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Masembe S, Migisha R, Turyasingura G, Aheisibwe H, Nzabandora E, Lule JC. Adverse maternal outcomes and associated factors among mothers of advanced age delivering at a tertiary hospital, southwestern Uganda: a cross-sectional study. BMC Pregnancy Childbirth 2024; 24:348. [PMID: 38714930 PMCID: PMC11075274 DOI: 10.1186/s12884-024-06557-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/29/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Mothers of advanced age, defined as pregnant women aged ≥ 35 years at the time of giving birth, are traditionally known to be associated with increased risks of adverse maternal outcomes. We determined the prevalence of adverse maternal outcomes and associated factors among mothers of advanced age who delivered at Kabale Regional Referral Hospital (KRRH), in Southwestern Uganda. METHODS We conducted a cross-sectional study at the Maternity Ward of KRRH from April to September 2023. We consecutively enrolled pregnant women aged ≥ 35 years during their immediate post-delivery period and before discharge. We obtained data on their socio-demographic, obstetric, medical characteristics and their maternal outcomes using interviewer-administered questionnaires. We defined adverse maternal outcome as any complication sustained by the mother that was related to pregnancy, delivery and immediate post-partum events (obstructed labour, antepartum haemorrhage, mode of delivery [cesarean or vacuum extraction], postpartum haemorrhage, hypertensive disorders of pregnancy, preterm or postdate pregnancy, anemia, premature rupture of membranes, multiple pregnancy, and maternal death). A participant was considered to have an adverse outcome if they experienced any one of these complications. We identified factors associated with adverse outcomes using modified Poisson regression. RESULTS Out of 417 participants, most were aged 35-37 years (n = 206; 49.4%), and had parity ≥ 5 (65.5%). The prevalence of adverse maternal outcomes was 37.6% (n = 157, 95%CI: 33.1-42.4%). Common adverse maternal outcomes included caesarian delivery (23%), and obstructed labour (14.4%). Other complications included anemia in pregnancy (4.5%), chorioamnionitis (4.1%), preterm prelabour rupture of membranes (3.9%), and chronic hypertension and preeclampsia (both 2.4%). Factors associated with adverse maternal outcomes were precipitate labour (adjusted prevalence ratio [aPR] = 1.95, 95%CI: 1.44-2.65), prolonged labour, lasting > 12 h (aPR = 2.86, 95%CI: 1.48-3.16), and chronic hypertension (aPR = 2.01, 95%CI: 1.34-3.9). CONCLUSION Approximately two-fifth of the advanced-aged mothers surveyed had adverse outcomes. Mothers with prolonged labour, precipitate labour and chronic hypertension were more likely to experience adverse outcomes. We recommend implementation of targeted interventions, emphasizing proper management of labor as well as close monitoring of hypertensive mothers, and those with precipitate or prolonged labor, to mitigate risks of adverse outcomes within this study population.
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Affiliation(s)
- Sezalio Masembe
- Department of Obstetrics and Gynaecology, Kabale School of Medicine, Kabale University, P.0 Box 317, Kabale, Uganda.
| | - Richard Migisha
- Department of Physiology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Godwin Turyasingura
- Department of Obstetrics and Gynaecology, Kabale School of Medicine, Kabale University, P.0 Box 317, Kabale, Uganda
| | - Hillary Aheisibwe
- Department of Obstetrics and Gynaecology, Kabale Regional Referral Hospital, Kabale, Uganda
| | - Emmanuel Nzabandora
- Department of Obstetrics and Gynaecology, Kabale Regional Referral Hospital, Kabale, Uganda
| | - John C Lule
- Department of Obstetrics and Gynaecology, Kabale School of Medicine, Kabale University, P.0 Box 317, Kabale, Uganda
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Rodrigues I, Soares H, Rocha G, Azevedo I. Impact of advanced maternal age on neonatal morbidity: a systematic review. J Matern Fetal Neonatal Med 2023; 36:2287981. [PMID: 38016703 DOI: 10.1080/14767058.2023.2287981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 11/21/2023] [Indexed: 11/30/2023]
Abstract
OBJECTIVE This systematic review aimed to understand the impact of advanced maternal age (AMA) on the neonatal morbidity, based on the available scientific evidence. METHODS A systematic search was conducted on 22 November 2021, using the PubMed and Scopus databases to identify studies that compared the morbidity of neonates delivered to AMA mothers with that of neonates delivered to non-AMA mothers. RESULTS Sixteen studies that evaluated the effect of AMA on the neonatal morbidity were included in this review. Nine of these studies found some association between AMA and increased neonatal morbidity (with two of them only reporting an increase in asymptomatic hypoglycemia, and one only reporting an association in twins), six found no association between AMA and neonatal morbidity and one study found a decrease in morbidity in preterm neonates. The studies that found an increase in overall neonatal morbidity with AMA considered older ages for the definition of AMA, particularly ≥40 and ≥45 years. CONCLUSION The current evidence seems to support a lack of association between AMA and the neonatal morbidity of the delivered neonates. However, more studies focusing on the neonatal outcomes of AMA pregnancies are needed to better understand this topic.
