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여성의 첫 출산 연령이 저체중출생아의 출생률에 미치는 영향

Effect of women's first childbearing age on the risk of low birth weight

  • 이정주 (중앙대학교 의과대학 소아과학교실)
  • 투고 : 2007.09.11
  • 심사 : 2007.10.22
  • 발행 : 2007.12.15

초록

목 적 : 사회경제적 환경의 변화로 첫 아이를 출산하는 어머니의 연령이 늦어지고 있다. 많은 연구자들이 첫 아이를 출산하는 어머니의 연령이 늦어지는 것과 저체중출생아의 출생율과의 관계에 대해 연구하였으나 아직 일치된 연구결과를 얻지 못하고 있다. 이에 따라 본 연구자들은 산모의 연령이 저체중출생아의 출생률에 미치는 영향을 알아보고자 본 연구를 시행하였다. 방 법 : 2001년부터 2003년까지 통계청의 인구동태자료 중 출생기록에 등록된 1,545,338명 중 단태아면서 첫 번째 아이인 736,167명을 대상으로 저체중출생아와 극소저체중출생아의 출생률에 대해 어머니의 나이, 직업, 학력, 결혼유무, 거주지, 결혼 기간, 아버지의 직업과의 관계를 다중 로지스틱 회귀분석을 이용하여 분석하였다. 결 과 : 산모의 연령에 따라 저체중출생아가 출생할 위험률은 30-34세, 35-40세, 40세 이상의 초산부는 25세에서 29세의 초산부에 비해 각각 1.3배, 2.1배, 2.4배 높게 나타났으며 어머니의 직업, 학력, 결혼유무, 거주지, 결혼 기간, 아버지의 직업 등을 감안하여도 1.3배, 1.9배, 2.0배로 모두 유의하게 높게 나타났다. 산모의 연령에 따라 극소체중출생아가 출생할 위험률은 30-34세, 40-44세, 45세 이상의 초산부는 25세에서 29세의 초산부에 비해 각각 1.8배, 3.3배, 3.7배 높게 나타났으며 어머니의 직업, 학력, 결혼유무, 거주지, 결혼 기간, 아버지의 직업 등을 보정하여도 1.6배, 2.7배, 2.6배로 모두 유의하게 높게 나타났다. 각각의 산모의 연령과 교육 정도, 결혼유무에 따른 저체중출생아의 출생률을 비교하였을 때 30대의 고등학교 졸업 이상이고 기혼인 산모에서 저체중출생아의 출생률(3.7%)은 20대의 고등학교 졸업이상이고 기혼인 산모보다 더 낮았다. 결 론 : 본 연구에서 산모가 나이가 많아질수록 저체중출생아와 극소저체중출생아가 출생할 위험률이 높으며 어머니의 직업, 학력, 결혼유무, 거주지, 결혼 기간, 아버지의 직업 등을 고려하여도 높다. 하지만 나이가 많은 산모라도 사회경제적 환경이 개선된 다면 저체중출생아의 출생률을 줄일 수 있고 사료된다.

Purpose : The aim of this study was to investigate the risk of low birth weight associated with delayed first childbearing in Korea. Methods : The national birth certificate data of the singletons and first babies in Korea from January 2001 to December 2003 (n=736,167) was used. Outcome measures were rates of low birth weight infant, very low birth weight infant between 6 maternal age group (<20 years, 20-24 years, 25-29 years, 30-34 years and >35years). Odd ratios were calculated by multiple logistic regression on marital state, maternal education, maternal occupation, paternal occupation, duration of marriage and address. Results : Compared with women aged 25 to 29 years, women aged 30-35 years, 35-40 years and over 40 years had higher odds ratios of low birth weight, odd ratios were 1.3, 2.1, 2.4 respectively. Even though adjusted by marital state, maternal education, maternal occupation, paternal occupation, duration of marriage and address, odds ratios were 1.3, 1.9, 2.0 respectively. Compared with women aged 25 to 29 years, women aged 30-35 years, 35-40 years and over 40 years had higher odds ratios of very low birth weight, odd ratios were 1.8, 3.3, 3.7 respectively. Even though adjusted, odd ratios were 1.6, 2.7, 2.6 respectively. Compared with the incidence of low birth weight in each maternal age, maternal education, marital state, married, high school graduated thirties women was lower incidence than unmarried, high school graduated twenties women. Conclusion : These findings suggest that delayed childbearing increase the risk of low birth weight and very low birth weight, but if pregnant women have better socioeconomic condition, the impact of advanced maternal age on the risk of low birth weight will be decreased.

