Pregnancy complications among nulliparous and multiparous women with advanced maternal age: a community-based prospectiv
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RESEARCH ARTICLE
Open Access
Pregnancy complications among nulliparous and multiparous women with advanced maternal age: a communitybased prospective cohort study in China Jiayou Luo1,2†, Chunli Fan3†, Miyang Luo1,2* , Junqun Fang4, Shujin Zhou5 and Fenfang Zhang5
Abstract Background: This study aimed to evaluate the incidence rates and risks of pregnancy complications among nulliparous and multiparous women with advanced maternal age (AMA, ≥35 years) in China. Methods: We performed a community-based prospective cohort study of 10,171 pregnant women in selected two sub-districts and 11 towns of Liuyang from 2013 to 2015. All subjects were followed up from the first prenatal care (at ≤12 weeks) to delivery, and risks of pregnancy complications were compared by parity and maternal age groups. Results: Among nulliparas, women with AMA showed significantly increased risks for gestational hypertension (OR 8.44, 95%CI 1.68–2.88), preeclampsia/eclampsia (OR 9.92, 95%CI 4.87–18.78), premature rupture of membrane (OR 6.84, 95%CI 2.00–17.69), as compared to women in the 20–29-year age group. Among multiparas with AMA, increased risks were found for gestational diabetes mellitus (OR 3.29, 95%CI 1.76–5.94), anemia (OR 1.85, 95%CI 1.25–2.69), polyhydramnios (OR 3.29, 95%CI 1.56–6.64), premature rupture of membrane (OR 5.14, 95%CI 2.12–12.29), and preterm labor (OR 1.89, 95CI 1.42–2.50). Conclusions: Women with AMA were associated with increased risks of pregnancy complications, and complications with increased risks differed in nulliparas and multiparas. Women with AMA should be identified as a high-risk group in clinical practice. Keywords: Community-based prospective cohort, Advanced maternal age, Pregnancy complications, Incidence
Background Since the 1970s, the Chinese government has implemented the one-child policy to control the rapid growth of the population for around 40 years. With emerging problem of the aging population, the population policy has gradually switched to the two-child policy which encourages the birth * Correspondence: [email protected] † Jiayou Luo and Chunli Fan contributed equally to this work. 1 Department of Women and Children Health, School of Public Health, Central South University, Changsha, Hunan Province, China 2 Hunan Provincial Key Laboratory of Clinical Epidemiology, Changsha, Hunan Province, China Full list of author information is available at the end of the article
of a second child since 2011 and has been fully implemented since 2016 [1]. With the impact of this new population policy, China is expected to see a sharp increase in fertility rate, and the proportion of women with advanced maternal age (AMA) is estimated to increase significantly [2]. Women with AMA may have increased risk for complications during pregnancy due to decreased ovarian and uterine function, as well as other concomitant diseases, which may result in threats to maternal and child health [3]. Thus, the prevention and control of complications in women with AMA during pregnancy have become a major challenge in
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