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Behboudi-Gandevani S, Bidhendi-Yarandi R, Hossein Panahi M, Mardani A, Prinds C, Vaismoradi M, Glarcher M. Prevalence of preterm birth in Scandinavian countries: a systematic review and meta-analysis. J Int Med Res 2023; 51:3000605231203843. [PMID: 37843530 PMCID: PMC10683576 DOI: 10.1177/03000605231203843] [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: 11/04/2022] [Accepted: 09/11/2023] [Indexed: 10/17/2023] Open
Abstract
OBJECTIVES As welfare societies, Scandinavian countries share characteristics of equality related to healthcare access, gender, and social services. However, cultural and lifestyle variations create country-specific health differences. This meta-analysis assessed the prevalence of preterm birth (PTB) and its categories in Scandinavian countries. METHODS A systematic search in key databases of literature published between 1990 and 2021 identified studies of the prevalence of PTB and its categories. Following the use of the Freeman-Tukey double arcsine transformation, a meta-analysis of weighted data was performed using the random-effects model and meta-prop method. RESULTS We identified 109 observational studies that involved 86,420,188 live births. The overall pooled prevalence (PP) of PTB was 5.3% (PP = 5.3%, 95% confidence interval [CI] 5.1%, 5.5%). The highest prevalence was in Norway (PP = 6.2%, 95% CI 5.3%, 7.0%), followed by Sweden (PP = 5.3%, 95% CI 5.1%, 5.4%), Denmark (PP = 5.2%, 95% CI 4.9%, 5.3%), and Iceland (PP = 5.0%, 95% CI 4.4%, 5.7%). Finland had the lowest PTB rate (PP = 4.9%, 95% CI 4.7%, 5.1%). CONCLUSIONS The overall PP of PTB was 5.3%, with small variations among countries (4.9%-6.2%). The highest and lowest PPs of PTB were in Norway and Finland, respectively.
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Affiliation(s)
| | - Razieh Bidhendi-Yarandi
- Department of Biostatistics and Epidemiology, School of Social Health, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohammad Hossein Panahi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Mardani
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Christina Prinds
- Department of Clinical Research, University South Denmark, Odense, Denmark; Department of Women’s Health, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Mojtaba Vaismoradi
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Faculty of Science and Health, Charles Sturt University, Orange, NSW, Australia
| | - Manela Glarcher
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
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Type of occupation and early antenatal care visit among women in sub-Saharan Africa. BMC Public Health 2022; 22:1118. [PMID: 35659653 PMCID: PMC9166586 DOI: 10.1186/s12889-022-13306-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 04/27/2022] [Indexed: 11/22/2022] Open
Abstract
Background Type of occupation has been linked to early antenatal care visits whereby women in different occupation categories tend to have different timing for antenatal care visits. Different occupations require varying levels of commitment, remuneration and energy requirements. This study, therefore, sought to investigate the association between the type of occupation and early antenatal care visits in sub-Saharan Africa. Methods This is a secondary analysis of Demographic and Health Survey data from 29 countries in sub-Saharan Africa conducted between 2010 and 2018. The study included 131,912 working women. We employed binary logistic regression models to assess the association between type of occupation and timely initiation of antenatal care visits. Results The overall prevalence of early initiation of antenatal care visits was 39.9%. Early antenatal care visit was high in Liberia (70.1%) but low in DR Congo (18.6%). We noted that compared to managerial workers, women in all other work categories had lower odds of early antenatal care visit and this was prominent among agricultural workers [aOR = 0.74, CI = 0.69, 0.79]. Women from Liberia [aOR = 3.14, CI = 2.84, 3.48] and Senegal [aOR = 2.55, CI = 2.31, 2.81] had higher tendency of early antenatal care visits compared with those from Angola. Conclusion The findings bring to bear some essential elements worth considering to enhance early antenatal care visits within sub-Saharan Africa irrespective of the type of occupation. Women in the agricultural industry need much attention in order to bridge the early antenatal care visit gap between them and workers of other sectors. A critical review of the maternal health service delivery in DR Congo is needed considering the low rate of early antenatal care visits.
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VURALLI D, SUCU M, TOTİK DOĞAN N. Evaluation of the factors affecting newborn weight. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1053457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Nourkami-Tutdibi N, Tutdibi E, Faas T, Wagenpfeil G, Draper ES, Johnson S, Cuttini M, Rafei RE, Seppänen AV, Mazela J, Maier RF, Nuytten A, Barros H, Rodrigues C, Zeitlin J, Zemlin M. Neonatal Morbidity and Mortality in Advanced Aged Mothers-Maternal Age Is Not an Independent Risk Factor for Infants Born Very Preterm. Front Pediatr 2021; 9:747203. [PMID: 34869105 PMCID: PMC8634642 DOI: 10.3389/fped.2021.747203] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 10/20/2021] [Indexed: 12/02/2022] Open
Abstract
Background: As childbearing is postponed in developed countries, maternal age (MA) has increased over decades with an increasing number of pregnancies between age 35-39 and beyond. The aim of the study was to determine the influence of advanced (AMA) and very advanced maternal age (vAMA) on morbidity and mortality of very preterm (VPT) infants. Methods: This was a population-based cohort study including infants from the "Effective Perinatal Intensive Care in Europe" (EPICE) cohort. The EPICE database contains data of 10329 VPT infants of 8,928 mothers, including stillbirths and terminations of pregnancy. Births occurred in 19 regions in 11 European countries. The study included 7,607 live born infants without severe congenital anomalies. The principal exposure variable was MA at delivery. Infants were divided into three groups [reference 18-34 years, AMA 35-39 years and very(v) AMA ≥40 years]. Infant mortality was defined as in-hospital death before discharge home or into long-term pediatric care. The secondary outcome included a composite of mortality and/or any one of the following major neonatal morbidities: (1) moderate-to-severe bronchopulmonary dysplasia; (2) severe brain injury defined as intraventricular hemorrhage and/or cystic periventricular leukomalacia; (3) severe retinopathy of prematurity; and (4) severe necrotizing enterocolitis. Results: There was no significant difference between MA groups regarding the use of surfactant therapy, postnatal corticosteroids, rate of neonatal sepsis or PDA that needed pharmacological or surgical intervention. Infants of AMA/vAMA mothers required significantly less mechanical ventilation during NICU stay than infants born to non-AMA mothers, but there was no significant difference in length of mechanical ventilation and after stratification by gestational age group. Adverse neonatal outcomes in VPT infants born to AMA/vAMA mothers did not differ from infants born to mothers below the age of 35. Maternal age showed no influence on mortality in live-born VPT infants. Conclusion: Although AMA/vAMA mothers encountered greater pregnancy risk, the mortality and morbidity of VPT infants was independent of maternal age.
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Affiliation(s)
- Nasenien Nourkami-Tutdibi
- Saarland University Medical Center, Hospital for General Pediatrics and Neonatology, Homburg, Germany
| | - Erol Tutdibi
- Saarland University Medical Center, Hospital for General Pediatrics and Neonatology, Homburg, Germany
| | - Theresa Faas
- Saarland University Medical Center, Hospital for General Pediatrics and Neonatology, Homburg, Germany
| | - Gudrun Wagenpfeil
- Saarland University Medical Center, Institute of Medical Biometry, Epidemiology and Medical Informatics, Homburg, Germany
| | - Elizabeth S Draper
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Samantha Johnson
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Marina Cuttini
- Clinical Care and Management Innovation Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Rym El Rafei
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - Anna-Veera Seppänen
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - Jan Mazela
- Department of Neonatology and Neonatal Infectious Diseases, Poznan University of Medical Sciences, Poznan, Poland
| | - Rolf Felix Maier
- Children's Hospital, University Hospital, Philipps University Marburg, Marburg, Germany
| | | | - Henrique Barros
- EPIUnit-Institute of Public Health, University of Porto, Porto, Portugal
| | - Carina Rodrigues
- EPIUnit-Institute of Public Health, University of Porto, Porto, Portugal
| | - Jennifer Zeitlin
- Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, INSERM, INRA, Paris, France
| | - Michael Zemlin
- Saarland University Medical Center, Hospital for General Pediatrics and Neonatology, Homburg, Germany
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Pospiech K, Czajkowski K. Amniotic fluid lactate level as a diagnostic tool for prolonged labour. JOURNAL OF MOTHER AND CHILD 2020; 24:3-7. [PMID: 33470958 PMCID: PMC8258834 DOI: 10.34763/jmotherandchild.20202403.2027.d-20-00011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Prolonged labour can lead to postpartum complications and adverse outcomes for both mother and baby. Measurable parameters can help in the active management of labour, timely diagnosis of dystocia and in the choice of the method of delivery. Progressive uterine contractions are necessary to complete labour successfully. Myometrial fatigue during prolonged labour causes a change from aerobic to anaerobic metabolism, resulting in an accumulation of intramuscular lactic acid and probably a subsequent increase in amniotic fluid lactate concentration. High amniotic fluid lactate level has been associated with ineffective uterine contractions leading to labour arrest. A considerable number of studies conducted so far indicate that the level of lactate in amniotic fluid may be a new non-invasive diagnostic tool for early prediction of prolonged labour and the need for immediate obstetric intervention. Low amniotic fluid lactate level may facilitate a decision to continue vaginal labour by oxytocin augmentation. A high level of amniotic fluid lactate is associated with surgical obstetric procedures. Measuring amniotic fluid lactate level might simplify the patient's allocation to a group, which will benefit from the administration of oxytocin and to a group that will not benefit from further prolongation of labour. This study aimed to briefly review current knowledge on amniotic fluid lactate concentrations measured using standard biochemical methods during the first stage of labour following normal pregnancy, as a possible diagnostic tool for prolonged labour. For this purpose, PubMed, EMBASE, Medline (1990 to July 2020) trials register and reference lists of relevant articles were searched.
