Advanced maternal age and its association with placenta praevia and placental abruption: a meta-analysis

Martinelli, Katrini Guidolini; Garcia, Érica Marvila; Neto, Edson Theodoro dos Santos; Gama, Silvana Granado Nogueira da

doi:10.1590/0102-311x00206116

Cited by 57 publications

(43 citation statements)

References 40 publications

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“…Even after adjustment for confounding factors, such as previous c-section, parity, smoking and use of ART, these differences remained significant.In the FATER trial, Cleary-Goldman et al [7] found a similar risk of placenta previa (AdjOR 2.8 at > 40 years) in a prospective study among more than 36000 patients. This association has also been described in a recent meta-analysis [32], although a main limitation was the lack of adjustment for confounding factors.…”

Section: Discussionsupporting

confidence: 72%

Impact of aging on obstetric outcomes: defining advanced maternal age in Barcelona

Nieto

Barrabes

Martínez

et al. 2019

BMC Pregnancy Childbirth

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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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Section: Discussionsupporting

confidence: 72%

Impact of aging on obstetric outcomes: defining advanced maternal age in Barcelona

Nieto

Barrabes

Martínez

et al. 2019

BMC Pregnancy Childbirth

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“…A systematic review by Martinelli et al found similar results, even after stratifying for parity. The authors suggest that atherosclerotic changes in the blood vessels may impair the flow and infarction as underlying causes, which may provoke a lower implant of the placenta in the uterine cavity [39]. Regarding fetal presentation, we found a non-vertex presentation of the fetus in 4,2% of women younger than 20 years and 5,7% in 40+ -year-old women.…”

Section: Discussionmentioning

confidence: 68%

Cesarean section on a rise—Does advanced maternal age explain the increase? A population register-based study

et al. 2019

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BackgroundIn Denmark, the cesarean section rate has increased by 49% between 1998 and 2015 and accounts for 21% of all births. Cesarean sections may cause short- as well as long-term consequences for both the mother and the child and impose further risks in future pregnancies. Delaying pregnancy until advanced maternal age at childbirth has been suggested as contributing to the increase. The proportion of women giving birth at 35 years or above increased from 15% (1998) to 21% (2015). Advanced maternal age at childbirth has been found to be related to increased pre-pregnancy morbidity and associated risk factors that may contribute to an increased risk of cesarean section. The aim of this study was to examine the association between advanced maternal age and cesarean section in a Danish population and the influence of demographic, anthropometric, health, and obstetric factors on this association.MethodsThis study draws on a national population-based cohort study of all Danish births between 1998 and 2015 (N = 1,122,964). Maternal age less than 30 years serves as reference with the following age categories: (30–34 years); (35–39 years), and (40 years and above). The primary outcome was a cesarean section. Multivariate regression models with adjustment for demographic, health, pregnancy, fetal, and obstetric characteristics were performed with the results further stratified by parity.ResultsIn general, a positive association between advanced maternal age and cesarean section was found. Only minor changes in the risk estimate occurred after adjustment for relevant confounders. In comparison with the reference category, nulliparous women aged 35-39- years had twice the risk for cesarean section (adjusted odds ratio (AOR) 2.18, 95% confidence interval (CI) [2.11–2.26]) whereas for women of 40 years or above, the risk was more than tripled (AOR 3.64, 95% CI [3.41–3.90]). For multiparous women aged 35-39-years the risk was more moderate, but still with an AOR of 1.56, 95% CI [1.53–1.60], and for those 40 years and above, the AOR was 2.02, 95% CI [1.92–2.09].ConclusionsOverall, cesarean section increased with increasing maternal age. Adjustment for maternal and obstetric risk factors had only a minor influence on the association. The association was stronger in nulliparous women compared to multiparous women. Given the lack of impact of demographic and health risks on the relationship between maternal age and cesarean section, the authors suggest obstetric culture could be added to the list of risk factors for a cesarean. Future research on obstetric culture is recommended as are studies on a possible age-related decrease in the ability to maintain the progression of labor.Trial registrationThe study uses depersonalized register data and has been approved by the Danish Data Protection Agency (2015-41-4168).

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“…Despite an abundance of data presented in narrative reviews regarding a general decline in successful ART procedures with advancing age, there is some lack of concrete data which would allow a robust conclusion to be drawn regarding a specific cut-off point at which critical decisions might be made for management of patients in the AMA category. This discrepancy of evidence is attributed to the fact that the majority of published studies compares cohorts of patients employing "age boxes" described by a large range in age frames between 30 and 35, 35 and 39 or above 40 [3][4][5]8,19,21,25].…”

Section: Discussionmentioning

confidence: 99%

“…A plethora of published data suggests that AMA exerts a negative impact on pregnancy outcomes accompanied with poor prognosis, both of which are associated with a variety of complications during both the gestational and delivery stage [3][4][5][6][7][8][9][10]. In addition, women over 35 report poorer results during In Vitro Fertilization (IVF) treatment due to inadequate ovarian stimulation as well as a lower embryo implantation rate [11,12].…”

Section: Introductionmentioning

confidence: 99%

Could the Age Difference of a Single Calendar Year between Patients Undergoing IVF at 34, 35 or at 36 Years Old Affect the IVF Outcome? A Retrospective Data Analysis

Pantos¹,

Sfakianoudis²,

Grigoriadis

et al. 2020

Medicina

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Background and Objectives: Clinicians are called to overcome age-related challenges in decision making during In Vitro Fertilization (IVF) treatment. The aim of this study was to investigate the possible impact of a single calendar year difference among patients aged 34, 35 and 36 on IVF outcomes. Materials and Methods: Medical records between 2008 and 2019 were analyzed retrospectively. The study group consisted of women diagnosed with tubal factor infertility. Sample size was divided in three categories at 34, 35 and 36 years of age. Embryo transfer including two blastocysts was performed for every patient. Comparisons were performed regarding hormonal profile, response to stimulation, quality of transferred embryos, positive hCG test and clinical pregnancy rate. Results: A total of 706 women were eligible to participate. Two-hundred and forty-eight women were 34, 226 were 35 while the remaining 232 were 36 years old. Regarding the hormonal profile, the number of accumulated oocytes and the quality of embryos transferred, no statistically significant difference was documented between the three age groups. Women aged 34 and 35 years old indicated a significantly increased positive hCG rate in comparison to women aged 36 years old (p-value = 0.009, p-value = 0.023, respectively). Women aged 34 and 35 years old presented with a higher clinical pregnancy rate in comparison to those aged 36 years old (p-value = 0.04, p-value = 0.05, respectively). Conclusion: A calendar year difference between patients undergoing IVF treatment at 34 or 35 years of age does not appear to exert any influence regarding outcome. When treatment involves patients above the age of 35, then a single calendar year may exert considerable impact on IVF outcome. This observation indicates that age 35 may serve as a valid cut-off point regarding IVF outcome.

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Advanced maternal age and its association with placenta praevia and placental abruption: a meta-analysis

Cited by 57 publications

References 40 publications

Impact of aging on obstetric outcomes: defining advanced maternal age in Barcelona

Impact of aging on obstetric outcomes: defining advanced maternal age in Barcelona

Cesarean section on a rise—Does advanced maternal age explain the increase? A population register-based study

Could the Age Difference of a Single Calendar Year between Patients Undergoing IVF at 34, 35 or at 36 Years Old Affect the IVF Outcome? A Retrospective Data Analysis

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