Maternal age and severe maternal morbidity: A population-based retrospective cohort study

Abstract

BackgroundOne of the United Nations’ Millennium Development Goals of 2000 was to reduce maternal mortality by 75% in 15 y; however, this challenge was not met by many industrialized countries. As average maternal age continues to rise in these countries, associated potentially life-threatening severe maternal morbidity has been understudied. Our primary objective was to examine the associations between maternal age and severe maternal morbidities. The secondary objective was to compare these associations with those for adverse fetal/infant outcomes.Methods and findingsThis was a population-based retrospective cohort study, including all singleton births to women residing in Washington State, US, 1 January 2003–31 December 2013 (n = 828,269).We compared age-specific rates of maternal mortality/severe morbidity (e.g., obstetric shock) and adverse fetal/infant outcomes (e.g., perinatal death). Logistic regression was used to adjust for parity, body mass index, assisted conception, and other potential confounders. We compared crude odds ratios (ORs) and adjusted ORs (AORs) and risk differences and their 95% CIs.Severe maternal morbidity was significantly higher among teenage mothers than among those 25–29 y (crude OR = 1.5, 95% CI 1.5–1.6) and increased exponentially with maternal age over 39 y, from OR = 1.2 (95% CI 1.2–1.3) among women aged 35–39 y to OR = 5.4 (95% CI 2.4–12.5) among women aged ≥50 y. The elevated risk of severe morbidity among teen mothers disappeared after adjustment for confounders, except for maternal sepsis (AOR = 1.2, 95% CI 1.1–1.4). Adjusted rates of severe morbidity remained increased among mothers ≥35 y, namely, the rates of amniotic fluid embolism (AOR = 8.0, 95% CI 2.7–23.7) and obstetric shock (AOR = 2.9, 95% CI 1.3–6.6) among mothers ≥40 y, and renal failure (AOR = 15.9, 95% CI 4.8–52.0), complications of obstetric interventions (AOR = 4.7, 95% CI 2.3–9.5), and intensive care unit (ICU) admission (AOR = 4.8, 95% CI 2.0–11.9) among those 45–49 y. The adjusted risk difference in severe maternal morbidity compared to mothers 25–29 y was 0.9% (95% CI 0.7%–1.2%) for mothers 40–44 y, 1.6% (95% CI 0.7%–2.8%) for mothers 45–49 y, and 6.4% for mothers ≥50 y (95% CI 1.7%–18.2%). Similar associations were observed for fetal and infant outcomes; neonatal mortality was elevated in teen mothers (AOR = 1.5, 95% CI 1.2–1.7), while mothers over 29 y had higher risk of stillbirth. The rate of severe maternal morbidity among women over 49 y was higher than the rate of mortality/serious morbidity of their offspring. Despite the large sample size, statistical power was insufficient to examine the association between maternal age and maternal death or very rare severe morbidities.ConclusionsMaternal age-specific incidence of severe morbidity varied by outcome. Older women (≥40 y) had significantly elevated rates of some of the most severe, potentially life-threatening morbidities, including renal failure, shock, acute cardiac morbidity, serious complications of obstetric interventions, and ICU admission. ...

Severe maternal morbidity during delivery hospitalisation in a large international administrative database, 2008–2013: a retrospective cohort

“…Given the differences in the trends in these comorbidities, as well as their known contribution to severe maternal morbidity from previous studies, they were included as confounders in our adjusted models. [10][11][12][13][14][15] Table 3 shows the adjusted OR and 95% CI of SMM excluding transfusions by country and risk factor. For all countries, advanced maternal age, hypertension, diabetes, and substance abuse were strongly associated with SMM.…”

“…Multiple logistic regression was used to estimate odds ratios (OR) and respective 95% confidence intervals (CI) of severe maternal morbidity for each country while adjusting for age, obesity, hypertension, diabetes, drug and alcohol use, and year. [10][11][12][13][14][15] We examined variables that existed within the data set that were known to be strongly associated with severe maternal morbidity. Models were created in a stepwise fashion.…”

“…Using the ICD-9-CM and ICD-10 Coding Algorithms for Elixhauser Comorbidities, we looked at the incidence of common maternal co-morbidities known to be associated with severe maternal morbidity, which included: obesity, hypertension, diabetes, and drug and alcohol use. [10][11][12][13][14][15] The Elixhauser indices are the most commonly used comorbidity indices using administrative data and have previously been examined within the GC dataset. 16 Of note, these indices include codes for pregnancy-induced morbidities such as gestational diabetes and pre-eclampsia.…”

Variation in competent and respectful delivery care in Kenya and Malawi: a retrospective analysis of national facility surveys

“…Younger women and those giving birth for the first time received higher‐quality care than women aged over 35. This finding is particularly concerning given that older women are at higher risk for complications than the 20–35 age group . Providers may believe that older women and those with previous childbirths require less attention and support since they are presumed to be experienced in childbirth.…”

Atenção Nutricional Às Gestantes De Baixo Risco: Contribuições Para as Políticas Públicas

“…Os dados supracitados constituem fatores de risco para desfechos perinatais ruins, ainda, repercutem negativamente no consumo de alguns alimentos em detrimento de outros, nas condições de vida e saúde, já que baixa escolaridade leva maior dificuldade em compreender os cuidados com a saúde da gestante acarretando início tardio do pré-natal ou ausência dele, alimentação e hábitos de vida inadequados 7 . Por outro lado, a presença paterna favorece o desenvolvimento de uma gestação confortável, por transmitir segurança e divisão e/ou compartilha das dificuldades e das responsabilidades desta fase 18 .…”