Advanced maternal age as a risk factor for adverse maternal and perinatal outcomes

Authors

  • Maria Eugenia Carducci Servicio de Obstetricia, Hospital Italiano de Buenos Aires. Instituto Universitario del Hospital Italiano de Buenos Aires.
  • Gustavo Izbizky Servicio de Obstetricia, Hospital Italiano de Buenos Aires. Instituto Universitario del Hospital Italiano de Buenos Aires.

DOI:

https://doi.org/10.31053/1853.0605.v81.n1.41447

Keywords:

maternal age , pregnancy complications , pregnancy outcome , perinatal care

Abstract

Introduction: A progressive increase in the age of women at first pregnancy is observed, a situation that has been associated with a greater risk of adverse maternal and perinatal effects.

Objective: The aim of this study was to describe the characteristics and the maternal and perinatal outcomes of nulliparas of 40 years and older and compare them with those of nulliparas under 40.

Study design: This was a retrospective cohort analysis of a database of pregnancy population who had attended their deliveries in a private university hospital.

Results: An association was observed between maternal age ≥ 40 with the maternal compound adverse outcome (OR 1,3; 95% CI: 1,1-1,6), gestational diabetes (OR 3,6; 95% CI: 1,80-3,7), hypertensive disorders/preeclampsia (OR 2,2; 95% CI: 1,6-3,1) and postpartum hemorrhage (4,7; 95% CI: 1,2-16,3), with advanced maternal age persisting as an independent risk factor for the maternal compound adverse outcome (OR 1,3; 95% CI: 1,1 -1,6) and the perinatal compound adverse outcome (OR 1,40; 95% CI: 1,2-1,7) in the multivariate analysis. A higher rate of preterm birth was observed in the group of older nulliparas (OR 1,6; 95% CI: 1,3-2,0) with a higher requirement for admission to NICU for their newborns (OR 1,3; 95% CI: 1,0-1,8).

Conclusions: Women with advanced maternal age constitute a high-risk population, whose attention and follow-up would require a differential approach aiming to improve maternal and perinatal outcomes.

Downloads

Download data is not yet available.

Author Biographies

  • Maria Eugenia Carducci, Servicio de Obstetricia, Hospital Italiano de Buenos Aires. Instituto Universitario del Hospital Italiano de Buenos Aires.

    She is a doctor received from the Faculty of Medicine of the UBA with an Honors Diploma, specialist in Tocogynecology, subspecialist in Maternal Fetal Medicine, Master in Sexual and Reproductive Health (UNC) and master's candidate in Health Informatics. Professor assigned to the UBA and Assistant of Practical Works of the Tocogynecological Clinic of the University Institute of the Italian Hospital of Buenos Aires. She works as Coordinator of the Maternal Fetal Medicine Section at the Italian Hospital of San Justo.

  • Gustavo Izbizky, Servicio de Obstetricia, Hospital Italiano de Buenos Aires. Instituto Universitario del Hospital Italiano de Buenos Aires.

    He is a doctor received from the Faculty of Medicine of the UBA with an Honors Diploma, specialist in Tocogynecology, Master in Clinical Effectiveness (UBA). He carries out teaching tasks as Associate Professor of the Tocogynecological Clinic, University Institute of the Italian Hospital of Buenos Aires, and Authorized Teacher UBA. In the field of care, he works as a doctor at the Obstetrics Service Hospital Italiano de Buenos Aires, having been Acting Head of the Obstetrics Service Hospital Italiano de Buenos Aires. He has extensive experience in clinical research, having been Coordinator of the Ethics Committee of Research Protocols Hospital Italiano de Buenos Aires.

References

1. Comisión Económica para América Latina y el Caribe. Anuario Estadístico de América Latina y el Caribe 2017. (CEPAL). Santiago de Chile, 2018. Disponible en: https://hdl.handle.net/11362/43239

2. GBD 2015 Maternal Mortality Collaborators. Global, regional, and national levels of maternal mortality, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016 Oct 8;388(10053):1775-1812. doi: 10.1016/S0140-6736(16)31470-2. Erratum in: Lancet. 2017 Jan 7;389(10064):e1.