키워드

참고문헌

  1. Korean National Statistical Office. Vital Statistics, Each year. Available from:URL:http://kosis.nso.go.kr/Magazine/ NEW/KP/KP01.xls
  2. Breart G. Delayed childbearing. Eur J Obstet Gynecol Reprod Biol 1997;75:71-3 https://doi.org/10.1016/S0301-2115(97)00190-5
  3. Jolly M, Sebire N, Harris J, Robinson S, Regan L. The risks associated with pregnancy in women aged 35 years or older. Hum Reprod 2000;15:11:2433-7 https://doi.org/10.1093/humrep/15.11.2433
  4. Tough SC, Newburn-Cook C, Johnston DW, Svenson LW, Rose S, Belik J. Delayed childbearing and its impact on population rate changes in lower birth weight, multiple birth, and preterm delivery. Pediatrics 2002;109:399-403 https://doi.org/10.1542/peds.109.3.399
  5. Jacobsson B, Ladfors L, Milsom I. Advanced maternal age and adverse perinatal outcome. Obstet Gynecol 2004;104:727- 33 https://doi.org/10.1097/01.AOG.0000140682.63746.be
  6. Yang Q, Greenland S, Flanders WD. Associations of maternal age-and parity-related factors with trends in low-birth weight rates: Unites States, 1980 through 2000. Am J Public Health 2006;96:856-61 https://doi.org/10.2105/AJPH.2004.049312
  7. Fretts RC, Schmittdiel J, Mclean F, Usher RH, Goldman MB. Increased maternal age and the risk of fetal death. New Engl J Med 1995;333:953-7 https://doi.org/10.1056/NEJM199510123331501
  8. Joseph KS, Allen AC, Dodds L, Turner LA, Scott H, Liston R. The perinatal effects of delayed childbearing. Obstet Gynecol 2005;105:1410-8 https://doi.org/10.1097/01.AOG.0000163256.83313.36
  9. Cleary-Goldman J, Malone FD, Vidaver J, Ball RH, Nyberg DA, Comstock CH et al. Impact of maternal age on obstetric outcome. Am J Obstet Gynecol 2005;105:983-90 https://doi.org/10.1097/01.AOG.0000158118.75532.51
  10. Forman MR, Meirik O, Berendes HW. Delayed childbearing in Sweden. JAMA 1984;252:3135-9 https://doi.org/10.1001/jama.252.22.3135
  11. Yuan W. Steffensen FH, Nielsen GL, Moller M, Olsen J, SOrensen HT. A population-based cohort study of birth and neonatal outcome in older primipara. Int J Gynaecol Obstet 2000;68:113-8 https://doi.org/10.1016/S0020-7292(99)00181-2
  12. Ziadeh SM. Maternal and perinatal outcome in nulliparous women aged 35 and older. Gynecol Obstet Invest 2002;54: 6-10 https://doi.org/10.1159/000064689
  13. Park JH, Lee JY, Park SJ. Effect of delayed first childbearing on low birth weight and pre-term birth. J Korean Soc Matern Child Health 2004;8:7-15
  14. Hook EB. Rates of chromosomal abnormalities at different maternal ages. Obstet Gynecol 1981;58:282-5
  15. Berkowitz GS, Skovron ML, Lapinski RH, Berkowitz RL. Delayed childbearing and the outcome of pregnancy. N Engl J Med 1990;322:10:659-6 https://doi.org/10.1056/NEJM199003083221004
  16. DikutJ, Padaiga, Grabauskas V, NadiauskienRJ, Basys V, GaiaisloenA. Maternal socio-economic factors and the risk of low birth weight in Lithuania. Medicina 2004;40:475-82
  17. Grimes DA, Gross GK. Pregnancy outcomes in black women aged 35 and older. Obstet Gynecol 1981;58:614-20
  18. Kirz DS, Dorchester W, Freeman RK. Advanced maternal age: the mature gravida. Am J Obstet Gynecol 1985;157:7-12
  19. Barkan SE, Bracken MD. Delayed childbearing: no evidence for increased risk of low birth weight and pre-term delivery. Am J Epidemiol 1987;125:101-9 https://doi.org/10.1093/oxfordjournals.aje.a114491
  20. Lee KS, Ferguson RM, Corpuz M, Gartner LM. Maternal age and incidence of low birth weight : a population study. Am J Obstet Gynecol 1988;158:1:84-9 https://doi.org/10.1016/0002-9378(88)90783-1
