- 作者：Mary Carolan ; PhD Mary.carolan@vu.edu.au (Associate Professor Midwifery)
- 关键词：Very advanced maternal age ; Hypertension ; Preterm birth ; Low birth weight
- 刊名：Midwifery
- 出版年：2013
- 出版时间：May, 2013
- 年：2013
- 卷：29
- 期：5
- 页码：479-489
- 全文大小：268 K
Objective
to examine the evidence in relation to very advanced maternal age (¡Ý45 years) and maternal and perinatal outcomes in high-income countries.Background
this review was conducted against a background of increasing fertility options for women aged ¡Ý=45 years and rising birth rates among this group of women.
Methods
established health databases including SCOPUS, MEDLINE, CINAHL, EMBASE and Maternity and Infant Care were searched for journal papers, published 2001-2011, that examined very advanced maternal age (VAMA) and maternal and perinatal outcomes. Further searches were based on references found in located articles. Keywords included a search term for maternal age ¡Ý45 years (very advanced maternal age, pregnancy aged 45 years and older) and a search term for maternal complications (caesarian section, hypertension, pre-eclampsia, gestational diabetes) and/or adverse perinatal outcome (preterm birth, low birth weight, small for gestational age, stillbirth, perinatal death). Of 164 retrieved publications, 10 met inclusion criteria.
Data extraction
data were extracted and organised under the following headings: maternal age ¡Ý45 years; maternal characteristics such as parity and use of artificial reproductive technology (ART); and pre-existing maternal conditions, such as diabetes and hypertension. Additional headings included: gestational conditions, such as pre-eclampsia and gestational diabetes (GDM); and perinatal outcomes, including fetal/infant demise; gestational age and weight. Study quality was assessed by using the Critical Appraisal Skills Programme (CASP) guidelines.
Findings
this review produced three main findings: (1) increased rates of stillbirth, perinatal death, preterm birth and low birth weight among women ¡Ý45 years; (2) increased rates of pre-existing hypertension and pregnancy complications such as GDM, gestational hypertension (GH), pre-eclampsia and interventions such as caesarian section; and (3) a trend of favourable outcomes, even at extremely advanced maternal age (50-65 years), for healthy women who had been screened to exclude pre-existing disease.
Key conclusions
although there is strong evidence of an association between very advanced maternal age and adverse maternal and perinatal outcomes, the absolute rate of stillbirth/perinatal death remains low, at less than 10 per 1000 births in most high-income countries. Therefore, although women in this age group encounter greater pregnancy risk, most will achieve a successful pregnancy outcome. Best outcomes appear to be linked to pre-existing maternal health, and pregnancy care at tertiary centres may also contribute. This information should be used to counsel women aged ¡Ý45 years who are contemplating pregnancy.