The Oldest Gravidas: A Review of Pregnancy Risks in Women Over 45

Salmeen, Kirsten; Zlatnik, Marya G.

doi:10.1097/ogx.0b013e318239125b

Cited by 8 publications

(4 citation statements)

References 51 publications

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“…The absolute rates and ORs were lower after adjustment for demographic and pre-pregnancy factors but remained elevated for sepsis among teenage mothers and for all other morbidities among older women. Our results confirm that perinatal mortality and neonatal morbidity are elevated among teenage mothers and older mothers, as compared with mothers aged 25–29 y [22–25]. The association between teenage motherhood and most adverse perinatal outcomes disappeared after adjustment for maternal demographic factors, with the exception of the neonatal death rate, which remained 50% higher.…”

Section: Discussionsupporting

confidence: 80%

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

et al. 2017

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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. ...

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Section: Discussionsupporting

confidence: 80%

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

et al. 2017

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“…This trend has resulted in a progressive shift of deliveries to the 30-39-year age group and around a quarter of twin birth rates are now attributable to reproductively ageing women. Older maternal age (>45 years) is associated with poorer pregnancy outcomes (Bewley et al, 2009;Johnson and Tough, 2012;Salmeen and Zlatnik, 2011;Usta and Nassar, 2008) in particular due to hypertensive disorders (Chibber, 2005;Kort et al, 2012). Advancing age is naturally associated with an increased incidence of chronic diseases such as severe chronic hypertension, cardiac diseases and diabetes (Naeye, 1983) and thus older women who undergo assisted reproduction treatment are more likely to start their pregnancy with a chronic medical condition (Laskov et al, 2012;Schieve et al, 2007;Segev et al, 2011).…”

Section: Maternal Antenatal Care In Assistedreproduction Twin Pregnanciesmentioning

confidence: 99%

Do assisted-reproduction twin pregnancies require additional antenatal care?

Jauniaux

Ben‐Ami

Maymon

2013

Reproductive BioMedicine Online

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Iatrogenic twinning has become the main side-effect assisted reproduction treatment. We have evaluated the evidence for additional care that assisted-reproduction twins may require compared with spontaneous twins. Misacarriages are increased in women with tubal problems and after specific treatments. Assisted-reproduction twin pregnancies complicated by a vanishing twin after 8 weeks have an increased risk of preterm delivery and of low and very low birthweight compared with singleton assisted-reproduction pregnancies. Monozygotic twin pregnancies occur at a higher rate after assisted reproduction treatment and are associated with a higher risk of perinatal complications. The incidence of placenta praevia and vasa praevia is increased in assisted-reproduction twin pregnancies. Large cohort studies do not indicate a higher rate of fetal congenital malformations in assisted-reproduction twins. Overall, assisted-reproduction twins in healthy women <45 years of age are not associated with a notable increase in antenatal complication rates and thus do not require additional antenatal care compared with spontaneous twins. The risks of maternal and fetal morbidity and mortality associated with assisted-reproduction twins is only increased in women with a pre-existing medical condition such as hypertensive disorders and diabetes and most of these risks can be avoided with single-embryo transfer. Following the birth of the first IVF baby, rumours started to spread in both the medical literature and the media about the long-term health effects for children born following assisted reproduction treatment. However, after more than 30 years, the most common complications associated with IVF treatment remain indirect and technical such as the failure of treatment and ovarian hyperstimulation. Iatrogenic twinning has become the main side-effect of assisted reproduction treatment and the increasing number of twin pregnancies, in particular in older women, has generated numerous debates on the need for additional healthcare provision. In this review, we have evaluated the evidence for additional care that assisted-conception twin pregnancies may require compared with spontaneous twin pregnancies. Twin pregnancies are obviously at higher risk of perinatal complications than singletons due to a natural increase in the incidence of fetal anomalies, antenatal disorders and obstetric and neonatal complications associated with the development of two fetuses instead of one. Overall, our review indicates that some antenatal complications are more frequent in assisted-conception twin pregnancies than in spontaneous twin pregnancies but their prevalence is low and thus their impact on the morbidity and mortality of an individual assisted-conception twin pregnancy is limited. Assisted reproduction treatment has become available to older women with pre-existing maternal medical conditions such as chronic hypertension and diabetes. The increased obstetrical risks in this population must be considered prior to attempts at assisted conception, a...

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“…[22][23][24] In fact, while there is higher education of caregivers about the early rehabilitation of the orbital cavities with anophthalmia or microphthalmia, it cannot be excluded that we observed an actually higher rate of ocular malformations, which could be the result of increasing maternal age and increasing risk factors in the gestation period. 25 To conclude, our study emphasizes the need and importance of creating a register of ocular prosthesis wearers to provide healthcare and policy makers with crucial information to actuate the necessary interventions for reducing risks, and the socio-economic and psychological impact of events leading to the application of an ocular prosthesis.…”

Section: Epidemiology Of Ocular Prosthesesmentioning

confidence: 99%

Ocular prostheses in the last century: a retrospective analysis of 8018 patients

Modugno¹,

Mantelli

Sposato

et al. 2013

Eye

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Purpose To analyze the clinical characteristics of patients with ocular prosthesis to assess the causes of eye loss in the different genders and age groups, and their incidence over the years. Methods We retrospectively examined the rates of ocular prosthesis application and related causes in the period from 1927 to 2011 in a referral center in Rome, Italy, and compared them over time. We also compared the results within the population in terms of age and gender. Results Of 8018 ocular prosthesis wearers, 63% were males and 37% were females, with a mean age of 29 years. The most frequent cause of ocular prosthesis application was a traumatic event (54%), with work-related eye injuries being the most frequent single cause of ocular trauma reported. Other frequent causes were end-stage ocular diseases, tumors, and malformations, without significant differences in gender. Tumors and malformations showed a slight increasing trend over time, while end-stage ocular diseases and work-related injuries remained unchanged, and other traumatic events decreased. Conclusion The constantly high frequency of ocular prosthesis application for work-related injuries and end-stage ocular diseases suggests that preventive measures for these events have not been addressed accordingly, and might represent a neglected public-health issue.

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The Oldest Gravidas: A Review of Pregnancy Risks in Women Over 45

Cited by 8 publications

References 51 publications

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

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

Do assisted-reproduction twin pregnancies require additional antenatal care?

Ocular prostheses in the last century: a retrospective analysis of 8018 patients

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