred less frequently in age-matched group than in VAMA group,and this difference was statistically significant.The rate of PE was lower in the age-matched group than in the VAMA group,and the difference between the two groups was statistically significant.Spontaneous miscarriage rates were lower in age-appropriate group than in VAMA group and difference was statistically significant.The incidence of fetal malformations was lower in the age-appropriate group than in the AMA group,and the difference was statistically significant.(2)Binary Logistic regression analysis: There was no significant difference in the risk of PP between the age-appropriate group and the VAMA group.The risk values for GDM,PE,spontaneous abortion,fetal distress,fetal malformation and caesarean section in women aged 40 years and over were2.332 times,8.808 times,15.655 times,2.740 times,9.340 times and 3.275 times those in women aged 20-34 years,respectively,and the differences were statistically significant.Conclusions:Pregnant women aged 35-39 years are susceptible to PP and CS,and the risk of PP is particularly higher than in pregnant women aged 40 years and over.In addition to CS,pregnant women aged 40 and over are also prone to GDM,PE,spontaneous abortion,fetal distress,fetal malformation and CS.