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Tambvekar SE, Adki S, Sheriar NK. Pregnancies in Elderly Mothers over 40 years: What to Expect from the Rising New Age High-Risk Cohort? J Obstet Gynaecol India 2023; 73:358-362. [PMID: 37701086 PMCID: PMC10492723 DOI: 10.1007/s13224-022-01701-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 08/04/2022] [Indexed: 03/29/2023] Open
Abstract
Introduction Elderly women are believed to experience many risks associated with pregnancy. Literature fails to provide a clear consensus on the age group in which there is a rise in risk and pathophysiology contributing. 'Pregnancies over forty' are increasing in society, owing to changing lifestyles and sensibilities of youth and the advent of assisted reproductive techniques. In India, studies on elderly pregnant women above 40 years of age are lacking. The aim of this study is to assess these pregnancies, their course, obstetric and perinatal outcomes in women delivering above 40 years. Methods The study group (Group A) comprised of pregnancies in 50 women at age ≥ 40 years on the date of delivery. The control group (Group B) had 50 women who delivered subsequent to the study group and age < 40. Various parameters and outcomes including parity, gestational age, number of gestations, co-existing medical illnesses, the incidence of hypertensive diseases of pregnancy (HDP), gestational diabetes mellitus (GDM), pre-term labor, mode of delivery, birth weight and obstetric and neonatal outcomes were compared. Chi-square test and independent T test were used for statistical analysis. Results While a good number of patients conceived spontaneously and with basic infertility management, i.e., 84% in the elderly gravid group (Group A) and 96% in the control group (Group B), the number of patients who required ART in Group A were statistically significant (Group A 16% and Group B 4%). Incidence of pre-existing medical diseases like hypertension, diabetes mellitus, thyroid dysfunction, other auto-immune diseases and chronic diseases were noted to be high (26%) in Group A (statistically significant difference). Incidence of HDP, GDM and fetal growth restriction were high in Group A. Tendency to have the presence of fibroid uterus was high in patients in Group A, i.e., 24%, compared to only 8% in the control group; difference was statistically significant. Proportion of pre-term deliveries were high in Group A. Cesarean section rate was high in Group A, though it was not statistically significant. Other perinatal observations and neonatal outcomes were comparable in both groups; differences were not statistically significant. Conclusion The study reveals an association of a high-risk course of pregnancies in women above the age of 40 years. Proportions of IVF pregnancies are higher in elderly women. Interestingly, the proportion of women in elderly group who conceived spontaneously and with basic infertility management including IUI was 84% in the present study. Medical comorbidities and incidence of fibroids were high in elderly women. Obstetric and neonatal outcomes of these pregnancies when managed efficiently are favorable.
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Affiliation(s)
- Sunil E. Tambvekar
- Nowrosjee Wadia Maternity Hospital, Seth G. S. Medical College, Parel, Mumbai, Maharashtra 400706 India
| | - Shilpa Adki
- Indira IVF Centre, Allahabad, Uttar Pradesh India
| | - Nozer K. Sheriar
- Holy Family Hospital, Hinduja Hospital, Breach Candy Hospital, Mumbai, Maharashtra India
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Singh M, Shekhar C, Shri N. Changes in age at last birth and its determinants in India. Sci Rep 2023; 13:10450. [PMID: 37369774 DOI: 10.1038/s41598-023-37370-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 06/20/2023] [Indexed: 06/29/2023] Open
Abstract
In recent years, developing and developed countries are witnessing delayed childbearing among women contributing to the overall decline in fertility rates. The age at which a woman has her last child impacts maternal and child health, especially in a country with high maternal and perinatal mortality rates. This study aims to investigate the trends of age at the last birth among Indian women and to identify the potential factors contributing towards higher maternal age. The present study uses the data from five consecutive rounds (1992-1993, 1998-1999, 2004-2005, 2015-2016, and 2019-2021) of the National Family Health Survey (NFHS). We have used descriptive statistics, bivariate, Cox proportional hazard regression analysis, multiple classification analysis (MCA), Kaplan-Meier curve, life table survival analysis, hierarchical clustered heat map, multivariate decomposition analysis (MDA) and geospatial mapping to fulfill the objective of the study. Results show that the proportion of women with age at last birth before reaching the age of 30 years was less than half (nearly 35%) during NFHS-I while during NFHS-V proportion becomes more than half and reaches 64.3% among 40-49 years women. Within three decades (1992-2021) there has been a decline of 15.8% in median age at last birth among women aged 40-49 years. Additionally, the highest percentage decline in predicted mean age at last birth was noted among individuals from rural area (10.7%, 3.3 years), Hindu religion (10.8%, 3.3 years), poor wealth quantile (12.5%, 4.0 years) and those with mass media exposure (10.6%, 3.2 years) from NFHS-I (1992-1993) to NFHS-V (2019-2021). Although there exists the need to delay age at first childbirth, the age at last childbirth also plays an important role in women's and child health status. Hence, it is important to address the healthcare needs of those delaying their childbirth.
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Affiliation(s)
- Mayank Singh
- Department of Fertility & Social Demography, International Institute for Population Sciences (IIPS), Mumbai, 400088, India
| | - Chander Shekhar
- Department of Fertility & Social Demography, International Institute for Population Sciences (IIPS), Mumbai, 400088, India
| | - Neha Shri
- Department of Survey Research and Data Analytics, International Institute for Population Sciences (IIPS), Mumbai, 400088, India.
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Abstract
Pre-eclampsia is a life-threatening disease of pregnancy unique to humans and a leading cause of maternal and neonatal morbidity and mortality. Women who survive pre-eclampsia have reduced life expectancy, with increased risks of stroke, cardiovascular disease and diabetes, while babies from a pre-eclamptic pregnancy have increased risks of preterm birth, perinatal death and neurodevelopmental disability and cardiovascular and metabolic disease later in life. Pre-eclampsia is a complex multisystem disease, diagnosed by sudden-onset hypertension (>20 weeks of gestation) and at least one other associated complication, including proteinuria, maternal organ dysfunction or uteroplacental dysfunction. Pre-eclampsia is found only when a placenta is or was recently present and is classified as preterm (delivery <37 weeks of gestation), term (delivery ≥37 weeks of gestation) and postpartum pre-eclampsia. The maternal syndrome of pre-eclampsia is driven by a dysfunctional placenta, which releases factors into maternal blood causing systemic inflammation and widespread maternal endothelial dysfunction. Available treatments target maternal hypertension and seizures, but the only 'cure' for pre-eclampsia is delivery of the dysfunctional placenta and baby, often prematurely. Despite decades of research, the aetiology of pre-eclampsia, particularly of term and postpartum pre-eclampsia, remains poorly defined. Significant advances have been made in the prediction and prevention of preterm pre-eclampsia, which is predicted in early pregnancy through combined screening and is prevented with daily low-dose aspirin, starting before 16 weeks of gestation. By contrast, the prediction of term and postpartum pre-eclampsia is limited and there are no preventive treatments. Future research must investigate the pathogenesis of pre-eclampsia, in particular of term and postpartum pre-eclampsia, and evaluate new prognostic tests and treatments in adequately powered clinical trials.
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Effect of maternal age on neonatal outcomes in very low birth weight singleton infants: a population-based study. J Perinatol 2023; 43:424-429. [PMID: 36739362 DOI: 10.1038/s41372-023-01620-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 03/23/2022] [Accepted: 01/20/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Little is known on the impact of maternal age (MA) on very low birth weight (VLBW) infants' outcomes. We tested the hypothesis that at both ends of MA there are increased adverse neonatal outcomes in VLBW infants. METHODS We used the Israel National Neonatal Network VLBW (≤1500 g) database. Maternal age was stratified as: <20, 20-24, 25-34 (reference group), 35-39 and ≥40 years. Statistical analyses were univariate and multivariable logistic regression analysis. RESULTS After adjustment, the infant outcomes of older mothers were similar to those of the reference group for mortality, RDS, severe ROP, NEC and sepsis. Mothers < 20 and 20-24 years old had higher odds of IVH grades 3-4 (OR 1.45, 95% CI 1.09-1.93 and OR 1.26, 95% CI 1.10-1.45, respectively), and BPD (OR 1.55, 95% CI 1.13-2.13 and OR 1.40, 95% CI 1.22-1.62, respectively). There were higher odds for PVL in infants of <20 year-old mothers (OR 1.83, 95% CI 1.26-2.65) and in infants of 35-39 year-old mothers (OR 1.38, 95% CI 1.12-1.69). Poor composite outcomes were significantly higher in the youngest maternal age categories (<20-year-old mothers (OR 1.63, 95% CI 1.28-2.08), and 20-24-year-old (OR 1.28, 95% CI 1.15-1.43). CONCLUSIONS Neonatal outcomes differ in relation to maternal age among very low birth weight newborns, with adverse outcomes more predominant in infants of younger mothers.
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Alanazi AS, Victor F, Rehman K, Khan YH, Yunusa I, Alzarea AI, Akash MSH, Mallhi TH. Pre-Existing Diabetes Mellitus, Hypertension and KidneyDisease as Risk Factors of Pre-Eclampsia: A Disease of Theories and Its Association with Genetic Polymorphism. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16690. [PMID: 36554576 PMCID: PMC9778778 DOI: 10.3390/ijerph192416690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 11/25/2022] [Accepted: 12/03/2022] [Indexed: 06/17/2023]
Abstract
Pre-existing diabetes, hypertension and kidney disorders are prominent risk factors of pre-eclampsia (PE). It is a multifactorial pregnancy disorder associated with high blood pressure, proteinuria, and multiorgan failure, which develops after the 20th week of pregnancy. It is one of the most feared pregnancy disorders, as it consumes thousands of fetomaternal lives per annum. According to clinical and pathological studies, the placenta appears to be a key player in the pathogenesis of PE; however, the exact origin of this disorder is still under debate. Defective placentation and angiogenesis are the hallmarks of PE progression. This angiogenic imbalance, together with maternal susceptibility, might determine the severity and clinical presentation of PE. This article comprehensively examines the mechanisms of pathogenesis of PE and current evidence of the factors involved in its progression. Finally, this article will explore the genetic association of PE, various candidate genes, their proposed mechanisms and variants involved in its pathogenesis.
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Affiliation(s)
- Abdullah Salah Alanazi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka 72388, Saudi Arabia
| | - Francis Victor
- Department of Pharmacy, University of Chenab, Gujrat 50700, Pakistan
| | - Kanwal Rehman
- Department of Pharmacy, The Women University, Multan 66000, Pakistan
| | - Yusra Habib Khan
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka 72388, Saudi Arabia
| | - Ismaeel Yunusa
- College of Pharmacy, University of South Carolina, Columbia, SC 29208, USA
| | | | | | - Tauqeer Hussain Mallhi
- Department of Clinical Pharmacy, College of Pharmacy, Jouf University, Sakaka 72388, Saudi Arabia
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Gain a Baby Lose a Tooth-Is There an Association between Periodontitis and Preterm Birth? J Clin Med 2022; 11:jcm11237183. [PMID: 36498757 PMCID: PMC9739114 DOI: 10.3390/jcm11237183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/22/2022] [Accepted: 11/26/2022] [Indexed: 12/12/2022] Open
Abstract
Preterm birth serves as one of the leading causes of neonatal mortality worldwide. The underlying mechanisms that contribute to preterm birth are not yet fully understood. However, an association between periodontitis and preterm birth has been proposed. The periodontal status and presence of periodontal pathogens in women with different birth outcomes have been previously examined. However, varying definitions of periodontitis and different microbiological methods make their interpretation challenging. The aim of this case-control study on women with and without preterm birth was to investigate their periodontal status using the current classification system for periodontal diseases. Moreover, differences in the periodontal microbiome of the study participants were investigated. Therefore, we collected data on oral and periodontal parameters in 77 puerperal women divided into two groups based on gestational age at delivery: 33 patients with preterm birth (PTB, <37 weeks) and 44 patients with term birth (TB, >37 weeks). These data included pocket probing depth (PPD), clinical attachment loss (CAL), bleeding on probing (BOP), gingival-bleeding index, DMFT index, and gynecologic and dental history. In addition, their oral microbiome was explored. Median CAL and percentage PPD ≥ 4 mm were significantly higher in the PTB group than in the TB group (p = 0.0128 and p = 0.047, respectively). Birth weight was significantly higher in periodontally healthy women than in those with gingivitis (p = 0.0078) or periodontitis (p = 0.0127). The periodontal microbiome differed significantly between groups. Our results are underlining the possible association between periodontitis and preterm delivery. Women with periodontitis had babies with significantly lower birth weights. The microbiome varied between the groups.