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Affiliation(s)
- Kinga Pospiech
- 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
| | - Krzysztof Czajkowski
- 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, Warsaw, Poland
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Metcalfe A, Ahmed SB, Nerenberg K. Age-period-cohort effects in pre-existing and pregnancy-associated diseases amongst primiparous women. Biol Sex Differ 2020; 11:19. [PMID: 32307020 PMCID: PMC7168828 DOI: 10.1186/s13293-020-00293-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 03/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The average age at first birth is steadily increasing in developed countries; however, demographic shifts in maternal age at childbearing have not occurred in isolation. While temporal increases in adverse pregnancy outcomes are typically attributed to increases in maternal age, little is known about how maternal health status has changed across maternal age, period of delivery, and birth cohort. METHODS Natality files were used to identify primiparous women delivering liveborn, singleton infants in the USA in 1989, 1994, 1999, 2004, 2009, and 2014 (n = 6,857,185). Age-period-cohort models using the intrinsic estimator adjusted for temporal trends in smoking and gestational weight gain were used to quantify temporal changes in the rates of pre-existing (chronic hypertension, pre-existing diabetes) and pregnancy-associated (pregnancy-associated hypertension, gestational diabetes, eclampsia) diseases. Log-linear models were used to model the impact of temporal changes on preterm birth, small, and large for gestational age (SGA/LGA) births. RESULTS Significant period effects resulted in temporal increases in the rate of chronic hypertension, pregnancy-associated hypertension, and gestational diabetes, and a significant decrease in the rate of eclampsia. These observed period effects were associated with a 10.6% increase in the rate of SGA and a 7.1% decrease in LGA. Had the rate of pre-existing and pregnancy-associated diseases remained static over this time period, the rate of preterm birth would have increased by 5.9%, but instead only increased by 4.4%. CONCLUSIONS Independent of changes in the incidence of pre-existing and pregnancy-associated diseases as women age, the obstetric population is becoming less healthy over time. This is important, as these changes have a direct negative impact on short-term obstetric outcomes and women's long-term health.
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Affiliation(s)
- Amy Metcalfe
- Department of Obstetrics and Gynecology, Foothills Medical Centre, University of Calgary, 1403 29 St NW, Calgary, Alberta, T2N 2T9, Canada. .,Department of Community Health Sciences, University of Calgary, Calgary, Canada. .,Department of Medicine, University of Calgary, Calgary, Canada.
| | - Sofia B Ahmed
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Kara Nerenberg
- Department of Obstetrics and Gynecology, Foothills Medical Centre, University of Calgary, 1403 29 St NW, Calgary, Alberta, T2N 2T9, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Canada.,Department of Medicine, University of Calgary, Calgary, Canada
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Barbuscia A, Martikainen P, Myrskylä M, Remes H, Somigliana E, Klemetti R, Goisis A. Maternal age and risk of low birth weight and premature birth in children conceived through medically assisted reproduction. Evidence from Finnish population registers. Hum Reprod 2020; 35:212-220. [PMID: 31967314 PMCID: PMC6993849 DOI: 10.1093/humrep/dez275] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 11/15/2019] [Indexed: 11/19/2022] Open
Abstract
STUDY QUESTION Does the risk of low birth weight and premature birth increase with age among mothers who conceive through medically assisted reproduction (MAR)? SUMMARY ANSWER Among MAR mothers, the risk of poorer birth outcomes does not increase with maternal age at birth except at very advanced maternal ages (40+). WHAT IS KNOWN ALREADY The use of MAR treatments has been increasing over the last few decades and is especially diffused among women who conceive at older ages. Although advanced maternal age is a well-known risk factor for adverse birth outcomes in natural pregnancies, only a few studies have directly analysed the maternal age gradient in birth outcomes for MAR mothers. STUDY DESIGN, SIZE, DURATION The base dataset was a 20% random sample of households with at least one child aged 0-14 at the end of 2000, drawn from the Finnish population register and other administrative registers. This study included children who were born in 1995-2000, because the information on whether a child was conceived through MAR or naturally was available only from 1995 onwards. PARTICIPANTS/MATERIALS, SETTING, METHODS The outcome measures were whether the child had low birth weight (LBW, <2500 g at birth) and whether the child was delivered preterm (<37 weeks of gestation). Conceptions through MAR were identified by examining data on purchases of prescription medication from the National Prescription Register. Linear probability models were used to analyse and compare the maternal age gradients in birth outcomes of mothers who conceived through MAR or naturally before and after adjustment for maternal characteristics (i.e. whether the mother suffered from acute/chronic conditions before the pregnancy, household income and whether the mother smoked during pregnancy). MAIN RESULTS AND THE ROLE OF CHANCE A total of 56 026 children, 2624 of whom were conceived through MAR treatments, were included in the study. Among the mothers who used MAR to conceive, maternal age was not associated with an increased risk of LBW (the overall prevalence was 12.6%) at ages 25-39. For example, compared to the risk of LBW at ages 30-34, the risk was 0.22 percentage points lower (95% CI: -3.2, 2.8) at ages 25-29 and was 1.34 percentage points lower (95% CI: -4.5, 1.0) at ages 35-39. The risk of LBW was increased only at maternal ages ≥40 (six percentage points, 95% CI: 0.2, 12). Adjustment for maternal characteristics only marginally attenuated these associations. In contrast, among the mothers who conceived naturally, the results showed a clear age gradient. For example, compared to the risk of LBW (the overall prevalence was 3.3%) at maternal ages 30-34, the risk was 1.1 percentage points higher (95% CI: 0.6, 1.6) at ages 35-39 and was 1.5 percentage points higher (95% CI: 0.5, 2.6) at ages ≥40. The results were similar for preterm births. LIMITATIONS, REASON FOR CAUTION A limited number of confounders were included in the study because of the administrative nature of the data used. Our ability to reliably distinguish mothers based on MAR treatment type was also limited. WIDER IMPLICATIONS OF THE FINDINGS This is the first study to analyse the maternal age gradient in the risk of adverse birth outcomes among children conceived through MAR using data from a nationally representative sample and controlling for important maternal health and socio-economic characteristics. This topic is of considerable importance in light of the widespread and increasing use of MAR treatments. STUDY FUNDING/COMPETING INTEREST(S) Funding for this project was provided by the European Research Council (grant no. 803959 MARTE to Alice Goisis and grant no. 336475 COSTPOST to Mikko Myrskylä). E.S. reports personal fees from Theramex, personal fees from Merck Serono, personal fees from Health Reimbursement Arrangement, non-financial support from Merck Serono and grants from Ferring, grants from Theramex, outside the submitted work. The remaining authors have no competing interests. TRIAL REGISTRTION NUMBER N/A.
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Affiliation(s)
- Anna Barbuscia
- Institut National d’études Démographiques (Ined), 9 cours des Humanités, Aubervilliers, Cedex 93322, France
- Social and Political Sciences Department, University of Lausanne, Géopolis Building, Lausanne 1015, Switzerland
| | - Pekka Martikainen
- Max Planck Institute for Demographic Research, Konrad-Zuse strasse 1, Rostock 18057, Germany
- Centre for Health Equity Studies, Stockholm University, SE - 106 91 Stockholm, Sweden
- Faculty of Social Sciences, University of Helsinki, Yliopistonkatu 3, Helsinki 00014, Finland
| | - Mikko Myrskylä
- Max Planck Institute for Demographic Research, Konrad-Zuse strasse 1, Rostock 18057, Germany
- Faculty of Social Sciences, University of Helsinki, Yliopistonkatu 3, Helsinki 00014, Finland
- Social Policy Department, London School of Economics, Houghton street, London WC2A 2AE, United Kingdom
| | - Hanna Remes
- Faculty of Social Sciences, University of Helsinki, Yliopistonkatu 3, Helsinki 00014, Finland
| | - Edgardo Somigliana
- Department of Clinincal Sciences and Community Health, University of Milan, Via Fanti 6 - Pad. Regina Elena, Milano 20122, Italy
| | - Reija Klemetti
- National Institute for Health and Welfare, Mannerheimintie 166, Helsinki, Finland
| | - Alice Goisis
- Max Planck Institute for Demographic Research, Konrad-Zuse strasse 1, Rostock 18057, Germany
- Centre for Longitudinal Studies, UCL Institute of Education, 20 Bedford Way, London WC1H 0AL, United Kingdom
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Baldwin K. The biomedicalisation of reproductive ageing: reproductive citizenship and the gendering of fertility risk. HEALTH RISK & SOCIETY 2019. [DOI: 10.1080/13698575.2019.1651256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Kylie Baldwin
- Centre for Reproduction Research, De Montfort University Leicester, Leicester, UK
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9
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Xie M, Lao TT, Du M, Sun Q, Qu Z, Ma J, Song X, Wang M, Xu D, Ma R. Risk for Cesarean section in women of advanced maternal age under the changed reproductive policy in China: A cohort study in a tertiary hospital in southwestern China. J Obstet Gynaecol Res 2019; 45:1866-1875. [PMID: 31264353 DOI: 10.1111/jog.14048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 06/09/2019] [Indexed: 11/28/2022]
Abstract
AIM To describe changed epidemiological features of advanced maternal age (AMA) and to examine the effect of AMA on the risk for Cesarean section (CS) in a Chinese pregnant population. METHODS This retrospective single-center cohort study investigated the changes of epidemiological features of AMA parturients with respect to the revised reproductive policy in China in 43 702 singleton deliveries with live birth at ≥28 weeks managed from January 2005 to December 2016. We also evaluated the pregnancy outcomes in different age groups and risk factors of CS with multivariate analysis. RESULTS In this 12-year study period, the average maternal age increased from 28.5 to 30.2 years, and the proportion of AMA raised from 6.5% to 17.2%. AMA was significantly associated with increased risk of adverse pregnancy outcomes, and after adjustment for confounding factors, AMA remained a significant independent risk factor for CS. Furthermore, the effect of AMA in nulliparous women on the risk of CS was more significant than in multiparous women, while the history of previous CS (adjusted odds ratio 39.85) and interdelivery interval ≥10 years (adjusted odds ratio 1.52) also increased the risk of CS in multiparous women. CONCLUSION AMA increased the risk of a number of adverse pregnancy outcomes, and was independently associated with increased risk for CS. The increasing number of AMA parturients with risk factors is likely to increase CS rate in China in the near future, thus it is imperative to reduce the rate of primary CS as a matter of policy.