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Affiliation(s)
- Inês Rodrigues
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Henrique Soares
- Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Neonatology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Gustavo Rocha
- Department of Neonatology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Inês Azevedo
- Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Neonatology, Centro Hospitalar Universitário de São João, Porto, Portugal
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Bekele GG, Yohannes Roga E, Gonfa DN, Yami AT, Fekene DB, Kabale WD. The effects of advanced maternal age on perinatal mortality in Ethiopia: A systematic review and meta-analysis. SAGE Open Med 2023; 11:20503121231201282. [PMID: 37786897 PMCID: PMC10541735 DOI: 10.1177/20503121231201282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 08/25/2023] [Indexed: 10/04/2023] Open
Abstract
Background Pregnancy in women over the age of 35 years is considered advanced maternal age. The relationship between advanced maternal age and the risk of perinatal mortality is still controversial. As a result, this systematic review and meta-analysis were carried out to clarify the relationship between advanced maternal age and perinatal mortality in Ethiopia. Methods The following electronic databases were used for this systematic review and meta-analysis: PubMed, Web of Science, Scopus, Science Direct, Google Scholar, HINARI, and African Journals Online up to March 2022. Addis Ababa, Gondor, and Jimma University research repositories were also searched. A random-effects model was used to pool study-specific odds ratios. Results A total of 18 articles, including a total of 45,541 participants, were included in the meta-analysis. A total of 11 cross-sectional, 2 case-control, and 5 cohort studies were included. The overall pooled estimate indicates that women with advanced maternal age had a 1.58 higher risk of perinatal mortality compared to women in the younger age group (odds ratio = 1.58; 95% Confidence Interval: 1.13-2.03). The subgroup analysis also revealed that there were differences in the effect size as the geographical region differed. The result showed that the odd of perinatal mortality was highest in the Oromia region and lowest in the Southern Nations Nationalities and Peoples' Region. Conclusion The overall pooled estimate indicates that women with advanced maternal age had a 1.58-fold higher risk of perinatal mortality. Even though this risk could also be increased with other comorbid diseases, it is important for healthcare providers and other concerned stakeholders to be aware of the increased risks associated with advanced maternal age and provide different intervention programs designed to create awareness and provide counseling services to couples who seek to have a child in their later ages about the risks of advanced maternal age pregnancy on perinatal mortality and other adverse pregnancy outcomes.
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Affiliation(s)
- Gemechu Gelan Bekele
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Ephrem Yohannes Roga
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Dajane Negesse Gonfa
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Amare Tesfaye Yami
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Daniel Belema Fekene
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
| | - Wogene Daro Kabale
- Department of Midwifery, College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
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Gantt A, Metz TD, Kuller JA, Louis JM, Cahill AG, Turrentine MA. Obstetric Care Consensus #11, Pregnancy at age 35 years or older. Am J Obstet Gynecol 2023; 228:B25-B40. [PMID: 35850202 DOI: 10.1016/j.ajog.2022.07.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Centers for Disease Control and Prevention data from 2020 demonstrate the continued upward trend in the mean age of pregnant individuals in the United States. Observational studies demonstrate that pregnancy in older individuals is associated with increased risks of adverse pregnancy outcomes-for both the pregnant patient and the fetus-that might differ from those found in younger pregnant populations, even in healthy individuals with no other comorbidities. There are several studies that suggest that advancing age at the time of pregnancy is associated with greater disparities in severe maternal morbidity and mortality. This document seeks to provide evidence-based clinical recommendations for minimizing adverse outcomes associated with pregnancy with anticipated delivery at an advanced maternal age. The importance and benefits of accessible health care from prepregnancy through postpartum care for all pregnant individuals cannot be overstated. However, this document focuses on and addresses the unique differences in pregnancy-related care for women and all those seeking obstetrical care with anticipated delivery at the age of 35 years or older within the framework of routine pregnancy care. This Obstetric Care Consensus document was developed using an a priori protocol in conjunction with the authors listed above.
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Zhang C, Yan L, Qiao J. Effect of advanced parental age on pregnancy outcome and offspring health. J Assist Reprod Genet 2022; 39:1969-1986. [PMID: 35925538 PMCID: PMC9474958 DOI: 10.1007/s10815-022-02533-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/24/2021] [Indexed: 10/16/2022] Open
Abstract
PURPOSE Fertility at advanced age has become increasingly common, but the aging of parents may adversely affect the maturation of gametes and the development of embryos, and therefore the effects of aging are likely to be transmitted to the next generation. This article reviewed the studies in this field in recent years. METHODS We searched the relevant literature in recent years with the keywords of "advanced maternal/paternal age" combined with "adverse pregnancy outcome" or "birth defect" in the PubMed database and classified the effects of parental advanced age on pregnancy outcomes and birth defects. Related studies on the effect of advanced age on birth defects were classified as chromosomal abnormalities, neurological and psychiatric disorders, and other systemic diseases. The effect of assisted reproduction technology (ART) on fertility in advanced age was also discussed. RESULTS Differences in the definition of the range of advanced age and other confounding factors among studies were excluded, most studies believed that advanced parental age would affect pregnancy outcomes and birth defects in offspring. CONCLUSION To some extent, advanced parental age caused adverse pregnancy outcomes and birth defects. The occurrence of these results was related to the molecular genetic changes caused by aging, such as gene mutations, epigenetic variations, etc. Any etiology of adverse pregnancy outcomes and birth defects related to aging might be more than one. The detrimental effect of advanced age can be corrected to some extent by ART.
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Affiliation(s)
- Cong Zhang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49, North garden road, Haidian district, Beijing, 100191, People's Republic of China
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, 100191, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, 100191, China
- Research Units of Comprehensive Diagnosis and Treatment of Oocyte Maturation Arrest (Chinese Academy of Medical Sciences), Beijing, 100191, China
- Savid Medical College (University of Chinese Academy of Sciences), Beijing, 100049, China
| | - Liying Yan
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49, North garden road, Haidian district, Beijing, 100191, People's Republic of China
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, 100191, China
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, 100191, China
- Research Units of Comprehensive Diagnosis and Treatment of Oocyte Maturation Arrest (Chinese Academy of Medical Sciences), Beijing, 100191, China
| | - Jie Qiao
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49, North garden road, Haidian district, Beijing, 100191, People's Republic of China.
- National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital), Beijing, 100191, China.
- Key Laboratory of Assisted Reproduction (Peking University), Ministry of Education, Beijing, 100191, China.
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, 100191, China.
- Research Units of Comprehensive Diagnosis and Treatment of Oocyte Maturation Arrest (Chinese Academy of Medical Sciences), Beijing, 100191, China.