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Li H, Nawsherwan, Fan C, Mubarik S, Nabi G, Ping YX. The trend in delayed childbearing and its potential consequences on pregnancy outcomes: a single center 9-years retrospective cohort study in Hubei, China. BMC Pregnancy Childbirth 2022; 22:514. [PMID: 35751047 PMCID: PMC9233367 DOI: 10.1186/s12884-022-04807-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 06/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Due to the advancement of modern societies, the proportion of women who delay childbearing until or beyond 30 years has dramatically increased in the last three decades and has been linked with adverse maternal-neonatal outcomes. OBJECTIVE To determine the trend in delayed childbearing and its negative impact on pregnancy outcomes. MATERIAL AND METHODS A tertiary hospital-based retrospective study was conducted in Wuhan University Renmin Hospital, Hubei Province, China, during the years 2011-2019. The joinpoint regression analysis was used to find a trend in the delayed childbearing and the multiple binary logistic regression model was used to estimate the association between maternal age and pregnancy outcomes. RESULTS Between 2011 and 2019, the trend in advanced maternal age (AMA ≥35 years) increased by 75% [AAPC 7.5% (95% CI: - 10.3, 28.9)]. Based on maternal education and occupation, trend in AMA increased by 130% [AAPC 11.8% (95% CI: 1.1, 23.7)] in women of higher education level, and 112.5% [AAPC 10.1% (95% CI: 9.4, 10.9)] in women of professional services. After adjusting for confounding factors, AMA was significantly associated with increased risk of gestational hypertension (aOR 1.5; 95% CI: 1.2, 2.1), preeclampsia (aOR 1.6; 95% CI: 1.4, 1.9), sever preeclampsia (aOR 1.7; 95% CI: 1.1, 2.6), placenta previa (aOR 1.8; 95% CI: 1.5, 2.2), gestational diabetes mellitus (aOR 2.5; 95% CI: 2.3, 2.9), preterm births (aOR 1.6; 95% CI: 1.4, 1.7), perinatal mortality (aOR 1.8; 95% CI: 1.3, 2.3), and low birth weight (aOR 1.3; 95% CI: 1.2, 1.4) compared with women aged < 30 years. CONCLUSION Our findings show a marked increase in delayed childbearing and its negative association with pregnancy outcomes.
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Affiliation(s)
- Hui Li
- Department of Medicine, Taixing People Hospital, Taizhou, Jiangsu, China
| | - Nawsherwan
- Department of Preventive Medicine, School of Health Sciences, Wuhan University, Wuhan, Hubei, China.
| | - Cuifang Fan
- Department of Obstetrics and Gynecology, Renmin Hospital, Wuhan University, Wuhan, Hubei, China
| | - Sumaira Mubarik
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan, Hubei, China
| | - Ghulam Nabi
- Institute of Nature Conservation, Polish Academy of Sciences, Krakow, Poland
| | - Yin Xiao Ping
- Department of Pediatrics, Taixing People Hospital, Taizhou, Jiangsu, China.
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Moroni G, Calatroni M, Ponticelli C. The Impact of Preeclampsia in Lupus Nephritis. Expert Rev Clin Immunol 2022; 18:1-13. [PMID: 35510378 DOI: 10.1080/1744666x.2022.2074399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/03/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Women with systemic lupus erythematosus (SLE), particularly those with lupus nephritis (LN), remain at high risk for adverse pregnancy outcome. Although in the last decades maternal and fetal outcomes have improved dramatically, preeclampsia remains a major cause of maternal and perinatal morbidity and mortality. AREAS COVERED A narrative review of literature was conducted, underlying the importance of pre-conception counseling, and focusing on the correlation between preeclampsia and LN. The clinical characteristics of preeclampsia were described, with emphasis on risk factors in LN and the differential diagnosis between preeclampsia and lupus flares. Additionally, the prevention and treatment of preeclampsia were discussed, as well as the management of short-term and long-term consequences of preeclampsia. We highlight the importance of a pre-pregnancy counseling from a multidisciplinary team to plan pregnancy during inactive SLE and LN. EXPERT OPINION Further studies are needed to evaluate the long-term consequences of pregnancy in LN. Considering that preeclamptic patients can be at high risk for long-term renal failure, we suggest renal checkup for at least 6-12 months after delivery in all patients.
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Affiliation(s)
- Gabriella Moroni
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Nephrology and Dialysis Division, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Marta Calatroni
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Nephrology and Dialysis Division, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Claudio Ponticelli
- Independent Researcher, Past Director Nephrology Policlinico, Milan, Italy
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Li H, Nawsherwan, Fan C, Yin S, Haq IU, Mubarik S, Nabi G, Khan S, Hua L. Changes in adverse pregnancy outcomes in women with advanced maternal age (AMA) after the enactment of China's universal two-child policy. Sci Rep 2022; 12:5048. [PMID: 35322808 PMCID: PMC8943149 DOI: 10.1038/s41598-022-08396-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 02/17/2022] [Indexed: 12/18/2022] Open
Abstract
The universal two-child policy (TCP; 2016) in China has affected many aspects of maternal-neonatal health. A tertiary hospital-based retrospective study (2011–2019) was used to find the association of these policy changes with maternal age and pregnancy outcomes in women with AMA (≥ 35 years) in the Hubei Province, China. The proportion of neonatal births to women with AMA increased by 68.8% from 12.5% in the one-child policy (OCP) period to 21.1% in the universal TCP period [aOR 1.76 (95% CI: 1.60, 1.93)]. In the univariate analysis, the proportion of preterm births (29.4% to 24.1%), low birth weight (LBW) (20.9% to 15.9%), and hypertensive disorders of pregnancy (HDP) (11.5% to 9.2%) significantly (p < 0.05) decreased in women with AMA from the OCP period to universal TCP period. However, the proportion of intrauterine growth restriction (IUGR) (0.2% to 0.7%) and gestational diabetes mellitus (GDM) (1.7% to 15.6%) was significantly (p < 0.05) increased over the policy changes. After adjusting for confounding factors, only the risk of GDM increased [aOR 10.91 (95% CI: 6.05, 19.67)] in women with AMA from the OCP period to the universal TCP period. In conclusion, the risk of GDM increased in women with AMA from the OCP period to the universal TCP period.
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Affiliation(s)
- Hui Li
- Department of Medicine, Taixing People Hospital, Taizhou, Jiangsu, China
| | - Nawsherwan
- Department of Preventive Medicine, School of Health Sciences, Wuhan University, Wuhan, Hubei, China.
| | - Cuifang Fan
- Department of Obstetrics and Gynecology, Renmin Hospital, Wuhan University, Wuhan, Hubei, China
| | - Shanshan Yin
- Henan Academy of Medical Sciences, Zhengzhou, Henan, China
| | - Ijaz Ul Haq
- Department of Public Health and Nutrition, The University of Haripur, Haripur, Pakistan
| | - Sumaira Mubarik
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan, Hubei, China
| | - Ghulam Nabi
- Institute of Nature Conservation, Polish Academy of Sciences, Krakow, Poland
| | - Suliman Khan
- Advanced Medical Center, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
| | - Linlin Hua
- Advanced Medical Center, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
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Kadour-Peero E, Sagi S, Awad J, Vitner D. The Maternal Age Cut-Off for an Increase in Composite Adverse Outcomes. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2021; 44:372-377. [PMID: 34740851 DOI: 10.1016/j.jogc.2021.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To investigate whether there is a specific maternal age cut-off at which there is an increase in maternal and neonatal adverse outcomes. METHODS A retrospective study comparing maternal and neonatal outcomes between nulliparous women of different ages. The receiver operating characteristic model with the Youden index was used to find the best age cut-off using cesarean delivery (CD) and composite adverse outcomes. A multivariable logistic regression analysis was calculated after adjusting for smoking, induction of labour, epidural use, hypertensive disorders, gestational diabetes, and birth weight. RESULTS The study included 11 343 nulliparous women. Age 28 years was found to be the cut-off age at which we found a significant increase in adverse outcomes. Women older than age 28 years had a higher risk of CD than women younger than 28 years (35.7% vs. 21.3%, P < 0.0001). They were also more likely to deliver prematurely (11.9% vs. 7.9%, P < 0.0001) and had higher rates hypertensive disorders (2.3% vs. 1.1%, P < 0.0001) and gestational diabetes mellitus (0.4% vs. 0.1%, P = 0.001). Furthermore, their babies were more likely to be growth restricted (1.1% vs. 0.3%, P < 0.0001). There were no differences in the rates of induction of labour or macrosomia. After adjusting for confounders, we found that women older than 28 years had higher risks of CD and adverse outcomes than younger women (aOR 1.9; 95% CI 1.744-2.1 and aOR 1.6; 95% CI 1.6-1.77, respectively). CONCLUSION Increasing maternal age is independently associated with adverse maternal and neonatal outcomes with an age cut-off of 28 years. Women older than age 28 years are at higher risk for composite adverse outcomes than younger women.
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Affiliation(s)
- Einav Kadour-Peero
- Department of Obstetrics and Gynecology, Bnai -Zion Medical Center, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Shlomi Sagi
- Department of Obstetrics and Gynecology, Bnai -Zion Medical Center, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Janan Awad
- Department of Obstetrics and Gynecology, Bnai -Zion Medical Center, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Dana Vitner
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Vandekerckhove M, Guignard M, Civadier MS, Benachi A, Bouyer J. Impact of maternal age on obstetric and neonatal morbidity: a retrospective cohort study. BMC Pregnancy Childbirth 2021; 21:732. [PMID: 34711168 PMCID: PMC8555100 DOI: 10.1186/s12884-021-04177-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 10/01/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Pregnancies in women over 35 years of age are becoming more frequent. The majority of studies point to an age of 35 as a provider of obstetric and neonatal complications. But several confounding factors are not taken into account and this results in contradictory results. METHODS The objective was to quantify the strength of the association between maternal age and obstetric and neonatal morbidity. This observational study was based on systematic records of 9 years of pregnancies managed in the Obstetrics and Gynaecology Department of Antoine Béclère Hospital, Clamart, France. In all, 24,674 pregnancies were managed at Antoine Béclère Hospital between April 1, 2007 and December 31, 2015, including 23,291 singleton pregnancies. Maternal age was the age at the beginning of pregnancy, taken as a quantitative variable. The main outcome measure was a composite "unfavourable" pregnancy outcome that included miscarriage, induced abortion, in utero foetal death, stillborn or newborn infant weighing under 500 g or delivered before 24 weeks of gestational age. Obstetric and neonatal morbidity comprised hospitalisation during pregnancy for more than 1 day, pre-eclampsia, gestational diabetes requiring hospitalisation, caesarean delivery, preterm birth, small-for-gestational age, and newborn transfer to the paediatric unit or neonatal intensive care unit. RESULTS Analyses were conducted among singleton pregnancies (n = 23,291) and were adjusted for obesity, assisted reproductive technology and geographical origin of the mother. Unfavourable pregnancy outcome rate tripled with age, from 5% among women aged 25 to 34 to 16% among those over 45. Women over 40 were twice as likely to be hospitalised as those aged 25 to 34. The caesarean section rate reached more than 40% among women over 40 and more than 60% in women over 45. The rate of newborn transfer to paediatric intensive care or a neonatal intensive care unit was doubled in women over 40 and small-for-gestational age was more frequent with age, reaching 34% in women over 45. CONCLUSIONS The risk of maternal-foetal complications increases steadily with age and is particularly high after 35 years and closer monitoring appears to be necessary. These results provide additional evidence and information for public health decision-makers.
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Affiliation(s)
- Mélanie Vandekerckhove
- Service de Gynécologie-Obstétrique, AP-HP, Hôpital Antoine Béclère, 157 rue de la Porte de Trivaux, 92141, Paris, Clamart, France.
