Analysis Of Pregnancy Complications And Adverse Pregnancy Outcomes Of Women With Advanced Maternal Age

Objective:Maternal age is closely related to the occurrence of pregnancy complications and adverse pregnancy outcomes.In the study,we analyzed the incidence rates of pregnancy complications and adverse pregnancy outcomes in women with advanced maternal age after the implementation of the "universal two-child" policy,and explored the risks of pregnancy complications and adverse pregnancy outcomes in women in different parity and age groups,and aim to provide reference for the management of women with advanced maternal age.Methods:The clinical data of pregnant women aged 30 years and above who gave birth to a single child in Jiangsu Subei People’s Hospital from 2016.01.01 to 2020.12.31 were collected.According to the inclusion and exclusion criteria,5218 subjects were selected for retrospective analysis.The patients were divided into non-advanced maternal age(30-34 years)group,advanced maternal age(35-39 years)group and very advanced maternal age(≥40 years)group of primiparas and multiparas according to parity and age,and SPSS 26.0 software was used to analyze the collected clinical data.To analyze the differences of the socio-demographic data and pre-pregnancy characteristics of the research objects,and the incidence rates of pregnancy complications and adverse pregnancy outcomes of women in different age and parity groups.The risks of pregnancy complications and adverse pregnancy outcomes were analyzed after adjusting for confounding factors.Results:1.From 2016 to 2020,a total of 17610 women who gave birth in Jiangsu Subei People’s Hospital,and a total of 5218 women who met the inclusion and exclusion criteria were included in this study,and among them 1374 cases(26.33%)were non-advanced maternal age nulliparas,230 cases(4.41%)were advanced maternal age nulliparas,36 cases(0.69%)were very advanced maternal age nulliparas,2262 cases(43.35%)were non-advanced maternal age multiparas,1084 cases(20.77%)were advanced maternal age multiparas and 232 cases(4.45%)were very advanced maternal age multiparas.The average age in this study was 33.30 ± 3.17 years,and the maximum age was 55 years old.1582 women aged 35 years and above account for 8.98% of the total and including 266 nulliparous women and 1316 multiparous women.Over the five-year period,the number of women aged 35 years and above peaked in 2017 although the number declined subsequently,the overall trend was upward.In terms of the way of pregnancy,the proportion of women with advanced maternal age and very advanced maternal age who are pregnant with assisted reproductive technology is higher than that of women with non-advanced maternal age,and the differences were statistically significant(P < 0.05).The previous delivery mode was cesarean section in most multipara women(67.22%)(P < 0.05).2.Women were Grouped by parity,and the results showed that the incidence of pregnancy complications in nulliparous and multiparas aged ≥35 years old was 1.39%-33.57%.And the top three pregnancy complications observed were gestational diabetes mellitus(33.57%),premature rupture of membranes(12.83%)and gestational hypertension(9.61%).The incidence of gestational hypertension,anemia,placental abruption,premature rupture of membranes,oligohydramnios and cesarean section in multiparas aged ≥35 years old was lower than that in primiparas aged ≥35 years old,and the differences were statistically significant(P < 0.05).3.To analyze the occurrence of pregnancy complications in different age groups of nulliparas and multiparas,the results showed that among nulliparas,the incidence of gestational hypertension,eclampsia/preeclampsia,gestational diabetes mellitus,anemia,placenta previa and placental abruption in nulliparas with advanced maternal age and very advanced maternal age were higher than that in non-advanced maternal age nulliparas and the differences were statistically significant(P < 0.05).The incidence of gestational hypertension,eclampsia/preeclampsia,gestational diabetes mellitus,placenta previa,placenta accreta and oligohydramnios in advanced maternal age and very advanced maternal age multiparas were higher than that in non-advanced maternal age multiparas(P < 0.05).4.Women were grouped by parity,and the differences in the incidence of adverse pregnancy outcomes between nulliparas and multiparas aged ≥35 years were analyzed.The results showed that the incidence of adverse pregnancy outcomes in women aged ≥35 years was 0.32%-20.67%,and the top three adverse pregnancy outcomes observed were newborns transferred to neonatal department(20.67%),premature birth(9.36%)and postpartum hemorrhage(6.76%).In women aged ≥35 years,the incidence of postpartum hemorrhage in multiparas was higher than that in primiparas,while the incidence of perinatal death in multiparas was