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Le Vu M, Matthes KL, Brabec M, Riou J, Skrivankova VW, Hösli I, Rohrmann S, Staub K. Health of singleton neonates in Switzerland through time and crises: a cross-sectional study at the population level, 2007-2022. BMC Pregnancy Childbirth 2024; 24:218. [PMID: 38528502 DOI: 10.1186/s12884-024-06414-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/12/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Being exposed to crises during pregnancy can affect maternal health through stress exposure, which can in return impact neonatal health. We investigated temporal trends in neonatal outcomes in Switzerland between 2007 and 2022 and their variations depending on exposure to the economic crisis of 2008, the flu pandemic of 2009, heatwaves (2015 and 2018) and the COVID-19 pandemic. METHODS Using individual cross-sectional data encompassing all births occurring in Switzerland at the monthly level (2007-2022), we analysed changes in birth weight and in the rates of preterm birth (PTB) and stillbirth through time with generalized additive models. We assessed whether the intensity or length of crisis exposure was associated with variations in these outcomes. Furthermore, we explored effects of exposure depending on trimesters of pregnancy. RESULTS Over 1.2 million singleton births were included in our analyses. While birth weight and the rate of stillbirth have remained stable since 2007, the rate of PTB has declined by one percentage point. Exposure to the crises led to different results, but effect sizes were overall small. Exposure to COVID-19, irrespective of the pregnancy trimester, was associated with a higher birth weight (+12 grams [95% confidence interval (CI) 5.5 to 17.9 grams]). Being exposed to COVID-19 during the last trimester was associated with an increased risk of stillbirth (odds ratio 1.24 [95%CI 1.02 to 1.50]). Exposure to the 2008 economic crisis during pregnancy was not associated with any changes in neonatal health outcomes, while heatwave effect was difficult to interpret. CONCLUSION Overall, maternal and neonatal health demonstrated resilience to the economic crisis and to the COVID-19 pandemic in a high-income country like Switzerland. However, the effect of exposure to the COVID-19 pandemic is dual, and the negative impact of maternal infection on pregnancy is well-documented. Stress exposure and economic constraint may also have had adverse effects among the most vulnerable subgroups of Switzerland. To investigate better the impact of heatwave exposure on neonatal health, weekly or daily-level data is needed, instead of monthly-level data.
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Affiliation(s)
- Mathilde Le Vu
- Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland
| | - Katarina L Matthes
- Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland
| | - Marek Brabec
- Institute of Computer Science of the Czech Academy of Sciences, Prague, Czech Republic
| | - Julien Riou
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Veronika W Skrivankova
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Irene Hösli
- Department of Obstetrics and Gynaecology, University Hospital of Basel, Basel, Switzerland
| | - Sabine Rohrmann
- Epidemiology, Biostatistics, and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Kaspar Staub
- Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland.
- Swiss School of Public Health (SSPH+), Zurich, Switzerland.
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Saccone G, Gragnano E, Ilardi B, Marrone V, Strina I, Venturella R, Berghella V, Zullo F. Maternal and perinatal complications according to maternal age: a systematic review and meta-analysis. Int J Gynaecol Obstet 2022; 159:43-55. [PMID: 35044694 PMCID: PMC9543904 DOI: 10.1002/ijgo.14100] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 12/22/2021] [Accepted: 01/12/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To evaluate the risk levels for maternal and perinatal complications at >=40, >=45, >50 years old compared to younger controls METHODS: Electronic databases were searched from their inception until March 2021. We included studies reporting pregnancy outcome in pregnant women 40, 45 and 50 years or older compared with controls at the time of delivery. Case reports, and case series were excluded. The primary outcome was the incidence of stillbirth. Meta-analysis was performed using the random effects model of DerSimonian and Laird, to produce summary treatment effects in terms of either a relative risk (RR) with 95% confidence interval (CI). Heterogeneity was measured using I-squared (Higgins I2 ). Subgroup analyses in women older than 45 years and in those older than 50 years were performed. RESULTS 27 studies, including 31,090,631, were included in the meta-analysis. The overall quality of the included studies was moderate to high. The vast majority of the included studies were retrospective cohort studies (21/27), four were population-based studies, and two were cross sectional studies. Women ≥ 40 years had significantly higher risk of stillbirth (RR 2.16, 95% CI 1.86 to 2.51), perinatal mortality, IUGR, neonatal death, admission to NICU, preeclampsia, preterm delivery, cesarean delivery, and maternal mortality compared to <40 yo women (RR 3.18, 95% CI 1.68 to 5.98). The increased risk for maternal mortality was 42.76 and 11.60 for women older than 50 years and for those older than 45 years, respectively, while those for stillbirth was 3.72 and 2.32. The risk of stillbirth and cesarean delivery was significantly higher in women >45 years compared to those aged 40-45, and in those >50 years compared to those aged 45-50. The risk of maternal mortality was significantly higher in women >50 years compared to those aged 40-45 (RR 60.40, 95% CI 13.28 to 274.74). CONCLUSIONS The risk of stillbirth, cesarean delivery, and maternal mortality increases with advancing maternal age. The risk ratio for maternal mortality was 3.18, 11.60, and 42.76 in women older than 40, older than 45, and older than 50 years, respectively. These data should be used when women with advanced maternal age are counselled regarding their risk in pregnancy.
