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

Background: Advanced maternal age is an important predictor for maternal and neonatal outcomes such as maternal mortality, low birth weight, stillbirth, preterm birth, cesarean section and preeclampsia. Objective: To determine the association of advanced maternal age and adverse maternal and neonatal outcomes in Iranian pregnant women. Methods: In this hospital-based cross-sectional study, 5117 pregnant women from 103 hospitals in Tehran, Iran, were participated in the study in 2015. The required data were gathered from hospitals which equipped to the department of obstetrics and gynecology. Advanced maternal age was considered as an independent variable and unwanted pregnancy, preeclampsia, preterm birth, cesarean section and low birth weight were considered as interested outcomes. Results: In our study, the prevalence of advanced maternal age was 12.08%. Advanced maternal age was significantly associated with higher risk of unwanted pregnancy (OR: 1.39, 95% CI: 1.12-1.73), preterm birth (OR: 1.75, 95% CI: 1.28- 2.39) and cesarean section (OR: 1.34, 95% CI: 1.03-1.74). In our study, there was no significant relationship between advanced maternal age and preeclampsia but this relationship could be clinically important (OR: 1.48, 95% CI: 0.99-2.20, P=0.052), and there is no significant relationship between advanced maternal age and low birth weight (OR: 1.08, 95% CI: 0.67-1.74, P=0.736). Conclusion: Advanced maternal age is associated with higher risk of unintended pregnancy, preterm birth and cesarean section but our findings did not support advanced maternal age as a risk factor associated with low birth weight.

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Advanced maternal age and adverse pregnancy outcomes: A cohort study

Taiwanese Journal of Obstetrics and Gynecology ◽

10.1016/j.tjog.2020.11.018 ◽

2021 ◽

Vol 60 (1) ◽

pp. 119-124

Author(s):

M. Guarga Montori ◽

A. Álvarez Martínez ◽

C. Luna Álvarez ◽

N. Abadía Cuchí ◽

P. Mateo Alcalá ◽

...

Keyword(s):

Cohort Study ◽

Pregnancy Outcomes ◽

Maternal Age ◽

Advanced Maternal Age ◽

Adverse Pregnancy Outcomes ◽

Adverse Pregnancy

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The effect of advanced maternal age on maternal and neonatal outcomes of placenta previa: A register-based cohort study

European Journal of Obstetrics & Gynecology and Reproductive Biology ◽

10.1016/j.ejogrb.2018.05.025 ◽

2018 ◽

Vol 227 ◽

pp. 1-7 ◽

Cited By ~ 6

Author(s):

Zahra Roustaei ◽

Katri Vehviläinen-Julkunen ◽

Tomi-Pekka Tuomainen ◽

Reeta Lamminpää ◽

Seppo Heinonen

Keyword(s):

Cohort Study ◽

Maternal Age ◽

Placenta Previa ◽

Advanced Maternal Age ◽

Neonatal Outcomes ◽

Maternal And Neonatal Outcomes

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Maternal age at first cesarean delivery related to adverse pregnancy outcomes in a second cesarean delivery: a multicenter, historical, cross-sectional cohort study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03608-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Shilei Bi ◽

Lizi Zhang ◽

Jingsi Chen ◽

Minshan Huang ◽

Lijun Huang ◽

...

Keyword(s):

