Increasing maternal age and obstetric outcomes

Epidemiological profile and obstetric outcomes of patients with peripartum congestive heart failure in Taiwan: a retrospective nationwide study

Background

During pregnancy, the hyperdynamic physiology of circulation can exacerbate many cardiovascular disorders. Congestive heart failure (CHF) usually occurs during late pregnancy, which is significantly associated with a high level of maternal and neonatal morbidities and mortalities. The profile of women who develop peripartum CHF (PCHF) is unknown. We investigated the epidemiological profiles of PCHF.

Methods

In this retrospective cohort study, PCHF patients were identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes in Taiwan’s National Health Insurance Research Database. Risk factors and obstetric outcomes were compared in women with and without PCHF.

Results

From 2,115,873 birth-mothers in Taiwan between 1997 and 2013, we identified 512 with PCHF (incidence: 24.20/10⁵). More women with than without PCHF were older (≥ 35, 18.16% vs. 9.62%), and had more multifetal gestations (7.42% vs. 1.40%), gestational hypertension (HTN) (19.2% vs. 1.31%), and gestational diabetes mellitus (4.10% vs. 0.67%). After the analysis had been adjusted for confounders, the leading comorbidities associated with PCHF were structural heart diseases (adjusted odds ratio [aOR]: 67.21; 95% confidence interval [CI]: 54.29–83.22), pulmonary diseases (aOR: 13.12; 95% CI: 10.28–16.75), chronic HTN (aOR: 11.27; 95% CI: 6.94–18.28), thyroid disease (aOR: 9.53; 95% CI: 5.27–17.23), and gestational HTN (aOR: 5.16; 95% CI: 3.89–6.85). PCHF patients also had a higher rate of cesarean sections (66.41% vs. 34.46%; p < 0.0001).

Conclusion

Maternal structural heart diseases, pulmonary diseases, thyroid disorders, and preexisting or gestational HTN are associated with a higher risk of developing PCHF. Birth-mothers with PCHF also had a higher risk of caesarean section and adverse outcomes, including maternal death. Our findings should benefit healthcare providers, and government and health insurance policy makers.

Electronic supplementary material

The online version of this article (10.1186/s12884-017-1486-2) contains supplementary material, which is available to authorized users.

Obstetric and perinatal outcomes in women ≥40years of age: Associations with fetal growth disorders

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.

Older maternal age and major depressive episodes in the first two years after birth: findings from the Parental Age and Transition to Parenthood Australia (PATPA) study

BACKGROUND

This study examines whether (1) older maternal age is associated with increased risk of depressive episodes between four months and two years after first birth and (2) the role of subsequent reproductive, social and child factors in vulnerability to later onset depression.

METHOD

592 women were recruited in the third trimester of pregnancy in three age-groups (≤ 30 years; 31-36 years,≥37 years); 434 (73%) completed all assessments at four months and two years after birth. Major Depression episodes (MDE) were assessed at four months and two years using the Mini International Neuropsychiatric Interview (MINI). Maternal (age, mode of conception, prior mood symptoms, health), child (temperament, health), reproductive (subsequent fertility treatment, pregnancy, birth, pregnancy loss) and social contextual variables (language background, paid work, practical support, life stresses) were assessed in pregnancy and postnatally using validated questionnaires and structured interview questions.

RESULTS

Maternal age was not related to prevalence or timing of MDE. Depression symptoms, poor child health, low practical support at four months and a non-English language background predicted episodes of depression between four months and two years, ps <0.05.

LIMITATIONS

Life history risks for depression were not considered, nor symptom profiles over time.

CONCLUSIONS

Findings indicate that despite a more complex reproductive context, older first time mothers are not more likely to report major depressive episodes in the first two years after birth. Prevalence for the whole sample was at the lower end of reported community ranges and was comparable early and later in the postpartum period. Screening for depression after childbirth should not be restricted to the early months.