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Karai A, Gyurkovits Z, Németh G, Orvos H, Paulik E. Adverse Maternal and Perinatal Outcome of Women Aged 40 Years or Over: A Retrospective Study. INTERNATIONAL JOURNAL OF CHILDBIRTH 2022. [DOI: 10.1891/ijc-2021-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUNDAdvanced maternal age is traditionally described to be 35 years of age or over. In recent years, new trends have suggested that it may be 40 years of age or over; this occurs in Hungary.AIMThe aim of this study was to determine the association between advanced maternal age and various adverse maternal and neonatal outcomes.METHODSA retrospective analysis was performed among women who delivered between 2015 and 2017. All women aged 40 years or over (cases) were involved into the analysis (n = 374). The controls (n = 378) were randomly selected from women aged 25 to 29 years who delivered during the same period considering the number of previous gestations and previous deliveries. The data collected from the medical records comprised the mothers’ demographic and obstetric characteristics and neonatal data. To assess the contribution of maternal age to various maternal and neonatal outcomes, multiple logistic regression analyses were used.RESULTSThe logistic regression analyses showed higher odds of gestational diabetes (AOR, adjusted odds ratio: 2.81), preeclampsia (AOR: 13.05), threatened preterm delivery (AOR: 3.62), and cesarean section (AOR: 3.31) in mothers of higher age. The odds of low birth weight (AOR: 2.56) and intensive care (AOR: 2.03) were significantly higher in older vs. younger mothers, while no significant associations were between maternal age and fetal macrosomia and congenital malformations.CONCLUSIONSConsidering our results, it is important to educate women about the consequences of delayed childbearing and the need of continuous observation within prenatal care.
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Abstract
SUMMARY Centers for Disease Control and Prevention data from 2020 demonstrate the continued upward trend in the mean age of pregnant individuals in the United States. Observational studies demonstrate that pregnancy in older individuals is associated with increased risks of adverse pregnancy outcomes-for both the pregnant patient and the fetus-that might differ from those in a younger pregnant population, even in healthy individuals with no other comorbidities. There are several studies that suggest advancing age at the time of pregnancy is associated with greater disparities in severe maternal morbidity and mortality. This document seeks to provide evidence-based clinical recommendations for minimizing adverse outcomes associated with pregnancy with anticipated delivery at an advanced maternal age. The importance and benefits of accessible health care from prepregnancy through postpartum care for all pregnant individuals cannot be overstated. However, this document focuses on and addresses the unique differences in pregnancy-related care for women and all those seeking obstetric care with anticipated delivery at age 35 years or older within the framework of routine pregnancy care. This Obstetric Care Consensus document was developed using an a priori protocol in conjunction with the authors listed above.
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Huang Y, Li D, Cai W, Zhu H, Shane MI, Liao C, Pan S. Distribution of Vaginal and Gut Microbiome in Advanced Maternal Age. Front Cell Infect Microbiol 2022; 12:819802. [PMID: 35694547 PMCID: PMC9186158 DOI: 10.3389/fcimb.2022.819802] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 04/20/2022] [Indexed: 11/13/2022] Open
Abstract
The distribution of the microbiome in women with advanced maternal age (AMA) is poorly understood. To gain insight into this, the vaginal and gut microbiota of 62 women were sampled and sequenced using the 16S rRNA technique. These women were divided into three groups, namely, the AMA (age ≥ 35 years, n = 13) group, the non-advanced maternal age (NMA) (age < 35 years, n = 38) group, and the control group (non-pregnant healthy women, age >35 years, n = 11). We found that the alpha diversity of vaginal microbiota in the AMA group significantly increased. However, the beta diversity significantly decreased in the AMA group compared with the control group. There was no significant difference in the diversity of gut microbiota among the three groups. The distributions of microbiota were significantly different among AMA, NMA, and control groups. In vaginal microbiota, the abundance of Lactobacillus was higher in the pregnant groups. Bifidobacterium was significantly enriched in the AMA group. In gut microbiota, Prevotella bivia was significantly enriched in the AMA group. Vaginal and gut microbiota in women with AMA were noticeably different from the NMA and non-pregnant women, and this phenomenon is probably related to the increased risk of complications in women with AMA.
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Affiliation(s)
- Yuxin Huang
- Department of Gynaecology and Obstetrics, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Dianjie Li
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Wei Cai
- Department of Gynaecology and Obstetrics, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Honglei Zhu
- Department of Gynaecology and Obstetrics, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Mc Intyre Shane
- Department of Gynaecology and Obstetrics, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Can Liao
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Prenatal Diagnostic Center, Guangzhou Women and Children’s Medical Center, Guangzhou, China
- *Correspondence: Can Liao, ; Shilei Pan,
| | - Shilei Pan
- Department of Gynaecology and Obstetrics, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- *Correspondence: Can Liao, ; Shilei Pan,
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Kim H, Kim MS, Seo Y, Yum SK. Short-term outcomes of very-low-birth-weight infants born to mothers of advanced and very advanced maternal age. J Matern Fetal Neonatal Med 2022; 35:9870-9877. [PMID: 35437100 DOI: 10.1080/14767058.2022.2065192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate whether advanced maternal age (35-39 years, AMA)/very advanced maternal age (≥40 years, VAMA) impacts neonatal outcomes of very-low-birth-weight (VLBW) infants. METHODS Data of VLBW infants admitted to our unit were reviewed. Demographic findings and neonatal outcomes were compared among maternal age [(<35 years, not advanced maternal age, n = 329), AMA (n = 209), and VAMA (n = 43)] groups. Univariate and multivariate analyses were performed to identify the associated risk factors for neonatal outcomes. RESULT Mortality and overall morbidities showed no significant intergroup differences, except for massive pulmonary hemorrhage (MPH). Multivariate analysis revealed that AMA/VAMA was not significantly associated with MPH development, while ≥ two doses of surfactant administration was. Higher gestational age and antenatal corticosteroid administration were protective. CONCLUSION AMA/VAMA is not associated with neonatal mortality and morbidities. Since the proportion of AMA/VAMA mothers is expected to increase, perinatal medicine practitioners should focus on approaches before and immediately after birth of such infants.
