Outcomes in Multiple Gestation Pregnancies among Canadian Women Age 35 Years and Older

Abstract

Multiple gestations are associated with an increased risk of maternal morbidity and mortality independent of maternal age. Previous reports by the Canadian Institute for Health Information established the overall association between advanced maternal age and complications related to pregnancy and childbirth. This article takes a more focused look at the association between advanced maternal age and maternal outcomes in multiple gestation pregnancies. We found, for mothers aged 35 years and older carrying multiples -after adjusting for mothers' parity, neighbourhood income and residence (rural/urban) -an increased risk of pregnancy complications including pre-existing hypertension, gestational hypertension, pre-eclampsia/eclampsia, gestational diabetes and placenta previa and an increased risk for Caesarean delivery. M ultiple gestations are pregnancies in which more than one fetus develops simultaneously in the mother's womb, with the subsequent delivery of multiple neonates. Rates of multiple births have been increasing in the past three decades in industrialized countries (Urquia et al. 2006). In Canada, the rate of multiple births rose by 18% between 199318% between and 200218% between (Qiu et al. 2008 and by 32% between 2000 (Statistics Canada 2009b.Like other developed countries, the average maternal age in Canada has been increasing as more babies are born to women aged 35 years and older. Between 1998 and 2007, the proportion of live births in this age group rose by more than 20% (Statistics Canada 2009a).Mother's age accounts for about one third of the increase in multiple pregnancies as women of advanced maternal age are physiologically more likely to have multiples (Beemsterboer et al. 2006;Martin et al. 2009). The remaining growth in the rate of multiples has been attributed to the availability of assisted reproductive technologies (Martin and Park 1999). Since women 35 years old and over may face difficulty conceiving, they are more likely to undergo fertility treatment, which, in turn, increases the chance of multiple gestations.To date, most research on the impact of advanced maternal age has not focused on multiple gestations. In this study, we examined the characteristics of mothers with multiple gestations and explored the association between advanced maternal age and adverse pregnancy complications and delivery interventions. Data Sources and MethodsThe study population was mothers 20 years of age and older with multiple gestations. All records of maternal delivery leading to multiple live births in Canadian hospitals between fiscal years 2006-2007 and 2008-2009 were included. Data were from the Canadian Institute for Health Information (CIHI) Discharge Abstract Database (DAD) and Fichier des hospitalisations MED-ÉCHO, ministère de la Santé et des Services sociaux du Québec. All maternal records were selected based on the discharge date.Multiple gestations were defined as delivery leading to two or more births in the same episode. Mothers 20-34 years of age with multiples made up o...

Maternal complications in twin pregnancies in Finland during 1987–2014: a retrospective study

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Early Diagnosis of Preeclampsia

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