The trend in delayed childbearing and its potential consequences on pregnancy outcomes: a single center 9-years retrospective cohort study in Hubei, China

Abstract

Background Due to the advancement of modern societies, the proportion of women who delay childbearing until or beyond 30 years has dramatically increased in the last three decades and has been linked with adverse maternal-neonatal outcomes. Objective To determine the trend in delayed childbearing and its negative impact on pregnancy outcomes. Material and methods A tertiary hospital-based retrospective study was conducted in Wuhan University Renmin Hospital, Hubei Province, China, during the years 2011–2019. The joinpoint regression analysis was used to find a trend in the delayed childbearing and the multiple binary logistic regression model was used to estimate the association between maternal age and pregnancy outcomes. Results Between 2011 and 2019, the trend in advanced maternal age (AMA ≥35 years) increased by 75% [AAPC 7.5% (95% CI: − 10.3, 28.9)]. Based on maternal education and occupation, trend in AMA increased by 130% [AAPC 11.8% (95% CI: 1.1, 23.7)] in women of higher education level, and 112.5% [AAPC 10.1% (95% CI: 9.4, 10.9)] in women of professional services. After adjusting for confounding factors, AMA was significantly associated with increased risk of gestational hypertension (aOR 1.5; 95% CI: 1.2, 2.1), preeclampsia (aOR 1.6; 95% CI: 1.4, 1.9), sever preeclampsia (aOR 1.7; 95% CI: 1.1, 2.6), placenta previa (aOR 1.8; 95% CI: 1.5, 2.2), gestational diabetes mellitus (aOR 2.5; 95% CI: 2.3, 2.9), preterm births (aOR 1.6; 95% CI: 1.4, 1.7), perinatal mortality (aOR 1.8; 95% CI: 1.3, 2.3), and low birth weight (aOR 1.3; 95% CI: 1.2, 1.4) compared with women aged < 30 years. Conclusion Our findings show a marked increase in delayed childbearing and its negative association with pregnancy outcomes.

Effect of the interaction between advanced maternal age and pre-pregnancy BMI on pre-eclampsia and GDM in Central China

“…A study in Hubei, China, found that the trend of advanced maternal age (age ≥35) increased by 75% from 2011 to 2019, and noted that advanced maternal age was associated with an increased risk of pre-eclampsia (OR=1.6) and GDM (OR=2.5) after adjusting for confounding factors. 29 Shan et al found that the risk of pre-eclampsia increased dramatically with maternal age. In addition, older pregnant women have a twofold to threefold risk of being diagnosed with GDM.…”

“…In different racial and ethnic groups, many epidemiological studies have reported positive associations between advanced maternal age and pre-eclampsia and GDM, which was consistent with our findings. A study in Hubei, China, found that the trend of advanced maternal age (age ≥35) increased by 75% from 2011 to 2019, and noted that advanced maternal age was associated with an increased risk of pre-eclampsia (OR=1.6) and GDM (OR=2.5) after adjusting for confounding factors 29. Shan et al found that the risk of pre-eclampsia increased dramatically with maternal age.…”

Cumulus expansion is impaired with advanced reproductive age due to loss of matrix integrity and reduced hyaluronan

“…In addition, there is a concordant decrease in oocyte quality which is associated with increased infertility and miscarriage rates (Broekmans et al, 2009). The shift to delayed childbearing in recent decades is associated with adverse fertility and maternal‐neonatal outcomes including chromosomal abnormalities, birth defects, increased risk of morbidity and mortality, high risk of cesarean delivery, preeclampsia, and postpartum hemorrhage (Aoyama et al, 2019; Hook, 1981; Li et al, 2022; Sauer, 2015; Sheen et al, 2018). Therefore, understanding the mechanisms of female reproductive aging is key to establishing new strategies to extend ovarian reproductive and endocrinological longevity and to improve infertility treatment outcomes.…”

Recent Status of Pregnancies at an Advanced Maternal Age at a Japanese Perinatal Center

“…In Japan, it has also been presumed to be due to the trend of late marriage accompanying women's social advancement and the development of assisted reproductive technology (ART) [4]. However, AMA, especially for ages over 40, has been reported to be an independent risk factor for adverse obstetric outcomes [1,[5][6][7][8]. Most studies have agreed that AMA is related to an increase of adverse maternal and fetal outcomes such as preeclampsia, fetal growth restriction, prematurity, and cesarean delivery [1,[5][6][7][8].…”

“…However, AMA, especially for ages over 40, has been reported to be an independent risk factor for adverse obstetric outcomes [1,[5][6][7][8]. Most studies have agreed that AMA is related to an increase of adverse maternal and fetal outcomes such as preeclampsia, fetal growth restriction, prematurity, and cesarean delivery [1,[5][6][7][8].…”