Maternal age and risk for adverse outcomes

Sheen, Jean‐Ju; Wright, Jason D.; Goffman, Dena; Kern-Goldberger, Adina R.; Booker, Whitney A.; Siddiq, Zainab; D’Alton, Mary E.; Friedman, Alexander M.

doi:10.1016/j.ajog.2018.08.034

Cited by 150 publications

(105 citation statements)

References 19 publications

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“…As the number of vAMA women increases, the impact of vAMA on birth outcomes remains underappreciated. A recent retrospective cohort study examined the risk for severe maternal morbidity and pregnancy complications across maternal age during delivery hospitalizations in the U.S. between 2006 and 2015 [25]. The authors analyzed a total of 36,944,292 deliveries, and concluded that women aged ≥45 years old were at the highest risk for a broad range of adverse outcomes during delivery hospitalizations among all age groups, with an ARR of 3.46 (95% CI: 3.15–3.80) for severe maternal morbidity compared women aged 25–29.…”

Section: Discussionmentioning

confidence: 99%

Adverse maternal and neonatal outcomes among singleton pregnancies in women of very advanced maternal age: a retrospective cohort study

Chen

Shen

et al. 2019

BMC Pregnancy Childbirth

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BackgroundThere is an increasing prevalence of women who tend to delay childbirth until a very advanced age. However, there is sparse data regarding very advanced maternal age (vAMA) and the interplay between vAMA and assisted reproductive technology (ART) on adverse perinatal outcomes. The study aimed to assess the risk of adverse maternal and neonatal outcomes of vAMA women (≥43 years), and to investigate the effect of maternal age on adverse maternal and neonatal outcomes in ART pregnancies.MethodsData was obtained from a population-based retrospective cohort of women who delivered in Ontario, Canada, between April 1st, 2012 and March 31st, 2015. The adjusted relative risks (ARR) and 95% confidence intervals (CI) for adverse maternal and neonatal outcomes were estimated by using multivariate log-binomial regression models among age groups. All models were stratified by the utilization of ART (ART and spontaneous conceptions).ResultsWomen at vAMA had a higher risk of composite outcome comprised of preeclampsia, intrauterine growth retardation, stillbirth, and placental abruption than the younger counterparts (ARR = 1.38, 95% CI: 1.23–1.55 compared to mothers aged 20–34; ARR = 1.26, 95% CI: 1.12–1.42 compared to mothers aged 35–42). Increased risk of the primary outcome in ART compared to spontaneous conception was only observed in women aged 20–34 years (ARR = 1.24, 95% CI: 1.14–1.35). For women conceived with ART, the risk for the primary outcome significantly increased in women at vAMA (ARR = 1.29, 95% CI: 1.01–1.65 compared to mothers aged 20–34; ARR = 1.36, 95% CI: 1.06–1.74 compared to mothers aged 35–42).ConclusionWomen at vAMA have higher risks of adverse maternal and neonatal outcomes. Although the utilization of ART may carry an independent role for adverse perinatal outcomes, it does not further enhance the adverse effect of vAMA.Electronic supplementary materialThe online version of this article (10.1186/s12884-018-2147-9) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Adverse maternal and neonatal outcomes among singleton pregnancies in women of very advanced maternal age: a retrospective cohort study

Chen

Shen

et al. 2019

BMC Pregnancy Childbirth

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“…International and European studies with large samples use public health registers, thereby providing a lot of information on the characteristics of the population (5,10). However, this is often at the expense of information such as the type of delivery, the methods of neonatology care which are sometimes different in hospitals.…”

Section: Discussionmentioning

confidence: 99%

Pregnancy at 40 years Old and Above: Obstetrical, Fetal, and Neonatal Outcomes. Is Age an Independent Risk Factor for Those Complications?

et al. 2020

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Objectives: Maternal age has been increasing for several decades with many of these late pregnancies between 40 and 45 years old. The main objective of this study is to assess whether maternal age is an independent factor of obstetric, fetal, and neonatal complications. Patients and methods: A monocentric, French study "exposed-unexposed" was conducted during 11 years in a maternity level IIB. Maternal and perinatal outcomes were studied using univariates and multivariate analysis. We compared women aged 40 and above in a 1:1 ratio with women of 25-35 years old. Results: One thousand nine hundred eighty-two women were 40 or older (mean age: 41.9) on the day of their delivery and compared to other 1,982 women who were aged between 25 and 35 years old (mean age: 30.7) Preeclampsia, gestational diabetes, were significantly higher in the study group (4.6 vs. 1.5% and 14.5 vs. 6.9%, respectively, p < 0.001). We found also a significant difference for gestational hypertension (3.1 vs. 1.1% p < 0.001), preterm birth (10.4 vs. 6.5% p < 0.001), cesarean (16.6 vs. 5.4% for scheduled cesarean, and 50.4 vs. 13.9% for emergency cesarean, p < 0.001) and fetal death in utero (2.1 vs. 0.5% in the study group, p < 0.001). These results were also significantly different in multivariate analysis. Conclusion: A pregnancy after 40 years old is worth considering today as far as the risk factors are controlled and understand by the patient and the obstetrician. However, they have a significantly higher risks of cesarean, preterm delivery, pre-eclampsia, gestational diabetes, and fetal death in utero (FDIU). It is therefore the responsibility of the obstetrician to inform correctly these women in a detailed way, to reassure them and to adapt the monitoring of their pregnancy accordingly.

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“…In addition to diabetes and preeclampsia, as a result of the greater prevalence of hypertension and glicometabolic disorders related to advanced maternal age, the consequent development of cardiovascular adverse events such as PPCM, ischaemic events or arrythmias related to them has also increased. Indeed, two retrospective studies, carried out in the USA, the first between 1991 and 2003 and the second between 2006 and 2015, both observed severe maternal morbidity because of cardiac disease during delivery women aged of ≥45 years [36,37].…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular Outcomes in Advanced Maternal Age Delivering Women. Clinical Review and Medico-Legal Issues

et al. 2019

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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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Maternal age and risk for adverse outcomes

Cited by 150 publications

References 19 publications

Adverse maternal and neonatal outcomes among singleton pregnancies in women of very advanced maternal age: a retrospective cohort study

Adverse maternal and neonatal outcomes among singleton pregnancies in women of very advanced maternal age: a retrospective cohort study

Pregnancy at 40 years Old and Above: Obstetrical, Fetal, and Neonatal Outcomes. Is Age an Independent Risk Factor for Those Complications?

Cardiovascular Outcomes in Advanced Maternal Age Delivering Women. Clinical Review and Medico-Legal Issues

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