3. Matthews TJ, Hamilton BE. First births to older women continue to rise. NCHS Data Brief. 2014 May;(152):1-8.

4. Berkowitz GS, Skovron ML, Lapinski RH, Berkowitz RL. Delayed childbearing and the outcome of pregnancy. N Engl J Med. 1990 Mar 8;322(10):659-64. doi: 10.1056/NEJM199003083221004.

5. Laopaiboon M, Lumbiganon P, Intarut N, Mori R, Ganchimeg T, Vogel JP, Souza JP, Gülmezoglu AM; WHO Multicountry Survey on Maternal Newborn Health Research Network. Advanced maternal age and pregnancy outcomes: a multicountry assessment. BJOG. 2014 Mar;121 Suppl 1:49-56. doi: 10.1111/1471-0528.12659.

6. Dirección General de Estadísticas y Censos. Ministerio de Economía y Finanzas. Ciudad de Buenos Aires. La fecundidad en la Ciudad Autónoma de Buenos Aires: situación al año 2017 Informe de resultados 1334; El Ministerio 2019. Disponible en: https://www.estadisticaciudad.gob.ar/eyc/wp-content/uploads/2019/01/ir_2019_1334.pdf.

7. Dirección de Estadística e Información en Salud. Ministerio de Salud y Desarrollo de la Nación. Estadísticas vitales. Información básica Argentina - Año 2017. Serie 5 (61) 2018. Disponible en: https://www.argentina.gob.ar/sites/default/files/serie5nro61.pdf.

8. Lean SC, Derricott H, Jones RL, Heazell AEP. Advanced maternal age and adverse pregnancy outcomes: A systematic review and meta-analysis. PLoS One. 2017 Oct 17;12(10):e0186287. doi: 10.1371/journal.pone.0186287.

9. Ziadeh S, Yahaya A. Pregnancy outcome at age 40 and older. Arch Gynecol Obstet. 2001 Mar;265(1):30-3. doi: 10.1007/s004040000122.

10. Ben-David A, Glasser S, Schiff E, Zahav AS, Boyko V, Lerner-Geva L. Pregnancy and Birth Outcomes Among Primiparae at Very Advanced Maternal Age: At What Price? Matern Child Health J. 2016 Apr;20(4):833-42. doi: 10.1007/s10995-015-1914-8.

11. Richards MK, Flanagan MR, Littman AJ, Burke AK, Callegari LS. Primary cesarean section and adverse delivery outcomes among women of very advanced maternal age. J Perinatol. 2016 Apr;36(4):272-7. doi: 10.1038/jp.2015.204.

12. McCall SJ, Nair M, Knight M. Factors associated with maternal mortality at advanced maternal age: a population-based case-control study. BJOG. 2017 Jul;124(8):1225-1233. doi: 10.1111/1471-0528.14216.

13. Fitzpatrick KE, Tuffnell D, Kurinczuk JJ, Knight M. Pregnancy at very advanced maternal age: a UK population-based cohort study. BJOG. 2017 Jun;124(7):1097-1106. doi: 10.1111/1471-0528.14269.

14. Schwartz D, Mayaux MJ. Female fecundity as a function of age: results of artificial insemination in 2193 nulliparous women with azoospermic husbands. Federation CECOS. N Engl J Med. 1982 Feb 18;306(7):404-6. doi: 10.1056/NEJM198202183060706.

15. Haddow JE. Prenatal screening for open neural tube defects, Down's syndrome, and other major fetal disorders. Semin Perinatol. 1990 Dec;14(6):488-503.

16. Gluck O, Mizrachi Y, Bar J, Barda G. The impact of advanced maternal age on the outcome of twin pregnancies. Arch Gynecol Obstet. 2018 Apr;297(4):891-895. doi: 10.1007/s00404-018-4656-1.

17. Valent AM, Newman T, Chen A, Thompson A, DeFranco E. Gestational age-specific neonatal morbidity among pregnancies complicated by advanced maternal age: a population-based retrospective cohort study. J Matern Fetal Neonatal Med. 2016;29(9):1485-90. doi: 10.3109/14767058.2015.1051955.