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Affiliation(s)
- Min Xie
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Terence T Lao
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong
| | - Mingyu Du
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Qian Sun
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zaiqing Qu
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Junnan Ma
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xinyan Song
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Mingfang Wang
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Dongqiong Xu
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Runmei Ma
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Kunming Medical University, Kunming, China.,Department of Obstetrics and Gynaecology, Kunming Angel Women and Children's Hospital, Kunming, China
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Impact of maternal age on intrapartum caesarean delivery rate in nulliparas with spontaneous labour. J Gynecol Obstet Hum Reprod 2019; 48:407-411. [PMID: 30797893 DOI: 10.1016/j.jogoh.2019.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 01/24/2019] [Accepted: 02/19/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND The advanced maternal age rate increases in developed countries. Older women have more pre-existing condition than youngest women and develop more frequently obstetrical pathologies responsible for a higher rate of caesarean delivery before labour and labour induction. For aged nulliparous without pathology who experience spontaneous labour, there is few data on the mode of delivery and on physiological labour according to maternal age. OBJECTIVE To compare the intrapartum caesarean delivery rate according to maternal age, for nulliparous with planned vaginal delivery and spontaneous labour at term. METHODS Retrospective cohort in a single academic institution between January 2000 and June 2017. All nulliparous women with planned vaginal delivery with live singleton in cephalic presentation at and after 37 weeks of gestation with spontaneous labour were included (n = 10,611). Two groups were compared: nulliparous women aged 20-34 and nulliparous women aged 35 and over. The main outcome was the intrapartum caesarean delivery rate. A subgroup analysis was performed for nulliparous with more advanced maternal age defined as women over 40. RESULTS Among the 10,611 women included in this analysis, 8,993 (84.8%) were aged 20-34 and 1,618 (15.2%) were aged over 35. From the latter 367 (22.7%) were over 40 years old. The intrapartum caesarean delivery rate was similar between women aged between 20 and 34 and women aged over 35 (10.8% compared to 8.8%; cOR 0.91, 95% CI 0.76-1.08; aOR 0.91, 95% CI 0.76-1.09). The indications of caesarean were similar in both groups. No differences were found between both groups for mean labour duration (430.9 min for the [20-34] years group compared to 428.0 min for the over 35 years group, p = 0.654). The subgroup analysis performed on nulliparous with more advanced maternal age yielded similar results. CONCLUSION For nulliparous at term in spontaneous labour, an advanced maternal age was not associated with an increased intrapartum caesarean delivery rate.
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Rahu K, Allvee K, Karro H, Rahu M. Singleton pregnancies after in vitro fertilization in Estonia: a register-based study of complications and adverse outcomes in relation to the maternal socio-demographic background. BMC Pregnancy Childbirth 2019; 19:51. [PMID: 30696425 PMCID: PMC6352442 DOI: 10.1186/s12884-019-2194-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 01/16/2019] [Indexed: 12/18/2022] Open
Abstract
Background An increased risk of adverse conditions related to in vitro fertilization (IVF) pregnancies has been repeatedly reported. Our study aimed to summarize outcome differences between pregnancies after IVF and after spontaneous conception (SC) in Estonia. Methods Data on all liveborn singletons to primiparas women aged 25–40 years during the period 2005–2014 were obtained from the Estonian Medical Birth Registry. There were 1778 and 33,555 newborns in the IVF and SC cohort, respectively. The relative risk of pregnancy-related complications and adverse pregnancy outcomes in the IVF cohort in comparison with the SC cohort was quantified by prevalence proportion ratios (RR) with 95% confidence intervals (CI) using modified Poisson regression models adjusted for maternal age, education, ethnicity, marital status and study period. Results The cohort of IVF singletons experienced a higher risk of preterm birth (RR 1.51; 95% CI 1.28–1.78), iatrogenic preterm birth (RR 1.62; 95% CI 1.32–1.98), very preterm birth (RR 1.49; 95% CI 1.00–2.23), low birthweight (RR 1.47; 95% CI 1.20–1.80), congenital anomalies (RR 1.51; 95% CI 1.08–2.11), and admission to a neonatal intensive care unit (RR 1.13; 95% CI 1.01–1.26). Somewhat elevated risk of spontaneous preterm birth did not reach statistical significance (RR 1.32; 95% CI 0.97–1.80). IVF mothers were at increased risk of placenta previa (RR 7.15; 95% CI 4.04–12.66), placental abruption (RR 2.12; 1.43–3.14) and cesarean section (RR 1.28; 95% CI 1.20–1.37). The risk of pre-eclampsia was borderline (RR 1.25; 95% CI 0.98–1.59). Adjustment for maternal age attenuated the associations between IVF and adverse outcomes. Maternal education, ethnicity and marital status had no effect on the magnitude of the risk estimates. Conclusions The increased risk of pregnancy-related complications and adverse pregnancy outcomes was observed in the Estonian cohort of IVF singletons in comparison with the cohort of SC singletons. The relative risk estimates grew with maternal age but were not influenced by the maternal education, ethnicity and marital status. To monitor the efficacy and safety of the used assisted reproductive technology, a specialized country-wide register should be created in Estonia.
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Affiliation(s)
- Kaja Rahu
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Hiiu 42, 11619, Tallinn, Estonia.
| | - Kärt Allvee
- Estonian Medical Birth Registry, National Institute for Health Development, Hiiu 42, 11619, Tallinn, Estonia
| | - Helle Karro
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, University of Tartu, L. Puusepa 8, 51014, Tartu, Estonia.,Tartu University Hospitals Womens Clinic, L. Puusepa 8, 51014, Tartu, Estonia
| | - Mati Rahu
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Hiiu 42, 11619, Tallinn, Estonia
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12
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Ogawa Y, Takeshima N, Furukawa TA. Maternal exposure to benzodiazepine and risk of preterm birth and low birth weight: A case-control study using a claims database in Japan. Asia Pac Psychiatry 2018; 10:e12309. [PMID: 29314716 DOI: 10.1111/appy.12309] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 12/07/2017] [Accepted: 12/11/2017] [Indexed: 01/26/2023]
Abstract
PURPOSE To examine (1) if the use of benzodiazepines and antidepressants during pregnancy may increase the risk of preterm birth and/or low birth weight (LBW), and, if yes, (2) which types of benzodiazepines or antidepressants have stronger influences. METHODS A case-control study was performed using a large claims database in Japan. Cases were mothers who had given birth to preterm and/or LBW infants between 2005 and 2014 (737 with preterm births and 1615 with LBW). Controls were mothers who had neither experienced preterm birth nor given birth to an LBW infant. RESULTS Overall, 42 058 births were included. The maternal use of benzodiazepines was significantly associated with an increased risk of preterm birth (adjusted odds ratio [OR], 2.03; 95% confidence interval [CI], 1.11-3.69, P < .05), while the maternal use of benzodiazepines was not significantly associated with LBW (adjusted OR, 1.55; 0.96-2.50). The use of antidepressants was not significantly associated with both preterm deliveries (adjusted OR, 0.57; 0.08-4.16) and LBW (adjusted OR, 0.56; 0.14-2.29). CONCLUSIONS Benzodiazepine use was associated with increased risk of preterm birth but not with LBW. Antidepressant use was not associated with both preterm deliveries and LBW.
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Affiliation(s)
- Yusuke Ogawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Nozomi Takeshima
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
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13
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Hautakangas T, Palomäki O, Eidstø K, Huhtala H, Uotila J. Impact of obesity and other risk factors on labor dystocia in term primiparous women: a case control study. BMC Pregnancy Childbirth 2018; 18:304. [PMID: 30021565 PMCID: PMC6052711 DOI: 10.1186/s12884-018-1938-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 07/11/2018] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Purpose of this study was to investigate differences between primiparous term pregnancies, one leading to vaginal delivery (VD) and the other to acute cesarean section (CS) due to labor dystocia in the first stage of labor. We particularly wanted to assess the influence of body mass index (BMI) on CS risk. METHODS A retrospective case-control study in a tertiary delivery unit with 5200 deliveries annually. Cases were 296 term primiparous women whose intended vaginal labor ended in acute CS because of dystocia. Controls were primiparas with successful vaginal delivery VD (n = 302). The data were retrieved from medical records. Multiple logistic regression analyses were used to assess the associations between BMI and covariates on labor dystocia. RESULTS In the cases ending with acute CS, women were older (OR 1.06 [1.03-1.10]), shorter (OR 0.94 [0.91-0.96]) and more often had a chronic disease (OR 1.60 [1.1-2.29]). In this group fetal malposition (OR 42.0 [19.2-91.9]) and chorioamnionitis (OR 10.9 [5.01-23.6]) were more common, labor was less often in an active phase (OR 3.37 [2.38-4.76]) and the cervix was not as well ripened (1.5 vs. 2.5 cm, OR 0.57 [0.48-0.67] on arrival at the birth unit. BMI was higher in the dystocia group (24.1 vs. 22.6 kg/m2, p < 0.001), and rising maternal pre-pregnancy BMI had a strong association with dystocia risk. If BMI increased by 1 kg/m2, the risk of CS was 10% elevated. Among obese primiparas, premature rupture of membranes, chorioamnionitis and induction of labor were more common. Their labors were less often in an active phase at hospital admission. Severely obese primiparas (BMI ≥ 35 kg/m2) had 4 hours longer labor than normal-weight parturients. CONCLUSIONS Labor dystocia is a multifactorial phenomenon in which the possibility to ameliorate the condition via medical treatment is limited. Hospital admission at an advanced stage of labor is recommended. Pre-pregnancy weight control in the population at reproductive age is essential, as a high BMI is strongly associated with labor dystocia.
