Lifestyle, nutrient intake, iron status, and pregnancy outcome in pregnant women of advanced maternal age

Impact of maternal age on neonatal outcomes among very preterm infants admitted to Chinese neonatal intensive care units: a multi-center cohort study

BACKGROUND

The percentage of advanced maternal age (aged over 35 years) mothers has been rising across the world, the evidence of maternal age on neonatal outcomes from low- and middle-income countries is scarce. Our objective was to evaluate the effect of maternal age on mortality and major morbidity among very preterm infants admitted to Chinese neonatal intensive care units.

METHODS

Data from a retrospective multi-center cohort of all complete care very preterm infants admitted to 57 neonatal intensive care units that participated in the Chinese Neonatal Network from January 1st to December 31st, 2019 were analyzed. Neonatal outcomes including mortality or any major morbidity, defined as necrotizing enterocolitis stage 2 or 3, moderate & severe bronchopulmonary dysplasia, severe intraventricular hemorrhage, cystic periventricular leukomalacia, severe retinopathy of prematurity, or sepsis. A multiple logistic regression model was constructed to analyze the independent association between maternal age and neonatal outcome.

RESULTS

Among 7,698 eligible newborns, 80.5% of very preterm infants were born to mothers between the ages of 21 and 35 years, with 18.0% born to mothers >35 years and 1.5% born to mothers <21 years. Higher rates of maternal hypertension, maternal diabetes, cesarean deliveries, antenatal steroid usage were noted as maternal age increased. The proportion of prenatal care, cesarean section, antenatal steroid usage and inborn for very preterm infants born to mothers <21 years was lower than those of mothers of other ages. Compared to the ages of 21-35 years group, the odds of severe intraventricular hemorrhage (adjusted odd ratio: 2.00, 95% CI: 1.08-3.71) was significantly higher in the ages of 15-20 years group. Increasing maternal age was associated with higher rates of small for gestational age and lower birth weight of very preterm infants, but no correlation between advanced maternal age and very preterm infants mortality or major morbidity.

CONCLUSIONS

Among very preterm infants, increasing maternal age was associated with higher rates of small for gestational age but not neonatal mortality or major morbidity. Young maternal age may increase the risk of severe intraventricular hemorrhage of very preterm infants.

Pregnancy and advanced maternal age-The associations between regular exercise and maternal and newborn health variables

INTRODUCTION

Despite the associations between delayed childbearing and poorer maternal and perinatal outcomes, little is known about these issues in regular exercisers and in women with healthy lifestyles. The aims of the present study were to: (a) compare lifestyle variables and exercise, pregnancy and birth outcomes in women ≥35 years and women <35 years of age, and (b) investigate the associations between regular exercise and maternal health and newborn variables in women of advanced maternal age.

MATERIAL AND METHODS

Healthy pregnant women (≥35 years, n = 104 and <35 years, n = 362) were allocated to the study from Rikshospitalet, Oslo University Hospital, Norway. The participants completed a validated self-administered questionnaire, the Physical Activity Pregnancy Questionnaire (PAPQ) in gestational weeks 32-36. Prepregnancy body weight (kg) was self-reported, whereas maternal weight (kg) was measured at gestational weeks 14-16, 22-24, 30-32, and 36-38. Details of the delivery (gestational week at delivery, mode of delivery, Apgar score) and birthweight (g) were obtained from the hospital's medical records.

RESULTS

More women <35 than ≥35 years of age reported to have exercised prepregnancy (83.7% vs 74.0%, P = 0.04) and in the 1st trimester (71.2% vs 61.5%, P = 0.05). At gestational week 36, fewer than 50% were exercising regularly, with no group differences (P = 0.74). Current alcohol use (10.5% vs 3.3%, P = 0.02) and tobacco use (5.8% vs 1.7%, P = 0.02) were higher among women ≥35 than women <35 years, whereas for healthy diet the result was reversed (<35 years 67.1% and ≥35 years 80.8%, P = 0.02). There were higher rates of post-term birth (13.5% vs 6.4%, P = 0.02) and induction of labor (40.5% vs 27.9%, P = 0.02) in the ≥35 years group, otherwise no other differences were observed in perinatal outcomes. In women with advanced maternal age, exercising ≥2 times weekly was associated with less pelvic girdle pain (40.0% vs 61.1%, P = 0.02), lower gestational weight gain (12.7 ± 4.0 kg vs 15.5 ± 5.5 kg, P < 0.01), fewer had gestational weight gain ≥16 kg (22.0% vs 51.9%, P < 0.01) and a newborn with macrosomia (10.0% vs 37.0%, P < 0.01). The results were unchanged after adjusting for recognized confounders.

