Days of sick leave and inpatient care at the time of pregnancy and childbirth in relation to maternal age

2017 ◽  
Vol 45 (3) ◽  
pp. 222-229 ◽  
Author(s):  
Lovisa Brehmer ◽  
Kristina Alexanderson ◽  
Erica Schytt
Keyword(s):  
Sick Leave ◽  
Older Women ◽  
Inpatient Care ◽  
Maternal Age ◽  
Mean Values ◽  
Younger Women ◽  
Pregnancy And Childbirth ◽  
Nulliparous Women ◽  
Starting Point ◽  
Delivery Date

Aims: To explore whether older women differ from younger women with respect to sick leave and inpatient care at the time around their first pregnancy and delivery. Methods: This was a descriptive population-based cohort study. The study population included all 236,176 nulliparous women registered as living in Sweden who gave birth to their first singleton infant in 2006–2010. Data from nationwide Swedish registers were used. Maternal age was categorized in five-year intervals. Time was calculated in years with the delivery date as the starting point, from two years before and up to three years after delivery. Descriptive statistics were used to calculate mean values and ANOVA tables were used to obtain the 95% confidence intervals of the means. Restriction was used to reduce potential confounding. Results: Women aged ⩾35 years had a higher annual mean number of sick leave days from two years before to one year after their delivery date compared with younger women. The range for all age categories in the year before the delivery date, including pregnancy, was 15.3–37.4 mean sick leave days. The mean number of inpatient days increased with each age category during the year after the date of delivery in the range 1.4–4.3 days. Conclusions: This first explorative study indicates the need for more knowledge on morbidity among older primiparous women. They had a higher number of days with sick leave and hospitalization in the year before and after their delivery date. This might reflect higher health risks during pregnancy and childbirth among older women; however, social factors and reverse causation might also be influential.

Pregnancy and neonatal outcomes of twin pregnancies – the role of maternal age

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Shlomi Toussia-Cohen ◽  
Aya Mohr-Sasson ◽  
Abraham Tsur ◽  
Gabriel Levin ◽  
Raoul Orvieto ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Older Women ◽  
Maternal Age ◽  
Younger Women ◽  
Cesarean Deliveries ◽  
Women Groups ◽  
Twin Pregnancies

Abstract Objectives We aim to study the association of maternal age with maternal and neonatal complications in twin pregnancies. Methods A retrospective cohort study of dichorionic–diamniotic twin pregnancies stratified into three groups according to maternal age (“A” <25, “B” 25–34 and “C” 35–44 years old). Outcome measures included pregnancy, delivery and neonatal complications. A sub-analysis of in vitro fertilization pregnancies only was conducted. Results Compared with younger women (groups A [n=65] and B [n=783]), older women [group C (n=392)] demonstrated significantly higher rates of gestational diabetes mellitus (B 6.6% vs. A 0%, p =0.027, C 10.2% vs. B 6.6%, p =0.032), were more likely to undergo cesarean deliveries (C 66.6%, B 57.6%, A 52.3%, p =0.007), and were at increased risk of having more than 20% difference in weight between the twins (C 24.5%, B 17.4%, A 16.9%, p =0.013). Other outcomes, including preeclampsia, did not differ between the groups. A sub-analysis of the in vitro fertilization only pregnancies was performed. Compared with younger women (groups A [n=18] and B [n=388]), older women (group C [n=230]) underwent more cesarean deliveries (p=0.004), and had more than 20% difference in weight between the twins (p<0.004). Other outcomes, including gestational diabetes mellitus rates and preeclampsia, did not differ between the groups. Conclusions Women at advanced maternal age with dichorionic twin pregnancies had significantly higher rates of gestational diabetes mellitus, cesarean deliveries and fetal weight discordancy as compared with younger women. In contrast, the incidence of preeclampsia was not affected by maternal age.

scholarly journals Preventing first births among adolescents in Mexico City’s public abortion programme

2021 ◽  
pp. bmjsrh-2020-200795
Author(s):  
Blair G Darney ◽  
Evelyn Fuentes-Rivera ◽  
Biani Saavedra-Avendano ◽  
Patricio Sanhueza-Smith ◽  
Raffaela Schiavon
Keyword(s):  
Logistic Regression ◽  
Older Women ◽  
First Trimester ◽  
Clinical Factors ◽  
First Birth ◽  
Trimester Abortion ◽  
Younger Women ◽  
Factors Associated ◽  
Nulliparous Women ◽  
Employed Women