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Affiliation(s)
- Tuija Hautakangas
- Department of Obstetrics and Gynecology, Central Hospital of Central Finland, Keskussairaalantie 19, 40620 Jyväskylä, Finland
| | - Outi Palomäki
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
| | | | - Heini Huhtala
- School of Health Sciences, Tampere University, Tampere, Finland
| | - Jukka Uotila
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
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Akowuah JA, Agyei-Baffour P, Awunyo-Vitor D. Determinants of Antenatal Healthcare Utilisation by Pregnant Women in Third Trimester in Peri-Urban Ghana. J Trop Med 2018; 2018:1673517. [PMID: 29666654 PMCID: PMC5832169 DOI: 10.1155/2018/1673517] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/24/2017] [Accepted: 12/27/2017] [Indexed: 11/27/2022] Open
Abstract
Access to quality healthcare still remains a major challenge in the efforts at reversing maternal morbidity and mortality. Despite the availability of established maternal health interventions, the health of the expectant mother and the unborn child remains poor due to low utilisation of interventions. The study examined the socioeconomic determinants of antenatal care utilisation in peri-urban Ghana using pregnant women who are in their third trimester. Two-stage sampling technique was used to sample 200 pregnant women who were in their third trimester from the District Health Information Management System software. Well-structured questionnaire was the instrument used to collect data from respondents. Descriptive statistics and inferential statistics including binary logit regression model were used to analyse the data with the help of SPSS and STATA software. The results showed varying utilisation levels of ANC. From the regression result, age, household size, and occupational status were identified as the important socioeconomic determinants of antenatal care utilisation among the respondents. The important system factors which influence antenatal care utilisation by the respondents are distance to ANC, quality of service, and service satisfaction. The study concludes that socioeconomic and health system factors are important determinants of antenatal care utilisation. Stepping up of interventions aimed at improving the socioeconomic status and addressing health system and proximity challenges could be helpful in improving antenatal care utilisation by pregnant women in Ghana.
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Affiliation(s)
- Jones Asafo Akowuah
- Department of Agricultural Economics, Agribusiness and Extension, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Peter Agyei-Baffour
- Department of Community Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Dadson Awunyo-Vitor
- Department of Agricultural Economics, Agribusiness and Extension, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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15
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Rumrich IK, Vähäkangas K, Viluksela M, Gissler M, Surcel HM, de Ruyter H, Jokinen J, Hänninen O. The MATEX cohort - a Finnish population register birth cohort to study health effects of prenatal exposures. BMC Public Health 2017; 17:871. [PMID: 29115964 PMCID: PMC5678812 DOI: 10.1186/s12889-017-4881-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 10/26/2017] [Indexed: 12/11/2022] Open
Abstract
Background The prevalence of chronic diseases, such as immune, neurobehavioral, and metabolic disorders has increased in recent decades. According to the concept of Developmental Origin of Health and Disease (DOHaD), developmental factors associated with environmental exposures and maternal lifestyle choices may partly explain the observed increase. Register-based epidemiology is a prime tool to investigate the effects of prenatal exposures over the whole life course. Our aim is to establish a Finnish register-based birth cohort, which can be used to investigate various (prenatal) exposures and their effects during the whole life course with first analyses focusing on maternal smoking and air pollution. In this paper we (i) review previous studies to identify knowledge gaps and overlaps available for cross-validation, (ii) lay out the MATEX study plan for register linkages, and (iii) analyse the study power of the baseline MATEX cohort for selected endpoints identified from the international literature. Methods/design The MATEX cohort is a fully register-based cohort identified from the Finnish Medical Birth Register (MBR) (1987–2015). Information from the MBR will be linked with other Finnish health registers and the population register to link the cohort with air quality data. Epidemiological analyses will be conducted for maternal smoking and air pollution and a range of health endpoints. Discussion The MATEX cohort consists of 1.75 million mother-child pairs with a maximum follow up time of 29 years. This makes the cohort big enough to reach sufficient statistical power to investigate rare outcomes, such as birth anomalies, childhood cancers, and sudden infant death syndrome (SIDS). The linkage between different registers allows for an extension of the scope of the cohort and a follow up from the prenatal period to decades later in life. Electronic supplementary material The online version of this article (10.1186/s12889-017-4881-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Isabell K Rumrich
- Department of Environmental and Biological Sciences, University of Eastern Finland (UEF), Kuopio, Finland. .,Department of Public Health Solutions, National Institute for Health and Welfare (THL), Kuopio, Finland.
| | - Kirsi Vähäkangas
- University of Eastern Finland (UEF), School of Pharmacy/Toxicology, Kuopio, Finland
| | - Matti Viluksela
- Department of Environmental and Biological Sciences, University of Eastern Finland (UEF), Kuopio, Finland.,Department of Public Health Solutions, National Institute for Health and Welfare (THL), Kuopio, Finland
| | - Mika Gissler
- Department of Information Services, National Institute for Health and Welfare, Helsinki, Finland
| | - Heljä-Marja Surcel
- Department of Welfare, National Institute for Health and Welfare, Oulu, Finland
| | | | - Jukka Jokinen
- Department of Public Health Solutions, National Institute for Health and Welfare (THL), Kuopio, Finland
| | - Otto Hänninen
- Department of Public Health Solutions, National Institute for Health and Welfare (THL), Kuopio, Finland
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16
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De Munck N, Vajta G. Safety and efficiency of oocyte vitrification. Cryobiology 2017; 78:119-127. [PMID: 28774548 DOI: 10.1016/j.cryobiol.2017.07.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 07/25/2017] [Accepted: 07/25/2017] [Indexed: 12/22/2022]
Abstract
As the oocyte is the starting point for a new life, artificial reproductive technology (ART) techniques should not affect the (ultra) structural and functional integrity, or the developmental competence. Oocyte vitrification -one of the most significant achievements in human ART during the past decade- should therefore be a safe and efficient technique. This review discusses the principles and developments of the existing and future techniques, applications possibilities and safety concerns. The broad range of vitrification media and devices that are currently available, show differences in their effects on the oocyte ultrastructure and preimplantation development. It is not yet fully decided whether this has an influence on the obstetric and neonatal outcome, since only limited information is available with different media and devices. For autologous oocytes, the obstetric and neonatal outcomes appear promising and comparable to pregnancies obtained with fresh oocytes. This however, is not the case for heterologous fresh or vitrified oocytes, where the immunological foreign foetus induces adverse obstetric and neonatal outcomes. Besides the oocyte vitrification process itself, the effect of multiple stimulations (for oocyte banking or for oocyte donors), seems to influence the possibility to develop gynaecological cancers further in life. Automated vitrification/warming should offer a consistent, cross-contamination free process that offers the highest safety level for the users. They should also produce more consistent results in survival, development and clinical pregnancies between different IVF clinics.
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Affiliation(s)
- Neelke De Munck
- Universitair Ziekenhuis Brussel (UZ Brussel), Centrum voor Reproductieve Geneeskunde, Laarbeeklaan 101, 1090 Brussels, Belgium.
| | - Gábor Vajta
- Central Queensland University, Bruce Highway, North Rockhampton QLD 4702, Australia
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17
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Aarnio K, Gissler M, Grittner U, Siegerink B, Kaste M, Tatlisumak T, Tikkanen M, Putaala J. Outcome of pregnancies and deliveries before and after ischaemic stroke. Eur Stroke J 2017; 2:346-355. [PMID: 31008326 DOI: 10.1177/2396987317723795] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 07/07/2017] [Indexed: 11/15/2022] Open
Abstract
Introduction Limited data exist on the outcome of pregnancies and deliveries in women with ischaemic stroke. We investigated the incidence of pregnancy- and delivery-related complications in women with ischaemic stroke before and after pregnancy compared with stroke-free matched controls. Patients and methods Of our 1008 consecutive patients aged 15-49 years with first-ever ischaemic stroke, 1994-2007, we included women with pregnancy data before or after stroke recorded in the Medical Birth Register (MBR) (n = 152), and for them searched stroke-free controls matched by age, parity, year of birth, residential area and multiplicity (n = 608). Data on hospital admissions and deaths (1987-2014) came from national health registries. Poisson regression mixed models allowed comparison of the incidence of complications. Results A total of 124 stroke mothers had 207 singleton pregnancies before and 45 mothers 68 pregnancies after stroke. The incidence rate ratio (IRR) for the composite outcome of pregnancy and delivery complications adjusted for socioeconomic status and maternal smoking was 1.43 (95% confidence interval [CI] 1.00-2.03, p = 0.05) for pre-stroke mothers, and 1.09 (95% CI 0.66-1.78) for post-stroke mothers, compared with matched controls. Similarly, the adjusted IRR for post-stroke hospital admission during pregnancy was 1.85 (95% CI 1.03-3.31). The IRR for perinatal death of the child was 3.43 (95% CI 0.57-20.53) before and 8.88 (95% CI 0.81-97.95) after stroke. Discussion and conclusions Compared with stroke-free mothers, we found a higher incidence of pregnancy- and delivery-related complications in mothers with ischaemic stroke. Larger studies are needed to verify our results.