CONCLUSIONS

The results indicate that regular exercise is associated with improvement in some of the risks of advanced maternal age.

Effect of maternal age on pregnancy outcome and cesarean delivery rate

Background

The aims of this retrospective study were to evaluate the maternal and prenatal outcomes between 35 years and older pregnancies and younger pregnancies, and the effects of the age of pregnancy, mother and newborn.

Methods

Pregnant women who gave birth in Vakif Gureba Training and Research Hospital, Clinic of Obstetrics and Gynecology in 2006 were retrospectively screened. Pregnant women aged 35 years and over were included in this study and the pregnant women between age range of 30 - 34 years were included in the control group.

Results

Pregnancy rate was found as 7.1% in 35 years and older women in all the deliveries, cesarean delivery rate was found as 46.1% in this group at 1 year period. However, cesarean delivery rate was 40.9% in the control group. Cesarean delivery rate was found as 31.6% in all the deliveries. The most common cause of cesarean section indication was fetal distress in advanced maternal age (AMA) (11.7%), whereas previous cesarean section was found as the most common cause in the control group (15.1%).

Conclusion

No significant difference was found between AMA group and normal pregnancies in terms of preterm labor, caesarian section, morbidity, mortality and chronic diseases such as hypertension and diabetes mellitus.

Nutritional status as assessed by nutrient intakes and biomarkers among women of childbearing age--is the burden of nutrient inadequacies growing in America?

OBJECTIVE

Understanding nutrient intakes among women of childbearing age within the USA is important given the accumulating evidence that maternal body weight gain and nutrient intakes prior to pregnancy may influence the health and well-being of the offspring. The objective of the present study was to evaluate nutritional status in women of childbearing age and to ascertain the influence of ethnicity and income on nutrient intakes.

DESIGN

Nutritional status was assessed using data on nutrient intakes through foods and supplements from the National Health and Nutrition Examination Survey. Biomarker data from the Centers for Disease Control and Prevention were used to assess nutritional status for selected nutrients. Poverty-income ratio was used to assess family income.

SUBJECTS

White (n 1560), African-American (n 889) and Mexican-American (n 761) women aged 19-30 and 31-50 years were included.

SETTING

A nationally representative sample of non-pregnant women of childbearing age resident in the USA.

RESULTS

African-American women had the lowest intakes of fibre, folate, riboflavin, P, K, Ca and Mg. Women (31-50 years) with a poverty-income ratio of ≤ 1.85 had significantly lower intakes of almost all nutrients analysed. Irrespective of ethnicity and income, a significant percentage of women were not consuming the estimated recommended amounts (Estimated Average Requirement) of several key nutrients: vitamin A (~80%), vitamin D (~78%) and fibre (~92%). Nutrient biomarker data were generally reflective of nutrient intake patterns among the different ethnic groups.

CONCLUSIONS

Women of childbearing age in the USA are not meeting nutrient intake guidelines, with differences between ethnic groups and socio-economic strata. These factors should be considered when establishing nutrition science advocacy and policy.

Advanced maternal age and the outcomes of preterm neonates: a social paradox?

OBJECTIVE

To estimate the effect of maternal age on survival free of major morbidity among preterm newborns younger than 33 weeks of gestation at birth.

METHODS

Data from a retrospective cohort of preterm newborns younger than 33 weeks of gestation admitted to Canadian neonatal intensive care units between 2003 and 2008 were analyzed. The primary outcome was survival without major morbidity (defined as bronchopulmonary dysplasia, intraventricular hemorrhage grade 3 or 4, periventricular leukomalacia, retinopathy of prematurity stage 3, 4 or 5, or necrotizing enterocolitis stage 2 or 3). Trends in outcomes in relation to maternal age groups were examined using a multivariable analysis that controlled for confounders.

RESULTS

Baseline comparison for the 12,326 eligible newborns revealed no differences in sex, small-for-gestational-age status, and chorioamnionitis among different maternal age groups. Higher rates of cesarean delivery, use of prenatal steroids, maternal hypertension, and diabetes were noted as maternal age increased (P<.01). Increasing maternal age was associated with increased survival without major morbidity (adjusted odds ratio [OR] 1.047, 95% confidence interval [CI] 1.001-1.095) and reductions in mortality (adjusted OR 0.922, 95% CI 0.855-0.955), necrotizing enterocolitis (adjusted OR 0.888, 95% CI 0.816-0.967), and sepsis (adjusted OR 0.904, 95% CI 0.862-0.948).

CONCLUSION

Among preterm newborns, the odds of survival without major morbidity improved by 5% and mortality (8%), necrotizing enterocolitis (11%), and sepsis (9%) reduced as maternal age group increased by 5 years.

LEVEL OF EVIDENCE

II.