Risk of Adverse Obstetric and Neonatal Outcomes by Maternal Age: Quantifying Individual and Population Level Risk Using Routine UK Maternity Data

Oakley, Laura; Penn, Nicole; Pipi, Maria; Oteng‐Ntim, Eugene; Doyle, Pat

doi:10.1371/journal.pone.0164462

Cited by 35 publications

(35 citation statements)

References 37 publications

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“…The different patterns can be attributed to the revision of reproductive policy in China which impacted the demographic characteristics of parturients over recent years. An increase in more mature parturients will inevitably increase the complications encountered, as AMA is known to increase the risk of hypertensive disorders in pregnancy, gestational diabetes mellitus (GDM), placenta previa, assisted vaginal delivery, CS, severe PPH, ICU admission and maternal mortality, as well as a number of perinatal morbidity including preterm birth, low birthweight and SGA infant, macrosomia and LGA infant, low AS at 5 min, NNU admission and neonatal mortality . These associations are confirmed in our study in the Chinese population.…”

Section: Discussionsupporting

confidence: 83%

“…In an official estimation, about 90 million couples are eligible for a second child, among whom about 60% are ≥35 years, and 50% are at or above 40 years . It is well established that AMA women have higher risk of adverse pregnancy outcomes including Cesarean section (CS), than non‐AMA women . Furthermore, China is among the countries with the highest CS rates worldwide according to a World Health Organization (WHO) global survey, and the high CS rate in the past two decades have resulted in numerous potential multiparous women with previous CS.…”

Section: Introductionmentioning

confidence: 99%

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Risk for Cesarean section in women of advanced maternal age under the changed reproductive policy in China: A cohort study in a tertiary hospital in southwestern China

Xie

Lao

et al. 2019

J of Obstet and Gynaecol

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Aim: To describe changed epidemiological features of advanced maternal age (AMA) and to examine the effect of AMA on the risk for Cesarean section (CS) in a Chinese pregnant population. Methods: This retrospective single-center cohort study investigated the changes of epidemiological features of AMA parturients with respect to the revised reproductive policy in China in 43 702 singleton deliveries with live birth at ≥28 weeks managed from January 2005 to December 2016. We also evaluated the pregnancy outcomes in different age groups and risk factors of CS with multivariate analysis. Results: In this 12-year study period, the average maternal age increased from 28.5 to 30.2 years, and the proportion of AMA raised from 6.5% to 17.2%. AMA was significantly associated with increased risk of adverse pregnancy outcomes, and after adjustment for confounding factors, AMA remained a significant independent risk factor for CS. Furthermore, the effect of AMA in nulliparous women on the risk of CS was more significant than in multiparous women, while the history of previous CS (adjusted odds ratio 39.85) and interdelivery interval ≥10 years (adjusted odds ratio 1.52) also increased the risk of CS in multiparous women. Conclusion: AMA increased the risk of a number of adverse pregnancy outcomes, and was independently associated with increased risk for CS. The increasing number of AMA parturients with risk factors is likely to increase CS rate in China in the near future, thus it is imperative to reduce the rate of primary CS as a matter of policy.

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Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

Risk for Cesarean section in women of advanced maternal age under the changed reproductive policy in China: A cohort study in a tertiary hospital in southwestern China

Xie

Lao

et al. 2019

J of Obstet and Gynaecol

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“…The literature describes maternal age at the extremes of reproductive life as a risk factor for complications in pregnancy (6,11) . A study of 468 patients who had abnormal umbilical cord insertion found a mean age of 36.5 ± 12.4 years and a mean gestational age of 21.83 ± 7.1 weeks (2) .…”

Section: Discussionmentioning

confidence: 99%

“…GH causes a significant impact on the health of the mother and the fetus/neonate, since it leads to placental insufficiency (11) . Women with GH more often present a decrease in the umbilical cord length than women without it (13) .…”

Section: Discussionmentioning

confidence: 99%

“…In a study that aimed to determine morphometric parameters of the umbilical cord, the mean calculated gestational age was 33.7 ± 5.8 weeks (7) . Women with GH are predisposed to a shorter gestational period (12) , findings that resemble our results considering that 28 (22.22%) of the women with high-risk pregnancies had a gestational age of less than 37 weeks.GH causes a significant impact on the health of the mother and the fetus/neonate, since it leads to placental insufficiency (11) . Women with GH more often present a decrease in the umbilical cord length than women without it (13) .…”

mentioning

confidence: 99%

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Associação entre as características macroscópicas do cordão umbilical, gestação de alto risco e repercussões neonatais

