Evaluation of risk factors’ importance on adverse pregnancy and neonatal outcomes in women aged 40 years or older

Abstract

BackgroundWomen of advanced age (40 years or older) are generally, at risk for pregnancy and delivery related problems. In addition, there is limited knowledge on being of advanced age and having been given Assisted Reproductive Treatment (ART) and its association with negative obstetric outcomes. Therefore, data from the Swedish Medical Birth Register was used to investigate pregnancy and neonatal outcomes for women aged 40 or more who had given birth. The secondary aim was to compare the obstetric outcomes of women who had used ART and women who had not undergone ART while adjusting for marital status across the age groups.MethodWomen of advanced age who had given birth in Sweden during 2007–2012 formed the index group, n = 37,558; a reference group of women comprised 71,472 women under the age of 40. An additional subgroup of women aged 45 or older when giving birth was also formed, n = 2229. The obstetric and neonatal data for all the women was derived from national register data.ResultsWomen of advanced age were more often single, had undergone ART, and more often experienced adverse obstetric outcomes than did younger women. The neonate’s health was also more often adversely affected expressed as being born with low birth weight and Small for Gestational Age (SGA), having lower Apgar scores, and having more health problems during the first week compared to the reference group.ConclusionsWomen who are approaching the upper limit of fecundity are at greater risk for having children who are preterm and SGA. The adverse effects of being preterm and SGA may have negative long-term effects, not only on the children but also on the mothers. This needs to be addressed more frequently in a clinical setting when advising women of all ages on pregnancy and ART treatment.

Effectiveness of telemedicine for pregnant women with gestational diabetes mellitus: an updated meta-analysis of 32 randomized controlled trials with trial sequential analysis

“…The location of the study may represent the inconsistency of scientific conditions and levels as well as various races of participants, resulting in heterogeneity among studies. Furthermore, the average age of pregnant women and the proportion of primipara can represent the physical and mental condition of pregnant women to some extent [55]. In addition, we found that WeChat interventions were more effective than other types of TM tools on more outcomes.…”

What has women’s reproductive health decision-making capacity and other factors got to do with pregnancy termination in sub-Saharan Africa? evidence from 27 cross-sectional surveys

“…For instance, Jolly et al [ 43 ] identified gestational diabetes mellitus as significantly common in the older age groups. Other studies have also found the risk of negative pregnancy outcomes among older women [ 44 – 47 ]. Ageing reproductive system and an ageing body have been identified as some of the factors that increase pregnancy-related risks in older women [ 48 ].…”

Mothers who have given birth at an advanced age - health status before and after childbirth

“…If this leads to a growth in the size of the single-parent-by choice group, further research on this group is needed. However, the results of our study indicate that health care needs to give more attention to the ever-growing population of single mothers, not just to any special subgroup (21,39,41).…”

“…The underestimation of the impact of age-related factors on female fertility and the overestimation of the use of ART in overcoming age-related infertility [48][49][50][51][52][53] probably contribute to the postponement of childbearing. The substantial risks for both the woman and the child associated with giving birth at advanced maternal age 21,39,54 call for appropriate physician counseling of older women who are considering ART 55 . It appears that education about fertility and infertility should be given a more prominent place in health programs focused on how to prevent sexually transmitted diseases and unwanted pregnancies in schools and health settings.…”