Term stillbirth in older women

Adverse Obstetrical and Perinatal Outcomes Among Advanced Age Pregnant Mothers in Northeast Ethiopia: A Comparative Cross-Sectional Study

Purpose

It is known that being pregnant at any reproductive age is not risk-free. Aside from this, older gravidity usually ends up with adverse outcomes both to the mother and newborn. Hence, the aim of this study was to investigate the association of adverse maternal and perinatal outcomes with advanced maternal age pregnancy in Northeastern Ethiopia.

Methods

A hospital-based comparative cross-sectional study was employed among pregnant mothers. The study was conducted among advanced age (≥35 years, n= 398) mothers and adult age (20–34 years, n=398) mothers. Socio-demographic, obstetrics, and pregnancy outcomes were checked from patient records. Descriptive statistics were used to describe parameters collected from patient records and comparing the two groups. Bivariable and multivariable logistic regressions were done to determine factors associated with maternal and perinatal outcomes. The magnitude of the association was measured using odds ratio at 95% confidence level and statistical significance was declared at a P-value of < 0.05.

Results

Advanced age mothers had significantly higher adverse pregnancy outcomes (64.6% vs 37.8%) compared with adult age mothers. This study shows that advanced maternal age is statistically associated with pregnancy-induced hypertension (AOR=3.14, 95% CI: 1.931–5.089), antepartum hemorrhage (AOR=2.22, 95% CI: 1.245–3.942), a cesarean delivery (AOR=2.59, 95% CI: 1.775–3.790), and postpartum hemorrhage (AOR=2.01, 95% CI: 1.445–2.819). Moreover, advanced maternal age pregnancy was also a risk factor for preterm delivery (AOR=3.01, 95% CI: 1.441–6.297), low birth weight (AOR=3.08, 95% CI: 1.735–5.492), low fifth minute Apgar score (AOR=3.99, 95% CI: 2.099–7.618), and perinatal death (AOR= 2.46, 95% CI: 1.360–4.42).

Conclusion

In this study, adverse pregnancy and perinatal outcomes among advanced aged mothers were high in a specialized hospital where emergency obstetric and newborn care is set and quality obstetric care is expected. Therefore, healthcare providers, the specialized hospital, and policymakers should give due emphasis to the effective intervention of advanced age pregnant mothers.

Advanced maternal age pregnancy and its adverse obstetrical and perinatal outcomes in Ayder comprehensive specialized hospital, Northern Ethiopia, 2017: a comparative cross-sectional study

BACKGROUND

Advanced maternal age generally denotes age after 35 years during the time of delivery. Despite the fact that being pregnant at any reproductive age is not risk-free, older gravidity usually culminates with adverse outcomes both to the mother and fetus or neonate. This study aimed to determine the association of adverse obstetrical and perinatal outcomes with advanced maternal age pregnancy. The study was conducted in Ayder comprehensive specialized hospital, north Ethiopia, from 2015 to 2017.

METHODS

chart review comparative cross-sectional study was employed. Data were retrieved from medical charts of 752 pregnant mothers (376 each for both the study;> 35-year-old and reference group;20-34 year old). Data was collected using a pretested and structured checklist using systematic sampling and data was entered & analyzed using SPSS version 20. Binary and multivariable logistic regression was run to determine the association of independent variables with dependent variables.

RESULTS

This study revealed that advanced maternal age pregnancy was significantly associated with pregnancy induced hypertension [AOR 4.15, 95% CI (2.272-7.575), p <  0.001], ante partum hemorrhage [AOR 2.54, 95% CI (1.32-4.91), P = 0.005] & cesarean delivery [AOR 2.722, 95% CI (1.777-4.170), p <  0.001]. Furthermore, advanced maternal age pregnancy was also increasingly associated with adverse perinatal outcomes like preterm delivery [AOR 3.622, 95% CI (1.469-8.930), p = 0.005], low birth weight [AOR 3.137, 95% CI (1.324-7.433), p = 0.009], perinatal death [AOR 2.54, 95% CI (1.141-5.635), p = 0.022] and low fifth minute APGAR score [AOR 7.507, 95% CI (3.134-17.98), p <  0.001]. Notwithstanding this, maternal age was not found to be associated with amniotic fluid disturbances, premature rupture of membranes and post-term pregnancy.

CONCLUSIONS

Advanced maternal age is markedly linked with adverse obstetrical and perinatal outcomes. Therefore, it is better for health care providers to counsel couples, who seek to have a child in their later ages, about the risks of advanced maternal age pregnancy. In addition, health care workers need to emphasize on how to improve advanced age mothers' health through the utilization of contraception to reduce pregnancy in this age group.

Exposure to tobacco smoke and stillbirth: a national prospective cohort study in rural China

INTRODUCTION

Parental exposure to tobacco smoke has been associated with an increased risk of stillbirth, while only a few studies took the overall parental tobacco exposure status into consideration. We aim to explore the relationship of parental smoking and passive smoking before and during pregnancy with stillbirth in a large Chinese rural cohort.

DESIGN

248 501 couples were enrolled in a national prospective cohort study conducted in rural China. Parental exposure to tobacco smoke before and during pregnancy, along with other risk factors, was ascertained by questionnaires. Pregnancy outcomes were recorded by physicians.

RESULTS

The ORs (Odds Ratios) of maternal active smoking, maternal passive smoking, paternal active smoking and paternal passive smoking were 2.07 (95% CI 1.25 to 3.41), 1.22 (95% CI 1.01 to 1.47), 1.36 (95% CI 1.13 to 1.63) and 1.10 (95% CI 0.87 to 1.39), respectively. The rates of stillbirth increased from 0.31% for the maternal non-smoking group to 0.43% for the smoking cessation during pregnancy group, to 0.64% for the decreased smoking group and 1.28% for the continuing smoking group. A similar pattern was found in the change in paternal smoking status and stillbirth. Stratified by maternal passive smoking, the OR of paternal smoking was 1.35 (95% CI 1.13 to 1.61) in the maternal non-smoking group and 1.67 (95% CI 1.09 to 2.56) in the maternal passive smoking group.

CONCLUSIONS

Parental exposure to tobacco smoke increased the risk of stillbirth, especially for those continuing smoking during pregnancy. Paternal smoking is an independent risk factor for stillbirth despite maternal passive smoking status.