18. Dirección de Estadística e Información en Salud. Ministerio de Salud y Desarrollo de la Nación. Estadísticas vitales. Información básica Argentina - Año 2015. Serie 5 (59) 2016. Disponible en: https://www.argentina.gob.ar/sites/default/files/boletinnro154xlugarderesidencia.pdf.

19. Osmundson SS, Gould JB, Butwick AJ, Yeaton-Massey A, El-Sayed YY. Labor outcome at extremely advanced maternal age. Am J Obstet Gynecol. 2016 Mar;214(3):362.e1-7. doi: 10.1016/j.ajog.2015.09.103.

20. Dietl A, Cupisti S, Beckmann MW, Schwab M, Zollner U. Pregnancy and Obstetrical Outcomes in Women Over 40 Years of Age. Geburtshilfe Frauenheilkd. 2015 Aug;75(8):827-832. doi: 10.1055/s-0035-1546109.

21. Jahromi BN, Husseini Z. Pregnancy outcome at maternal age 40 and older. Taiwan J Obstet Gynecol. 2008 Sep;47(3):318-21. doi: 10.1016/S1028-4559(08)60131-X.

22. Mills M, Rindfuss RR, McDonald P, te Velde E; ESHRE Reproduction and Society Task Force. Why do people postpone parenthood? Reasons and social policy incentives. Hum Reprod Update. 2011 Nov-Dec;17(6):848-60. doi: 10.1093/humupd/dmr026.

23. Lemoine ME, Ravitsky V. Sleepwalking Into Infertility: The Need for a Public Health Approach Toward Advanced Maternal Age. Am J Bioeth. 2015;15(11):37-48. doi: 10.1080/15265161.2015.1088973.

24. Solimano A. Comisión Económica para América Latina y el Caribe. The middle class and the development process. Serie Macroeconomía del Desarrollo, (65). CEPAL. Santiago de Chile; 2008. Disponible en: https://hdl.handle.net/11362/5432.

25. Schimmel MS, Bromiker R, Hammerman C, Chertman L, Ioscovich A, Granovsky-Grisaru S, Samueloff A, Elstein D. The effects of maternal age and parity on maternal and neonatal outcome. Arch Gynecol Obstet. 2015 Apr;291(4):793-8. doi: 10.1007/s00404-014-3469-0.

26. ACOG Committee on Practice Bulletins--Obstetrics. ACOG practice bulletin. Diagnosis and management of preeclampsia and eclampsia. Number 33, January 2002. Obstet Gynecol. 2002 Jan;99(1):159-67. doi: 10.1016/s0029-7844(01)01747-1.

27. Sheen JJ, Wright JD, Goffman D, Kern-Goldberger AR, Booker W, Siddiq Z, D'Alton ME, Friedman AM. Maternal age and risk for adverse outcomes. Am J Obstet Gynecol. 2018 Oct;219(4):390.e1-390.e15. doi: 10.1016/j.ajog.2018.08.034.

28. Cnattingius S, Forman MR, Berendes HW, Isotalo L. Delayed childbearing and risk of adverse perinatal outcome. A population-based study. JAMA. 1992 Aug 19;268(7):886-90.

29. Clark SL, Miller DD, Belfort MA, Dildy GA, Frye DK, Meyers JA. Neonatal and maternal outcomes associated with elective term delivery. Am J Obstet Gynecol. 2009 Feb;200(2):156.e1-4. doi: 10.1016/j.ajog.2008.08.068.

30. ACOG committee opinion no. 561: Nonmedically indicated early-term deliveries. Obstet Gynecol. 2013 Apr;121(4):911-915. doi: 10.1097/01.AOG.0000428649.57622.a7.

Published

2024-03-27

Issue

Section

Original Papers

How to Cite

1.
Carducci ME, Izbizky G. Advanced maternal age as a risk factor for adverse maternal and perinatal outcomes. Rev Fac Cien Med Univ Nac Cordoba [Internet]. 2024 Mar. 27 [cited 2024 Nov. 18];81(1):24-39. Available from: https://revistas.unc.edu.ar/index.php/med/article/view/41447

Similar Articles

31-40 of 912

You may also start an advanced similarity search for this article.