Прегравидарная подготовка, антенатальное наблюдение и профилактика акушерских осложнений у женщин старшего репродуктивного возраста: обзор литературы

Цель: систематизировать современные данные о сохранении репродуктивного здоровья у женщин старшего репродуктивного возраста и представить клинически применимые подходы к преконцепционной подготовке, антенатальному наблюдению и послеродовому ведению.
Материалы и методы. Выполнен нарративный обзор публикаций, индексируемых в PubMed/MEDLINE, eLibrary.ru, КиберЛенинка и Google Scholar, за период с января 2014 г. по март 2026 г. Рассматривались систематические обзоры, метаанализы, клинические рекомендации, консенсусные документы профессиональных сообществ и оригинальные исследования, посвященные возраст-ассоциированным репродуктивным и акушерским рискам.
Результаты. Старший репродуктивный возраст ассоциирован с повышением риска преэклампсии, гестационного сахарного диабета, преждевременных родов, хромосомных аномалий плода и ряда перинатальных осложнений. Однако календарный возраст не должен рассматриваться как единственный критерий интенсификации наблюдения. Наиболее клинически значимыми компонентами ведения являются преконцепционная оценка репродуктивного и соматического статуса, коррекция модифицируемых факторов риска, медико-генетическое консультирование, выбор стратегии скрининга анеуплоидий
нутритивная поддержка, ранняя оценка риска преэклампсии, диагностика гестационного сахарного диабета и индивидуализированное планирование срока родоразрешения.
Заключение. Для женщин 35 лет и старше клинически оправдана риск-ориентированная модель ведения, в которой объем обследования и профилактических вмешательств определяется не только возрастом, но и овариальным резервом, соматической коморбидностью, акушерским анамнезом и результатами раннего антенатального скрининга

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