- Université Paris-Saclay, 94807, le Kremlin Bicêtre, France.
| | - Mélanie Guignard
- Service de Gynécologie-Obstétrique, AP-HP, Hôpital Antoine Béclère, 157 rue de la Porte de Trivaux, 92141, Paris, Clamart, France
| | - Marie-Sophie Civadier
- Service du département d'informatique médical, AP-HP, Hôpital Antoine Béclère, 92141, Clamart, France
| | - Alexandra Benachi
- Service de Gynécologie-Obstétrique, AP-HP, Hôpital Antoine Béclère, 157 rue de la Porte de Trivaux, 92141, Paris, Clamart, France
- Université Paris-Saclay, 94807, le Kremlin Bicêtre, France
| | - Jean Bouyer
- Université Paris-Saclay, UVSQ, Inserm, CESP, 94807, Villejuif, France
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Schrey-Petersen S, Tauscher A, Dathan-Stumpf A, Stepan H. Diseases and complications of the puerperium. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:arztebl.m2021.0168. [PMID: 33972015 PMCID: PMC8381608 DOI: 10.3238/arztebl.m2021.0168] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 02/28/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND In terms of maternal morbidity and mortality, the puerperium is just as significant as pregnancy and childbirth. Nearly half of all maternal deaths occur in the time after delivery. METHODS This review is based on pertinent articles in English and German from the years 2000- 2020 that were retrieved by a selective search in MEDLINE and EMBASE, as well as on the available guidelines in English and German and on German-language textbooks of obstetrics. RESULTS The most common and severe complications are, in the post-placental phase, bleeding and disturbances of uterine involution; in the first seven days after delivery, infection (e.g., endomyometritis, which occurs after 1.6% [0.9; 2.5] of all births) and hypertension-related conditions. Thromboembolism, incontinence and disorders of the pelvic floor, mental disease, and endocrine disturbances can arise at any time during the puerperium. In an Australian study, the incidence of embolism was 0.45 per 1000 births, with 61.3% arising exclusively after delivery. CONCLUSION Basic familiarity with the most common and severe diseases in the puerperium is important for non-gynecologists as well, among other things because highly acute, lifethreatening complications can arise that demand urgent intervention.
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Affiliation(s)
| | - Anne Tauscher
- Division of Obstretics, University of Leipzig Medical Center
| | | | - Holger Stepan
- Division of Obstretics, University of Leipzig Medical Center
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Trotman H, Samms-Vaughan M, Coore-Desai C, Reece JA, Olugbuyi O. Neonatal Outcome of Babies Born to Women 40 Years and Older in a Jamaican Birth Cohort. Am J Perinatol 2021; 40:619-623. [PMID: 34044455 DOI: 10.1055/s-0041-1730350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The study aimed to determine the outcome of babies born to women ≥40 years in a Jamaican birth cohort. PATIENTS AND METHODS Maternal demographic data and neonatal data for women ≥40 years who delivered live singleton babies and their younger counterparts aged 20 30 years were extracted from the JA KIDS birth cohort dataset. Outcome measures were preterm birth, low birth weight, very low birth weight, extremely low birth weight, macrosomia, a low 5-minute Apgar score <7, admission to the neonatal unit, and neonatal death. Descriptive analyses were performed; statistical significance was taken at the level p <0.05. RESULTS A total of 5,424 women and their babies were entered into the study, 5,099 (94%) women were aged 20 to 30 years (mean age ± standard deviation [SD]: 24.5 ± 3.2 years) and 325 (6%) were aged ≥40 years (mean age ± SD: 41.5 ± 1.6 years). A greater percentage of preterm babies (18%) were born to women ≥40 years than to their younger counterparts (14%; p = 0.04). There was no difference in the proportion of low birth weight infants, very low birth weight infants, or extremely low birth weight infants born between the two groups (p > 0.05). There was also no significant difference in the proportion of babies who were macrosomic and in those who had a low 5-minute Apgar score <7. There were 866 (16%) neonatal admissions, 67/325 (21%) of these babies were born to women aged ≥40 years and 799/5,099 (16%) were born to their younger counterparts (p = 0.01). The commonest reason for admission was prematurity. While 60 babies died, there was no significant difference between both groups with 56 (1%) born to women 20 to 30 years and 4 (1%) born to women ≥40 years (p = 0.48). CONCLUSION Adverse outcomes noted for babies born to women ≥40 years were prematurity and the need for neonatal admission. However, no excess mortality was recorded. KEY POINTS · Women 40 years and older are more likely to have a chronic illness such as hypertension and diabetes and to have an operative delivery.. · Babies born to women 40 years and older are more likely to be late premature infants and require neonatal admission.. · However, there is no increased risk of neonatal mortality..
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Affiliation(s)
- Helen Trotman
- Department of Child and Adolescent Health, Faculty of Medical Sciences, University of the West Indies, Mona, St. Andrew, Jamaica
| | - Maureen Samms-Vaughan
- Department of Child and Adolescent Health, Faculty of Medical Sciences, University of the West Indies, Mona, St. Andrew, Jamaica
| | - Charlene Coore-Desai
- Department of Child and Adolescent Health, Faculty of Medical Sciences, University of the West Indies, Mona, St. Andrew, Jamaica
| | - Jody-Ann Reece
- Department of Child and Adolescent Health, Faculty of Medical Sciences, University of the West Indies, Mona, St. Andrew, Jamaica
| | - Oluwayomi Olugbuyi
- Department of Child and Adolescent Health, Faculty of Medical Sciences, University of the West Indies, Mona, St. Andrew, Jamaica
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Pereira MM, Torrado J, Sosa C, Zócalo Y, Bia D. Shedding light on the pathophysiology of preeclampsia-syndrome in the era of Cardio-Obstetrics: Role of inflammation and endothelial dysfunction. Curr Hypertens Rev 2021; 18:17-33. [DOI: 10.2174/1573402117666210218105951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 01/02/2021] [Accepted: 01/18/2021] [Indexed: 11/22/2022]
Abstract
:
Preeclampsia (PE) is a worldwide pregnancy complication with serious maternal and neonatal consequences. Our understanding of PE pathophysiology has significantly evolved over the last decades by recognizing that endothelial dysfunction and systemic inflammation, with an associated angiogenic imbalance, are key pieces of this still incomplete puzzle. In the present era, where no single treatment to cure or treat this obstetric condition has been developed so far, PE prevention and early prediction poses the most useful clinical approach to reduce the PE burden. Although most PE episodes occur in healthy nulliparous women, the identification of specific clinical conditions that increase dramatically the risk of PE provides a critical opportunity to improve outcomes by acting on potential reversible factors, and also contribute to better understand this pathophysiologic enigma. In this review, we highlight major clinical contributors of PE and shed light about their potential link with endothelial dysfunction and inflammation.
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Affiliation(s)
- María M. Pereira
- Department of Obstetrics and Gynecology, Virginia Commonwealth University, Richmond, VA, United States
| | - Juan Torrado
- Department of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States
| | - Claudio Sosa
- Department of Obstetrics and Gynecology “C”, Pereira-Rossell Hospital, School of Medicine, Republic University, Montevideo, Uruguay
| | - Yanina Zócalo
- Centro Universitario de Investigación, Innovación y Diagnóstico Arterial, Department of Physiology, School of Medicine, Republic University, Montevideo, Uruguay
| | - Daniel Bia
- Centro Universitario de Investigación, Innovación y Diagnóstico Arterial, Department of Physiology, School of Medicine, Republic University, Montevideo, Uruguay
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Correa-de-Araujo R, Yoon SS(S. Clinical Outcomes in High-Risk Pregnancies Due to Advanced Maternal Age. J Womens Health (Larchmt) 2021; 30:160-167. [PMID: 33185505 PMCID: PMC8020515 DOI: 10.1089/jwh.2020.8860] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Although the influence of advanced maternal age (AMA) and delayed childbearing on adverse maternal and perinatal outcomes has been studied extensively, no universal consensus on the definition of AMA exists. This terminology currently refers to the later years of a woman's reproductive life span and generally applies to women age ≥35 years. AMA increases the risk of pregnancy complications, including ectopic pregnancy, spontaneous abortion, fetal chromosomal abnormalities, congenital anomalies, placenta previa and abruption, gestational diabetes, preeclampsia, and cesarean delivery. Such complications could be the cause of preterm birth and increase the risk of perinatal mortality. For women who have a chronic illness, pregnancy may lead to additional risk that demands increased monitoring or surveillance. The management of pregnant women of AMA requires understanding the relationship between age and preexisting comorbidities. The outcomes from pregnancy in AMA may have a negative impact on women's health as they age because of both the changes from the pregnancy itself and the increased risk of pregnancy-related complications. Postpartum depression affects women of AMA at higher rates. Links between preeclampsia and the risk of future development of cardiovascular disease require follow-up surveillance. The association between hypertensive pregnancy disorders and cognitive and brain functions needs further investigation of sex-specific risk factors across the life span. Educating providers and women of AMA is crucial to facilitate clinical decision making and such education should consider cultural influences, risk perception, and women's health literacy, as well as providers' biases and system issues.
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Affiliation(s)
- Rosaly Correa-de-Araujo
- Division of Geriatrics and Clinical Gerontology, U.S. Department of Health and Human Services, National Institute on Aging, National Institutes of Health, Bethesda, Maryland, USA
| | - Sung Sug (Sarah) Yoon
- Division of Extramural Science Programs, U.S. Department of Health and Human Services, National Institute of Nursing Research, National Institutes of Health, Bethesda, Maryland, USA
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Asefa U, Ayele WM. Adverse Obstetrical and Perinatal Outcomes Among Advanced Age Pregnant Mothers in Northeast Ethiopia: A Comparative Cross-Sectional Study. Int J Womens Health 2020; 12:1161-1169. [PMID: 33324117 PMCID: PMC7733333 DOI: 10.2147/ijwh.s284124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/25/2020] [Indexed: 12/05/2022] Open
Abstract
Purpose It is known that being pregnant at any reproductive age is not risk-free. Aside from this, older gravidity usually ends up with adverse outcomes both to the mother and newborn. Hence, the aim of this study was to investigate the association of adverse maternal and perinatal outcomes with advanced maternal age pregnancy in Northeastern Ethiopia. Methods A hospital-based comparative cross-sectional study was employed among pregnant mothers. The study was conducted among advanced age (≥35 years, n= 398) mothers and adult age (20–34 years, n=398) mothers. Socio-demographic, obstetrics, and pregnancy outcomes were checked from patient records. Descriptive statistics were used to describe parameters collected from patient records and comparing the two groups. Bivariable and multivariable logistic regressions were done to determine factors associated with maternal and perinatal outcomes. The magnitude of the association was measured using odds ratio at 95% confidence level and statistical significance was declared at a P-value of < 0.05. Results Advanced age mothers had significantly higher adverse pregnancy outcomes (64.6% vs 37.8%) compared with adult age mothers. This study shows that advanced maternal age is statistically associated with pregnancy-induced hypertension (AOR=3.14, 95% CI: 1.931–5.089), antepartum hemorrhage (AOR=2.22, 95% CI: 1.245–3.942), a cesarean delivery (AOR=2.59, 95% CI: 1.775–3.790), and postpartum hemorrhage (AOR=2.01, 95% CI: 1.445–2.819). Moreover, advanced maternal age pregnancy was also a risk factor for preterm delivery (AOR=3.01, 95% CI: 1.441–6.297), low birth weight (AOR=3.08, 95% CI: 1.735–5.492), low fifth minute Apgar score (AOR=3.99, 95% CI: 2.099–7.618), and perinatal death (AOR= 2.46, 95% CI: 1.360–4.42). Conclusion In this study, adverse pregnancy and perinatal outcomes among advanced aged mothers were high in a specialized hospital where emergency obstetric and newborn care is set and quality obstetric care is expected. Therefore, healthcare providers, the specialized hospital, and policymakers should give due emphasis to the effective intervention of advanced age pregnant mothers.
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Affiliation(s)
- Ukba Asefa
- Department of Gynecology and Obstetrics, Dessie Specialized Referral Hospital, Dessie, Amhara Regional State, Ethiopia
| | - Wolde Melese Ayele
- Department of Epidemiology and Biostatistics, Wollo University, Dessie, Amhara Regional State, Ethiopia
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Plant M, Armstrong C, Ruggiero A, Sherrill C, Uberseder B, Jeffries R, Nevarez J, Jorgensen MJ, Kavanagh K, Quinn MA. Advanced maternal age impacts physiologic adaptations to pregnancy in vervet monkeys. GeroScience 2020; 42:1649-1661. [PMID: 32588342 PMCID: PMC7732933 DOI: 10.1007/s11357-020-00219-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 06/15/2020] [Indexed: 12/17/2022] Open
Abstract
The trend to delay pregnancy in the USA has resulted in the number of advanced maternal age (AMA) pregnancies to also increase. In humans, AMA is associated with a variety of pregnancy-related pathologies such as preeclampsia (PE). While AMA is known to be a factor which contributes to the development of pregnancy-induced diseases, the molecular and cellular mechanisms giving rise to this phenomenon are still very limited. This is due in part to lack of a preclinical model which has physiologic relevance to human pregnancy while also allowing control of environmental and genetic variability inherent in human studies. To determine potential physiologic relevance of the vervet/African green monkey (Chlorocebus aethiops sabaeus) as a preclinical model to study the effects of AMA on adaptations to pregnancy, thirteen age-diverse pregnant vervet monkeys (3-16 years old) were utilized to measure third trimester blood pressure (BP), complete blood count, iron measurements, and hormone levels. Significant associations were observed between third trimester diastolic BP and maternal age. Furthermore, the presence of leukocytosis with enhanced circulating neutrophils was observed in AMA mothers compared to younger mothers. Moreover, we observed a negative relationship between maternal age and estradiol, progesterone, and cortisol levels. Finally, offspring born to AMA mothers displayed a postnatal growth retardation phenotype. These studies demonstrate physiologic impairment in the adaptation to pregnancy in AMA vervet/African green monkeys. Our data indicate that the vervet/African green monkey may serve as a useful preclinical model and tool for deciphering pathological mediators of maternal disease in AMA pregnancy.