Salge

Reis

Siqueira

et al. 2018

Rev. esc. enferm. USP

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Objective:To verify the association between the macroscopic characteristics of the umbilical cord, high-risk pregnancy and neonatal repercussions. Method: A crosssectional study carried out from January 2012 to January 2015 in a public maternity hospital in Goiânia/GO. The study population consisted of 126 recent puerperal women with diagnosis of high-risk pregnancy, and 139 clinically normal women (control group). Macroscopic features of the umbilical cord, maternal, fetal and neonatal diseases, gestational age, Apgar score, birth weight, head circumference and parity were evaluated. Data were descriptively analyzed. Results: 265 puerperal women and their respective newborns participated in the study. The most frequent characteristics of the umbilical cord of those with high-risk pregnancy and those from the control group were the absence of true knots (97.6% and 2.4%, respectively), length between 35 and 70 centimeters and paracentral insertion (81.7% and 18.3%). A statistical difference was observed between the high-risk pregnancy group and extremes of maternal age (p=0.004). Conclusion:The analysis and description of the characteristics of the umbilical cord carried out by the nurse lend important information about the neonatal prognosis. This evaluation subsidizes clinical practice and seeks to ensure the safety of the (mother-baby) binomial throughout the perinatal period. DESCRIPTORS INTRODUCTIONIn the gestational process, the line between normality and disease is extremely thin and the imbalance represents a high risk of maternal-fetal morbidity and mortality (1)(2) . About 20% of pregnancies have some type of complication (3) . Thus, women with alterations during pregnancy constitute a group known as "high-risk pregnant women"; a small number of pregnant women who have specific characteristics or because they suffer some injury are more likely to develop an unfavorable pregnancy (4) . In Brazil, high-risk pregnancies occur in 10% to 20% of the cases and are related to the occurrence of some disorders, the most frequent of which are gestational hypertension (GH) and gestational diabetes mellitus (GDM) (5) . Nearly 3/4 of maternal deaths in the world occur due to direct obstetric causes, and among them deaths due to hypertensive disorders represent about 14% (6) . There is a close relationship between placenta/umbilical cord, fetus and the change in its functions, as in the cases of GH and GDM. This relationship establishes different patterns of pregnancy outcomes and also the evolution of fetal and/or maternal injury (3) . The umbilical cord is an essential structure for maintenance of intrauterine life, and it can be used for assessing adverse perinatal conditions, thus contributing to a good neonatal prognosis (7) . This evaluation is performed through the macroscopic identification of umbilical cord alterations, and could, for example, elucidate causes of perinatal hypoxia which are not evidenced in the clinic, thus providing a better understanding of the physiopathogenesis of fetal events.I...

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A population‐based study of the relationship between advanced maternal age and premature/early‐term birth in Brazil

Gama

Martinelli

Dias

et al. 2021

Intl J Gynecology & Obste

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Objective To verify whether advanced maternal age (AMA), defined as women of ≥35 years, is associated with premature and early‐term birth in Brazil, according to the onset of labor (spontaneous or provider‐initiated). Methods Cross‐sectional population‐based study. The “Birth in Brazil” study interviewed 23 894 puerperal women between 2011 and 2012, in all regions of Brazil. The current analysis included 17 994 adult mothers and their newborns (15 448 aged between 20–34 years, and 2536 ≥ 35 years). A propensity score was used to assess the likelihood of AMA women giving birth to premature or early‐term infants (spontaneous or provider‐initiated) compared to women aged 20–34 years. To balance the groups, we used maternal, prenatal, and childbirth characteristics. Results The general prematurity rate was 10.24%, of which the majority of births were spontaneous (55.73%). Conversely, early‐term births were more often provider‐initiated (54.81%). AMA did not increase the chance of premature births, whether spontaneous or provider‐initiated. However, AMA was associated with a higher rate of provider‐initiated early‐term birth (OR = 1.48; 95% CI: 1.23–1.77). Conclusion AMA alone does not contribute to premature birth; AMA’s independent association with provider‐initiated early‐term birth may not be based solely on clinical indications.

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Risk of Adverse Obstetric and Neonatal Outcomes by Maternal Age: Quantifying Individual and Population Level Risk Using Routine UK Maternity Data

Cited by 35 publications

References 37 publications

Risk for Cesarean section in women of advanced maternal age under the changed reproductive policy in China: A cohort study in a tertiary hospital in southwestern China

Risk for Cesarean section in women of advanced maternal age under the changed reproductive policy in China: A cohort study in a tertiary hospital in southwestern China

Associação entre as características macroscópicas do cordão umbilical, gestação de alto risco e repercussões neonatais

A population‐based study of the relationship between advanced maternal age and premature/early‐term birth in Brazil

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