IntroductionWe examined parity and age among women seeking an abortion in Mexico City’s public first-trimester abortion programme, Interrupcion Legal de Embarazo (ILE). We hypothesised that younger women, especially students, used abortion to prevent first births while older women used abortion to limit births.MethodsWe used clinical data from a sample of 47 462 women who had an abortion between 2007 and 2016 and classified them as nulliparous or parous according to previous births prior to the abortion. We used logistic regression to identify sociodemographic and clinical factors associated with using abortion to prevent a first birth (nulliparous) versus limiting births (parous) and calculated absolute multivariable predicted probabilities.ResultsOverall, 41% of abortions were in nulliparous women seeking to prevent a first birth, and 59% were in women who already had one or more children. The adjusted probability of using abortion to prevent a first birth was 80.4% (95% CI 78.3 to 82.4) for women aged 12–17 years and 54.3% (95% CI 51.6 to 57.0) for women aged 18–24 years. Adolescents (aged 12–17 years) who were employed or students had nearly 90% adjusted probability of using abortion to prevent a first birth (employed 87.8%, 95% CI 82.9 to 92.8; students 88.5%, 95% CI 82.9 to 94.1). At all ages, employed women and students had higher probabilities of using abortion to prevent a first birth compared with unemployed women and women who work in the home.ConclusionLegal first-trimester abortion services in Mexico can help prevent first births in adolescents, especially students.

scholarly journals Optimal Endometrial Preparation Protocols for Frozen-thawed Embryo Transfer Cycles by Maternal Age

2020 ◽  
Author(s):  
Qizhen Zheng ◽  
Hongzhan Zhang ◽  
Shiru Xu ◽  
Shan Xiao ◽  
Xuejin Wang ◽  
...  
Keyword(s):  
Older Women ◽  
Embryo Transfer ◽  
Live Birth ◽  
Pregnancy Outcomes ◽  
Maternal Age ◽  
Independent Effect ◽  
Miscarriage Rate ◽  
Younger Women ◽  
Endometrial Preparation ◽  
Early Miscarriage

Abstract Background: It is paramount to consider the appropriate preparation of the endometrium to receive the transferred embryos as the amount of frozen embryo transfer (FET) cycles is increasing worldwide. However, there remains lack of evidence about what is the most optimal protocol of endometrial preparation regarding pregnancy outcomes in different subgroup of infertile women. This retrospective cohort study was aim to explore the best endometrial preparation protocols among different maternal age groups.Methods: A total of 16870 FET cycles were categorized into three groups based on endometrial preparation protocols: Natural cycle (NC n=3893), artificial cycles (AC, n=11459) and AC with pretreatment with GnRH-a (AC+GnRH-a, n=1518). Logistic regression was performed to investigate the independent effect of endometrial preparation protocols on IVF pregnancy outcomes. Subgroup analyses were conducted to evaluate the most optimal endometrial preparation protocols for different maternal age groups.Results: In overall populations, after controlling for potential confounders, the incidence of live birth (NC as reference; AC: adjusted odds ratio (aOR) =0.840, 95%CI 0.774-0.912; AC+GnRHa: aOR=0.907, 95%CI 0.795-1.034) in NC was significantly higher than that of AC, while comparable to that of AC+GnRH-a. The early miscarriage rate (AC: aOR=1.413, 95%CI 1.220-1.638; AC+GnRHa: aOR=1.537, 95%CI 1.232-1.919) was significantly lower in NC compared to either AC group. In younger women, the live birth rates (AC: aOR=0.894, 95%CI 0.799-1.001; AC+GnRHa: aOR=1.111, 95%CI 0.923-1.337) were comparable between the three groups, with a slightly higher in AC+GnRH-a. Early miscarriage rate was only significantly lower in NC compared to that of AC without GnRH-a (aOR=1.452, 95%CI 1.159-1.820). While in older women, the incidence of live birth (AC: aOR=0.811, 95%CI 0.718-0.916; AC+GnRHa: aOR=0.760, 95%CI 0.626-0.923) was significantly higher, and early miscarriage (AC: aOR=1.358, 95%CI 1.114-1.655; AC+GnRHa: aOR=1.717, 95%CI 1.279-2.305) was significantly lower in NC compared to those of two AC groups.Conclusions: NC protocol is associated with lower early miscarriage late in overall IVF population. There is a mild favor of AC+GnRH-a in younger women, while the priority of NC is remarkable in older women. Maternal age should be a considerable factor when determine endometrial preparation method for FET.