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Affiliation(s)
- HyoYun Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Min Soo Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yumi Seo
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sook Kyung Yum
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Nogueira da Gama SG, Martinelli KG, Soares Dias BA, Pereira-Esteves AP, do Carmo Leal M, Dos Santos-Neto ET. A population-based study of the relationship between advanced maternal age and premature/early-term birth in Brazil. Int J Gynaecol Obstet 2021; 159:173-181. [PMID: 34860423 DOI: 10.1002/ijgo.14057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 10/25/2021] [Accepted: 12/02/2021] [Indexed: 12/20/2022]
Abstract
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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Affiliation(s)
| | - Katrini Guidolini Martinelli
- Federal University of Espirito Santo (UFES), Postgraduate Program in Public Health, Vitoria, Espírito Santo, Brazil
| | | | | | - Maria do Carmo Leal
- Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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DiLabio J, Zwicker JG, Sherlock R, Daspal S, Shah PS, Shah V. Maternal age and long-term neurodevelopmental outcomes of preterm infants < 29 weeks gestational age. J Perinatol 2021; 41:1304-1312. [PMID: 32694856 DOI: 10.1038/s41372-020-0735-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/09/2020] [Accepted: 07/07/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The objective of this study is to assess the impact of maternal age on neurodevelopmental (ND) outcomes of infants < 29 weeks gestational age (GA) at 18-24 months. STUDY DESIGN A retrospective cohort study of preterm infants < 29 weeks GA admitted to Canadian tertiary NICUs was performed. The primary outcome was a composite of death or ND impairment (NDI)/significant NDI (sNDI) at 18-24 months. Association between maternal age and outcome was assessed across maternal age groups (15-19, 20-34, 35-39 and ≥40 years) using logistic regression after adjusting for confounders. RESULTS Of 3691 eligible infants, 2652 with complete data were included in the analysis. Significant differences in maternal characteristics existed across age groups. The only difference in neonatal characteristics was the incidence of bronchopulmonary dysplasia (p < 0.01). There was no association between maternal age and death or NDI/sNDI after controlling for confounders. CONCLUSION Maternal age is not associated with differences in NDI/sNDI rates among Canadian preterm infants < 29 weeks GA.
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Affiliation(s)
- Julia DiLabio
- Division of Neonatology, Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Jill G Zwicker
- Department of Occupational Science & Occupational Therapy and Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Rebecca Sherlock
- Division of Neonatology, Surrey Memorial Hospital, Surrey, BC, Canada
| | - Sibasis Daspal
- Division of Neonatology, Royal University Hospital, Saskatoon, SK, Canada
| | - Prakesh S Shah
- Division of Neonatology, Department of Paediatrics, University of Toronto, Toronto, ON, Canada
- Department of Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada
| | - Vibhuti Shah
- Division of Neonatology, Department of Paediatrics, University of Toronto, Toronto, ON, Canada.
- Department of Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada.
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Trotman H, Samms-Vaughan M, Coore-Desai C, Reece JA, Olugbuyi O. Neonatal Outcome of Babies Born to Women 40 Years and Older in a Jamaican Birth Cohort. Am J Perinatol 2021; 40:619-623. [PMID: 34044455 DOI: 10.1055/s-0041-1730350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The study aimed to determine the outcome of babies born to women ≥40 years in a Jamaican birth cohort. PATIENTS AND METHODS Maternal demographic data and neonatal data for women ≥40 years who delivered live singleton babies and their younger counterparts aged 20 30 years were extracted from the JA KIDS birth cohort dataset. Outcome measures were preterm birth, low birth weight, very low birth weight, extremely low birth weight, macrosomia, a low 5-minute Apgar score <7, admission to the neonatal unit, and neonatal death. Descriptive analyses were performed; statistical significance was taken at the level p <0.05. RESULTS A total of 5,424 women and their babies were entered into the study, 5,099 (94%) women were aged 20 to 30 years (mean age ± standard deviation [SD]: 24.5 ± 3.2 years) and 325 (6%) were aged ≥40 years (mean age ± SD: 41.5 ± 1.6 years). A greater percentage of preterm babies (18%) were born to women ≥40 years than to their younger counterparts (14%; p = 0.04). There was no difference in the proportion of low birth weight infants, very low birth weight infants, or extremely low birth weight infants born between the two groups (p > 0.05). There was also no significant difference in the proportion of babies who were macrosomic and in those who had a low 5-minute Apgar score <7. There were 866 (16%) neonatal admissions, 67/325 (21%) of these babies were born to women aged ≥40 years and 799/5,099 (16%) were born to their younger counterparts (p = 0.01). The commonest reason for admission was prematurity. While 60 babies died, there was no significant difference between both groups with 56 (1%) born to women 20 to 30 years and 4 (1%) born to women ≥40 years (p = 0.48). CONCLUSION Adverse outcomes noted for babies born to women ≥40 years were prematurity and the need for neonatal admission. However, no excess mortality was recorded. KEY POINTS · Women 40 years and older are more likely to have a chronic illness such as hypertension and diabetes and to have an operative delivery.. · Babies born to women 40 years and older are more likely to be late premature infants and require neonatal admission.. · However, there is no increased risk of neonatal mortality..
