Impact of aging on obstetric outcomes: defining advanced maternal age in Barcelona

Abstract Background Women of advanced maternal age (AMA) are a growing population, with higher obstetric risks. The Mediterranean population has specific characteristics different from other areas. Thus, the objective of this study was to establish a cut-off to define AMA in a selected mediterranean population coming from a tertiary referral private/mutual health hospital in Barcelona. Methods Retrospective cohort of euploid singleton pregnancies delivered from January 2007 to June 2017. Main maternal outcomes were: gestational diabetes, preeclampsia, placenta previa, c-section and prolonged hospitalization (≥ 7 days). Main adverse perinatal outcomes were: stillbirth, prematurity, preterm prelabor rupture of membranes, low birth weight, need of admission at a neonatal intensive care unit and perinatal mortality. Adjustment for confounding factors (smoking, previous comorbilities, parity, assisted reproductive techniques (ART) and obesity) was performed. Results A total of 25054 pregnancies were included. Mean maternal age was 34.7 ± 4.2 years, with 2807 patients in the group of age between 40 and 44 years (11.2%) and 280 patients ≥45 years (1.1%). Women at AMA had higher incidence of previous comorbilities (compared to the reference group of women < 30 years): prior c-section, chronic hypertension and obesity. In addition, they were more likely to use ART. After adjusting for confounding factors, maternal age was an independent and statistically significant risk factor for gestational diabetes (OR 1.66/2.80/3.14) for ages 30–39, 40–44 and ≥ 45 years respectively, c-section (OR 1.28/2.41/7.27) and placenta previa (OR 2.56/4.83) for ages 40–44 and ≥ 45 years respectively, but not for preeclampsia (neither early-onset nor late-onset). Risk of emergency c-section was only increased in women ≥45 years (OR, 2.03 (95% CI, 1.50–2.74). In the other groups of age, the increase in c-section rate was because of elective indications. Age ≥ 45 years was associated with iatrogenic prematurity < 37 weeks (OR 2.62, 95% CI 1.30–5.27). No other relevant associations between AMA and maternal or neonatal outcomes were found. Conclusions Maternal age is an independent risk factor for adverse obstetric outcomes. Age ≥ 40 years was associated to relevant increased risks and reveals to be an adequate cut-off to define AMA in our population.

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Does advanced maternal age influence obstetric outcome: a study in a tertiary care centre

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20190976 ◽

2019 ◽

Vol 8 (4) ◽

pp. 1313

Author(s):

Jose C. V. ◽

Lissiamma George ◽

Sunitha Sukumaran

Keyword(s):

High Risk ◽

Gestational Diabetes ◽

Maternal Age ◽

Tertiary Care ◽

Advanced Maternal Age ◽

Chronic Hypertension ◽

Care Hospital ◽

Tertiary Care Centre ◽

Younger Women ◽

Medical Disorders

Background: Advanced maternal age defined as age 35 years and older at estimated date of delivery has become increasingly common in last two to three decades. The International Federation of Gynaecology and Obstetrics in 1958 recommended that all women going through their first pregnancy over the age of 35 years should be considered high risk for pregnancy and included in this category 1.Methods: A one-year prospective observational study conducted in a tertiary care hospital after institutional ethical clearance. All 165 women above 35yrs who delivered during this period were taken as Cohort 1. Same number of women aged between 20 and 34 years were randomly selected as comparison group (Cohort 2). Both the groups were compared in terms of preexisting medical disorders, obstetrical morbidities, antenatal complications, intrapartum complications.Results: Older and younger women had similar antenatal booking, occupational and socioeconomic status. The main reason for pregnancy at advanced age group was late marriage. The risk of chronic hypertension, gestational diabetes mellitus, pre-existing medical disorders were higher in advanced maternal age.Conclusions: Increasing maternal age is associated with elevated risks for pregnancy complications. They are at high risk for gestational diabetes, cesarean section and to have low birth weight babies. Since these women are at higher risk of complications, they should be advised to adhere to frequent antenatal visits and close supervision.

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Teenage pregnancy as a risk factor for placental abruption: Findings from the prospective Japan environment and children’s study

PLoS ONE ◽

10.1371/journal.pone.0251428 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0251428

Author(s):

Hyo Kyozuka ◽

Tsuyoshi Murata ◽

Toma Fukusda ◽

Akiko Yamaguchi ◽

Aya Kanno ◽

...

Keyword(s):

Risk Factor ◽

Confidence Interval ◽

Teenage Pregnancy ◽

Odds Ratio ◽

Maternal Age ◽

Adjusted Odds Ratio ◽

Placental Abruption ◽

Advanced Maternal Age ◽

Chronic Hypertension ◽

Care Providers

Objective Placental abruption is a significant obstetric complication that affects both maternal and neonatal mortality and morbidity. The present study examined the effect of maternal age on the incidence of placental abruption. Methods We used data of singleton pregnancies from the Japan Environment and Children’s Study, which was a prospective birth cohort study conducted between January 2011 and March 2014 across 15 regional centers in Japan. A multiple regression model was used to identify whether maternal age (<20 years, 20–24 years, 25–29 years, 30–34 years, and ≥35 years) is a risk factor for placental abruption. The analyses were conducted while considering the history of placental abruption, assisted reproductive technology, number of previous deliveries, smoking during pregnancy, body mass index before pregnancy, and chronic hypertension. Results A total of 94,410 Japanese women (93,994 without placental abruption and 416 with placental abruption) were recruited. Herein, 764, 8421, 25915, 33517, and 25793 women were aged <20 years, 20–24 years, 25–29 years, 30–34 years, and ≥35 years, respectively. Besides advanced maternal age (≥35 years; adjusted odds ratio: 1.7, 95% confidence interval: 1.1–2.5), teenage pregnancy was also a risk factor for placental abruption (adjusted odds ratio: 2.8, 95% confidence interval: 1.2–6.5) when the maternal age of 20–24 years was set as a reference. Conclusions In the Japanese general population, besides advanced maternal age, teenage pregnancy was associated with placental abruption. Recently, the mean maternal age has been changing in Japan. Therefore, it is important for obstetric care providers to provide proper counseling to young women based on up-to-date evidence.