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Affiliation(s)
- Karoliina Aarnio
- Clinical Neurosciences, Neurology, University of Helsinki, Finland
- Department of Neurology, Helsinki University Hospital, Finland
| | - Mika Gissler
- National Institute for Health and Welfare, Finland
- Karolinska Institute, Sweden
| | - Ulrike Grittner
- Center for Stroke Research Berlin (CSB) Charité Universitätsmedizin Berlin, Germany
- Department of Biostatistics and Clinical Epidemiology, Charité Universitätsmedizin Berlin, Germany
| | - Bob Siegerink
- Center for Stroke Research Berlin (CSB) Charité Universitätsmedizin Berlin, Germany
| | - Markku Kaste
- Clinical Neurosciences, Neurology, University of Helsinki, Finland
- Department of Neurology, Helsinki University Hospital, Finland
| | - Turgut Tatlisumak
- Clinical Neurosciences, Neurology, University of Helsinki, Finland
- Department of Neurology, Helsinki University Hospital, Finland
- Institute of Neurosciences and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Minna Tikkanen
- Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Finland
| | - Jukka Putaala
- Clinical Neurosciences, Neurology, University of Helsinki, Finland
- Department of Neurology, Helsinki University Hospital, Finland
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18
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Perinatal and social factors predicting caesarean birth in a 2004 Australian birth cohort. Women Birth 2017; 30:506-510. [PMID: 28688791 DOI: 10.1016/j.wombi.2017.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 04/27/2017] [Accepted: 05/02/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND The proportion of babies born by caesarean section in Australia has almost doubled over the last 25 years. Factors known to contribute to caesarean such as higher maternal age, mothers being overweight or obese, or having had a previous caesarean do not completely account for the increased rate and it is clear that other influences exist. AIM To identify previously unsuspected risk factors associated with caesarean using nationally-representative data from the Longitudinal Study of Australian Children. METHODS Data were from the birth cohort, a long-term prospective study of approximately 5000 children that includes richly-detailed data regarding maternal health and exposures during pregnancy. Logistic regression was used to examine the contribution of a wide range of pregnancy, birth and social factors to caesarean. FINDINGS 28% of 4862 mothers were delivered by caesarean. The final adjusted analyses revealed that use of diabetes medication (OR=3.1, 95% CI=1.7-5.5, p<0.001) and maternal mental health problems during pregnancy (OR=1.3, CI=1.1-1.6, p=0.003) were associated with increased odds of caesarean. Young maternal age (OR=0.6, CI=0.5-0.7, p<0.001), having two or more children (OR=0.7, CI=0.6-0.9, p<0.001), and fathers having an unskilled occupation (OR=0.7, CI=0.6-1.0, p=0.036) were associated with reduced odds of caesarean. CONCLUSION Our findings raise the prospect that the effect of additional screening and support for maternal mental health on caesarean rate should be subject of prospective study.
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19
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Lisonkova S, Potts J, Muraca GM, Razaz N, Sabr Y, Chan WS, Kramer MS. Maternal age and severe maternal morbidity: A population-based retrospective cohort study. PLoS Med 2017; 14:e1002307. [PMID: 28558024 PMCID: PMC5448726 DOI: 10.1371/journal.pmed.1002307] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 04/20/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND One of the United Nations' Millennium Development Goals of 2000 was to reduce maternal mortality by 75% in 15 y; however, this challenge was not met by many industrialized countries. As average maternal age continues to rise in these countries, associated potentially life-threatening severe maternal morbidity has been understudied. Our primary objective was to examine the associations between maternal age and severe maternal morbidities. The secondary objective was to compare these associations with those for adverse fetal/infant outcomes. METHODS AND FINDINGS This was a population-based retrospective cohort study, including all singleton births to women residing in Washington State, US, 1 January 2003-31 December 2013 (n = 828,269). We compared age-specific rates of maternal mortality/severe morbidity (e.g., obstetric shock) and adverse fetal/infant outcomes (e.g., perinatal death). Logistic regression was used to adjust for parity, body mass index, assisted conception, and other potential confounders. We compared crude odds ratios (ORs) and adjusted ORs (AORs) and risk differences and their 95% CIs. Severe maternal morbidity was significantly higher among teenage mothers than among those 25-29 y (crude OR = 1.5, 95% CI 1.5-1.6) and increased exponentially with maternal age over 39 y, from OR = 1.2 (95% CI 1.2-1.3) among women aged 35-39 y to OR = 5.4 (95% CI 2.4-12.5) among women aged ≥50 y. The elevated risk of severe morbidity among teen mothers disappeared after adjustment for confounders, except for maternal sepsis (AOR = 1.2, 95% CI 1.1-1.4). Adjusted rates of severe morbidity remained increased among mothers ≥35 y, namely, the rates of amniotic fluid embolism (AOR = 8.0, 95% CI 2.7-23.7) and obstetric shock (AOR = 2.9, 95% CI 1.3-6.6) among mothers ≥40 y, and renal failure (AOR = 15.9, 95% CI 4.8-52.0), complications of obstetric interventions (AOR = 4.7, 95% CI 2.3-9.5), and intensive care unit (ICU) admission (AOR = 4.8, 95% CI 2.0-11.9) among those 45-49 y. The adjusted risk difference in severe maternal morbidity compared to mothers 25-29 y was 0.9% (95% CI 0.7%-1.2%) for mothers 40-44 y, 1.6% (95% CI 0.7%-2.8%) for mothers 45-49 y, and 6.4% for mothers ≥50 y (95% CI 1.7%-18.2%). Similar associations were observed for fetal and infant outcomes; neonatal mortality was elevated in teen mothers (AOR = 1.5, 95% CI 1.2-1.7), while mothers over 29 y had higher risk of stillbirth. The rate of severe maternal morbidity among women over 49 y was higher than the rate of mortality/serious morbidity of their offspring. Despite the large sample size, statistical power was insufficient to examine the association between maternal age and maternal death or very rare severe morbidities. CONCLUSIONS Maternal age-specific incidence of severe morbidity varied by outcome. Older women (≥40 y) had significantly elevated rates of some of the most severe, potentially life-threatening morbidities, including renal failure, shock, acute cardiac morbidity, serious complications of obstetric interventions, and ICU admission. These results should improve counselling to women who contemplate delaying childbirth until their forties and provide useful information to their health care providers. This information is also useful for preventive strategies to lower maternal mortality and severe maternal morbidity in developed countries.
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Affiliation(s)
- Sarka Lisonkova
- Department of Obstetrics and Gynaecology, University of British Columbia and Children’s and Women’s Health Centre of British Columbia, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jayson Potts
- Department of Medicine, University of British Columbia and BC Women’s Hospital and Health Centre, Vancouver, British Columbia, Canada
| | - Giulia M. Muraca
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Neda Razaz
- Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Yasser Sabr
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Wee-Shian Chan
- Department of Medicine, University of British Columbia and BC Women’s Hospital and Health Centre, Vancouver, British Columbia, Canada
| | - Michael S. Kramer
- Department of Pediatrics, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
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20
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Qureshi AI, Saeed O, Malik AA, Suri MFK. Pregnancy in advanced age and the risk of stroke in postmenopausal women: analysis of Women's Health Initiative Study. Am J Obstet Gynecol 2017; 216:409.e1-409.e6. [PMID: 27956201 DOI: 10.1016/j.ajog.2016.12.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 11/14/2016] [Accepted: 12/01/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND The incidence of pregnancy in advanced age among women is increasing because of the availability of assisted reproduction, although the long-term health consequences are not known. OBJECTIVE The purpose of this study was to determine the effect of pregnancy in advanced age on the occurrence of cardiovascular events in a large cohort of postmenopausal women. STUDY DESIGN We analyzed the data for 72,221 women aged 50-79 years who were enrolled in the observational arm of the Women's Health Initiative study. We determined the effect of pregnancy in advanced age (last pregnancy at age ≥40 year) on the risk of ischemic stroke, hemorrhagic stroke, myocardial infarction, and cardiovascular death over a mean period (±standard deviation) of 12±1 years using Cox Proportional Hazards analysis after adjusting for potential confounders. RESULTS A total of 3306 of the 72,221 participants (4.6%) reported pregnancy in advanced age. Compared with pregnancy in normal age, the rates of ischemic stroke (3.8% vs 2.4%), hemorrhagic stroke (1.0% vs 0.5%), and cardiovascular death (3.9% vs 2.3%) were significantly higher among women with pregnancy in advanced age. In multivariate analysis, women with pregnancy in advanced age were 50% more likely to experience a hemorrhagic stroke (hazard ratio, 1.5; 95% confidence interval, 1.0-2.1) after adjustment for age, race/ethnicity, congestive heart failure, systolic blood pressure, atrial fibrillation, alcohol use, and cigarette smoking. There was no significant difference in the risk of ischemic stroke, myocardial infarction, and cardiovascular death among women with pregnancy in advanced age after adjustment for potential confounders. CONCLUSION Women with pregnancy at an advanced age have a higher risk for hemorrhagic stroke in the postmenopausal period.
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21
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Robson SJ, Costa CM. Thirty years of the World Health Organization's target caesarean section rate: time to move on. Med J Aust 2017; 206:181-185. [DOI: 10.5694/mja16.00832] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 09/28/2016] [Indexed: 12/21/2022]
Affiliation(s)
- Stephen J Robson
- Centenary Hospital for Women and Children, ANU Medical School, Canberra, ACT
| | - Caroline M Costa
- Department of Obstetrics and Gynaecology, James Cook University School of Medicine, Cairns, QLD
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22
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Klemetti R, Gissler M, Sainio S, Hemminki E. At what age does the risk for adverse maternal and infant outcomes increase? Nationwide register-based study on first births in Finland in 2005-2014. Acta Obstet Gynecol Scand 2016; 95:1368-1375. [PMID: 27623182 DOI: 10.1111/aogs.13020] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 09/06/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION It is poorly understood if there are specific ages at which adverse outcomes during pregnancy and childbirth start to increase (threshold-ages). The purpose of this study was to examine at which maternal ages the use of maternity care and the risks for adverse maternal and infant outcomes increase. MATERIAL AND METHODS National data from the Finnish Medical Birth Register including all first-time mothers aged 20 years or over with singleton pregnancies in 2005-2014 were analyzed (n = 228 348). Odds ratios for each outcome at different ages were calculated by logistic regression, using women aged 20-24 (n = 56 282) as the reference and adjusting for socioeconomic position and urbanity of residence. The threshold-age was defined as the first significant adjusted odds ratio after which the risk remained significant. RESULTS The threshold-ages for use of maternity care varied from 25 years for cesarean section (OR 1.08, 95% CI 1.03-1.14) to 38 years for having 16 or more antenatal visits (1.13, 1.04-1.21). Four threshold-ages were found for maternal health outcomes: 25 years for gestational diabetes (OR 1.15, 1.09-1.23), 27 years for placenta previa (OR 1.75, 1.11-2.75), 33 years for gestational hypertension (1.14, 1.03-1.27), and 38 years for preeclampsia (OR 1.48, 1.12-1.96). The threshold-ages for infant health outcomes varied from 28 years for preterm birth (37 weeks, OR 1.10, 1.02-1.19) to 36 years for perinatal mortality (OR 2.10, 1.44-3.07). CONCLUSIONS Different threshold-ages were identified. Most adverse outcomes occurred earlier than the traditional cut-off ages for high risk pregnancy, which have been set at 35 or 40 years.