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Affiliation(s)
- Gabriele Saccone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Elisabetta Gragnano
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Bernadette Ilardi
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Vincenzo Marrone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Ida Strina
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Roberta Venturella
- Division of Obstetrics and Gynecology, University of Catanzaro, Catanzaro, Italy
| | - Vincenzo Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Fulvio Zullo
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy.,Division of Obstetrics and Gynecology, University of Catanzaro, Catanzaro, Italy
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Donoso E, Carvajal JA. Epidemiological difference could explain the higher infant mortality in Chile compared with Cuba. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.anpede.2020.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Donoso E, Carvajal JA. [Epidemiological difference could explain the higher infant mortality in Chile compared with Cuba]. An Pediatr (Barc) 2020; 94:28-35. [PMID: 32444314 DOI: 10.1016/j.anpedi.2020.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/02/2020] [Accepted: 04/06/2020] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Cuba has the lowest infant mortality rate in Latin America, while Chile has an infant mortality rate above the average of Organization for Economic Cooperation and Development (OECD) countries. OBJECTIVE To compare the epidemiology of infant mortality between Chile and Cuba in order to find characteristics that may explain the differences found. METHOD Comparative analysis between Chile and Cuba of infant mortality rate, causes of mortality, live birth weight, and maternal age, in 2015. RESULTS Cuba had a lower infant, neonatal, early and late mortality than Chile, with no differences in post-neonatal mortality. Chile had a higher infant mortality due to, alterations of the nervous system, urinary system, chromosomal alterations, respiratory distress syndrome, and disorders related to the short duration of gestation. Chile had a higher frequency of mothers ≥ 35 years old and live births weighing <2,500 g. The possible effects of health inequities could not be analyzed due to lack of data. CONCLUSIONS It is possible to attribute the lower infant mortality rate in Cuba to: selective abortion due to congenital malformations and chromosomal anomalies, lower epidemiological risk of the Cuban pregnant population, and lower frequency of live births with low birth weight.
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Affiliation(s)
- Enrique Donoso
- División de Obstetricia y Ginecología, Departamento de Obstetricia, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - Jorge A Carvajal
- División de Obstetricia y Ginecología, Departamento de Obstetricia, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
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Leader J, Bajwa A, Lanes A, Hua X, Rennicks White R, Rybak N, Walker M. The Effect of Very Advanced Maternal Age on Maternal and Neonatal Outcomes: A Systematic Review. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2018; 40:1208-1218. [PMID: 29681506 DOI: 10.1016/j.jogc.2017.10.027] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 10/24/2017] [Accepted: 10/25/2017] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To summarize information on the maternal and perinatal outcomes among pregnant women with a maternal age greater or equal to 45 years old compared with women with a maternal age of less than 45. METHODS A comprehensive systematic search of online databases from January 1946 through June 2015 was completed. The maternal outcomes were: fetal loss, preterm birth, full-term birth, complications of pregnancy, the type of delivery, and periconception hemorrhage. The fetal outcomes were: intrauterine growth restriction/LGA, fetal anomalies, APGAR score, and neonatal death. RESULTS Twenty articles were included in the systematic review and 15 included in the meta-analysis. There was a 2.60 greater likelihood of fetal loss (I2 = 99%). Newborns of women of a very advanced maternal age were 2.49 more likely to have a concerning 5-minute APGAR score. Very advanced maternal age women had a 3.32 greater likelihood of pregnancy complications (I2 = 91%). There was a 1.96 greater likelihood of preterm birth at very advanced maternal age (I2 = 91%) and a 4 times greater likelihood of having to deliver through Caesarean section (I2 = 97%). CONCLUSION This systematic review showed an increased risk of adverse maternal and perinatal outcomes. The large amount of heterogeneity among most outcomes that were investigated suggest results must be interpreted with caution.