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Affiliation(s)
- Helen Trotman
- Department of Child and Adolescent Health, Faculty of Medical Sciences, University of the West Indies, Mona, St. Andrew, Jamaica
| | - Maureen Samms-Vaughan
- Department of Child and Adolescent Health, Faculty of Medical Sciences, University of the West Indies, Mona, St. Andrew, Jamaica
| | - Charlene Coore-Desai
- Department of Child and Adolescent Health, Faculty of Medical Sciences, University of the West Indies, Mona, St. Andrew, Jamaica
| | - Jody-Ann Reece
- Department of Child and Adolescent Health, Faculty of Medical Sciences, University of the West Indies, Mona, St. Andrew, Jamaica
| | - Oluwayomi Olugbuyi
- Department of Child and Adolescent Health, Faculty of Medical Sciences, University of the West Indies, Mona, St. Andrew, Jamaica
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Bakhsh H, Alenizy H, Alenazi S, Alnasser S, Alanazi N, Alsowinea M, Alharbi L, Alfaifi B. Amniotic fluid disorders and the effects on prenatal outcome: a retrospective cohort study. BMC Pregnancy Childbirth 2021; 21:75. [PMID: 33482755 PMCID: PMC7821638 DOI: 10.1186/s12884-021-03549-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 01/08/2021] [Indexed: 12/02/2022] Open
Abstract
Background The amniotic fluid is a protective liquid present in the amniotic sac. Two types of amniotic fluid disorders have been identified. First refers to polyhydramnios, which is an immoderate volume of amniotic fluid with an Amniotic Fluid Index (AFI) greater than 24 cm. Second includes oligohydramnios, which refers to decreased AFI i.e., less than 5 cm. This study aims to; a) identify the maternal risk factors associated with amniotic fluid disorders, b) assess the effect of amniotic fluid disorders on maternal and fetal outcome c) examine the mode of delivery in pregnancy complicated with amniotic fluid disorders. Methods A comparative retrospective cohort study design is followed. Sample of 497 pregnant women who received care at King Abdullah bin Abdul-Aziz University Hospital (KAAUH) between January 2017 to October 2019 was included. Data were collected from electronic medical reports, and was analyzed using descriptive statistics. Association of qualitative variables was conducted by Chi-square test, where p-value < 0.05 was considered statistically significant. Results Among the collected data, 2.8% of the cases had polyhydramnios and 11.7% patients had oligohydramnios. One case of still born was identified. A statically significant association was found between polyhydramnios and late term deliveries (P = 0.005) and cesarean section (CS) rates (P = 0.008). The rate of term deliveries was equal in normal AFI and oligohydramnios group (P = 0.005). Oligohydramnios was mostly associated with vaginal deliveries (P = 0.008). Oligohydramnios and polyhydramnios were found to be associated with diabetes mellitus patients (P = 0.005), and polyhydramnios with gestational diabetes patients (P = 0.052). Other maternal chronic diseases showed no effect on amniotic fluid index, although it might cause other risks on the fetus. Conclusion Diabetes mellitus and gestational diabetes are the most important maternal risk factors that can cause amniotic fluid disorders. Maternal and fetal outcome data showed that oligohydramnios associated with gestational age at term and low neonatal birth weight with high rates of vaginal deliveries, while polyhydramnios associated with gestational age at late term and high birth weight with higher rates of CS. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03549-3.
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Affiliation(s)
- H Bakhsh
- Clinical Sciences Department, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia. .,Department of Obstetrics & Gynecology, King Abdullah bin Abdulaziz University Hospital, Riyadh, Saudi Arabia.
| | - H Alenizy
- Clinical Sciences Department, College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia.,Department of Obstetrics & Gynecology, King Abdullah bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
| | - S Alenazi
- College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - S Alnasser
- College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - N Alanazi
- College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - M Alsowinea
- College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - L Alharbi
- College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - B Alfaifi
- College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
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14
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Liu X, Huang D, Wang Y, Gao Y, Chen M, Bai Y, Wu M, Luo X, Qi H. Birth and birth-related obstetrical characteristics in southwestern China associated with the current adjustment of family planning policy: a 7-year retrospective study. Sci Rep 2020; 10:15949. [PMID: 32994428 PMCID: PMC7525438 DOI: 10.1038/s41598-020-73039-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 09/10/2020] [Indexed: 11/09/2022] Open
Abstract
In China, the adjustment of the family planning policy was expected to increase the number of births and trigger a change in the demographic and obstetrical background of pregnant women. The policy itself, and corresponding background variations of the pregnant mothers, might have various influences on certain birth-related characteristics. Moreover, the adaption of the medical system to the policy needs to be demonstrated. To address these issues, over 50,000 individual records from January 2012 to December 2018 were collected from a large tertiary care centre of southwest China as a representative. The monthly numbers of deliveries and births showed stabilized patterns after remarkable upward trends. Policy-sensitive women, among whom older age and multiparity were typical features, contributed considerably to the remarkable additional births. Indeed, multivariable logistic regression analysis identified the child policy and these two background characteristics as factors influencing CS (caesarean section) rate and certain pregnancy complications or adverse outcomes. After the implementation of the two-child policy, a care provider was faced with fewer but more difficult cases. Briefly speaking, more individual-based studies on family planning policy and more efforts to improve obstetrical service are needed to better guide clinical practice in the new era.
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Affiliation(s)
- Xiyao Liu
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.,China-Canada-New Zealand Joint Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, No.1 Yixueyuan Road, Yuzhong District, Chongqing, 400016, China
| | - Dongni Huang
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.,China-Canada-New Zealand Joint Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, No.1 Yixueyuan Road, Yuzhong District, Chongqing, 400016, China
| | - Yu Wang
- First Clinical Institute, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing, 400016, China
| | - Yuwen Gao
- School of Public Health and Management, Chongqing Medical University, No. 1 Yixueyuan Road, Yuzhong District, Chongqing, 400016, China
| | - Miaomiao Chen
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.,China-Canada-New Zealand Joint Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, No.1 Yixueyuan Road, Yuzhong District, Chongqing, 400016, China.,Maternal and Child Health Hospital of Hubei Province, No. 745 Wuluo Road, Hongshan District, Wuhan, 430070, Hubei, China
| | - Yuxiang Bai
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.,China-Canada-New Zealand Joint Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, No.1 Yixueyuan Road, Yuzhong District, Chongqing, 400016, China
| | - Mengshi Wu
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.,China-Canada-New Zealand Joint Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, No.1 Yixueyuan Road, Yuzhong District, Chongqing, 400016, China
| | - Xin Luo
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China. .,China-Canada-New Zealand Joint Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, No.1 Yixueyuan Road, Yuzhong District, Chongqing, 400016, China.
| | - Hongbo Qi
- Department of Obstetrics, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China. .,China-Canada-New Zealand Joint Laboratory of Maternal and Fetal Medicine, Chongqing Medical University, No.1 Yixueyuan Road, Yuzhong District, Chongqing, 400016, China.