WHAT IS THE RIGHT AGE TO REPRODUCE?

2006 ◽  
Vol 17 (3) ◽  
pp. 185-204 ◽  
Author(s):  
M NWANDISON ◽  
S BEWLEY
Keyword(s):  
Older Women ◽  
Maternal Age ◽  
Biological Clock ◽  
Point Of View ◽  
Demographic Shift ◽  
Younger Women ◽  
The Past ◽  
Healthy Mother ◽  
Human Reproductive ◽  
The Right

This article examines the question as to what is the right age to reproduce from the biological point of view of its purpose; that of achieving a healthy mother and baby. We start with an assumption that issues surrounding sex, fertility, pregnancy, miscarriage, abortion and childbearing are private and emotionally laden. We are not looking at, nor judging, individual reproductive choices; what might be “right” for one person, or couple, in one context will be unsuitable for another. It is traditional obstetric and gynaecological teaching that human reproductive outcomes are worse at the extremes of maternal age. Yet the advice given in a recent BMJ editorial entitled “Which career first? The securest age for childbearing remains 20–35” appeared to be controversial. The ensuing scientific and media interest raised such headlines as “Horns of the dilemma”, “A sinister article”, “Late mums face baby misery” and “Are we having children too late? IVF not the answer, say docs”. Products have recently appeared on the market offering kits to women to indicate the time left on their ‘biological clock’ so they can choose whether to continue pursuing their career or try for a baby. Why is there so much interest in the right time to reproduce? Are women (and men) doing something differently compared to the past? If there has been a demographic shift in the age women reproduce (hitherto unexplained), there are important and specific risks older women may face as compared to younger women.

scholarly journals Association of body mass index and maternal age with first stage duration of labour

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Louise Lundborg ◽  
Xingrong Liu ◽  
Katarina Åberg ◽  
Anna Sandström ◽  
Ellen L. Tilden ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Maternal Age ◽  
Normal Weight ◽  
The Body ◽  
Younger Women ◽  
Individualized Approach ◽  
Quantile Regression Analysis ◽  
Labour Time ◽  
Group 1

AbstractTo evaluate associations between early-pregnancy body mass index (BMI) and active first stage labour duration, accounting for possible interaction with maternal age, we conducted a cohort study of women with spontaneous onset of labour allocated to Robson group 1. Quantile regression analysis was performed to estimate first stage labour duration between BMI categories in two maternal age subgroups (more and less than 30 years). Results show that obesity (BMI > 30) among younger women (< 30 years) increased the median labour duration of first stage by 30 min compared with normal weight women (BMI < 25), and time difference estimated at the 90th quantile was more than 1 h. Active first stage labour time differences between obese and normal weight women was modified by maternal age. In conclusion: (a) obesity is associated with longer duration of first stage of labour, and (b) maternal age is an effect modifier for this association. This novel finding of an effect modification between BMI and maternal age contributes to the body of evidence that supports a more individualized approach when describing labour duration.

scholarly journals Extended embryo culture is effective for patients of an advanced maternal age

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
R. Sainte-Rose ◽  
C. Petit ◽  
L. Dijols ◽  
C. Frapsauce ◽  
F. Guerif
Keyword(s):  
Live Birth ◽  
Embryo Culture ◽  
Maternal Age ◽  
Chromosomal Abnormalities ◽  
Inner Cell Mass ◽  
Cell Mass ◽  
Advanced Maternal Age ◽  
Birth Rates ◽  
Younger Women ◽  
Live Birth Rates

AbstractThe aim of this study was to determine the effectiveness of extended embryo culture in advanced maternal age (AMA) patients (37–43 years). In this retrospective analysis, 21,301 normally fertilized zygotes from 4952 couples were cultured until the blastocyst stage. Blastocyst development, including kinetics and morphology, transfer rate, implantation and live birth rates, were measured. In AMA patients, the blastocyst rate was significantly decreased as compared to that in younger women. On day 5, blastocysts underwent growth retardation in AMA patients, which was highlighted by a decreased rate of full/expanded blastocysts. Organization of the cells (trophectoderm and inner cell mass) was unaffected by age. However, in AMA patients, a ‘good’ morphology blastocyst had a decreased probability to implant compared with an ‘average’ morphology blastocyst in younger women. While the rates of blastocyst transfer and useful blastocysts were similar to younger patients, in AMA patients, both implantation and live birth rates were significantly reduced. Our results support the idea that extended embryo culture is not harmful for AMA patients. However, embryo selection allowed by such culture is not powerful enough to avoid chromosomal abnormalities in the developed blastocysts and therefore cannot compensate for the effect of a woman’s age.