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Affiliation(s)
- Reija Klemetti
- National Institute for Health and Welfare (THL), Helsinki, Finland.,Department of Public Health, Helsinki University, Helsinki, Finland
| | - Mika Gissler
- National Institute for Health and Welfare (THL), Helsinki, Finland.,Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | | | - Elina Hemminki
- National Institute for Health and Welfare (THL), Helsinki, Finland.,Department of Public Health, Helsinki University, Helsinki, Finland
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Zapata-Masias Y, Marqueta B, Gómez Roig MD, Gonzalez-Bosquet E. Obstetric and perinatal outcomes in women ≥40years of age: Associations with fetal growth disorders. Early Hum Dev 2016; 100:17-20. [PMID: 27391869 DOI: 10.1016/j.earlhumdev.2016.04.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 04/20/2016] [Accepted: 04/21/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Evidence indicates that advanced maternal age is associated with adverse obstetric and perinatal outcomes. The purpose of this study was to evaluate pregnancy outcomes in women of advanced maternal age (≥40years). METHODS Using a prospective study design, data were collected by the Department of Obstetrics at the San Joan de Deu Hospital of Barcelona during the 1 June 2009 to 31 May 2012 period. The results were compared across three maternal age groups (≥40 [n=654], 35-39 [n=2781], and <35 [n=7893] years). RESULTS Of the 11328 births recorded during the study period, pregnancy-related complications were more common in women ≥40years of age. The most common disorder was diabetes (8.5% in the ≥40, 5.3% in the 35-39, and 3.0% in the <35years age groups). The women ≥40years of age also had significantly more premature births (p=0.001) and cesarean sections (17% in the ≥40, 12.5% in the 35-39, and 7.9% in the <35-year age groups; p=0.001). Intrauterine growth retardation was significantly more frequent in women aged ≥40years (17.4% in the ≥40, 15% in the 35-39, and 14.0% in the <35-year age groups; p=0.03). Fetal macrosomia was significantly more common in women ≥40years (15.4% in the ≥40, 12.6% in the 35-39, and 12% in the <35-year age groups; p=0.03). CONCLUSION Maternal age ≥40years was associated with poorer obstetric and perinatal outcomes and increased the risks of cesarean section, intrauterine growth retardation, and fetal macrosomia.
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Affiliation(s)
- Yesenia Zapata-Masias
- BCNatal - Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Deu, University of Barcelona, Pg. Sant Joan de Deu, nº 2 Esplugues, 08950, Barcelona, Spain.
| | - Belén Marqueta
- BCNatal - Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Deu, University of Barcelona, Pg. Sant Joan de Deu, nº 2 Esplugues, 08950, Barcelona, Spain.
| | - M D Gómez Roig
- BCNatal - Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Deu, University of Barcelona, Pg. Sant Joan de Deu, nº 2 Esplugues, 08950, Barcelona, Spain.
| | - Eduardo Gonzalez-Bosquet
- BCNatal - Barcelona Center for Maternal Fetal and Neonatal Medicine, Hospital Sant Joan de Deu, University of Barcelona, Pg. Sant Joan de Deu, nº 2 Esplugues, 08950, Barcelona, Spain.
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24
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Herstad L, Klungsøyr K, Skjærven R, Tanbo T, Forsén L, Åbyholm T, Vangen S. Elective cesarean section or not? Maternal age and risk of adverse outcomes at term: a population-based registry study of low-risk primiparous women. BMC Pregnancy Childbirth 2016; 16:230. [PMID: 27535233 PMCID: PMC4988032 DOI: 10.1186/s12884-016-1028-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 08/15/2016] [Indexed: 02/06/2023] Open
Abstract
Background Maternal age at delivery and cesarean section rates are increasing. In older women, the decision on delivery mode may be influenced by a reported increased risk of surgical interventions during labor and complications with increasing maternal age. We examined the association between maternal age and adverse outcomes in low-risk primiparous women, and the risk of adverse outcomes by delivery modes, both planned and performed (elective and emergency cesarean section, operative vaginal delivery, and unassisted vaginal delivery) in women aged ≥ 35 years. Methods A population-based registry study was conducted using data from the Medical Birth Registry of Norway and Statistics Norway including 169,583 low-risk primiparas with singleton, cephalic labors at ≥ 37 weeks during 1999 − 2009. Outcomes studied were obstetric blood loss, maternal transfer to intensive care units, 5-min Apgar score, and neonatal complications. We adjusted for potential confounders using relative risk models and multinomial logistic regression. Results Most adverse outcomes increased with increasing maternal age. However, the increase in absolute risks was low, except for moderate obstetric blood loss and transfer to the neonatal intensive care unit (NICU). Operative deliveries increased with increasing maternal age and in women aged ≥ 35 years, the risk of maternal complications in operative delivery increased. Neonatal adverse outcomes increased mainly in emergency operative deliveries. Moderate blood loss was three times more likely in elective and emergency cesarean section than in unassisted vaginal delivery, and twice as likely in operative vaginal delivery. Low Apgar score and neonatal complications occurred two to three times more often in emergency operative deliveries than in unassisted vaginal delivery. However, comparing outcomes after elective cesarean section and planned vaginal delivery, only moderate blood loss (higher in elective cesarean section), neonatal transfer to NICU and neonatal infections (both higher in planned vaginal delivery) differed significantly. Conclusions Most studied adverse outcomes increased with increasing maternal age, as did operative delivery. Although emergency operative procedures were associated with an increased risk of adverse outcomes, the absolute risk difference in complications between the modes of delivery was low for the majority of outcomes studied. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-1028-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lina Herstad
- Norwegian National Advisory Unit on Women's Health, Women and Children's Division, Oslo University Hospital Rikshospitalet, PO Box 4950, Nydalen, N-0424, Oslo, Norway.
| | - Kari Klungsøyr
- Medical Birth Registry of Norway, Norwegian Institute of Public Health, Bergen, Norway.,Departments of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Rolv Skjærven
- Medical Birth Registry of Norway, Norwegian Institute of Public Health, Bergen, Norway.,Departments of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Tom Tanbo
- University of Oslo, Oslo, Norway.,Department of Gynecology, Oslo University Hospital, Oslo, Norway
| | - Lisa Forsén
- Norwegian National Advisory Unit on Women's Health, Women and Children's Division, Oslo University Hospital Rikshospitalet, PO Box 4950, Nydalen, N-0424, Oslo, Norway.,Norwegian Institute of Public Health, Oslo, Norway
| | - Thomas Åbyholm
- University of Oslo, Oslo, Norway.,Department of Obstetrics, Oslo University Hospital, Oslo, Norway
| | - Siri Vangen
- Norwegian National Advisory Unit on Women's Health, Women and Children's Division, Oslo University Hospital Rikshospitalet, PO Box 4950, Nydalen, N-0424, Oslo, Norway
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25
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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; 36:272-7. [PMID: 26741572 DOI: 10.1038/jp.2015.204] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 11/09/2015] [Accepted: 11/19/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To assess associations between primary cesarean delivery and adverse delivery outcomes with very advanced maternal age. STUDY DESIGN We conducted a population-based cohort study including 78,880 births to mothers 25 years and older with singleton births from 2003 to 2012 using Washington State birth certificates and hospital discharge data, excluding births to women with a prior cesarean section. The primary outcome was mode of delivery. Secondary outcomes included maternal transfusion, chorioamnionitis, severe perineal lacerations and prolonged length of stay. Outcomes of births to women of advanced maternal age (35 to 39, 40 to 44) and very advanced maternal age (45 to 49, ⩾50) were compared with referent births among women aged 25 to 34 years. General linear models with a log-link function were used to calculate unadjusted and adjusted relative risks and 95% confidence intervals (CIs). RESULT Proportions and risks of primary cesarean section increased with age (25 to 34 years, referent: 20.0%; 35 to 39 years: 25.9%, relative risk (RR)=1.25 (95% CI=1.20 to 1.29); 40 to 44 years: 30.9%, RR=1.45 (95% CI=1.40 to 1.50); 45 to 49 years: 35.7%, RR=1.59 (95% CI=1.45 to 1.75); and ⩾50 years: 60.7%, RR=2.44 (95% CI=1.95 to 3.05); P-trend <0.001). Associations did not differ between primiparous and multiparous women. No differences were noted for measures of maternal morbidity, except there was a trend of increasing risk of prolonged length of stay among births to older women (P-trend <0.001). CONCLUSION Primary cesarean delivery risk continues to increase above age 35 regardless of prior vaginal birth, with the highest risk among women aged 50 years and older.
