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Advisor(s)
Abstract(s)
Introdução: Ao longo dos últimos anos tem-se assistido não só a um aumento da idade média da mãe ao nascimento do primeiro filho, como também a um aumento da taxa de fecundidade em mulheres acima dos 35 anos. As alterações fisiológicas associadas à idade mais avançada acarretam riscos para a mãe e para o filho, sendo muitas vezes subvalorizadas na prática clínica.
Objetivos: Analisar variáveis sociodemográficas, variáveis clínicas (relativas à vigilância pré-natal, parto e puerpério) e complicações materno-infantis, em mães com idade igual ou superior a 38 anos. Posteriormente, comparar os resultados encontrados com um grupo controlo composto por mães dos 15 aos 37 anos.
Métodos: Trata-se de um estudo retrospetivo, analítico e observacional. Foram recolhidos dados dos processos médicos das grávidas e respetivos recém-nascidos cujo parto ocorreu entre 2013 e 2015 no Centro Hospitalar Cova da Beira.
Resultados: A amostragem final foi constituída por 184 mulheres com idades entre os 35 e 48 no grupo de estudo e 364 mulheres no grupo controlo. Verificou-se que, apesar da idade, uma percentagem considerável de mulheres no grupo de estudo foi mãe pela primeira vez (42,78%). No que diz respeito à vigilância da gravidez não foram encontradas diferenças significativas. Relativamente à Diabetes Gestacional, apesar da diferença entre os grupos não ser estatisticamente significativa (X2=2,924; p=0,087), já pode ser considerada sugestiva, uma vez que o p value é bastante próximo de 0.05. Foi possível concluir que a distribuição é idêntica entre os dois grupos (X2=0,318, p=0,853), face ao termo da gravidez. No grupo de estudo houve uma maior percentagem de partos por cesariana (31,1%) relativamente ao grupo controlo (23%), sendo que estas diferenças têm significado estatístico (X2=6,88, p=0,03). Não foram encontradas diferenças significativas no valor do APGAR tanto ao 1º (t=-0,048; p=0,962) como ao 5º minuto (t=-0,312; p=0,755) entre os dois grupos.
Conclusão: A idade média da mãe ao nascimento do primeiro filho tem vindo a aumentar nos últimos anos em Portugal. Esta realidade nacional também se faz sentir no Centro Hospitalar Cova da Beira, que apresenta uma quantidade significativa de primíparas de idade acima dos 35. Verificou-se ainda que as grávidas mais velhas apresentam potencialmente maior risco de vir a desenvolver Diabetes Gestacional, assim como de ter um parto distócico por cesariana. Esta mudança no paradigma da realidade clínica deve acarretar consigo uma nova preocupação ao acompanhar as grávidas com idades mais avançadas. A desvalorização dos riscos associados à idade pode ter efeitos deletérios na saúde da mãe e do recém-nascido, razão pela qual se deve apostar na prevenção e seguimentos apropriados. Apenas assim se pode garantir uma evolução e acompanhamento adequados para cada caso.
Introduction: In the last few years, the mean age of women at first childbirth has been steadily rising alongside with fertility rates among women aged 35 and older. The physiological changes associated with older age entail greater risks to both mother and newborn, most of which are commonly underestimated in clinical practice. Objectives: To study sociodemographic variables and clinical variables related to pregnancy, delivery and puerperal surveillance, as well as maternal-infant complications, in women with older maternal age (38 and over). The results are compared to those of a control group composed by mothers with ages between 15 and 37. Methods: This is an observational, analytical and retrospective study. Data was obtained from the files of pregnant women and newborns whose delivery occurred between 2013 and 2015 at Centro Hospitalar Cova da Beira. Results: The sample is composed of 184 women of ages between 35 and 48 years old as the study group and 364 control group women. It was found that, despite their age, a considerable number of women in the study group were primiparous (42,78%). No significant differences were found between both groups concerning pregnancy follow up. Concerning gestational diabetes, despite the fact that the results were not statistically significant (X2=2,924; p=0,087), they can be considered highly suggestive, since the p value is approximately 0.05. Regarding term pregnancy, the distribuition was identical in both group (X2=0,318, p=0,853). There seems to be a higher prevalence of caesarean delivery in older women (31,1%) when compared to the control group (23%) with these values having statistical significance (X2=6,88, p=0,03). No meaningful differences were found concerning the APGAR score in both the first (t=-0,048; p=0,962) and fifth minute (t=-0,312; p=0,755) between both groups. Conclusion: Women’s mean age at first childbirth has been rising in Portugal over the past few years. This phenomenon can also be seen at Centro Hospitalar Cova da Beira, where there is a significant amount of primiparous women aged 35 and over. It was found that elder pregnant women have a higher risk of developing Gestational Diabetes, as well as ending up with caesarean delivery. This paradigm shift in clinical practice should entail a newfound concern in pregnancy follow-up of elder women. Overlooking the risks associated with older age can have deleterious effects on the health of both mother and child, which is why appropriate prevention and monitoring must be encouraged. This is in order to ensure adequate follow-up for every case.
Introduction: In the last few years, the mean age of women at first childbirth has been steadily rising alongside with fertility rates among women aged 35 and older. The physiological changes associated with older age entail greater risks to both mother and newborn, most of which are commonly underestimated in clinical practice. Objectives: To study sociodemographic variables and clinical variables related to pregnancy, delivery and puerperal surveillance, as well as maternal-infant complications, in women with older maternal age (38 and over). The results are compared to those of a control group composed by mothers with ages between 15 and 37. Methods: This is an observational, analytical and retrospective study. Data was obtained from the files of pregnant women and newborns whose delivery occurred between 2013 and 2015 at Centro Hospitalar Cova da Beira. Results: The sample is composed of 184 women of ages between 35 and 48 years old as the study group and 364 control group women. It was found that, despite their age, a considerable number of women in the study group were primiparous (42,78%). No significant differences were found between both groups concerning pregnancy follow up. Concerning gestational diabetes, despite the fact that the results were not statistically significant (X2=2,924; p=0,087), they can be considered highly suggestive, since the p value is approximately 0.05. Regarding term pregnancy, the distribuition was identical in both group (X2=0,318, p=0,853). There seems to be a higher prevalence of caesarean delivery in older women (31,1%) when compared to the control group (23%) with these values having statistical significance (X2=6,88, p=0,03). No meaningful differences were found concerning the APGAR score in both the first (t=-0,048; p=0,962) and fifth minute (t=-0,312; p=0,755) between both groups. Conclusion: Women’s mean age at first childbirth has been rising in Portugal over the past few years. This phenomenon can also be seen at Centro Hospitalar Cova da Beira, where there is a significant amount of primiparous women aged 35 and over. It was found that elder pregnant women have a higher risk of developing Gestational Diabetes, as well as ending up with caesarean delivery. This paradigm shift in clinical practice should entail a newfound concern in pregnancy follow-up of elder women. Overlooking the risks associated with older age can have deleterious effects on the health of both mother and child, which is why appropriate prevention and monitoring must be encouraged. This is in order to ensure adequate follow-up for every case.
Description
Keywords
Complicações Materno-Fetais Efeitos Maternos Adversos Gravidez Idade Materna Avançada