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Affiliation(s)
- Maren Plant
- Department of Pathology, Section on Comparative Medicine, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Cecilia Armstrong
- Department of Pathology, Section on Comparative Medicine, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Alistaire Ruggiero
- Department of Pathology, Section on Comparative Medicine, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Chrissy Sherrill
- Department of Pathology, Section on Comparative Medicine, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Beth Uberseder
- Department of Pathology, Section on Comparative Medicine, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Rachel Jeffries
- Department of Pathology, Section on Comparative Medicine, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Justin Nevarez
- Department of Pathology, Section on Comparative Medicine, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Matthew J Jorgensen
- Department of Pathology, Section on Comparative Medicine, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Kylie Kavanagh
- Department of Pathology, Section on Comparative Medicine, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA
| | - Matthew A Quinn
- Department of Pathology, Section on Comparative Medicine, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157, USA.
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Torous VF, Roberts DJ. Placentas From Women of Advanced Maternal Age. Arch Pathol Lab Med 2020; 144:1254-1261. [PMID: 32101452 DOI: 10.5858/arpa.2019-0481-oa] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The percentage of pregnant women with advanced maternal age (AMA) has increased during the past several decades due to various socioeconomic factors and advances in assisted reproduction. These pregnancies are associated with adverse maternal and fetal outcomes. However, the underlying placental pathology has not been well described. OBJECTIVE.— To investigate the placental histopathology associated with AMA pregnancies. DESIGN.— Placental pathology from 168 AMA women 35 years or older at delivery was reviewed. The cases were subdivided into 2 age subgroups, ages 35 to 39 and 40 or older, as well as a "pure AMA" subgroup where the only indication for placental examination was AMA. A group of 60 consecutive non-AMA placentas was also identified and used as comparison. The spectrum of histologic features in each case was catalogued. RESULTS.— Of the overall AMA cases, meconium deposition was seen in 55% (93 of 168), chorangiosis in 40% (68 of 168), and acute chorioamnionitis in 36% (60 of 168). Fetal vascular malperfusion was also seen with high frequency (30%; 50 of 168). Two histologic alterations found to be significantly different between the 35 to 39 and greater than 40 age subgroups were fetal vascular malperfusion (11% [7 of 65] versus 42% [43 of 103]; P = .001) and delayed villous maturation (1.5% [1 of 65] versus 13% [13 of 103]; P = .02). The pure AMA subgroup showed no statistically significant differences compared with the overall AMA group. Chronic deciduitis was the only statistically significant difference between the overall AMA group and the non-AMA comparison group (14% [23 of 168] versus 30% [18 of 60]; P = .02). CONCLUSIONS.— Our findings, particularly the high frequency of fetal vascular malperfusion, suggest that AMA should be an independent indication for placental pathologic examination.
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Affiliation(s)
- Vanda F Torous
- From the Department of Pathology, Massachusetts General Hospital, Boston, and Harvard Medical School, Boston, Massachusetts
| | - Drucilla J Roberts
- From the Department of Pathology, Massachusetts General Hospital, Boston, and Harvard Medical School, Boston, Massachusetts
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Tzur Y, Yogev Y. Prepregnancy counseling in women over 50 years of age. Best Pract Res Clin Obstet Gynaecol 2020; 70:21-27. [PMID: 32773290 DOI: 10.1016/j.bpobgyn.2020.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/17/2020] [Accepted: 07/01/2020] [Indexed: 10/23/2022]
Abstract
Over the past decade, there has been a steep rise in the proportion of women who become pregnant at an advanced maternal age. Personal goals and cultural changes along with the advancement in artificial reproductive therapies have enabled women who wish to defer childbearing when given an opportunity to do so, and pregnancy rates in this age group are not likely to decrease. However, accumulating evidence suggests that pregnancies at an advanced maternal age are associated with an increased risk for maternal and neonatal complications. This review provides an evidence-based view of advanced maternal age pregnancy and focuses on prepregnancy counseling to optimize women's health prior to conception.
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Affiliation(s)
- Yossi Tzur
- Lis Maternity Hospital, Department of Obstetrics & Gynecology, Sourasky Medical Center, Tel Aviv University, Israel
| | - Yariv Yogev
- Lis Maternity Hospital, Department of Obstetrics & Gynecology, Sourasky Medical Center, Tel Aviv University, Israel.
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Moreira MEL, Lucena SL, Magalhães PSCD, Rocha AD, Costa ACC, Soares FVM. MACRONUTRIENTS OF MOTHERS' MILK OF VERY LOW BIRTH WEIGHT INFANTS: ANALYSIS ACCORDING TO GESTATIONAL AGE AND MATERNAL VARIABLES. REVISTA PAULISTA DE PEDIATRIA 2020; 39:e2019097. [PMID: 32578667 PMCID: PMC7309577 DOI: 10.1590/1984-0462/2021/39/2019097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 08/18/2019] [Indexed: 11/22/2022]
Abstract
Objective: To analyze the composition of macronutrients present in the milk of mothers
of preterm newborn infants (PTNB) - protein, fat, carbohydrate, and calories
- by gestational age (GA), chronological age (CA) and maternal
variables. Methods: Longitudinal study that analyzed 215 milk samples from the 51 mothers of
PTNB admitted in three Neonatal Intensive Care Units of Rio de Janeiro from
May/2013-January/2014. Milk collection was performed by pickup pump, on a
fixed day of each week until discharge. The spectrophotometric technique
with Infrared Analysis (MilkoScan Minor 104) was used for the quantitative
analysis. A sample of 7 mL of human milk was taken from the total volume of
milk extracted by the mother. The data was grouped by GA (25-27, 28-31,
32-36, 37-40 weeks) and by CA (zero to 4, 5-8, 9-12, 13-16 weeks). Results: Protein, carbohydrate, fat and calories did not show any pattern of change,
with no difference among groups of GA. When the macronutrients were analyzed
by groups of CA, protein decreased, with significant difference between the
first two groups of CA. Carbohydrates, fat and calories presented increasing
values in all groups, without significant differences. Weight gain during
pregnancy, maternal hypertension and maternal age were associated with
changes in fat and calories in the first moment of the analysis of milk. Conclusions: There was a significant decrease in the levels of protein during the first
eight weeks after birth. CA may be an important factor in the composition of
human milk.
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Affiliation(s)
| | - Sabrina Lopes Lucena
- Instituto Nacional de Saúde da Mulher e da Criança Fernandes Figueira, Rio de Janeiro, RJ, Brazil
| | | | - Adriana Duarte Rocha
- Instituto Nacional de Saúde da Mulher e da Criança Fernandes Figueira, Rio de Janeiro, RJ, Brazil
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The impact of advanced maternal age on pregnancy outcome. Best Pract Res Clin Obstet Gynaecol 2020; 70:2-9. [PMID: 32773291 DOI: 10.1016/j.bpobgyn.2020.06.006] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/08/2020] [Indexed: 01/24/2023]
Abstract
Advanced maternal age is becoming an increasingly relevant issue in high-income developed countries. Lower fertility, greater need for assisted reproductive therapy, and an increase in comorbidities, such as hypertension and diabetes, are some of the reasons for the rise in adverse maternal and fetal outcomes. This chapter reviews and summarizes the recent publications on the impact of advanced maternal age on pregnancy outcomes.
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Early prediction of preeclampsia via machine learning. Am J Obstet Gynecol MFM 2020; 2:100100. [PMID: 33345966 DOI: 10.1016/j.ajogmf.2020.100100] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/04/2020] [Accepted: 03/07/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Early prediction of preeclampsia is challenging because of poorly understood causes, various risk factors, and likely multiple pathogenic phenotypes of preeclampsia. Statistical learning methods are well-equipped to deal with a large number of variables, such as patients' clinical and laboratory data, and to select the most informative features automatically. OBJECTIVE Our objective was to use statistical learning methods to analyze all available clinical and laboratory data that were obtained during routine prenatal visits in early pregnancy and to use them to develop a prediction model for preeclampsia. STUDY DESIGN This was a retrospective cohort study that used data from 16,370 births at Lucile Packard Children Hospital at Stanford, CA, from April 2014 to January 2018. Two statistical learning algorithms were used to build a predictive model: (1) elastic net and (2) gradient boosting algorithm. Models for all preeclampsia and early-onset preeclampsia (<34 weeks gestation) were fitted with the use of patient data that were available at <16 weeks gestational age. The 67 variables that were considered in the models included maternal characteristics, medical history, routine prenatal laboratory results, and medication intake. The area under the receiver operator curve, true-positive rate, and false-positive rate were assessed via cross-validation. RESULTS Using the elastic net algorithm, we developed a prediction model that contained a subset of the most informative features from all variables. The obtained prediction model for preeclampsia yielded an area under the curve of 0.79 (95% confidence interval, 0.75-0.83), sensitivity of 45.2%, and false-positive rate of 8.1%. The prediction model for early-onset preeclampsia achieved an area under the curve of 0.89 (95% confidence interval, 0.84-0.95), true-positive rate of 72.3%, and false-positive rate of 8.8%. CONCLUSION Statistical learning methods in a retrospective cohort study automatically identified a set of significant features for prediction and yielded high prediction performance for preeclampsia risk from routine early pregnancy information.
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Does parity affect pregnancy outcomes in the elderly gravida? Arch Gynecol Obstet 2019; 301:85-91. [PMID: 31768744 DOI: 10.1007/s00404-019-05386-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 11/09/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To identify whether older primiparas have more complications than do women who continue to deliver children into their late reproductive age. Patients of at least 35 years of age at delivery were included. Within this cohort, data from primiparous and multiparous women were compared. METHODS This retrospective study was based on electronic medical records from a single academic center, with more than 7000 deliveries annually. The impact of parity on maternal complications was assessed using a multivariate logistic regression model that adjusted for baseline maternal characteristics and medical history. RESULTS During the study period, there were 54 283 deliveries in our medical center. A total of 13,982 (25.7%) patients were at least 35 years old at delivery. The rate of twin pregnancy was higher in the primiparous group (1.9%) as compared to the multiparous group (0.8%, 95% CI 0.30-0.64, P < 0.001), as was the incidence of delivery prior to 34 weeks (6.1% of the primiparas versus 2.9% of the multiparas, P < 0.001, OR 2.16, 95% CI 1.75-2.68); hypertensive disorders (3.9% versus 1.7%, P < 0.001, 95% CI 0.33-0.57); diabetes (4.6% versus 3.2%, P = 0.003, 95% CI 0.55-0.88); and IUGR (10.5% versus 4.7%, P < 0.001, 95% CI 0.35-049), respectively. The increased risk for pre-term delivery, hypertensive disorders, diabetes, and IUGR was maintained after logistic regression analysis. CONCLUSION We found that pregnancy complications typical to older parous women are significantly more common among primiparas, indicating that not only older age, but also having a first child relatively late in the reproductive period contributes to adverse pregnancy outcomes.
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Desplanches T, Bouit C, Cottenet J, Szczepanski E, Quantin C, Fauque P, Sagot P. Combined effects of increasing maternal age and nulliparity on hypertensive disorders of pregnancy and small for gestational age. Pregnancy Hypertens 2019; 18:112-116. [PMID: 31586783 DOI: 10.1016/j.preghy.2019.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 09/09/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND The mean age of women delivering for the first time is increasing, and this combination could lead to an increased risk of perinatal complications. OBJECTIVES The objective was to evaluate the potential combined effects of nulliparity and increasing maternal age on small for gestational age (SGA < 10th percentile) and hypertensive disorders of pregnancy (HDP). STUDY DESIGN A population-based cohort study was conducted using data routinely collected on all births in 11 hospitals in the Burgundy perinatal network between 2007 and 2016. Pregnant women with singleton deliveries aged 20 years or older were included at delivery and divided into groups according to maternal age (20 to 24-year-old group as a reference). Multivariate logistic regression models, adjusted on smoking, body mass index, chronic high blood pressure and birth date, were performed. RESULTS A total of 137,791 women were included. Whatever the parity, the risks of SGA and HDP increased with maternal age, but the increase began earlier in nulliparous women. Compared to multiparous women, the risk of SGA in nulliparous women increased with maternal age (aOR = 1.5 95% CI [1.4-1.7] for age 20-24 rising to 2.2 [1.8-2.8] for age 40-49). We found evidence that parity modified the association between maternal age and SGA (test for interaction p < 0.001). The risk of HDP was constantly higher in nulliparous women, whatever the maternal age. CONCLUSION The combination of increasing maternal age and nulliparity has a more negative impact on the occurrence of SGA than either risk factor alone.