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Affiliation(s)
- M K Richards
- Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - M R Flanagan
- Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - A J Littman
- Seattle Epidemiologic Research and Information Center, Puget Sound Health Care System, Department of Veterans Affairs, Seattle, WA, USA.,Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA.,Health Services Research and Development, Puget Sound Health Care System, Department of Veterans Affairs, Seattle, WA, USA
| | - A K Burke
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA, USA
| | - L S Callegari
- Department of Epidemiology, University of Washington School of Public Health, Seattle, WA, USA.,Health Services Research and Development, Puget Sound Health Care System, Department of Veterans Affairs, Seattle, WA, USA.,Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA, USA
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26
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De Munck N, Belva F, Van de Velde H, Verheyen G, Stoop D. Closed oocyte vitrification and storage in an oocyte donation programme: obstetric and neonatal outcome. Hum Reprod 2016; 31:1024-33. [DOI: 10.1093/humrep/dew029] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 02/02/2016] [Indexed: 01/04/2023] Open
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27
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Brignardello-Petersen R, Carrasco-Labra A, Jadad AR, Johnston BC, Tomlinson G. Diverse criteria and methods are used to compare treatment effect estimates: a scoping review. J Clin Epidemiol 2016; 75:29-39. [PMID: 26891950 DOI: 10.1016/j.jclinepi.2016.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 01/16/2016] [Accepted: 02/04/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To determine what criteria researchers use to assess whether the estimates of effect of an intervention on a dichotomous outcome are different when obtained using different study designs. STUDY DESIGN AND SETTING Scoping review of the literature. We included studies of dichotomous outcomes in which authors compared the estimates of effects from different study designs. We performed searches in electronic databases and in the list of references of relevant studies. Two reviewers independently selected studies and abstracted data. We created a list of the criteria used to compare estimates of effects between study designs, described their main features, and classified them using a clinical perspective. RESULTS We included 26 studies, from which we identified 24 criteria. Most of the studies focused on comparing estimates from observational studies and randomized controlled trials (n = 19). The most common criteria aimed to determine whether there was a difference or not (n = 18), provided guidance for such a judgment (n = 16), and were based on the point estimates (n = 11). We judged 14 criteria to be appropriate and classified them as either statistically related or clinically related. CONCLUSION We found that diverse criteria are used to compare effect estimates between study designs. Familiarity with these would aid in the interpretation of results from different studies regarding the same question.
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Affiliation(s)
- Romina Brignardello-Petersen
- Evidence-Based Dentistry Unit, Faculty of Dentistry, University of Chile, Sergio Livingstone 943, Independencia, Santiago 8380492, Chile; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M6, Canada.
| | - Alonso Carrasco-Labra
- Evidence-Based Dentistry Unit, Faculty of Dentistry, University of Chile, Sergio Livingstone 943, Independencia, Santiago 8380492, Chile
| | - Alejandro R Jadad
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M6, Canada; Institute for Global Health Equity and Innovation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M6, Canada; Centre for Global eHealth Innovation, R Fraser Elliot Building, 190 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada
| | - Bradley C Johnston
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M6, Canada; Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Room 11.9859, West Toronto, Ontario M5G 0A4, Canada; Department of Anesthesia and Pain Medicine, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada
| | - George Tomlinson
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M6, Canada; Department of Medicine, University Health Network and Mt Sinai Hospital, Toronto, Eaton North, 13th Floor, Room 238, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada
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28
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Pregnancy and Birth Outcomes Among Primiparae at Very Advanced Maternal Age: At What Price? Matern Child Health J 2015; 20:833-42. [DOI: 10.1007/s10995-015-1914-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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29
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Nicopoullos JDM, Wren M, Abdalla H. Treatment and preservation at the extremes of reproductive age: a case report outlining the ethical dilemmas. J Assist Reprod Genet 2015; 32:1547-50. [PMID: 26319526 PMCID: PMC4615914 DOI: 10.1007/s10815-015-0551-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 07/24/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE The purpose of the study was to report a livebirth from a cryopreserved embryo created from autologous oocytes collected at 47 years and 9 months that outlines the ethical difficulties of decision-making at the extreme of reproductive age. METHODS The method used was IVF and embryo cryopreservation within an assisted conception unit prior to adjuvant cancer treatment in a nulliparous patient diagnosed with breast carcinoma (47 years and 9 months at oocyte collection). RESULTS A 47-year-old nulliparous woman was diagnosed with breast malignancy during work-up for fertility treatment. Ovarian stimulation yielded one embryo from four oocytes that was cryopreserved to allow completion of adjuvant treatment. Subsequent embryo transfer cycle led to a live birth of a healthy baby girl at term, weighing 3.37 kg. CONCLUSION This paper demonstrates the oldest reported age of autologous oocyte collection to have achieved a livebirth. In women where most would consider treatment futile, we highlight the difficulties in decision-making in this group of patients.
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Affiliation(s)
| | - Marie Wren
- Lister Fertility Clinic, Lister Hospital, Chelsea Bridge Rd, London, SW1W 8RH, UK
| | - Hossam Abdalla
- Lister Fertility Clinic, Lister Hospital, Chelsea Bridge Rd, London, SW1W 8RH, UK
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30
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Dietl A, Cupisti S, Beckmann MW, Schwab M, Zollner U. Pregnancy and Obstetrical Outcomes in Women Over 40 Years of Age. Geburtshilfe Frauenheilkd 2015; 75:827-832. [PMID: 26366002 DOI: 10.1055/s-0035-1546109] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 04/28/2015] [Accepted: 04/29/2015] [Indexed: 12/20/2022] Open
Abstract
Introduction: Delayed childbearing is increasing, and advanced maternal age has been associated with an increased risk of obstetrical complications. The purpose of this study was to evaluate pregnancy outcomes in women with advanced maternal age (≥ 40 years). Methods: Maternal and obstetrical data were collected from the Department of Obstetrics and Gynecology of the University of Wuerzburg for the period from 2006 to 2011. In this retrospective analysis we compared the outcomes for women aged ≥ 40 years (n = 405) with those of three younger subgroups (I: < 30 y; II: 30-34 y; III: 35-39 y). Results: Pregnant women older than 40 years had more chronic diseases such as hypertension, needed medical treatment more frequently and had a higher thrombosis risk. Pregnancy-induced diseases such as gestational diabetes, preeclampsia and pregnancy-associated hypertension occurred more often in women ≥ 40 years of age. Compared to mothers who were younger than 30 years, primiparous women ≥ 40 years had a more than four times higher overall cesarean section rate and four times higher elective cesarean section rate. Furthermore, they required longer hospital stays, both after cesarean section and after vaginal delivery. The preterm birth rate (≤ 32 weeks of gestation) was similar across the different age groups. Conclusions: The outcomes of pregnancy and childbirth and for newborns born to women ≥ 40 years did not vary significantly from those of younger women if the following conditions were met: a) pre-existing chronic diseases were treated medically and dietetically; b) pregnancy-induced morbidity was monitored regularly and controlled medically; c) women attended regular prenatal check-ups; d) a healthy lifestyle was adhered to during pregnancy, and e) delivery occurred in a perinatal center.
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Affiliation(s)
- A Dietl
- Department of Obstetrics and Gynecology, University of Freiburg i. Br., Freiburg i. Br
| | - S Cupisti
- Department of Obstetrics and Gynecology, University of Erlangen, Erlangen
| | - M W Beckmann
- Department of Obstetrics and Gynecology, University of Erlangen, Erlangen
| | - M Schwab
- Department of Obstetrics and Gynecology, University of Würzburg, Würzburg
| | - U Zollner
- Department of Obstetrics and Gynecology, University of Würzburg, Würzburg
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31
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Robson S, Campbell B, Pell G, Wilson A, Tyson K, de Costa C, Permezel M, Woods C. Concordance of maternal and paternal decision-making and its effect on choice for vaginal birth after caesarean section. Aust N Z J Obstet Gynaecol 2015; 55:257-61. [DOI: 10.1111/ajo.12326] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Accepted: 01/15/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Stephen Robson
- Australian National University Medical School; Canberra Australian Capital Territory Australia
| | - Beth Campbell
- Townsville Hospital; Townsville Queensland Australia
| | | | - Anne Wilson
- Calvary John James Hospital; Canberra Australian Capital Territory Australia
| | - Kate Tyson
- Mercy Hospital for Women; Melbourne Victoria Australia
| | - Caroline de Costa
- School of Medicine and Dentistry; James Cook University; Cairns Queensland Australia
| | | | - Cindy Woods
- School of Medicine and Dentistry; James Cook University; Cairns Queensland Australia
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32
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Parker SE, Werler MM, Gissler M, Tikkanen M, Ananth CV. Placental abruption and subsequent risk of pre-eclampsia: a population-based case-control study. Paediatr Perinat Epidemiol 2015; 29:211-9. [PMID: 25761509 PMCID: PMC4400232 DOI: 10.1111/ppe.12184] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Pre-eclampsia and placental abruption may share a common pathophysiologic mechanism, namely, uteroplacental ischaemia. The aim of this study was to investigate the association between placental abruption and risk of pre-eclampsia in a subsequent pregnancy, and to determine whether the association differs by the gestational age at the time of abruption. METHODS A nested case-control study among multiparous women in the Medical Birth Register of Finland from 1996-2010 was conducted. Cases of pre-eclampsia (n = 6487) and frequency matched controls (n = 25,948) were linked to the Hospital Discharge Registry to ascertain data on prior abruption. Abruption was categorised as preterm (<37 weeks) or term (≥37 weeks) based on the gestational age at delivery. We fit logistic regression models to evaluate the associations between abruption and the odds of pre-eclampsia in the subsequent pregnancy before and after adjusting for potential confounders. RESULTS Preterm abruption was associated with over a twofold increase in risk of pre-eclampsia [odds ratio (OR) 2.2, 95% confidence interval (CI) 1.5, 3.3] in a subsequent pregnancy. In contrast, term abruption was not associated with pre-eclampsia (OR 1.1, 95% CI 0.7, 1.7). The association between preterm abruption and pre-eclampsia was further elevated among women with a history of pre-eclampsia. Associations with preterm abruption were also strengthened when the outcome was pre-eclampsia with early delivery (<34 weeks). CONCLUSIONS These findings suggest that placental abruption in a prior pregnancy is associated with a different risk profile of pre-eclampsia based on the gestational age of the abruption-affected pregnancy.