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15
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Schwartz A, Many A, Shapira U, Rosenberg Friedman M, Yogev Y, Avnon T, Agrawal S, Shinar S. Perinatal outcomes of pregnancy in the fifth decade and beyond- a comparison of very advanced maternal age groups. Sci Rep 2020; 10:1809. [PMID: 32020027 PMCID: PMC7000770 DOI: 10.1038/s41598-020-58583-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 01/06/2020] [Indexed: 11/16/2022] Open
Abstract
To study the effect of very advanced maternal age on perinatal outcomes. A retrospective cohort study of women aged 45 years and above, who delivered ≥22 weeks of gestation in a single tertiary center between 1/ 2011 and 12/ 2018. Maternal and neonatal outcomes were compared between women ≥50 years and women of 45-49 years at delivery. Of 83,661 parturients, 593 (0.7%) were 45-49 years old and 64 (0.07%) were ≥50 years old. Obstetrical characteristics were comparable, though the rate of chronic hypertension and preeclampsia with severe features were greater in women ≥50 years (6.2% vs 1.4%, p = 0.04, 15.6% vs 7.0%, p = 0.01, 95% CI 0.19-0.86, respectively). Elective cesarean deliveries were independently associated with advanced maternal age ≥50 (OR 2.63 95% CI 1.21-5.69). Neonatal outcomes were comparable for singletons, but rates of ventilatory support and composite severe neonatal outcomes were higher in twin pregnancies of women ≥50 years (42.8% vs 13.5%, p = 0.01, and 21.4% vs 4.0%, p = 0.03, respectively). Healthy women ≥50 have higher elective cesarean rates, despite similar maternal and neonatal characteristics.
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Affiliation(s)
- Anat Schwartz
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Sourasky Medical Center, Tel Aviv, Israel.
| | - Ariel Many
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Sourasky Medical Center, Tel Aviv, Israel
| | - Udi Shapira
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Rosenberg Friedman
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Sourasky Medical Center, Tel Aviv, Israel
| | - Yariv Yogev
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Sourasky Medical Center, Tel Aviv, Israel
| | - Tomer Avnon
- Department of Obstetrics and Gynecology, Lis Maternity Hospital, Sourasky Medical Center, Tel Aviv, Israel
| | - Swati Agrawal
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, ON, Canada
| | - Shiri Shinar
- Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, ON, Canada
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16
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Shi Y, Ma J, Xue Y, Wang J, Yu B, Wang T. The assessment of combined karyotype analysis and chromosomal microarray in pregnant women of advanced maternal age: a multicenter study. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:318. [PMID: 31475188 DOI: 10.21037/atm.2019.06.63] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Retrospectively analyzed the results of prenatal diagnosis and hoped to provide scientific clinical guidance of prenatal screening and diagnosis for the women in advanced maternal age (AMA). Methods In total, 4,224 women of AMA who accepted prenatal diagnosis by amniocentesis (AC) from two prenatal diagnosis centers were recruited for this study. After genetic counseling and informed consent, 3,475 women received karyotype analysis only, 703 were examined by both karyotype analysis and chromosomal microarray (CMA), while 46 cases selected CMA only. Both centers used the same detection platform, experimental scheme, and quality control standards. Results A total of 164 women with chromosomal abnormal results were found, the abnormality rate was 3.88% (164/4,224). Among them, 145 (3.4%, 145/4,224) cases were detected as abnormal chromosome number, 19 cases (0.4%, 19/4,224) as abnormal chromosome structure. Compared with simple AMA women, the abnormality rate was significantly increased in the AMA women who combined with other indications, particularly in number abnormalities (22.5% vs. 1.0%, P<0.001). Forty-eight copy number variations (CNVs) were detected, moreover 10 cases (0.24%, 10/4,224) were proved as pathogenic or likely pathogenic CNVs. With the CMA technology, the rate of additional abnormalities with clinical significance was 1.42% (10/703). Chromosome number abnormalities significantly increased with age (P<0.001), while there were no such trends in chromosomal structural abnormalities (P=0.624). Conclusions About 3.88% fetuses of AMA women had chromosomal abnormalities, the abnormality rate increased with their age. The application of CMA could increase the diagnostic rate by about 1.4% for AMA women, and greatly reduce their tension.
