The association between young maternal age and pregnancy outcome

Abstract

Objective: We aimed to determine the association between young maternal age at delivery with adverse pregnancy outcome in a single, tertiary, university-affiliated medical center.

Methods: A retrospective, cohort, matched control study using the first percentile distribution of maternal age at delivery (21 years old, n?=?461) as the study group, and four control groups by maternal age matched by parity in a 2:1 ratio (22–25, 26–30, 31–35 and 36–40 years; n?=?922 each).

Results: Women aged ≤21 years were found to have lower rates of chronic hypertension [compared with women aged 36–40 years old (0.0% versus 1.3%, p?<?0.05)], lower rates of gestational diabetes mellitus (GDM) (1.3% versus 3.7%, p?=?0.007), higher rates of perineal lacerations [compared with women aged 31–35 and 36–40 years old, 41% versus 31.8% and 31.1%, respectively, p?<?0.01)], higher rates of postpartum hemorrhage (4.6% versus 1.5%, p?<?0.0001) and higher rates of low 5-min Apgar score (2.2% versus 0.8%, p?=?0.004). No significant differences were found in terms gestational age at delivery, birth weight, fetal sex, intrapartum or antepartum mortality.

Conclusion: Young maternal age at delivery is associated with increased risk of short-term complications after delivery.     

A significant linear association exists between advanced maternal age and adverse perinatal outcome

Objective  

The present study was aimed to investigate perinatal outcome of elderly nulliparous patients.     

产前筛查结果与不良妊娠结局关系分析

目的:探讨血清学唐氏筛查和孕妇外周血胎儿游离DNA产前筛查(NIPT)结果与不良妊娠结局的关系.方法:选取2017年2月1日至2019年6月1日在上海市第一人民医院产前诊断中心接受中孕期血清学唐氏筛查(2483例)和NIPT(2312例)的孕妇,随访妊娠结局.比较血清学唐氏筛查高风险、中风险、低风险孕妇发生不良妊娠结局...     

The association between prenatal maternal objective stress,perceived stress,preterm birth and low birthweight

Abstract

Objective: To evaluate the association between prenatal maternal stress, preterm birth (PTB) and low birthweight (LBW).

Methods: Forty-seven women exposed to life-threatening rocket attacks during pregnancy were compared to 78 unexposed women. Women were interviewed within 9 months of delivery regarding socio-demographic background, smoking and perceived level of stress prenatally. Clinical data was obtained from hospital records and information regarding rocket attacks was obtained from official local authorities.

Results: Women exposed to rocket attacks during the second trimester of pregnancy were more likely to deliver LBW infants than were unexposed women (14.9% versus 3.3%, p?=?0.03). No association was found between stress exposure and PTB. A multivariate logistic regression revealed that every 100 alarm increment increased the risk of LBW by 1.97 (adj.OR?=?1.97, 95%CI 1.05–3.7). Perceived stress was not associated with LBW.

Conclusions: Exposure to rocket attacks during the second trimester of pregnancy was associated with LBW. Objective stress can be used as an indicator of stress. Further studies are required to understand the underlying mechanism.     

The association between maternal race and adverse outcomes in twin pregnancies with similar healthcare access

Objective: To compare twin pregnancy outcomes between white and nonwhite women with similar access to health care.

Methods: Retrospective cohort study of all twin pregnancies delivered by a single maternal–fetal medicine practice from 2005–2016. All patients had private health insurance and equal access to physician care. Outcomes were compared between white and nonwhite women using logistic regression to adjust for differences at baseline.

Results: Of the 858 women included, 730 (85.1%) were white and 128 (14.9%) were nonwhite. Univariate analysis demonstrated that nonwhite women had higher rates of preterm birth <32 weeks (12.5 versus 6.7%, p?=?.022), cesarean delivery (78.1% versus 61.4% of all women, p?p?p?=?.029) and gestational diabetes (23.2% versus 7.3%, p?Conclusions: Nonwhite women with twin pregnancies have an increased risk of adverse outcomes that cannot be explained by access to care. Although improving access to care is an important goal for health care systems, our data suggest that this alone will not eliminate all disparities in health care outcomes between women of different races.     

Does young maternal age increase the risk of adverse obstetric,fetal and neonatal outcomes: A cohort study

Objective

To determine whether young maternal age is associated with increased risks of adverse obstetric, fetal and perinatal outcomes.