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Affiliation(s)
- Thomas Desplanches
- Dijon University Hospital, Pôle de Gynécologie-Obstétrique, Médecine Fœtale et Stérilité Conjugale, Dijon F-21000, France.
| | - Camille Bouit
- Dijon University Hospital, Pôle de Gynécologie-Obstétrique, Médecine Fœtale et Stérilité Conjugale, Dijon F-21000, France
| | - Jonathan Cottenet
- Dijon University Hospital, Service de Biostatistique et d'Informatique Médicale (DIM), Dijon F-21000, France; Inserm, CIC 1432, Clinical Epidemiology Unit, Dijon, France; Dijon University Hospital, Clinical Investigation Center, Clinical Epidemiology Unit, Dijon, France
| | - Emilie Szczepanski
- Dijon University Hospital, Pôle de Gynécologie-Obstétrique, Médecine Fœtale et Stérilité Conjugale, Dijon F-21000, France
| | - Catherine Quantin
- Dijon University Hospital, Service de Biostatistique et d'Informatique Médicale (DIM), Dijon F-21000, France; Inserm, CIC 1432, Clinical Epidemiology Unit, Dijon, France; Dijon University Hospital, Clinical Investigation Center, Clinical Epidemiology Unit, Dijon, France
| | - Patricia Fauque
- Dijon University Hospital, Laboratoire de Biologie de la Reproduction, Dijon F-21000, France; Inserm 1231, Equipe GAD, Génétique des Anomalies du Développement, Dijon University Hospital, France
| | - Paul Sagot
- Dijon University Hospital, Pôle de Gynécologie-Obstétrique, Médecine Fœtale et Stérilité Conjugale, Dijon F-21000, France; University of Burgundy, Dijon, France
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De Viti D, Malvasi A, Busardò F, Beck R, Zaami S, Marinelli E. Cardiovascular Outcomes in Advanced Maternal Age Delivering Women. Clinical Review and Medico-Legal Issues. ACTA ACUST UNITED AC 2019; 55:medicina55100658. [PMID: 31569595 PMCID: PMC6843194 DOI: 10.3390/medicina55100658] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 09/23/2019] [Accepted: 09/24/2019] [Indexed: 02/07/2023]
Abstract
Background and objecives: Adverse cardiovascular outcomes during pregnancy have increased over the past few decades, with increased numbers of women delivering later in their reproductive life. Other factors include higher rates of female obesity, diabetes, hypertension, cardiovascular diseases and assisted reproductive technology, which has extended fertility. Those at risk require extensive prenatal maternal screening, constant pregnancy supervising, monitoring during labor, delivery and puerperium and careful anesthetic evaluation during delivery. Materials and Methods: The present review reports the relevant information available on cardiovascular outcomes in advanced maternal age delivering women and related medico-legal issues. The search was performed on Pubmed, Cochrane, Semantic Scholar, Medline and Embase databases, accessed by Ovid, including among others the terms "cardiomyopathy", "ischaemic heart disease", "arrhythmias", "hypertension", "peripartum period", "diabetes", "advanced maternal age" "anesthesia", "maternal morbidity and mortality" and "litigation". Results: To the extent that underestimating risk factors for peripartum cardiomyopathy (PPCM) can adversely impact maternal and fetal outcomes, the legal implications of misdiagnosis or mismanagement can result in high compensatory damages. Substantial indemnity payments drive up costs of insurance coverage. Conclusions: Multidisciplinary approaches are necessary from obstetricians, cardiologists, anesthesiologists and perinatologists for pregnancy monitoring and delivery outcomes.
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Affiliation(s)
- Daniele De Viti
- Department of Cardiology, Santa Maria Hospital, GVM Care & Research, 70124 Bari, Italy.
| | - Antonio Malvasi
- Department of Obstetrics and Gynecology, Santa Maria Hospital, GVM Care & Research, 70124 Bari, Italy.
| | - Francesco Busardò
- Section of Legal Medicine, Università Politecnica delle Marche, 60120 Ancona, Italy.
| | - Renata Beck
- Department of Anesthesia and Analgesia, Santa Maria Hospital, GVM Care & Research, 70124 Bari, Italy.
| | - Simona Zaami
- Unit of Forensic Toxicology (UoFT), Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University, 00161 Rome, Italy.
| | - Enrico Marinelli
- Unit of Forensic Toxicology (UoFT), Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University, 00161 Rome, Italy.
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Claramonte Nieto M, Meler Barrabes E, Garcia Martínez S, Gutiérrez Prat M, Serra Zantop B. Impact of aging on obstetric outcomes: defining advanced maternal age in Barcelona. BMC Pregnancy Childbirth 2019; 19:342. [PMID: 31547808 PMCID: PMC6757376 DOI: 10.1186/s12884-019-2415-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 07/18/2019] [Indexed: 12/16/2022] Open
Abstract
Background Women of advanced maternal age (AMA) are a growing population, with higher obstetric risks. The Mediterranean population has specific characteristics different from other areas. Thus, the objective of this study was to establish a cut-off to define AMA in a selected mediterranean population coming from a tertiary referral private/mutual health hospital in Barcelona. Methods Retrospective cohort of euploid singleton pregnancies delivered from January 2007 to June 2017. Main maternal outcomes were: gestational diabetes, preeclampsia, placenta previa, c-section and prolonged hospitalization (≥ 7 days). Main adverse perinatal outcomes were: stillbirth, prematurity, preterm prelabor rupture of membranes, low birth weight, need of admission at a neonatal intensive care unit and perinatal mortality. Adjustment for confounding factors (smoking, previous comorbilities, parity, assisted reproductive techniques (ART) and obesity) was performed. Results A total of 25054 pregnancies were included. Mean maternal age was 34.7 ± 4.2 years, with 2807 patients in the group of age between 40 and 44 years (11.2%) and 280 patients ≥45 years (1.1%). Women at AMA had higher incidence of previous comorbilities (compared to the reference group of women < 30 years): prior c-section, chronic hypertension and obesity. In addition, they were more likely to use ART. After adjusting for confounding factors, maternal age was an independent and statistically significant risk factor for gestational diabetes (OR 1.66/2.80/3.14) for ages 30–39, 40–44 and ≥ 45 years respectively, c-section (OR 1.28/2.41/7.27) and placenta previa (OR 2.56/4.83) for ages 40–44 and ≥ 45 years respectively, but not for preeclampsia (neither early-onset nor late-onset). Risk of emergency c-section was only increased in women ≥45 years (OR, 2.03 (95% CI, 1.50–2.74). In the other groups of age, the increase in c-section rate was because of elective indications. Age ≥ 45 years was associated with iatrogenic prematurity < 37 weeks (OR 2.62, 95% CI 1.30–5.27). No other relevant associations between AMA and maternal or neonatal outcomes were found. Conclusions Maternal age is an independent risk factor for adverse obstetric outcomes. Age ≥ 40 years was associated to relevant increased risks and reveals to be an adequate cut-off to define AMA in our population.
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Affiliation(s)
- Marta Claramonte Nieto
- Department of Obstetrics, Gynecology and Reproduction, Dexeus Mujer, Hospital Universitari Quiron Dexeus, Barcelona, Spain.
| | - Eva Meler Barrabes
- BCNatal, Hospital Clínic of Barcelona and Hospital Sant Joan de Déu, Barcelona, Spain
| | - Sandra Garcia Martínez
- Department of Epidemiology and Statistics, Dexeus Mujer, Hospital Universitari Quiron Dexeus, Barcelona, Spain
| | - Mireia Gutiérrez Prat
- Department of Obstetrics, Gynecology and Reproduction, Dexeus Mujer, Hospital Universitari Quiron Dexeus, Barcelona, Spain
| | - Bernat Serra Zantop
- Director of Obstetrics Department, Dexeus Mujer, Hospital Universitari Quiron Dexeus, Barcelona, Spain
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Okada K, Saito I, Katada C, Tsujino T. Influence of quality of sleep in the first trimester on blood pressure in the third trimester in primipara women. Blood Press 2019; 28:345-355. [PMID: 31266373 DOI: 10.1080/08037051.2019.1637246] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: The purpose of this study was to clarify the relationship between decreased sleep quality during the first trimester and a rise in blood pressure during an otherwise normal course of pregnancy in primipara women. Materials and methods: We recruited 128 pregnant women (primipara) who visited the obstetrics and gynecology clinic for medical examination, of which 89 were longitudinally investigated from the first to the third trimester after obtaining informed consent. A survey was conducted in the first, second, and third trimesters to evaluate sleep quality using the Japanese version of the Pittsburgh Sleep Quality Index (PSQI-J). Patients were assigned to either a good sleep quality group (PSQI-J ≤ 5) or a poor sleep quality group (PSQI-J ≥ 6). Blood pressure was measured using a home blood pressure measurement method. We analyzed the relationship between sleep quality in the first trimester and blood pressure during pregnancy. Results: The increase in morning systolic blood pressure from first to third trimester was larger in the poor sleep quality group than in the good sleep quality group (7.1 ± 7.0 vs. 3.0 ± 5.6 mmHg, p < .01). Sleep latency (r = 0.38, β = 0.43, p = .02) and sleep disturbances (r = 0.24, β = 0.33, p = .04) in the first trimester affected the increase in systolic blood pressure during pregnancy. Conclusions: Understanding sleep quality at the beginning of pregnancy can help predict a rise in systolic blood pressure in the third trimester. This emphasizes the importance of sleep education during pregnancy.
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Affiliation(s)
- Kimie Okada
- Graduate School of Health Sciences, Kobe University , Kobe , Japan.,Department of Nursing, School of Nursing, Hyogo University of Health Sciences , Kobe , Japan
| | - Izumi Saito
- Graduate School of Health Sciences, Kobe University , Kobe , Japan
| | - Chihiro Katada
- Department of Nursing, School of Nursing, Hyogo University of Health Sciences , Kobe , Japan
| | - Takeshi Tsujino
- Department of Pharmacy, School of Pharmacy, Hyogo University of Health Sciences , Kobe , Japan
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Avnon T, Ovental A, Many A. Twin versus singleton pregnancy in women ≥ 45 years of age: comparison of maternal and neonatal outcomes. J Matern Fetal Neonatal Med 2019; 34:201-206. [PMID: 30931655 DOI: 10.1080/14767058.2019.1602115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives: The aim of the study is to compare the effect of very advanced maternal age (≥45 years) on maternal and neonatal outcomes of twin and singleton pregnancies.Materials and methods: This retrospective cohort study included women ≥ 45 years of age who gave birth to twins. Each was randomly matched to two women ≥ 45 years of age who gave birth to singletons within 7 days of the study subject. Data on maternal age, gravidity, parity, background medical information, body mass index at conception, number of fetuses, mode of conception (either spontaneous or assisted reproductive technology [ART]), mode of delivery, and gestational age at delivery were extracted from a real-time computerized database.Results: The data of 75 twin pregnancies of women aged ≥ 45 years were compared with those of 150 singleton pregnancies matched for maternal age. There were significantly more cases of hypertensive complications among the twin pregnancies compared to the singleton pregnancies (41.33 versus 14.00%, respectively, OR = 3.33, 95% CI = 2.26-8.30, p = .000) and more cases of preeclamptic toxemia (29.33 versus 12.00%, respectively, OR = 3.04, 95% CI = 1.51-6.13, p = .001). The duration of twin pregnancies was much shorter compared to singleton pregnancies, with a higher incidence of deliveries prior to 37 weeks' gestation (56.00 versus 8.00%, respectively, OR = 14.64, 95% CI = 6.94-30.85, p = .000), and deliveries prior to 34 weeks' gestation (22.67 versus 2.00%, respectively, OR = 14.36, 95% CI = 4.06-50.86, p = .000). More infants of twin pregnancies had a low birth weight (68.00 versus 10.00%, respectively, OR = 19.13, 95% CI = 10.14-36.06, p = .000), and many had a very low birth weight (10.67 versus 0.67%, respectively, OR = 17.79, 95% CI = 2.33-135.97, p = .000). The infants of twin pregnancies also included more cases of intubation (10.00 versus 0.00%, respectively, p = .000), more cases of hypoglycemia (12.67 versus 5.33%, respectively, OR = 2.57, 95% CI = 1.09-6.08, p = .026), and were admitted much more often to the neonatal intensive care unit (36.00 versus 8.00%, respectively, OR = 6.47, p = .00, CI = 3.29-12.74).Conclusions: Women ≥ 45 years of age with twin pregnancies and their neonates sustain more severe adverse outcome compared to matched pairs of singleton pregnancies. It is recommended that a single embryo transfer should be offered in preference to multiple embryos when those women are undergoing ART.
