背景:在≥35岁的女性中,胎儿丢失的风险高于年轻女性。本研究旨在探讨高龄产妇(AMA)胎儿丢失的原因及影响因素。
方法:2018年12月至2020年6月在福建省妇幼保健院产科进行首次产前检查的单胎(<14孕周)AMA女性纳入本队列研究。那些在14孕周之前终止妊娠的人被排除在外。进行了基线调查,并进行随访直至终止妊娠。提取临床资料,分析其中胎儿丢失的原因。在嵌套病例对照研究中,AMA胎儿丢失妇女作为病例组,同期无胎儿丢失的妇女作为对照组,以1:2的比例与年龄和孕周相匹配。采用Logistic回归模型分析胎儿丢失的影响因素。
结果:共纳入239例胎儿丢失妇女和478例对照。胎儿丢失的原因最常见的是胎儿因素,其次是母亲因素,脐带因素,和胎盘因素。多因素logistic回归分析显示初中及以下文化程度(调整比值比(aOR)=5.13,95%置信区间(CI):2.19-12.02),高中教育(AOR=4.91,95%CI:2.09-11.54),居住在农村地区(aOR=2.85,95%CI:1.92-4.25),失业率(AOR=1.81,95%CI:1.20-2.71),自然流产史(aOR=1.88,95%CI:1.26-2.80),早产史(aOR=11.08,95%CI:2.90-42.26),妊娠期高血压疾病(aOR=7.20,95%CI:2.24-23.12),胎膜早破(aOR=4.12,95%CI:1.53~11.11)是胎儿丢失的危险因素。
结论:教育水平低,失业,异常妊娠/分娩史,妊娠并发症与AMA中胎儿丢失的发生率相关。因此,早期识别和有针对性的干预,应该进行。
BACKGROUND: The risk of fetal loss is higher among ≥35-year-olds than younger women. The present
study aimed to explore the causes and factors influencing fetal loss in advanced maternal age (AMA).
METHODS: AMA women with singleton fetuses (< 14 gestational weeks) who underwent their first prenatal examination in the Obstetrics Department of Fujian Maternity and Child Health Hospital from December 2018 to June 2020 were included in this cohort
study. Those who terminated the pregnancy before 14 gestational weeks were excluded. A baseline survey was conducted, and follow-up was carried out until the termination of the pregnancy. Clinical data were extracted to analyse the causes of fetal loss among them. In the nested case-control
study, the AMA women with fetal loss were enrolled as the case group, and women without fetal loss in the same period were enrolled as the control group, in a 1:2 ratio matched by age and gestational weeks. Logistic regression models were used to analyse the factors influencing fetal loss.
RESULTS: A total of 239 women with fetal loss and 478 controls were enrolled. The causes of fetal loss were most often fetal factors, followed by maternal factors, umbilical cord factors, and placental factors. Multivariate logistic regression analysis indicated that junior high school education and below (adjusted odds ratio (aOR) = 5.13, 95% confidence interval (CI): 2.19-12.02), senior high school education (aOR = 4.91, 95% CI: 2.09-11.54), residence in a rural area (aOR = 2.85, 95% CI: 1.92-4.25), unemployment (aOR = 1.81, 95% CI: 1.20-2.71), spontaneous abortion history (aOR = 1.88, 95% CI: 1.26-2.80), preterm birth history (aOR = 11.08, 95% CI: 2.90-42.26), hypertensive disorders of pregnancy (aOR = 7.20, 95% CI: 2.24-23.12), and preterm premature rupture of membranes (aOR = 4.12, 95% CI: 1.53-11.11) were risk factors for fetal loss.
CONCLUSIONS: Low educational level, unemployment, abnormal pregnancy/labor history, and pregnancy complications were correlated with the incidence of fetal loss in AMA. Thus, early identification as well as a targeted intervention, should be conducted.