Effect of Parity and Advanced Maternal Age on Obstetric Outcome
Notice bibliographique
Résumé
Increasing numbers of women are becoming pregnant later in life, and there is concern over the potential risk of such pregnancies to the health of both the mother and the fetus. Whether or not advanced maternal age is associated with various obstetric complications is controversial, and the effect of parity on risk is unclear. This retrospective cohort study examined the role of parity on obstetric outcomes in pregnant women aged 40 years or older. The authors obtained data from the databases of two university hospitals and evaluated various known obstetric risk factors in a cohort of 16,427 singleton pregnancies delivered between January 1998 and December 2001. Of the 15,727 pregnancies (95.7%) that satisfied the inclusion criteria, 606 (3.9%) were in women aged 40 years or older. Nulliparous women age 40 or more were more likely than younger nuliparas to have a body mass index (BMI) >25 (28.5% versus 21.3%; P < .014), pregestational diabetes mellitus (1.0% versus 0.1%; P < .003), and chronic hypertension (2.0% versus 0.3%; P < .001), as well as gestational diabetes, preeclampsia, antepartum and postpartum hemorrhage, cesarean birth, delivery before 37 weeks, and spontaneous preterm delivery before 37 weeks. However, nulliparous women in both age groups had the same incidence of preterm birth, labor before 32 weeks of pregnancy, perinatal mortality rate, incidence of small for gestational age neonates, and low Apgar scores. Older multiparas were more likely than younger multiparas to have antepartum and postpartum hemorrhage and delivery before 37 weeks. Birth weights were similar between the two groups but older multiparas were more likely to have an infant with an Apgar score less that 7 at 1 minute. Multiple logistic regression analysis for variables such as smoking status, high BMI, antepartum hemorrhage, hypertension, and preexisting and gestational diabetes, showed that, in nulliparous women advanced age was associated only with cesarean delivery (49.0% versus 20.8%, P < .001), preterm birth before 37 weeks (16.0% versus 7.0%, P < .001), spontaneous preterm labor before 37 weeks (5.5% versus 1.0%, P < .001), and low birth weight (15.5% versus 7.1%, P < .001). In multiparous women, advanced age was associated with cesarean delivery (27.3% versus 15.7%, P < .001) and preterm birth before 37 weeks (9.6% versus 6.7%, P < .024). These findings indicate that several important obstetric outcome parameters are influenced by parity in women aged 40 years or older. Advanced age is associated with adverse obstetric outcomes primarily in nulliparas, although both nulliparous and multiparous older women are at increased risk of preterm birth.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,010 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».