  21. Kramer MS. Determinant of low birth weight: methodological assessment and meta-analysis. Bull word Health Org 1987; 65:663-737
  22. Eisner V, Brazie JV, Pratt MW, Hexter AC. The risk of low birthweight. Am J Public Health 1979:69:887-93 https://doi.org/10.2105/AJPH.69.9.887
  23. Bianco A, Stone J, Lynch L, Lapinski R, Berkowitz G, Berkowitz RL. Pregnancy outcome at age 40 and older. Obstet Gynecol 1996;87:917-22 https://doi.org/10.1016/0029-7844(96)00045-2
  24. Katwijk CV, Peeters LLH. Clinical aspects of pregnancy after the age of 35 years; a review of the literature. Hum Reprod Update 1998;4:2:185-94 https://doi.org/10.1093/humupd/4.2.185
  25. Barton JR, Bergauer NK, Jacques ID, Coleman SK, Stanziano GJ, Sibai BM. Does advanced maternal age affect pregnancy outcome in women with mild hypertension remote from term? Am J Obstet Gynecol 1997;176:1236-40 https://doi.org/10.1016/S0002-9378(97)70340-5
  26. Salanave B, Bouvier-Colle MH. The likely increase maternal mortality rates in the United Kingdom and in France until 2005. Paediatr Perinat Epidemiol 1996;10:418-22 https://doi.org/10.1111/j.1365-3016.1996.tb00067.x
  27. Hansen JP. Older maternal age and pregnancy outcome: a review of the literature. Obstet Gynecol Surv 1986;41:726-42 https://doi.org/10.1097/00006254-198611000-00024
  28. Cnattingius S, Forman MR, Berendes HW, Isotalo L. Delayed childbearing and risk of adverse perinatal outcome: a population- based study. JAMA 1992;268:886-90 https://doi.org/10.1001/jama.268.7.886
  29. Gilbert WM, Mesbitt TS, Danielsen B. Childbearing beyond age 40:pregnancy outcome in 24,032 cases. Obstet Gynecol 1999;93:9-14 https://doi.org/10.1016/S0029-7844(98)00382-2
  30. Dildy GA, Jackson GM, Fowers GK, Oshiro BT, Varner MW, Clark SL. Very advanced maternal age: pregnancy after age 45. Am J Obstet Gynecol 1996;175:668-74 https://doi.org/10.1053/ob.1996.v175.a74402
  31. Dulitzki M, Soriano D, Schiff E, Chetrit A, Mashiach S, Seidman DS. Effect of very advanced maternal age on pregnancy outcome and rate of cesarean delivery. Obstet Gynecol 1998;92:935-9 https://doi.org/10.1016/S0029-7844(98)00335-4
  32. Choi SR, Kim GJ, Lee SP, Kim SY, Yoon SJ, Lee ED. A clinical study of pregnancy and delivery in women aged 40 years and older. Korean J Obstet Gynecol 2003;46:3:612-6
  33. Jang EC, Shon ES, Lim HT, Kim KJ, Lee HH, Choi HJ. A clinical study in pregnancy women over the age of 35. Korean J Obstet Gynecol 2002;45:5:816-23
  34. Gisselmann MD. Education, infant mortality, and low birth weight in Sweden 1973-1990: Emergence of the low birth weight paradox. Scand J Public Health 2005;33:65-71 https://doi.org/10.1080/14034940410028352
  35. Chia SE, Lee KS, Chen OY. Low birth weight in relation to parental occupations-a population-based registry in Singapore( 1994-1998). Neurotoxicol Teratol 2004;26:285-90 https://doi.org/10.1016/j.ntt.2003.10.009
  36. Lee JJ, Park CG, Lee KS. Birth weight distribution by gestational age in korean population: using finite mixture model. Korean J Pediatr 2005;48:1179-86
  37. David RJ. Population-based intrauterine growth curves from computerized birth certificates. South Med J 1983;76:1401-6 https://doi.org/10.1097/00007611-198311000-00020
  38. Platt RW, Abrahamowicz M, Kramer MS, Joseph KS, Mery L, Blondel B, et al. Detecting and eliminating erroneous gestational ages: a normal mixture model. Statist Med 2001; 20:3491-503 https://doi.org/10.1002/sim.1095

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  5. 산모 연령과 영아 사망과의 관련성 연구 vol.14, pp.9, 2007, https://doi.org/10.14400/jdc.2016.14.9.379