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Affiliation(s)
- Tomer Avnon
- Department of Obstetrics & Gynecology, Lis Maternity & Women's Hospital, Tel-Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amit Ovental
- Department of Neonatology, Dana Dwek Children's Hospital, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Ariel Many
- Department of Obstetrics & Gynecology, Lis Maternity & Women's Hospital, Tel-Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Abstract
PURPOSE The aim of our meta-analysis was to explore whether advanced maternal age (AMA) is regarded as an important risk factor for predicting macrosomia or not. METHODS Three databases were systematically reviewed and reference lists of relevant articles were checked. Meta-analysis of published cohort studies was done comparing whether AMA was associated with macrosomia and adjusting for potential confounding factors. Calculations of pooled estimates were conducted in random-effects models. Heterogeneity was tested by using chi-square test and I2 statistics. Publication bias was estimated from Egger's test (linear regression method) and Begg's test (rank correlation method). RESULTS Twelve cohort studies met the inclusion criteria. The meta-analysis showed that AMA was associated with macrosomia as an important risk factor. The adjusted odds ratio calculated for 12 studies (compared aged 35-39 years to aged <30 years) was 1.42, 95% confidence interval (CI) (1.25-1.60) for random-effect model and 6 studies (compared aged ≥40 years to aged <30 years) was 1.40, 95% CI (1.02-1.78) for random-effect model. There was no indication of a publication bias either from the result of Egger's test or Begg's test. CONCLUSION Regardless of the underlying mechanism, our finding indicated that AMA should be considered as an important risk factor for macrosomia. To adequately evaluate the clinical evolution of AMA, the effect of AMA on macrosomia need to be carefully assessed and monitored.
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Affiliation(s)
- Rui-Xue Dai
- 1 Department of Acute Infectious Diseases, Disease Control and Prevention Center of Fuyang, Fuyang, Anhui, China
| | - Xiu-Jie He
- 2 Medical Department, Fuyang Hospital of Anhui Medical University, Fuyang, Anhui, China
| | - Chuan-Lai Hu
- 2 Medical Department, Fuyang Hospital of Anhui Medical University, Fuyang, Anhui, China.,3 Division of Nutrition and Food Hygiene, School of Public Health, Anhui Medical University, Hefei, Anhui, China
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Impact of maternal age on intrapartum caesarean delivery rate in nulliparas with spontaneous labour. J Gynecol Obstet Hum Reprod 2019; 48:407-411. [PMID: 30797893 DOI: 10.1016/j.jogoh.2019.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 01/24/2019] [Accepted: 02/19/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND The advanced maternal age rate increases in developed countries. Older women have more pre-existing condition than youngest women and develop more frequently obstetrical pathologies responsible for a higher rate of caesarean delivery before labour and labour induction. For aged nulliparous without pathology who experience spontaneous labour, there is few data on the mode of delivery and on physiological labour according to maternal age. OBJECTIVE To compare the intrapartum caesarean delivery rate according to maternal age, for nulliparous with planned vaginal delivery and spontaneous labour at term. METHODS Retrospective cohort in a single academic institution between January 2000 and June 2017. All nulliparous women with planned vaginal delivery with live singleton in cephalic presentation at and after 37 weeks of gestation with spontaneous labour were included (n = 10,611). Two groups were compared: nulliparous women aged 20-34 and nulliparous women aged 35 and over. The main outcome was the intrapartum caesarean delivery rate. A subgroup analysis was performed for nulliparous with more advanced maternal age defined as women over 40. RESULTS Among the 10,611 women included in this analysis, 8,993 (84.8%) were aged 20-34 and 1,618 (15.2%) were aged over 35. From the latter 367 (22.7%) were over 40 years old. The intrapartum caesarean delivery rate was similar between women aged between 20 and 34 and women aged over 35 (10.8% compared to 8.8%; cOR 0.91, 95% CI 0.76-1.08; aOR 0.91, 95% CI 0.76-1.09). The indications of caesarean were similar in both groups. No differences were found between both groups for mean labour duration (430.9 min for the [20-34] years group compared to 428.0 min for the over 35 years group, p = 0.654). The subgroup analysis performed on nulliparous with more advanced maternal age yielded similar results. CONCLUSION For nulliparous at term in spontaneous labour, an advanced maternal age was not associated with an increased intrapartum caesarean delivery rate.
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Perinatal outcome of twin pregnancies according to maternal age. Obstet Gynecol Sci 2019; 62:93-102. [PMID: 30918877 PMCID: PMC6422846 DOI: 10.5468/ogs.2019.62.2.93] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/27/2018] [Accepted: 10/10/2018] [Indexed: 11/17/2022] Open
Abstract
Objective To investigate the perinatal outcomes of twin pregnancies according to maternal age. Methods This is a retrospective cohort study of twin pregnancies delivered ≥24 weeks' gestation at a tertiary academic hospital from 1995 to 2016. Subjects were categorized into 5 groups according to maternal age: <25, 25–29, 30–34, 35–39, and ≥40 years. Maternal and neonatal outcomes of each maternal age group were analyzed using the Jonckheere-Terpstra test and the linear-by-linear association test. Results A total of 1,936 twin pregnant women were included, of which 47 (2.4%), 470 (24.3%), 948 (49.0%), 417 (21.5%), and 54 (2.7%) women were aged <25, 25–29, 30–34, 35–39, and ≥40 years, respectively. Higher maternal age was significantly associated with a higher rate of dichorionic twins and a higher risk of gestational diabetes and placenta previa. However, rates of preterm labor, preterm premature rupture of membranes, cervical incompetence, preterm delivery, preeclampsia, placenta abruption, and cesarean section were not associated with maternal age. Birth weight increased and the rate of admission to the neonatal intensive care unit (NICU) decreased with older maternal age, but other neonatal outcomes did not change with age. Maternal age was significantly associated with a lower rate of NICU admission after controlling for potential confounding factors in multivariable analysis. Conclusion Advanced maternal age in twin pregnancies was associated with increased risk of gestational diabetes, placenta previa, and higher birth weight but a lower rate of NICU admission. However, other outcomes were not significantly associated with maternal age.
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Davis S, Dylewski J, Shah PB, Holmen J, You Z, Chonchol M, Kendrick J. Risk of adverse maternal and fetal outcomes during pregnancy in living kidney donors: A matched cohort study. Clin Transplant 2019; 33:e13453. [PMID: 30472740 PMCID: PMC6342653 DOI: 10.1111/ctr.13453] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 10/30/2018] [Accepted: 11/16/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND We examined the risk of adverse pregnancy outcomes in primiparous kidney donors compared to matched controls. METHODS Fifty-nine women with a history of kidney donation prior to their first pregnancy with normal renal function and no history of kidney disease, diabetes or chronic hypertension were matched 1:4 by age (within 2 years) and race to women with two kidneys using data from an integrated healthcare delivery system. Adverse pregnancy outcomes were defined as preterm delivery (delivery <37 weeks), delivery via cesarean section, gestational hypertension, preeclampsia/eclampsia, gestational diabetes, length of stay in the hospital >3 days, infant death/transfer to acute facility and low birthweight (<2500 g). RESULTS Living kidney donors did not have a higher risk of adverse outcomes compared to matched controls. There was a trend toward an increased risk of preeclampsia/eclampsia in kidney donors but it did not reach statistical significance (Odds ratio [OR]: 2.96, 95% CI: 0.98-8.94, P = 0.06). However, in kidney donors ≤30 years of age, there was a fourfold increased risk of preeclampsia/eclampsia (OR: 4.09, 95% CI: 1.07-15.59, P = 0.04). CONCLUSION Overall, the risk of pregnancy-associated complications following kidney donation is small but potential female kidney donors should be counseled on the possible increased risk of preeclampsia.
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Affiliation(s)
- Scott Davis
- Division of Renal Diseases and Hypertension, University of Colorado School of Medicine, Aurora, CO
| | - James Dylewski
- Division of Renal Diseases and Hypertension, University of Colorado School of Medicine, Aurora, CO
| | - Pratik B Shah
- Division of Renal Diseases and Hypertension, University of Colorado School of Medicine, Aurora, CO
| | - John Holmen
- Homer Warner Center, Intermountain Health Care, Salt Lake City, UT
| | - Zhiying You
- Division of Renal Diseases and Hypertension, University of Colorado School of Medicine, Aurora, CO
| | - Michel Chonchol
- Division of Renal Diseases and Hypertension, University of Colorado School of Medicine, Aurora, CO
| | - Jessica Kendrick
- Division of Renal Diseases and Hypertension, University of Colorado School of Medicine, Aurora, CO
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Pariente G, Wainstock T, Walfisch A, Sheiner E, Harlev A. Advanced Maternal Age and the Future Health of the Offspring. Fetal Diagn Ther 2018; 46:139-146. [PMID: 30466094 DOI: 10.1159/000493191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 08/24/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We aimed to evaluate the association between advanced maternal age and the long-term health of the offspring. METHODS In this population-based cohort study, hospitalizations of offspring up to the age of 18 years were compared according to maternal age. The incidence of long-term hospitalizations of the offspring due to cardiovascular, endocrine, neurological, hematological, respiratory and gastro-intestinal morbidities was evaluated. Deliveries occurred between the years 1991 and 2014 in a tertiary medical center. Kaplan-Meier survival curves were used to compare cumulative morbidity incidence. Cox regression models were performed to control for confounders. RESULTS During the study period, 202,709 deliveries were included, of which 26,287 (12.9%) were in women aged 35-39 years, and 6,718 (3.3%) in women aged 40-50 years. Children born to older mothers did not have a significantly different cumulative incidence of long-term pediatric morbidities evaluated, as compared with the comparison group, using Kaplan-Meier survival analyses. In the Cox regression analyses, advanced maternal age did not exhibit an independent association with long-term morbidities of the offspring. CONCLUSION Despite the association of advanced maternal age with adverse maternal and immediate neonatal outcomes, there does not seem to be an association with the long-term morbidity of the offspring.
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Affiliation(s)
- Gali Pariente
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel,
| | - Tamar Wainstock
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Asnat Walfisch
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Avi Harlev
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Goisis A, Schneider DC, Myrskylä M. Secular changes in the association between advanced maternal age and the risk of low birth weight: A cross-cohort comparison in the UK. POPULATION STUDIES 2018; 72:381-397. [PMID: 29582702 DOI: 10.1080/00324728.2018.1442584] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Existing studies provide contradictory evidence concerning the association between child health and advanced maternal age. A potential explanation for the lack of consensus on this issue is changes over time in the costs and benefits of giving birth at an advanced age. This is the first study to investigate secular changes in the characteristics of older mothers and in the association between advanced maternal age and child health. We use data from four UK cohort studies, covering births from 1958 to 2001, and use low birth weight (LBW) as a marker for child health. We find that across successive birth cohorts, the negative association between advanced maternal age and LBW becomes progressively weaker; and that this pattern is partially explained by secular changes in the characteristics of older mothers. Our results suggest that associations between maternal age and child outcomes are tied to a specific population and point in time.
