青少年(<20岁)和高龄产妇(>35岁)妊娠具有不良风险,需要在不良妊娠结局负担最高的中低收入国家进行严格审查。
■描述患病率和不良妊娠(孕产妇,围产期,和新生儿)与六个国家的极端孕产妇年龄相关的结局。
■我们对从刚果民主共和国进行的基于人群的队列研究中前瞻性收集的数据进行了历史队列分析。危地马拉,印度,肯尼亚,巴基斯坦,赞比亚在2010年至2020年之间。我们包括孕妇及其新生儿。我们描述了这些孕妇年龄组(<20、20-24、25-29、30-35和>35岁)中与妊娠相关的患病率和不良妊娠结局。通过拟合Poisson模型调整位点,获得每个孕妇年龄组与20-24岁参照组的相对风险和95%置信区间。产妇年龄,奇偶校验,多个妊娠,母亲教育,产前保健,和交货地点。还进行了按区域的分析。
■我们分析了602,884例分娩;13%(78,584)为青少年,5%(28,677)为高龄(AMA)。总体孕产妇死亡率(MMR)为每100,000例活产中147例死亡,并且随着孕产妇年龄的增长而增加:青少年为83例,AMA组中为298例。AMA组在所有地区的MMR最高。青少年妊娠与围产期死亡率1.07(1.02-1.11)和新生儿死亡率1.13(1.06-1.19)的校正相对风险(aRR)相关。相比之下,AMA与产妇死亡率的aRR为2.55(1.81至3.59)相关,围产期死亡率为1.58(1.49-1.67),新生儿死亡率为1.30(1.20-1.41),与20-24岁女性怀孕相比。这种模式在所有地区总体相似,即使在<18岁和18-19岁年龄组。
■评估的LMICs中的孕产妇死亡率很高,并且随着孕产妇年龄组的增加而增加。虽然不那么普遍,AMA与较高的不良孕产妇死亡率风险相关,就像青春期,与不良围产期死亡率相关,区域差异很小。
UNASSIGNED: Adolescent (<20 years) and advanced maternal age (>35 years) pregnancies carry adverse risks and warrant a critical review in low- and middle-income countries where the burden of adverse pregnancy outcomes is highest.
UNASSIGNED: To describe the prevalence and adverse pregnancy (maternal, perinatal, and neonatal) outcomes associated with extremes of maternal age across six countries.
UNASSIGNED: We performed a historical cohort analysis on prospectively collected data from a population-based cohort study conducted in the Democratic Republic of Congo, Guatemala, India, Kenya, Pakistan, and Zambia between 2010 and 2020. We included pregnant women and their neonates. We describe the prevalence and adverse pregnancy outcomes associated with pregnancies in these maternal age groups (<20, 20-24, 25-29, 30-35, and >35 years). Relative risks and 95% confidence intervals of each adverse pregnancy outcome comparing each maternal age group to the reference group of 20-24 years were obtained by fitting a Poisson model adjusting for site, maternal age, parity, multiple gestations, maternal education, antenatal care, and delivery location. Analysis by region was also performed.
UNASSIGNED: We analyzed 602,884 deliveries; 13% (78,584) were adolescents, and 5% (28,677) were advanced maternal age (AMA). The overall maternal mortality ratio (MMR) was 147 deaths per 100,000 live births and increased with advancing maternal age: 83 in the adolescent and 298 in the AMA group. The AMA groups had the highest MMR in all regions. Adolescent pregnancy was associated with an adjusted relative risk (aRR) of 1.07 (1.02-1.11) for perinatal mortality and 1.13 (1.06-1.19) for neonatal mortality. In contrast, AMA was associated with an aRR of 2.55 (1.81 to 3.59) for maternal mortality, 1.58 (1.49-1.67) for perinatal mortality, and 1.30 (1.20-1.41) for neonatal mortality, compared to pregnancy in women 20-24 years. This pattern was overall similar in all regions, even in the <18 and 18-19 age groups.
UNASSIGNED: The maternal mortality ratio in the LMICs assessed is high and increased with advancing maternal age groups. While less prevalent, AMA was associated with a higher risk of adverse maternal mortality and, like adolescence, was associated with adverse perinatal mortality with little regional variation.