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Affiliation(s)
- Jordana Leader
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Health Research Group, Ottawa, ON.
| | - Amrit Bajwa
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Health Research Group, Ottawa, ON
| | - Andrea Lanes
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Health Research Group, Ottawa, ON; University of Ottawa School of Epidemiology, Public Health and Preventive Medicine, Ottawa, ON; BORN Ontario, Ottawa, ON
| | - Xiaolin Hua
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Health Research Group, Ottawa, ON; Department of Obstetrics and Gynecology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China; University of Ottawa Department of Obstetrics and Gynecology, Ottawa, ON
| | - Ruth Rennicks White
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Health Research Group, Ottawa, ON
| | - Natalie Rybak
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Health Research Group, Ottawa, ON
| | - Mark Walker
- OMNI Research Group, Clinical Epidemiology Program, Ottawa Health Research Group, Ottawa, ON; BORN Ontario, Ottawa, ON; University of Ottawa Department of Obstetrics and Gynecology, Ottawa, ON
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Pregnancy outcomes in women greater than 45 years: a cohort control study in a multi-ethnic inner city population. Arch Gynecol Obstet 2013; 289:1125-8. [PMID: 24297301 DOI: 10.1007/s00404-013-3097-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 11/11/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To examine the pregnancy outcomes of women >45 years in a multi-ethnic population when compared to controls and to reflect on socio-demographic details of the older mothers. DESIGN A retrospective cohort control study over an 8-year period in an inner city London hospital with multi-ethnic population. The influence of advanced maternal age (>45 years at time of delivery) on fetal and maternal outcomes was assessed by comparing these women to controls (aged 20-30 years) matched for ethnicity, country of origin and parity. RESULTS Data from 64 cases and 64 controls were compared. Ninety percent of the index group had undergone assisted conception. Mothers >45 years had a fourfold increase in cesarean section (35/64 vs 8/64), a threefold increase in blood loss (669.2 vs 272.4 ml) (both p < 0.001) and were more likely to have preterm birth (12/64 vs 3/64) (p < 0.05). Only 5 % of the 64 women were born in the United Kingdom, 52 % were unemployed and 50 % were not fluent in English. Seventy-five percent of the study population were multiparous, 52 % of the pregnancies were unplanned and 90 % had conceived spontaneously. CONCLUSION In an inner city immigrant population, older mothers >45 years were more likely to have cesarean sections, postpartum hemorrhage and premature deliveries. Moreover, social and demographic factors suggest that late child bearing is influenced by cultural factors such as acceptance of large families and lack of contraception.
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Maternal and neonatal outcomes of spontaneously conceived pregnancies in mothers over 45 years: a review of the literature. Arch Gynecol Obstet 2012; 285:1161-6. [DOI: 10.1007/s00404-012-2219-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Accepted: 01/05/2012] [Indexed: 10/14/2022]
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Schoen C, Rosen T. Maternal and perinatal risks for women over 44--a review. Maturitas 2009; 64:109-13. [PMID: 19822268 DOI: 10.1016/j.maturitas.2009.08.012] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Revised: 08/24/2009] [Accepted: 08/24/2009] [Indexed: 11/18/2022]
Abstract
It has been widely documented that advanced maternal age constitutes a risk to both mother and child. The purpose of this review is to examine the risks posed to the pregnant mother over the age of 44 and determine if they are experienced in greater frequency than in their younger cohorts. A review of the recent literature demonstrates a significant increased incidence of cesarean section, pregnancy-induced hypertension, gestational diabetes, and perinatal mortality. There also appears to be different rates of maternal complications depending on mode of conception with assisted reproductive technology conferring a higher risk in this population. Further study is recommended in mode of conception and parity to examine the effects on maternal and fetal risks.
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Affiliation(s)
- Corina Schoen
- Robert Wood Johnson Medical School, New Brunswick, NJ 08901, United States.
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