Risk Factor ◽

Cohort Study ◽

Cesarean Delivery ◽

Maternal Age ◽

Reference Group ◽

Multivariate Logistic Regression Analysis ◽

Advanced Maternal Age ◽

Adverse Outcomes ◽

Cross Sectional ◽

Singleton Pregnancies

Abstract Background To determine the effects of maternal age at first cesarean on maternal complications and adverse outcomes of pregnancy with the second cesarean. Methods This was a multicenter, historical, cross-sectional cohort study involving singleton pregnancies ≥28 gestational weeks, with a history of 1 cesarean delivery, and who underwent a second cesarean between January and December 2017 at 11 public tertiary hospitals in 7 provinces of China. We analyzed the effects of maternal age at first cesarean on adverse outcomes of pregnancy in the second cesarean using multivariate logistic regression analysis. Results The study consisted of 10,206 singleton pregnancies. Women were at first cesarean between 18 and 24, 25–29, 30–34, and ≥ 35 years of age; and numbered 2711, 5524, 1751, and 220 cases, respectively. Maternal age between 18 and 24 years at first cesarean increased the risk of placenta accreta spectrum (aOR, 1.499; 95% CI, 1.12–2.01), placenta previa (aOR, 1.349; 95% CI, 1.07–1.70), intrahepatic cholestasis of pregnancy (aOR, 1.947; 95% CI, 1.24–3.07), postpartum hemorrhage (aOR, 1.505; 95% CI, 1.05–2.16), and blood transfusion (aOR, 1.517; 95% CI, 1.21–1.91) in the second cesarean compared with the reference group (aged 25–29 years). In addition, maternal age ≥ 35 years at first cesarean was a risk factor for premature rupture of membranes (aOR, 1.556; 95% CI, 1.08–2.24), placental abruption (aOR, 6.464, 95% CI, 1.33–31.51), uterine rupture (aOR, 7.952; 95% CI, 1.43–44.10), puerperal infection (aOR, 6.864; 95% CI, 1.95–24.22), neonatal mild asphyxia (aOR, 4.339; 95% CI, 1.53–12.32), severe asphyxia (aOR, 18.439; 95% CI, 1.54–220.95), and admission to a neonatal intensive care unit (aOR, 2.825; 95% CI, 1.54–5.17) compared with the reference group (aged 25–29 years). Conclusions Maternal age between 18 and 24 years or advanced maternal age at first cesarean was an independent risk factor for adverse maternal outcomes with the second cesarean. Advanced maternal age at the first cesarean specifically increased adverse neonatal outcomes with the second. Therefore, decisions as to whether to perform a first cesarean at a young or advanced maternal age must be critically evaluated.

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The implications for advanced maternal age on pregnancy complications and adverse neonatal outcomes

Perinatal Journal ◽

10.2399/prn.21.0293005 ◽

2021 ◽

Vol 29 (3) ◽

pp. 200-209

Author(s):

Zeynep Gedik Özköse ◽

Süleyman Cemil Oğlak

Keyword(s):

Birth Weight ◽

Cesarean Section ◽

Pregnancy Outcomes ◽

Maternal Age ◽

Advanced Maternal Age ◽

Neonatal Outcomes ◽

Apgar Scores ◽

Adverse Neonatal Outcomes ◽

Adverse Pregnancy ◽

Nicu Admission

Objective This study aimed to determine the effect of advanced maternal age (AMA) on maternal and neonatal outcomes in pregnant women aged ≥35 years compared with patients aged 30–34 years. Also, we aimed to analyze the risk estimates of potential confounders to identify whether these variables contributed to the development of adverse pregnancy outcomes or not. Methods This retrospective cohort study included 2284 pregnant women aged ≥35 years at the time of delivery who was delivered in a tertiary referral hospital from January 1, 2016, to December 31, 2020. We further classified these women into two subgroups: 35–39 years as early AMA (EAMA), and ≥40 years as very AMA (VAMA). Pregnancy complications and adverse neonatal outcomes were recorded. Results Compared to younger women, pregnant AMA women had significantly higher risks of complicated pregnancies, including a higher risk of gestational diabetes mellitus (GDM, p<0.001), polyhydramnios (p<0.001), cesarean section (p<0.001), stillbirths (p<0.001), major fetal abnormality (p<0.001), preterm delivery (p<0.001), lower birth weight (p<0.001), lower 5-minute Apgar scores (p<0.001), lower umbilical artery blood pH values (p<0.001), neonatal intensive care unit (NICU) admission (p<0.001), and length of NICU stay (p<0.001). Conclusion We found a strong and significant association between VAMA and adverse pregnancy outcomes, including an increased risk of GDM, polyhydramnios, cesarean section, and adverse neonatal outcomes, including a higher risk of stillbirths, preterm delivery, lower birth weight, lower 5-minute Apgar scores, and NICU admission.

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