Study design

Register-based study using the data from a computerized database of a University Hospital for the years 1994–2001. The study population included 8514 primiparous women aged less than 31 who delivered a singleton infant. Using maternal age as a continuous variable, crude and adjusted relative risks (RRs) were estimated for each maternal and perinatal outcome.

Results

Crude and adjusted RRs of anaemia during pregnancy and fetal death consistently increased with younger maternal age. After adjustment for confounding factors, RRs (95% confidence interval) of fetal death and anaemia were respectively 1.37 (1.09–1.70) and 1.27 (1.15–1.40) for a 16-year-old compared to a 20-year-old mother. Younger mothers had significantly decreased risks of obstetric complications (preeclampsia, caesarean section, operative vaginal delivery and post-partum haemorrhage). Higher prevalence of prematurity and low birth weight in infants born to teenagers were not attributable to young maternal age after adjustment for confounding factors.

Conclusion

In our population, younger maternal age was significantly and consistently associated to greater risks of fetal death and anaemia and to lower risks of adverse obstetric outcomes.     

Advanced maternal age and adverse pregnancy outcomes: A cohort study

ObjectivesTo assess the association between advanced maternal age and adverse perinatal outcomes in single pregnancies.Materials and methodsA cohort study was conducted using data from 27,455 singleton births attended at our hospital between 2007 and 2018. Three maternal age groups were established, and perinatal outcomes were compared between-groups (<35 years (n = 19,429; 70.7%), 35–40 years (n = 7189; 26.2%), and >40 years (n = 846; 3.1%). The data were compared using chi-square analysis and the results were adjusted using a logistic regression model. Decision trees were designed to examine the fetal mortality and caesarean section variables. We used the SPSS 23 statistical software program for the statistical analysis.ResultsThe mean age of the women was 31.21 years. No differences were found associated with age for neonatal acidosis, an Apgar score <7 at 5 min after birth, threatened preterm labour, preterm rupture of membranes, or high-grade perineal tear. The analyses found statistically significant increases in the rates of hypertensive disorders, diabetes mellitus, induction of labour, and caesarean section, after 35 years of age. The risks of fetal death, neonatal admission, small for gestational age, placenta previa, instrument delivery, maternal ICU admission, and postpartum haemorrhage were greater after 40 years of age.ConclusionsThe results of our study indicated that women >35 years of age had worse perinatal outcomes, compared with younger women. This finding was more evident in patients >40 years of age, which highlighted the greater risk of fetal death and serious maternal complications in this group.     

Advanced maternal age and adverse perinatal outcomes in an Asian population

Objective

To investigate (1) whether there is an increasing trend in the mean maternal age at the birth of the first child and in the group of women giving birth at age 35 or older, and (2) the association between advanced maternal age and adverse perinatal outcomes in an Asian population.

Study design

We conducted a retrospective cohort study involving 39,763 Taiwanese women who delivered after 24 weeks of gestation between July 1990 and December 2003. Multivariable logistic regression was used to adjust for potential confounding variables.

Results

During the study period, the mean maternal age at the birth of the first child increased from 28.0 to 29.7 years, and the proportion of women giving birth at age 35 or older increased from 11.4% to 19.1%. Compared to women aged 20–34 years, women giving birth at age 35 or older carried a nearly 1.5-fold increased risk for pregnancy complications and a 1.6–2.6-fold increased risk for adverse perinatal outcomes. After adjusting for the confounding effects of maternal characteristics and coexisting pregnancy complications, women aged 35–39 years were at increased risk for operative vaginal delivery (adjusted odds ratio [OR] 1.5, 95% confidence interval [CI] 1.2–1.7) and cesarean delivery (adjusted OR 1.6, 95% CI 1.5–1.7), while women aged 40 years and older were at increased risk for preterm delivery (before 37 weeks of gestation) (adjusted OR 1.7, 95% CI 1.3–2.2), operative vaginal delivery (adjusted OR 3.1, 95% CI 2.0–4.6), and cesarean delivery (adjusted OR 2.6, 95% CI 2.2–3.1). In those women who had a completely uncomplicated pregnancy and a normal vaginal delivery, advanced maternal age was still significantly associated with early preterm delivery (before 34 weeks of gestation), a birth weight <1500 g, low Apgar scores, fetal demise, and neonatal death.