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Affiliation(s)
- Alice Goisis
- a London School of Economics and Political Science
- b Max Planck Institute for Demographic Research
| | | | - Mikko Myrskylä
- a London School of Economics and Political Science
- b Max Planck Institute for Demographic Research
- c University of Helsinki
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Kean N, Turner J, Flatley C, ClinEpi M, Kumar S. Maternal age potentiates the impact of operative birth on serious neonatal outcomes. J Matern Fetal Neonatal Med 2018; 33:598-605. [PMID: 29985073 DOI: 10.1080/14767058.2018.1498478] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Background: Pregnancies at the extremes of maternal age (<20 and >35) are associated with adverse obstetric and perinatal outcomes. There is limited evidence regarding the influence of maternal age on serious neonatal outcomes by mode of delivery. The aim of this study thus was to assess the relationship between maternal age and mode of delivery and its impact on a composite of serious neonatal outcomes.Methods: This was a retrospective cohort study of low risk women birthing at term in Australia's largest maternity hospital over a 7-year period. Intrapartum and perinatal outcomes were collated and a composite of severe adverse neonatal outcomes (SANO) was generated. Multiple regression was applied to adjust for confounders and generate adjusted odds ratios for the risk of SANO according to mode of delivery and maternal age.Results: A total of 84,698 women were included in this study of which 1572 (1.9%) were aged <20 years, 7471 (8.8%) were aged 20-24 years, 20,125 (23.8%) were aged 25-29 years, 31,594 (37.3%) were aged 30-34 years, 19,371 (22.9%) were aged 35-40 years, 4280 (5.1%) were aged 40-44 years and 285 (0.3%) were aged ≥45 years. The incidence of SANO was significantly greater among adolescents compared to all other age groups. Overall, SANO was most likely to occur following Emergency Caesarean Section (EmCS) for severe intrapartum hemorrhage/uterine rupture compared to all other indications. Instrumental delivery was associated with the greatest odds of SANO (adjusted odds ratios (aOR) 3.31, 95% CI 3.08-3.55, p < .001) while spontaneous vaginal delivery (SVD) was associated with the lowest odds (aOR 0.46, 95% CI 0.43-0.48, p < .001). The adjusted odds for SANO was lowest in women aged 30-34 years (aOR 0.92, 95% CI 0.87-0.97, p < .001). The odds of SANO following an SVD increased with maternal age, with women aged 40-44 years having the highest odds. Similarly, the odds of SANO following an instrumental delivery increased with maternal age (age <20 years: aOR 2.21, 95% CI 1.38-3.54, p < .001 versus age 35-39 years: aOR 3.76, 95% CI 3.16-4.48, p < .001).Conclusion: This large retrospective cohort study has demonstrated that maternal age not only affects the mode of delivery and the incidence of adverse neonatal outcomes but that the effect of mode of delivery upon the risk of SANO is not independent of maternal age.
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Affiliation(s)
- Nicola Kean
- Faculty of Medicine, University of Queensland, Whitty Building, Brisbane, Australia
| | - Jessica Turner
- Faculty of Medicine, University of Queensland, Whitty Building, Brisbane, Australia.,Mater Research Institute, University of Queensland, Brisbane, Australia
| | | | - M ClinEpi
- Mater Research Institute, University of Queensland, Brisbane, Australia
| | - Sailesh Kumar
- Faculty of Medicine, University of Queensland, Whitty Building, Brisbane, Australia.,Mater Research Institute, University of Queensland, Brisbane, Australia
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Diejomaoh MFE, Al-Jassar W, Bello Z, Karunakaran K, Mohammed A. The Relevance of the Second Cesarean Delivery in the Reduction of Institutional Cesarean Delivery Rates. Med Princ Pract 2018; 27:555-561. [PMID: 30165369 PMCID: PMC6422118 DOI: 10.1159/000493362] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2017] [Revised: 08/30/2018] [Accepted: 08/30/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The cesarean delivery rate has increased worldwide. The aim of our study was to assess the events associated with the second cesarean deliveries in our institution. SUBJECTS AND METHODS All cesarean deliveries at the Maternity Hospital, Kuwait, from January 1 to December 31, 2013, were identified. A comparative study was undertaken on patients having their first and second cesarean deliveries. The social and clinical characteristics of these patients were extracted from our records and the antenatal, intrapartum, and postpartum course of the pregnancies and their outcomes documented. RESULTS During the study period, 10,586 deliveries were recorded, including 3,676 cesarean deliveries, i.e., a cesarean delivery rate of 34.7%. 840 of these patients were undergoing their first cesarean delivery (group A) and 607 patients were undergoing their second (group B); 484 patients from group A and 341 patients from group B with complete records were analyzed. Mean age (30.89 ± 4.93 vs. 29.94 ± 5.56 years, p = 0.008), parity (1.49 ± 1.22 vs. 0.98 ± 1.60, p < 0.0001), gestational age at delivery (38.12 ± 2.61 vs. 37.66 ± 3.11 weeks, p = 0.02), and fetal birth weight (3,211.60 ± 691.51 vs. 2,829.73 ± 863.26 g, p < 0.001) were significantly higher in group B than in group A. 53.2% of the patients in group B requested repeat cesarean delivery, their second cesarean. The rate of maternal morbidity was low. CONCLUSIONS The incidence of repeat cesarean delivery in group B is high, and its reduction should contribute to a lowering of the overall cesarean delivery rate.
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Affiliation(s)
- Michael F E Diejomaoh
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kuwait University, Safat,
- Department of Obstetrics and Gynecology, Maternity Hospital, Safat,
| | - Waleed Al-Jassar
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kuwait University, Safat, Kuwait
- Department of Obstetrics and Gynecology, Maternity Hospital, Safat, Kuwait
| | - Zainab Bello
- Department of Obstetrics and Gynecology, Maternity Hospital, Safat, Kuwait
| | | | - Asiya Mohammed
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kuwait University, Safat, Kuwait
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Johnson-Harrison TA, Trotman H. Neonatal Outcome of Babies Born to Women 40 Years and over at the University Hospital of the West Indies 2012-2013. J Trop Pediatr 2018; 64:225-230. [PMID: 28985435 DOI: 10.1093/tropej/fmx053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM This article aims to determine neonatal outcome of babies born to women ≥40 years at the University Hospital of the West Indies. METHODS This was a matched retrospective cohort study looking at the outcome of all babies born to women ≥40 years and control babies born to women aged 20-30 years at the University Hospital of the West Indies over a 2-year period. Maternal and neonatal demographic data and course of admission for admitted neonates were recorded. Descriptive analyses were performed. RESULTS One hundred and ninety-eight neonates were born to women ≥40 years and 208 to their younger counterparts, M:F 1:1.2. There was no difference in the number of preterm or low birth weight infants, the number of neonates with a low 5 min Apgar score <7, the number of neonates admitted or the number of neonates who died between women ≥40 years and their younger counterparts (p > 0.05). CONCLUSION No difference in adverse neonatal outcome was noted between women ≥40 years and their younger counterparts.
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Affiliation(s)
- Terry Ann Johnson-Harrison
- Department of Child & Adolescent Health, Faculty of Medical Sciences, University of the West Indies, Mona, St. Andrew, Jamaica
| | - Helen Trotman
- Department of Child & Adolescent Health, Faculty of Medical Sciences, University of the West Indies, Mona, St. Andrew, Jamaica
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Abstract
OBJECTIVE To provide an overview of delayed child-bearing and to describe the implications for women and health care providers . OPTIONS Delayed child-bearing, which has increased greatly in recent decades, is associated with an increased risk of infertility, pregnancy complications, and adverse pregnancy outcome . This guideline provides information that will optimize the counselling and care of Canadian women with respect to their reproductive choices . OUTCOMES Maternal age is the most important determinant of fertility, and obstetric and perinatal risks increase with maternal age . Many women are unaware of the success rates or limitations of assisted reproductive technology and of the increased medical risks of delayed child-bearing, including multiple births, preterm delivery, stillbirth, and Caesarean section . This guideline provides a framework to address these issues . EVIDENCE Studies published between 2000 and August 2010 were retrieved through searches of PubMed and the Cochrane Library using appropriate key words (delayed child-bearing, deferred pregnancy, maternal age, assisted reproductive technology, infertility, and multiple births) and MeSH terms (maternal age, reproductive behaviour, fertility) . The Internet was also searched using similar key words, and national and international medical specialty societies were searched for clinical practice guidelines and position statements . Data were extracted based on the aims, sample, authors, year, and results . VALUES The quality of evidence was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care. SPONSOR The Society of Obstetricians and Gynaecologists of Canada. RECOMMENDATIONS
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Jones BP, Saso S, Mania A, Smith JR, Serhal P, Ben Nagi J. The dawn of a new ice age: social egg freezing. Acta Obstet Gynecol Scand 2018; 97:641-647. [PMID: 29480938 DOI: 10.1111/aogs.13335] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 02/18/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Benjamin P. Jones
- West London Gynaecological Cancer Center; Hammersmith Hospital; Imperial College NHS Trust; London UK
- Department of Surgery and Cancer; Imperial College London; London UK
| | - Srdjan Saso
- West London Gynaecological Cancer Center; Hammersmith Hospital; Imperial College NHS Trust; London UK
- Department of Surgery and Cancer; Imperial College London; London UK
| | | | - J. Richard Smith
- West London Gynaecological Cancer Center; Hammersmith Hospital; Imperial College NHS Trust; London UK
- Department of Surgery and Cancer; Imperial College London; London UK
| | - Paul Serhal
- Center for Reproductive and Genetic Health; London UK
| | - Jara Ben Nagi
- Center for Reproductive and Genetic Health; London UK
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Booker WA, Ananth CV, Wright JD, Siddiq Z, D'Alton ME, Cleary KL, Goffman D, Friedman AM. Trends in comorbidity, acuity, and maternal risk associated with preeclampsia across obstetric volume settings. J Matern Fetal Neonatal Med 2018; 32:2680-2687. [PMID: 29478359 DOI: 10.1080/14767058.2018.1446077] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The objective of this study was to characterize morbidity, acuity, and maternal risks associated with preeclampsia across hospitals with varying obstetric volumes. METHODS This retrospective cohort analysis used a large administrative data source, the Perspective database, to characterize the risk for preeclampsia from 2006 to 2015. Hospitals were classified as having either low (≤1000), moderate (1001-2000), or high (≥2000) delivery volume. The primary outcomes included preeclampsia, antihypertensive administration, comorbidity, and related severe maternal morbidity. Severe maternal morbidity was estimated using criteria from the Centers for Disease Control and Prevention. Comorbidity was estimated using an obstetric comorbidity index. Univariable comparisons were made with Chi-squared test. Adjusted log linear regression models were fit to assess factors associated with severe morbidity with risk ratios with 95% confidence intervals as the measures of effect. Population weights were applied to create national estimates. RESULTS Of 36,985,729 deliveries included, 1,414,484 (3.8%) had a diagnosis of preeclampsia. Of these, 779,511 (2.1%) had mild, 171,109 (0.5%) superimposed, and 463,864 (1.3%) severe preeclampsia. The prevalence of mild, superimposed, and severe preeclampsia each increased over the study period with severe and superimposed preeclampsia as opposed to mild preeclampsia increasing the most proportionately (53.2 and 102.5 versus 10.8%, respectively). The use of antihypertensives used to treat severe range hypertension increased with use of intravenous labetalol increasing 31.5%, 43.2%, and 36.1% at low-, medium-, and high-volume hospitals. Comorbid risk also increased across hospital volume settings as did risk for severe maternal morbidity. CONCLUSIONS Preeclampsia is increasing across obstetric care settings with preeclamptic patients demonstrating increasing comorbid risk, increased risk for severe morbidity, and more frequent need for treatment of acute hypertension.
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Affiliation(s)
- Whitney A Booker
- a Department of Obstetrics and Gynecology , College of Physicians and Surgeons, Columbia University , New York , NY , USA
| | - Cande V Ananth
- a Department of Obstetrics and Gynecology , College of Physicians and Surgeons, Columbia University , New York , NY , USA.,b Department of Epidemiology , Joseph L. Mailman School of Public Health, Columbia University , New York , NY , USA
| | - Jason D Wright
- a Department of Obstetrics and Gynecology , College of Physicians and Surgeons, Columbia University , New York , NY , USA
| | - Zainab Siddiq
- a Department of Obstetrics and Gynecology , College of Physicians and Surgeons, Columbia University , New York , NY , USA
| | - Mary E D'Alton
- a Department of Obstetrics and Gynecology , College of Physicians and Surgeons, Columbia University , New York , NY , USA
| | - Kirstin L Cleary
- a Department of Obstetrics and Gynecology , College of Physicians and Surgeons, Columbia University , New York , NY , USA
| | - Dena Goffman
- a Department of Obstetrics and Gynecology , College of Physicians and Surgeons, Columbia University , New York , NY , USA
| | - Alexander M Friedman
- a Department of Obstetrics and Gynecology , College of Physicians and Surgeons, Columbia University , New York , NY , USA
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Berhe AK, Kassa GM, Fekadu GA, Muche AA. Prevalence of hypertensive disorders of pregnancy in Ethiopia: a systemic review and meta-analysis. BMC Pregnancy Childbirth 2018; 18:34. [PMID: 29347927 PMCID: PMC5774029 DOI: 10.1186/s12884-018-1667-7] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 01/11/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although hypertensive disorders of pregnancy are the leading cause of poor perinatal outcomes in Ethiopia, there is no study that shows the national prevalence. Therefore, the aim of this study was to estimate the national pooled prevalence of hypertensive disorders of pregnancy from studies conducted in different parts of the country. METHODS Databases; MEDLINE, PubMed, HINARI, EMBASE, Google Scholar and African Journals Online were searched by using different search terms on HDP and Ethiopia. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument was used for critical appraisal of studies. The analysis was done using STATA 14 software. The Cochran Q test and I2 test statistics were used to test heterogeneity of studies. Egger's test was used to show the publication bias. The pooled prevalence of HDP and the odds ratio (OR) with 95% confidence interval was presented using forest plots. RESULT Seventeen studies were included in this review, with a total of 258,602 pregnant women. The overall pooled prevalence of hypertensive disorders of pregnancy in Ethiopia was 6.07% (95% CI: 4.83%, 7.31%). The Subgroup analysis by region and year of study showed a higher prevalence of hypertensive disorders of pregnancy in Southern Nations, Nationalities, and Peoples' Region, 10.13% (95% CI = (8.5, 12.43)), and reduction in the rate of HDP from 1990's to 2010's, 8.54% reducing to 5.71% respectively. The pooled prevalence of pregnancy-induced hypertension (PIH) and preeclampsia/eclampsia alone were 6.29 and 5.47 respectively. Pregnant women ≥ 35 years old are more likely to develop hypertensive disorders of pregnancy, OR = 1.64 (95% CI = (1.18, 2.28)). No statistically significant difference was observed between HDP and younger maternal age (less than 20 years old); OR = 2.92 (95% CI = (0.88, 9.70)). There was no association between hypertensive disorders of pregnancy and number of pregnancy, OR = 1.37 (95% CI = 0.78, 2.41)). CONCLUSIONS The prevalence of hypertensive disorders of pregnancy is high in Ethiopia. The problem is more common among older pregnant women (> 35 years old). Government and other stakeholders should give due attention to an early screening of hypertension during pregnancy.