lower than that in primiparas,and the differences were statistically significant(P < 0.05).5.To analyze the incidence of adverse pregnancy outcomes in different age groups among nulliparas and multiparas.The results showed that in nulliparas and multiparas,the incidence rates of preterm birth,newborns transferred to neonatal department and neonatal asphyxia in women with advanced maternal age and very advanced maternal age were higher than that in women with non-advanced maternal age,the differences were statistically significant(P < 0.05).Among nulliparas,the incidence rate of perinatal death in nulliparas with advanced maternal age and very advanced maternal age was higher than that in nulliparas with non-advanced maternal age,the differences were statistically significant.Among multiparas,the incidence rates of postpartum hemorrhage in advanced maternal age and very advanced maternal age multiparas were higher than that in nonadvanced multiparas,and the differences were statistically significant(P < 0.05).6.We selected possible confounding factors according to the basic situation of women aged ≥35 years.After adjusting for confounding factors,the differences in the risks of pregnancy complications and adverse pregnancy outcomes between primiparas and multiparas aged ≥35 years were analyzed.The risk of placental abruption,premature rupture of membranes,oligohydramnios and cesarean delivery in multiparas was lower than that in primiparas,while the risk of postpartum hemorrhage in multiparas was far higher than that in primiparas,the differences were statistically significant(P < 0.05).7.After selected and corrected the confounding factors,we analyzed the difference of the risks of pregnancy complications in different age groups of nulliparas and multiparas.The results showed that the risk of gestational hypertension,eclampsia/preeclampsia,gestational diabetes mellitus,placenta previa,placental abruption and cesarean section in nulliparas of advanced maternal age and very advanced maternal age were higher than those in nulliparas of non-advanced maternal age,and the risk of anemia in primiparas of very advanced maternal age was higher than that in nulliparas of non-advanced maternal age,the differences were statistically significant(P < 0.05).The risk of gestational hypertension,eclampsia/pre-eclampsia,gestational diabetes mellitus,placenta previa,placenta accreta and cesarean section in multipara women of advanced maternal age and very advanced maternal age were higher than those in multipara women of non-advanced maternal age,and the risk of oligohydramnios in multipara women of very advanced maternal age was higher than that in multipara women of non-advanced maternal age,and the differences were statistically significant(P < 0.05).8.After adjusting the potential confounding factors,we analyzed the difference of the risks of adverse pregnancy outcomes in different age groups of nulliparas and multiparas.And the results showed that the risks of preterm birth and perinatal death in advanced maternal age and very advanced maternal age nulliparas were higher than those in nonadvanced nulliparas.The risks of newborns transferred to neonatal department and neonatal asphyxia in very advanced maternal age nulliparas were higher than those in non-advanced nulliparas,and the differences were statistically significant(P < 0.05).Among multiparas,the risk of postpartum hemorrhage,newborns transferred to neonatal department and neonatal asphyxia in multiparas with advanced maternal age and very advanced maternal age was higher than that in multiparas with non-advanced maternal age,and the risk of preterm birth in multiparas with advanced maternal age was higher than that in multiparas with non-advanced maternal age and the differences were statistically significant(P < 0.05).Conclusion:1.From 2016 to 2020,the number of women with advanced maternal age and very advanced maternal age showed an increasing trend.2.Among women aged ≥35 years,nulliparas had higher risk of pregnancy complications than multiparas.In primiparas and multiparas,the risk of pregnancy complications in women with advanced maternal age and very advanced maternal age was higher than that in women with non-advanced maternal age.3.Among nulliparas and multiparas,the risks of adverse pregnancy outcomes in women with advanced maternal age and very advanced maternal age were higher than that in women with non-advanced maternal age,and the risk increased with maternal age.4.Age ≥35 years is an independent risk factor for multiple pregnancy complications and adverse pregnancy outcomes in both nulliparas and multiparas.Strengthening the perinatal management of women with advanced maternal age and assessing the risk of pregnancy according to parity and age can help to reduce the occurrence of pregnancy complications and adverse pregnancy outcomes.