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

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.

Analysis of individual-level and community-level effects on advanced maternal age pregnancy in Nigeria

“…This study examined individual and community effects on advanced maternal age pregnancy, a growing phenomenon with serious implications for maternal, neonatal and child morbidity and mortality [30,[16][17][18][19][20]. The study improved upon previous studies by examining the individual and contextual effects on AMA pregnancy which were largely ignored in most existing hospital-based studies [21-23, 25, 2, 26].…”

“…Two, the proportion of women delaying motherhood for the purpose of achieving education and career enhancement is steadily increasing in the country [15]. Irrespective of the reasons for AMA pregnancy across the world, AMA pregnancy is a safe motherhood issue worthy of further investigation because evidence abounds that AMA pregnancy elevates the risks of maternal, neonatal and child mortality [16][17][18][19][20]. In a number of countries, numerous studies have examined different aspects of AMA pregnancy [21][22][23][24][25][26].…”

Obstetrical and Perinatal Complications after Assisted Reproduction: what matters is age, not the procedure

“…One of the key factors regarding perinatal outcomes of pregnancies is the age of women. In Spain, mean maternal age at fi rst delivery has risen from 25,2 years in 1975 to 32,2 years in 2018 [13] through 30,7 in 2016 [12]. In 2018, 37,65% of deliveries were among mothers above 35 years and 7,79% over 40 years [12,13].…”

“…In Spain, mean maternal age at fi rst delivery has risen from 25,2 years in 1975 to 32,2 years in 2018 [13] through 30,7 in 2016 [12]. In 2018, 37,65% of deliveries were among mothers above 35 years and 7,79% over 40 years [12,13]. Diff erent factors such as diffi culties in conciliating, a delayed economic independence present in western countries are the responsible of the delayed motherhood.…”

“…However, other factors, such as advanced maternal age (over 35 years of age, AMA), could be related to these complications. During the last years, a steadily increase of maternal age has been observed worldwide [10][11][12][13]. In Spain, more than 37% and 8% of deliveries occurred in the AMA and very advanced age (over 40 years of age, VAMA) groups respectively [14].…”