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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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Abstract TMP82: Increased Intracerebral Hemorrhage During Acute and Chronic Hypertension in Alzheimer's Transgenic Mice

Stroke ◽

10.1161/str.44.suppl_1.atmp82 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

David H Cribbs ◽

Giselle Passos ◽

Vitaly Vasilevko

Keyword(s):

Risk Factor ◽

Transgenic Mice ◽

Intracerebral Hemorrhage ◽

Amyloid Precursor Protein ◽

Significant Risk ◽

Significant Risk Factor ◽

Chronic Hypertension ◽

Cerebrovascular System ◽

The Brain ◽

Tg2576 Mice

Hypertension is a major risk factor for intracerebral hemorrhage (ICH), and the accumulation of amyloid-beta (Aβ) in the cerebrovascular system, cerebral amyloid angiopathy (CAA), is also a significant risk factor for intracerebral hemorrhage ICH. Currently, there are no animal studies demonstrating a direct involvement of hypertension in the accumulation of Alzheimer’s disease-like pathology. To address this issue we have developed several mouse models that combine hypertension protocols with amyloid precursor protein (APP) transgenic mice (Tg2576), which accumulate significant CAA in the large cerebral vessels and the meninges by 18 months of age. The goal of this study was to determine the effect of acute and chronic hypertension on ICH in wildtype and a transgenic mouse model overexpressing a mutant human amyloid precursor protein (Tg2576 mice) associated with early onset AD and CAA. Fifteen-month-old Tg2576 mice and non-transgenic (nTg) littermates were treated with an angiotensin II (AngII) infusion (1000 ng/kg/min) and L-NAME (100 mg/kg/day) in drinking water to produce chronic hypertension. One week later, transient acute hypertension was induced by daily AngII injections (0.5 μg/g, s.c., twice daily) to produce ICH. A similar increase in mean blood pressure was observed in Tg2576 and nTg mice when evaluated 2 weeks after initiation of treatment. However Tg2576 mice had a higher incidence of signs of stroke compared with nTg littermates (P > 0.05). These data suggest that the accumulation of Aβ in the brain has an important role in development of ICH. Moreover, there was robust glial activation and increase in CAA in the gray matter of Tg2576 mice showing that hypertension may affect gray as well as white matter in the brain. Further studies may provide insights into the hypertension-induced changes in the cerebral vascular system that initiated the increase in CAA. The accumulation of Aβ in the cerebrovascular system is a significant risk factor for intracerebral hemorrhage (ICH), and has been linked to endothelial transport failure and blockage of perivascular drainage. While management of hypertension and atherosclerosis can reduce the incidence of ICH, there are currently no approved therapies for attenuating CAA.

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Risk factors of childhood leukemia

Paediatrica Indonesiana ◽

10.14238/pi54.6.2014.358-64 ◽

2014 ◽

Vol 54 (6) ◽

pp. 358

Author(s):

Paulina K. Bangun ◽

Bidasari Lubis ◽

Sri Sofyani ◽

Nelly Rosdiana ◽

Olga R. Siregar

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Birth Weight ◽

Maternal Age ◽

Childhood Leukemia ◽

Significant Risk ◽

Significant Risk Factor ◽

High Birth Weight ◽

Parental Age ◽

Prenatal Risk Factors

Background The incidence of childhood leukemia has increasedannually. Recent studies have shown that childhood leukemia isinitiated in utero, and have focused on prenatal risk factors suchas birth weight and parental age. Exposure to pesticides andradiation, as well as parental smoking, breastfeeding, and thenumber of older siblings have also been sugges ted as risk factorsfor childhood leukemia.Objective To evaluate possible risk factors for childhood leukemia,including birth weight, parental age, and other risk factors.Methods This case-con trol study was conducted from October2011 to February 2012 in Haji Adam Malik Hospital, Medan .Case subjects were children aged below 18 years and diagnosedwith leukemia. Control subjects were children aged below 18years who were diagnosed with any non-cancerous acute illnessesin this hospital, and individually matched for age and gen der tothe case subject group. Patients and parents were asked to fill astructured questionnaire. Data was analyzed using conditionallogistic regression .Results A total of 140 subjects were eligible, with 70 subjects ineach group. Birth weight 2: 4000 g and maternal age 2:35 yearswere significant risk factors with OR 10.13 (95%CI 1.124 to 91.2 7)and OR 4.98 (95%CI 1.276 to 19.445), respectively. Paternal ageof 2:35 years was not a significant risk factor. Exposure to pesticideswas also noted as another significant risk factor (OR= 6.66; 95%CI2.021 to 21.966) .Conclusion High birth weight, advan ced maternal age, andexposure to pesticides are risk factors of childhood leukemia.

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