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Affiliation(s)
- Samantha E. Parker
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Martha M. Werler
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Mika Gissler
- National Institute of Health and Welfare (THL), Helsinki, Finland,NHV Nordic School of Public Health, Gothenburg, Sweden
| | - Minna Tikkanen
- Department of Obstetrics and Gynecology, Helsinki University Central Hospital, University of Helsinki, Finland
| | - Cande V. Ananth
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
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33
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The impact of antenatal testing for advanced maternal age on cesarean delivery rate at an urban institution. Am J Perinatol 2015; 32:101-6. [PMID: 24858316 PMCID: PMC4849897 DOI: 10.1055/s-0034-1376312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Antenatal testing has been implemented for advanced maternal age (AMA) women given their increased stillbirth risk. Our objective was to evaluate cesarean delivery and induction rates after the start of antenatal testing at our institution. STUDY DESIGN A retrospective cohort study of AMA women (≥ 40 years) who delivered at our institution was performed. Testing for AMA began in 2005. AMA women who delivered before (unexposed) and after (exposed) the implementation were compared. Our primary outcome was cesarean delivery and secondary outcome was induction. Chi-square compared categorical variables and multivariable logistic regression calculated odds ratio (OR) and controlled for confounders. RESULTS A total of 276 women were included (147 unexposed and 129 exposed). The cesarean rate was higher in the exposed group (53 vs. 39%, OR 1.76 [1.09-2.84]). The increased risk of cesarean remained after adjusting for race, previous cesarean, multiple gestations, and parity (adjusted OR 1.85 [1.05-3.28]). When excluding those with previous cesareans, the risk of primary cesarean was not significant (OR 1.57 [0.89-2.76]). The induction rate was not different (38 vs. 33%, p = 0.4). CONCLUSIONS While overall cesareans increased, there was no difference in primary cesarean and induction rates for AMA women after implementation of antenatal testing for AMA.
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34
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Herstad L, Klungsøyr K, Skjaerven R, Tanbo T, Forsén L, Åbyholm T, Vangen S. Maternal age and emergency operative deliveries at term: a population-based registry study among low-risk primiparous women. BJOG 2014; 122:1642-51. [PMID: 25100277 DOI: 10.1111/1471-0528.12962] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To study the association between maternal age and emergency operative delivery. The roles of in-labour indications, and birthweight ≥ 4000 g, gestational age ≥ 42 weeks, induction of labour, and epidural use, according to maternal age were explored. DESIGN Population-based study. SETTING Medical Birth Registry of Norway and Statistics Norway. POPULATION We studied 169 583 low-risk primiparous mothers with singleton, cephalic labours, at ≥37 weeks of gestation, from 1999 to 2009. METHODS The associations between maternal age and mode of delivery were analysed using multinomial regression analyses, adjusting for sociodemographic factors. MAIN OUTCOME MEASURES Emergency caesarean section and operative vaginal delivery. RESULTS Of women aged ≥40 years, 22% had emergency caesarean sections and 24% had operative vaginal deliveries, giving adjusted relative risk ratios (RRRs) of 6.60 (95% confidence interval, 95% CI 5.53-7.87) and 3.30 (95% CI 2.79-3.90), respectively, when compared with women aged 20-24 years. Adjustments for sociodemographic factors only slightly changed the estimates. Dystocia was the main indication, followed by fetal distress. All of the listed factors increased the level of emergency operative deliveries, mainly because of an increase in dystocia. The increase in risk for emergency caesarean section by all factors, and for operative vaginal deliveries by epidural, were greater in older than in younger women, but were significant for epidural only. CONCLUSIONS We found a close association between maternal age and emergency operative delivery in low-risk primiparas. Contributory factors increased the risk for both emergency operative delivery and epidural more in older than in younger women.
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Affiliation(s)
- L Herstad
- Women and Children's Division, Norwegian Resource Centre for Women's Health, Oslo University Hospital, Rikshospitalet, Norway
| | - K Klungsøyr
- Medical Birth Registry of Norway, Norwegian Institute of Public Health, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - R Skjaerven
- Medical Birth Registry of Norway, Norwegian Institute of Public Health, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - T Tanbo
- University of Oslo, Oslo, Norway.,Department of Gynaecology, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - L Forsén
- Women and Children's Division, Norwegian Resource Centre for Women's Health, Oslo University Hospital, Rikshospitalet, Norway.,Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - T Åbyholm
- University of Oslo, Oslo, Norway.,Department of Obstetrics, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - S Vangen
- Women and Children's Division, Norwegian Resource Centre for Women's Health, Oslo University Hospital, Rikshospitalet, Norway.,Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
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35
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Cobo A, Serra V, Garrido N, Olmo I, Pellicer A, Remohí J. Obstetric and perinatal outcome of babies born from vitrified oocytes. Fertil Steril 2014; 102:1006-1015.e4. [PMID: 25064408 DOI: 10.1016/j.fertnstert.2014.06.019] [Citation(s) in RCA: 132] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 06/06/2014] [Accepted: 06/12/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To assess outcomes after oocyte vitrification on obstetric and perinatal outcomes compared with those achieved with fresh oocytes. DESIGN Retrospective cohort study. SETTING Private university-affiliated IVF center. PATIENT(S) Children born after use of vitrified oocytes (1,027 from 804 pregnancies) and fresh oocytes (1,224 from 996 pregnancies). Singleton and multiples pregnancies from own and donated ova were included. INTERVENTION(S) Oocyte vitrification by the Cryotop method. MAIN OUTCOME MEASURE(S) Pregnancy, delivery, and neonatal outcomes. RESULT(S) Vitrification had no clinically relevant adverse effects on obstetric and perinatal outcomes after adjusting for potential confounders. No differences were found between the vitrified and fresh oocyte groups in the rate of obstetric problems (including diabetes, pregnancy-induced hypertension, preterm birth, anemia, and cholestasis), gestational age at delivery, birth weight, Apgar scores, birth defects, admission to neonatal intensive care unit (ICU), perinatal mortality, and puerperal problems. Only a greater number of invasive procedures (adjusted odds ratio 2.12; 95% confidence interval 1.41-3.20), and a reduced occurrence of urinary tract infection (adjusted odds ratio 0.51; 95% confidence interval 0.28-0.91), were observed in the vitrified oocytes group. CONCLUSION(S) Although our data, the largest series to date, suggest that oocyte vitrification does not increase adverse obstetric and perinatal outcomes in children conceived with vitrified oocytes, further studies with larger samples are required to reinforce our conclusions.
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Affiliation(s)
- Ana Cobo
- Instituto Valenciano de Infertilidad, Universidad de Valencia, Valencia, Spain.
| | - Vicente Serra
- Instituto Valenciano de Infertilidad, Universidad de Valencia, Valencia, Spain
| | - Nicolás Garrido
- Instituto Valenciano de Infertilidad, Universidad de Valencia, Valencia, Spain
| | - Inés Olmo
- Instituto Valenciano de Infertilidad, Universidad de Valencia, Valencia, Spain
| | - Antonio Pellicer
- Instituto Valenciano de Infertilidad, Universidad de Valencia, Valencia, Spain
| | - José Remohí
- Instituto Valenciano de Infertilidad, Universidad de Valencia, Valencia, Spain
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36
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Would it be too late? A retrospective case-control analysis to evaluate maternal-fetal outcomes in advanced maternal age. Arch Gynecol Obstet 2014; 290:1109-14. [PMID: 25027820 DOI: 10.1007/s00404-014-3367-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 07/08/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate maternal-fetal outcomes in women of advanced maternal age (AMA; >35 years old) and women of physiological maternal age as controls (C; <35 years old). METHODS Single-center, retrospective case-control analysis, from January 1 to December 31, 2013. For each group, we evaluated obstetric history, number of twin pregnancies, delivery mode, incidence of obstetric diseases and neonatal outcomes (5-min Apgar score, neonatal weight, meconium stained fluid rate, admission to the neonatal intensive care unit rate, and incidence of congenital malformations). Data are presented as n (%) and analyzed with χ (2) test and Fisher exact test (when required). A p value < 0.05 was considered statistically significant. Moreover, we calculated the odds ratio (OR), with confidence interval (CI) at 95 %. RESULTS We enrolled 1,347 pregnant women, 210 (15.6 %) in AMA and 1,137 (84.4 %) C. AMA patients showed a higher rate of previous (anamnestic) spontaneous abortion (SA; p = 0.001; OR = 2.10) and previous (anamnestic) voluntary pregnancy termination (p = 0.022; OR = 1.59), iterative cesarean section (p = 0.026; OR = 2.33), SA (p = 0.001; OR = 12.82), preterm delivery (p = 0.001; OR = 69.84), congenital malformations (p = 0.036; OR = 3.94). In C there was a greater number of nulliparous (p = 0.009; OR = 0.52) and vaginal deliveries (p = 0.025; OR = 0.41). There were not any statistically significant differences between the two groups for twin pregnancies (p = 0.862; OR = 0.97), first cesarean section (p = 0.145; OR = 0.95), other obstetric diseases and neonatal outcomes. CONCLUSION AMA could be considered an important risk factor only for SA and PTD and does not influence neonatal outcomes except for congenital malformations.
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37
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Affiliation(s)
- Wr Cohen
- Department of Obstetrics and Gynecology, University of Arizona College of Medicine, Tucson, AZ, USA
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38
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Baghurst P, Robson S, Antoniou G, Scheil W, Bryce R. The association between increasing maternal age at first birth and decreased rates of spontaneous vaginal birth in South Australia from 1991 to 2009. Aust N Z J Obstet Gynaecol 2014; 54:237-43. [DOI: 10.1111/ajo.12182] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 12/18/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Peter Baghurst
- School of Reproductive Medicine and Paediatrics; Faculty of Health Sciences; University of Adelaide; Adelaide South Australia Australia
| | - Stephen Robson
- Department of Obstetrics and Gynaecology; Australian National University Medical School; Canberra Australian Capital Territory Australia
| | - Georgia Antoniou
- Department of Orthopaedic Surgery; Women's and Children's Hospital; Adelaide South Australia Australia
| | - Wendy Scheil
- Pregnancy Outcome Unit; South Australian Department of Health; Adelaide South Australia Australia
| | - Robert Bryce
- Centre for Perinatal Care; Flinders Medical Centre; Adelaide South Australia Australia
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