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Affiliation(s)
- Ye Shi
- Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Changzhou 213003, China
| | - Jun Ma
- The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215000, China
| | - Ying Xue
- The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215000, China
| | - Jing Wang
- Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Changzhou 213003, China
| | - Bin Yu
- Changzhou Maternity and Child Health Care Hospital Affiliated to Nanjing Medical University, Changzhou 213003, China
| | - Ting Wang
- The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou 215000, China
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17
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Zhang X, Xu H, Hu R, Xiong Y, Gu W, Zhou Q, Li X. Changing trends of adverse pregnancy outcomes with maternal age in primipara with singleton birth: A join point analysis of a multicenter historical cohort study in China in 2011-2012. Acta Obstet Gynecol Scand 2019; 98:997-1003. [PMID: 30801657 DOI: 10.1111/aogs.13595] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 02/17/2019] [Accepted: 02/19/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Adverse pregnancy outcomes are related to two opposite maternal factors, youth and aging. However, the change in trend of specific outcomes with childbearing age is unknown. The aim of this study was to investigate the changing trend of various maternal and neonatal outcomes with maternal age from 17 to 44 years. MATERIAL AND METHODS Data were extracted from the medical records from 2011-2012 of 39 public hospitals of 14 cities in China. The eligibility criteria were primiparity and singleton birth. Join point regression analysis was used to estimate the percent change per year of age (PCA) to explore the trends of adverse pregnancy outcomes with regard to maternal age and to identify the join point of maternal age when the trend was changed. RESULTS A total of 89 171 women were eligible for analysis. There were four categories of trend styles. Continuously increasing trends were linear for placenta previa (PCA, 0.1%), placenta implantation (PCA, 0.09%) and postpartum hemorrhage (PCA, 0.22%), and nonlinear for gestational diabetes mellitus with one join point of 23 years (PCA, 0.17% and 0.71%) and cesarean section with four join points of 25, 28, 31 and 36 years (PCA, 1.39%, 0.34%, 1.51%, 3.49% and 0.94%). Continuously decreasing trends were linear for intrahepatic cholestasis (PCA, -0.02%) and nonlinear for anemia with one join point of 28 years (PCA, -0.49% and -0.04%). The bidirective trends were downward to upward for preterm birth (PCA, -2.93%, -0.36% and 0.38%), hypertension in pregnancy (PCA, -0.09%, 0.47%), low birthweight (PCA 0.51% and 0.38%), low 1-minute Apgar score (PCA, -0.28% and 0.07%), low 5-minute Apgar score at (PCA, -0.10% and 0.06%) and neonatal intensive care unit admission (PCA, -1.92%, -0.07% and 0.12%) with a nadir age of 28 years. The bidirective trend was upward to downward for macrosomia (PCA, 0.39% and -0.11%), with a peak age of 30 years. CONCLUSIONS The changes in the trend of specific outcomes were different with maternal age, which means that youth, aging or both could affect the outcomes.
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Affiliation(s)
- Xiaolei Zhang
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Huangfang Xu
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Rong Hu
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Yu Xiong
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Weirong Gu
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Qiongjie Zhou
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China.,Women's Health and Perinatology Research Group, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Xiaotian Li
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China.,Institute of Biomedical Sciences, Fudan University, Shanghai, China
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18
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Infante-Torres N, Molina-Alarcón M, Gómez-Salgado J, Rodríguez-Almagro J, Rubio-Álvarez A, Hernández-Martínez A. Relationship between the Duration of the Second Stage of Labour and Neonatal Morbidity. J Clin Med 2019; 8:E376. [PMID: 30889863 PMCID: PMC6463039 DOI: 10.3390/jcm8030376] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 02/11/2019] [Accepted: 03/14/2019] [Indexed: 12/02/2022] Open
Abstract
(1) Background: To assess the relationship between the duration of the second stage of labour and the neonatal morbidity risk; (2) Methods: An observational, analytical, retrospective cohort study was performed at the "Mancha-Centro" Hospital (Spain) during the 2013⁻2016 period. Data were collected from 3863 women who gave a vaginal birth. The studied neonatal morbidity variables were umbilical cord arterial pH, 5-min Apgar score, need for advanced neonatal resuscitation, and a composite neonatal morbidity variable on which the multivariate analysis was done. A univariate analysis was used for the potential risk factors and a multivariate analysis with binary logistic regression to control for possible confounding factors; (3) Results: The univariate analysis showed a statistically significant relationship between the duration of the second stage of labour and a high risk of advanced neonatal resuscitation and composite neonatal morbidity in multiparous women. However, after performing the multivariate analysis for the variable "composite neonatal morbidity", we observed no relationship with the duration of the second stage of labour in either nulliparous or multiparous women; (4) Conclusions: The duration of the second stage of labour was not related to an increased risk of neonatal morbidity in our study population.
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Affiliation(s)
| | | | - Juan Gómez-Salgado
- Department of Nursing, Faculty of Nursing, University of Huelva, Huelva 21071, Spain.
- Espíritu Santo University, Guayaquil 092301, Ecuador.
| | | | - Ana Rubio-Álvarez
- Obstetrics Service, Torrejón of Ardoz Hospital, Madrid 28850, Spain.
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19
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A Comprehensive Approach to Care of Women of Advanced Maternal Age. Nurs Womens Health 2019; 23:124-134. [PMID: 30825416 DOI: 10.1016/j.nwh.2019.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 12/19/2018] [Accepted: 01/01/2019] [Indexed: 12/19/2022]
Abstract
Advanced maternal age, historically defined as ages 35 years and older, is used to describe the later years in the female reproductive life span when rates of adverse pregnancy outcomes increase. The preconception period represents an opportunity to ensure the use of safe medications and optimize care for medical comorbidities. Routine prenatal care should be augmented with counseling on fetal aneuploidy with a detailed anatomic survey. Surveillance for preterm labor and preeclampsia is recommended. Growth assessment and antepartum testing for specific women are advised, particularly those ages 40 years and older and those with select medical problems. Despite an increased incidence of complications, most women of advanced maternal age will have normal pregnancies and will benefit from the compassionate care provided by midwives, advanced practice registered nurses (including nurse practitioners and clinical nurse specialists), and perinatal nurses.