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Affiliation(s)
| | | | - Gedefaw Abeje Fekadu
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, P.O.Box 79, Bahir Dar, Ethiopia
| | - Achenef Asmamaw Muche
- Department of Epidemiology and Biostatistics, Institute of public health, University of Gondar, Gondar, Ethiopia
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Marozio L, Picardo E, Filippini C, Mainolfi E, Berchialla P, Cavallo F, Tancredi A, Benedetto C. Maternal age over 40 years and pregnancy outcome: a hospital-based survey. J Matern Fetal Neonatal Med 2017; 32:1602-1608. [DOI: 10.1080/14767058.2017.1410793] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Luca Marozio
- Department of Surgical Sciences, University of Turin, Turin, Italy
- Department of Obstetrics and Gynecology 1, University of Turin, Turin, Italy
| | - Elisa Picardo
- Department of Surgical Sciences, University of Turin, Turin, Italy
- Department of Obstetrics and Gynecology 1, University of Turin, Turin, Italy
| | | | - Erika Mainolfi
- Department of Surgical Sciences, University of Turin, Turin, Italy
- Department of Obstetrics and Gynecology 1, University of Turin, Turin, Italy
| | - Paola Berchialla
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Franco Cavallo
- Department of Public Health and Paediatrics, University of Turin, Turin, Italy
| | - Annalisa Tancredi
- Department of Surgical Sciences, University of Turin, Turin, Italy
- Department of Obstetrics and Gynecology 1, University of Turin, Turin, Italy
| | - Chiara Benedetto
- Department of Surgical Sciences, University of Turin, Turin, Italy
- Department of Obstetrics and Gynecology 1, University of Turin, Turin, Italy
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Salman L, Shmueli A, Chen R, Ashwal E, Hiersch L, Yogev Y, Aviram A. Choice of scheduled cesarean delivery versus trial of labor for advanced maternal age primiparous women. J Matern Fetal Neonatal Med 2017; 32:979-984. [PMID: 29065732 DOI: 10.1080/14767058.2017.1397121] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We aimed to evaluate perinatal outcomes of advanced maternal age (AMA) primiparous women seeking scheduled cesarean delivery (CD) versus a trial of labor (TOL). MATERIALS AND METHODS This was a retrospective cohort study of primiparous women ≥40 years of age carrying a single fetus, who delivered at a tertiary, university-affiliated medical center (2007-2014). We compared perinatal outcomes of women who chose a scheduled CD with those who chose TOL. Subsequently, we compared women who had successful TOL (sTOL) with those who had a failed TOL (fTOL). RESULTS Out of 62 102 deliveries during the study period, inclusion criteria were met by 374 women. Of them, 83 (22.2%) women had a scheduled CD, and 291 (77.8%) had TOL. Of the TOL group, 118 women (40.5%) had fTOL and 173 (59.5%) had sTOL. Women in the fTOL had higher rates of 1-min Apgar score <7, neonatal asphyxia and adverse neonatal composite outcome compared with women in the sTOL group (p < .05). After adjusting for potential confounders, compared with sTOL, fTOL was not associated with adverse neonatal composite outcome. Compared with scheduled CD, fTOL was associated with an increased risk for adverse neonatal composite outcome (aOR 2.65, 95% CI 1.13-6.19, p = .03). CONCLUSION AMA primiparous women attempting TOL have comparable outcome to those seeking scheduled CD, however, women with fTOL have higher rates of adverse neonatal outcome.
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Affiliation(s)
- Lina Salman
- a Helen Schneider Hospital for Women, Rabin Medical Center , Petach Tikva , Israel
| | - Anat Shmueli
- a Helen Schneider Hospital for Women, Rabin Medical Center , Petach Tikva , Israel
| | - Rony Chen
- a Helen Schneider Hospital for Women, Rabin Medical Center , Petach Tikva , Israel
| | - Eran Ashwal
- b Lis Maternity and Women's Hospital , Tel Aviv Sourasky Medical Center , Tel Aviv , Israel
| | - Liran Hiersch
- b Lis Maternity and Women's Hospital , Tel Aviv Sourasky Medical Center , Tel Aviv , Israel
| | - Yariv Yogev
- b Lis Maternity and Women's Hospital , Tel Aviv Sourasky Medical Center , Tel Aviv , Israel
| | - Amir Aviram
- b Lis Maternity and Women's Hospital , Tel Aviv Sourasky Medical Center , Tel Aviv , Israel
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Johnson JA, Tough S. N° 271-Report de la grossesse. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:e516-e533. [DOI: 10.1016/j.jogc.2017.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Avnon T, Haham A, Many A. Twin pregnancy in women above the age of 45 years: maternal and neonatal outcomes. J Perinat Med 2017; 45:787-791. [PMID: 27805908 DOI: 10.1515/jpm-2016-0196] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 09/29/2016] [Indexed: 11/15/2022]
Abstract
Childbearing age continues to rise and, with the increasing implementation of assisted reproductive technology (ART), the number of multiple pregnancies has also risen. This is a retrospective cohort study on maternal and neonatal outcomes of the twin pregnancies of 57 women aged ≥45 years compared to 114 younger women who gave birth in our institution between January 2011 and August 2015. Data were extracted from the real-time computerized database. The rates of hypertensive complications and pre-eclampsia (PE) were much higher in the study group compared to the controls (24/57 vs. 19/114, P=0.000 and 15/57 vs. 13/114, P=0.013, respectively). The respective incidence of very low birth weight (VLBW) was also significantly higher (14/114 vs. 12/228, P=0.021). Infants in the study group required four times more intubation and had a higher admission rate to the neonatal intensive care unit (NICU) compared to control infants (14/114 vs. 6/228 P=0.000 and 42/114 vs. 57/228, P=0.023, respectively). We conclude that women older than 45 years with twin pregnancies have higher maternal and perinatal complications with worse outcomes in comparison with younger women. When pregnancy is attempted via ART, embryo transfer of only one embryo should be considered in this age group.
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Sari I, Pinarbasi H, Pinarbasi E, Yildiz C. Association between the soluble epoxide hydrolase gene and preeclampsia. Hypertens Pregnancy 2017; 36:315-325. [DOI: 10.1080/10641955.2017.1388390] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Ismail Sari
- Department of Medical Biochemistry, School of Medicine, Niğde Ömer Halisdemir University, Niğde, Turkey
| | - Hatice Pinarbasi
- Department of Biochemistry, School of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Ergun Pinarbasi
- Department of Medical Biology, School of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Caglar Yildiz
- Department of Gynecology and Obstetrics, School of Medicine, Cumhuriyet University, Sivas, Turkey
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Ogawa K, Urayama KY, Tanigaki S, Sago H, Sato S, Saito S, Morisaki N. Association between very advanced maternal age and adverse pregnancy outcomes: a cross sectional Japanese study. BMC Pregnancy Childbirth 2017; 17:349. [PMID: 29017467 PMCID: PMC5635576 DOI: 10.1186/s12884-017-1540-0] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 10/06/2017] [Indexed: 11/23/2022] Open
Abstract
Background While several studies have demonstrated the increased risk of pregnancy complications for women of advanced age, few studies have focused on women with very advanced age (≥ 45), despite the increasing rate of pregnancy among such women. Furthermore, how such risks of increase in age differ by maternal characteristics are also poorly understood. Thus, we aimed to clarify pregnant outcomes among women with very advanced age and how the effect of age differs by method of conception and parity. Methods We used the national multicenter Japan Society of Obstetrics and Gynecology perinatal database, including 365,417 women aged 30 years or older who delivered a singleton between 2005 and 2011. We divided women into four groups based on age (years): 30–34, 35–39, 40–44, and ≥45, and compared risk of adverse birth outcomes between the groups using Poisson regression. Effect modification by parity and use of assisted reproductive technology (ART) was also evaluated. Results: Compared with women aged 30–34 years, women aged 45 or older had higher risk of emergency cesarean delivery [adjusted risk ratio (aRR): 1.77, 95% confidence interval (95% CI): 1.58–1.99], preeclampsia (aRR: 1.86, 95% CI: 1.43–2.42), severe preeclampsia (aRR: 2.03, 95% CI: 1.31–3.13), placenta previa (aRR: 2.17, 95% CI: 1.60–2.95), and preterm birth (aRR: 1.20, 95% CI: 1.04–1.39). The effect of older age on risk of emergency cesarean section, preeclampsia, and preterm birth were significantly greater among those who conceived naturally compared to those who conceived by ART. The effect on emergency cesarean section was stronger among primiparous women, whereas the risk of preeclampsia associated with older age was significantly greater among multiparous women. Conclusions Very advanced maternal age (≥ 45) was related to greater risk for adverse birth outcomes compared to younger women, especially for maternal complications including cesarean section, preeclampsia, severe preeclampsia, and placenta previa. The magnitude of the influence of age also differed by conception method and by parity.
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Affiliation(s)
- Kohei Ogawa
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan. .,Collaborative Departments of Advanced Pediatric Medicine, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-cho, Aoba-ku, Sendai-shi, Miyagi, 980-8575, Japan.
| | - Kevin Y Urayama
- Department of Social Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan.,Graduate School of Public Health, St Luke's International University, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Shinji Tanigaki
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Haruhiko Sago
- Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan.,Collaborative Departments of Advanced Pediatric Medicine, Graduate School of Medicine, Tohoku University, 1-1 Seiryo-cho, Aoba-ku, Sendai-shi, Miyagi, 980-8575, Japan
| | - Shoji Sato
- Perinatal Center, Oita Prefectural Hospital, 476 Bunyo, Oita-shi, Oita, 870-8511, Japan
| | - Shigeru Saito
- Department of Obstetrics & Gynecology, University of Toyama, School of Medicine, 2630 Sugitani, Toyama-shi, Toyama, 930-0194, Japan
| | - Naho Morisaki
- Department of Social Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan
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Parkington HC, Sheehan PM, Coleman HA, Brennecke SP. Mother Nature versus Father Time. J Physiol 2017; 595:1849-1850. [PMID: 28105704 DOI: 10.1113/jp273914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Helena C Parkington
- Department of Physiology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, 3800, Australia
| | - Penelope M Sheehan
- Department of Maternal-Fetal Medicine Pregnancy Research Centre, Royal Women's Hospital, Parkville, Victoria, 3052, Australia
| | - Harold A Coleman
- Department of Physiology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, 3800, Australia
| | - Shaun P Brennecke
- Department of Maternal-Fetal Medicine Pregnancy Research Centre, Royal Women's Hospital, Parkville, Victoria, 3052, Australia.,Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, 3010, Australia
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Guesdon E, Vincent-Rohfritsch A, Bydlowski S, Santulli P, Goffinet F, Le Ray C. Oocyte donation recipients of very advanced age: perinatal complications for singletons and twins. Fertil Steril 2017; 107:89-96. [DOI: 10.1016/j.fertnstert.2016.09.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 08/31/2016] [Accepted: 09/11/2016] [Indexed: 10/20/2022]
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50
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