scholarly journals Uterine Cervical Change at Term Examined Using Ultrasound Elastography: A Longitudinal Study

2020 ◽  
Vol 10 (1) ◽  
pp. 75
Author(s):  
Hyun Soo Park ◽  
Hayan Kwon ◽  
Ja-Young Kwon ◽  
Yun Ji Jung ◽  
Hyun-Joo Seol ◽  
...  
Keyword(s):  
Longitudinal Study ◽  
Cervical Length ◽  
Labor Induction ◽  
Ultrasound Elastography ◽  
Antenatal Visit ◽  
Mean Values ◽  
Nulliparous Women ◽  
Hardness Ratio ◽  
Cesarean Delivery Rate ◽  
Time Of Admission

The aim of the study was to investigate if there are changes in elastographic parameters in the cervix at term around the time of delivery and if there are differences in the parameters between women with spontaneous labor and those without labor (labor induction). Nulliparous women at 36 weeks of gestation eligible for vaginal delivery were enrolled. Cervical elastography was performed and cervical length were measured using the E-CervixTM system (WS80A Ultrasound System, Samsung Medison, Seoul, Korea) at each weekly antenatal visit until admission for spontaneous labor or labor induction. E-Cervix parameters of interest included elasticity contrast index (ECI), internal os strain mean level (IOS), external os strain mean level (EOS), IOS/EOS strain mean ratio, strain mean level, and hardness ratio. Regression analysis was performed using days from elastographic measurement at each visit to admission for delivery and the presence or absence of labor against cervical length, and each E-Cervix parameter fitted to a linear model for longitudinal data measured repeatedly. A total of 96 women were included in the analysis, (spontaneous labor, n = 39; labor induction, n = 57). Baseline characteristics were not different between the two groups except for cesarean delivery rate. Cervical length decreased with advancing gestation and was different between the two groups. Most elastographic parameters including ECI, IOS, EOS, strain mean, and hardness ratio were significantly different between the two groups. In addition, ECI, IOS, and strain mean values significantly increased with advancing gestation. Our longitudinal study using ultrasound elastography indicated that E-cervix parameters tended to change linearly at term near the time of admission for delivery and that there were differences in E-Cervix parameters according to the presence or absence of labor.

scholarly journals Utilization of preimplantation genetic testing in the USA

2021 ◽  
Author(s):  
Kaitlyn Roche ◽  
Catherine Racowsky ◽  
Joyce Harper
Keyword(s):  
Genetic Testing ◽  
Older Women ◽  
State Level ◽  
Oocyte Retrieval ◽  
Preimplantation Genetic Testing ◽  
Annual Increase ◽  
Younger Women ◽  
Live Birth Rates ◽  
Significant Difference ◽  
The Usa

Abstract Purpose To evaluate the use of preimplantation genetic testing (PGT) and live birth rates (LBR) in the USA from 2014 to 2017 and to understand how PGT is being used at a clinic and state level. Methods This study accessed SART data for 2014 to 2017 to determine LBR and the CDC for years 2016 and 2017 to identify PGT usage. Primary cycles included only the first embryo transfer within 1 year of an oocyte retrieval; subsequent cycles included transfers occurring after the first transfer or beyond 1 year of oocyte retrieval. Results In the SART data, the number of primary PGT cycles showed a significant monotonic annual increase from 18,805 in 2014 to 54,442 in 2017 (P = 0.042) and subsequent PGT cycles in these years increased from 2946 to 14,361 (P = 0.01). There was a significant difference in primary PGT cycle use by age, where younger women had a greater percentage of PGT treatment cycles than older women. In both PGT and non-PGT cycles, the LBR per oocyte retrieval decreased significantly from 2014 to 2017 (P<0001) and younger women had a significantly higher LBR per oocyte retrieval compared to older women (P < 0.001). The CDC data revealed that in 2016, just 53 (11.4%) clinics used PGT for more than 50% of their cycles, which increased to 99 (21.4%) clinics in 2017 (P< 0.001). Conclusions A growing number of US clinics are offering PGT to their patients. These findings support re-evaluation of the application for PGT.

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