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20
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Kiersnowska I, Baranowska B, Bączek G, Węgrzyn P. Pregnancy, childbirth and puerperium health problems in women after 35 year of age: A systematic literature review. MEDICAL SCIENCE PULSE 2018. [DOI: 10.5604/01.3001.0012.7989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Advancing medical knowledge, improving quality of life and increasing life expectancy have resulted in increased numbers of women deciding to deliver a child over 35 years of age. Infertility in delayed motherhood is associated not only with medical but also with psychological problems. The question of delayed motherhood concerns the whole world, and is of interest not only to obstetricians, but also economists and demographers. The purpose of our study was to identify and review studies into the health problems of women over 35 years of age in pregnancy (Advanced Maternal Age), delivery and the puerperium. Original papers investigating health problems in women over 35 years of age related to pregnancy, childbirth and the puerperium published between August 2017, and January 2018 were identified. Databases including PubMed, Scopus, ProQuest Central, and Elsevier Clinical Key Journals were utilised. After removing duplicates and those not meeting inclusion criteria, 15 studies were reviewed. Findings are discussed according to three time periods; before pregnancy, during pregnancy, and during childbirth and the puerperium. AMA mothers, especially primiparous women, were more likely to suffer with underlying chronic diseases and were more likely to have been treated for infertility. Increased use ART (Assisted Reproduction Techniques) can explain an increased rate of multiple pregnancies and the resultant rise in both caesarean section deliveries and premature births. Study groups subclassified according to maternal age allowed outcomes which are progressive with age to be identified. All the studies we reviewed have reported similar health problems in women over 35 years of age. The most common health problems in pregnancy, during childbirth and the puerperium in women over 35 years of age are diabetes mellitus type one and two, hypertension, preeclampsia, and cholestasis
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Affiliation(s)
- Iwona Kiersnowska
- Department of Obstetrics and Perinatology, Medical University of Warsaw, Poland
| | - Barbara Baranowska
- Department of Obstetrics and Gynecology Didactics, Medical University of Warsaw, Poland
| | | | - Piotr Węgrzyn
- Department of Obstetrics and Perinatology, Medical University of Warsaw, Poland
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21
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Arya S, Mulla ZD, Plavsic SK. Outcomes of Women Delivering at Very Advanced Maternal Age. J Womens Health (Larchmt) 2018; 27:1378-1384. [DOI: 10.1089/jwh.2018.7027] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sushila Arya
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas
| | - Zuber D. Mulla
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas
| | - Sanja Kupesic Plavsic
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas
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22
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Shapiro GD, Bushnik T, Wilkins R, Kramer MS, Kaufman JS, Sheppard AJ, Yang S. Adverse birth outcomes in relation to maternal marital and cohabitation status in Canada. Ann Epidemiol 2018; 28:503-509.e11. [PMID: 29937402 DOI: 10.1016/j.annepidem.2018.05.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 04/11/2018] [Accepted: 05/07/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE An increasing percentage of children are born to couples who cohabit but are not legally married. Using data from a nationally representative Canadian sample, we estimated associations of maternal marital and cohabitation status with stillbirth, infant mortality, preterm birth (PTB), and small- and large-for-gestational-age (SGA and LGA) birth. METHODS The 2006 Canadian Birth-Census Cohort was created by linking birth registration data with the 2006 long-form census. We used log-binomial regression to estimate risk ratios (RRs) for adverse birth outcomes associated with being single or living with a common-law partner. Analyses were adjusted for maternal age and education. RESULTS Data were analyzed for 130,931 singleton births. Adjusted RRs (95% confidence intervals) for single mothers compared with married mothers were 1.92 (1.51-2.42) for stillbirth, 2.08 (1.55-2.81) for infant mortality, 1.36 (1.27-1.46) for PTB, 1.31 (1.22-1.39) for SGA birth, and 0.95 (0.90-1.01) for LGA birth. Adjusted RRs for cohabiting mothers compared with married mothers were 0.93 (0.74-1.16) for stillbirth, 1.05 (0.81-1.35) for infant mortality, 1.09 (1.03-1.15) for PTB, 1.05 (0.99-1.10) for SGA birth, and 0.96 (0.92-1.00) for LGA birth. CONCLUSIONS In a nationally representative Canadian birth cohort, cohabiting and legally married women experienced similar birth outcomes, but most outcomes for single women were substantially worse.
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Affiliation(s)
- Gabriel D Shapiro
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
| | - Tracey Bushnik
- Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada
| | - Russell Wilkins
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Michael S Kramer
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada; Department of Pediatrics, McGill University, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Jay S Kaufman
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Amanda J Sheppard
- Aboriginal Cancer Control Unit, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Seungmi Yang
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
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23
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Firestein MR, Abellar R, Myers MM, Welch MG. Increased trophoblast inclusions in placentas from prematurely born infants: A potential marker of risk for preterm neurodevelopmental outcomes. Placenta 2017; 60:61-63. [PMID: 29208241 DOI: 10.1016/j.placenta.2017.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 10/13/2017] [Accepted: 10/21/2017] [Indexed: 01/21/2023]
Abstract
Trophoblast inclusions (TIs) are placental abnormalities of the trophoblast bilayer. Present in 2-8% of full-term placentas, they are associated with poor neurodevelopment, including autism. Although previously unstudied, examination of chorionic villi from 108 preterm births revealed a ∼4 fold increase in the frequency of TIs (30.5%). Frequency of TIs was inversely related to gestational age (GA); 43% of placentas <30 weeks and 20% of placentas ≥32 weeks had TIs (χ2 = 4.41, p = 0.036). This increased prevalence in preterm infants suggests that TIs may indicate adverse intrauterine processes or undetected genetic abnormalities and could identify infants at risk for poor neurodevelopment.
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Affiliation(s)
| | - Rosanna Abellar
- Department of Pathology & Cell Biology, Columbia University Medical Center, New York, NY, 10032, USA
| | - Michael M Myers
- Department of Pediatrics, Columbia University Medical Center, New York, NY, 10032, USA; Department of Psychiatry, Columbia University Medical Center, New York, NY, 10032, USA
| | - Martha G Welch
- Department of Pathology & Cell Biology, Columbia University Medical Center, New York, NY, 10032, USA; Department of Pediatrics, Columbia University Medical Center, New York, NY, 10032, USA; Department of Psychiatry, Columbia University Medical Center, New York, NY, 10032, USA
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