Conclusion

In this population of Taiwanese women, there is an increasing trend in the mean maternal age at the birth of the first child. Furthermore, advanced maternal age is independently associated with specific adverse perinatal outcomes.     

The effect of maternal age, parity, and prenatal care on perinatal outcome in adolescent mothers

Maternal age and prenatal care were found to influence the risk for having a small-for-gestational age infant in white adolescent mothers who had both one and two previous live births. However, poor care exerted a relatively stronger affect than young age for primiparous mothers, while the reverse was found for multiparous mothers. Moreover, for women with first births, there was an interaction between variables in that early prenatal care promoted better pregnancy outcome for younger teenagers than for older teens or adults. These results indicate that the perinatal risks of adolescent pregnancy are affected by both physiologic factors and prenatal care.     

高龄妊娠对子代影响的流行病学研究

高龄孕妇一般是指孕妇的分娩年龄≥35岁。流行病学研究发现随着年龄增高人类生育能力呈逐渐下降趋势,随着女性年龄的增长卵子不断老化,其出生缺陷、妊娠并发症均升高。本文将对其以上两方面进行阐述。     

Adverse pregnancy outcomes in cases involving extremely young maternal age

ObjectiveTo assess pregnancy outcomes among adolescent girls 16 years old or younger and their newborns.MethodsA cohort study was carried out at Siriraj Hospital, Mahidol University, Bangkok, Thailand, using completed charts for 1061 girls aged 16 years or younger (study group) and 1100 women aged 20 to 29 years (reference group) delivered at that hospital between January 1, 2006, and December 31, 2010. Demographic data, maternal laboratory investigations, maternal complications, placental complications, medications administered in hospital, and neonatal outcomes were recorded.ResultsAnemia (odds ratio [OR], 1.86; confidence interval [CI], 1.52–2.26); heart disease (OR, 0.38; CI 0.15–0.90), thyroid disorder (OR, 0.054; CI, 0.01–0.40), pulmonary disease (OR, 0.89; CI, 0.41–1.93); medical and obstetrics complications including gestational diabetes mellitus (OR, 0.04; CI, 0.01–0.29), placenta previa (OR 1.04, CI 0.06–16.60), preterm labor (OR, 1.98; CI, 1.55–2.53), as well as mean neonatal weight (2830.77 ± 81.31 g and 3038.53 ± 482.23 g; P = 0.001) were different in the 2 groups and the differences were statistically significant.ConclusionAdverse maternal and neonatal outcomes were common in the study group. Extensive education about contraception and safe sex on the one hand, and an effective care plan if pregnancy occurs, should be provided to teenage girls to reduce these poor outcomes.     

Inadequate prenatal care and maternal country of birth: a retrospective study of southeast Spain

Objective

To quantify the association between the maternal country of birth and inadequacy in the use of prenatal care, and to identify factors that might explain this association.

Study design

A retrospective case series was carried out in a public hospital in southern Spain, including 6873 women who delivered between 2005 and 2007. The maternal country of birth was categorised into four regional groups: Spain, Maghreb (north-west Africa), Eastern Europe and Others (non-Spain), while the use of prenatal care was quantified according to a modified Kotelchuck index: APNCU-1M and APNCU 2M. The effect of country of birth on inadequate prenatal care was analysed using a multiple logistic regression model designed to accommodate factors such as age, parity, previous miscarriages, and pre-gestational and gestational risks. Likelihood ratio tests were performed to assess any interactions.

Results

A significant association was found between maternal country of birth and inadequate prenatal care regardless of the index used. Under APNCU 1-M the strength of association was strongest for Eastern European origin (odds ratio (OR) 6.17, 95% confidence interval (CI) 5.2–7.32), followed by the Maghreb (OR: 5.58, 95% CI: 4.69–6.64). These associations remained virtually unchanged after adjusting for potential confounders. Interactions were observed between age and parity, with the highest risk of inadequacy seen among the Eastern European childbearing women over 34 years of age having 1–2 previous children (OR: 7.63, 95% CI: 3.65–15.92).

Conclusion

Prenatal health care initiatives would benefit from the study of a larger number of variables to address the differences between different groups of women. We recommend the widespread use of standardised indices for the study of prenatal care utilisation.     

Association between maternal HBsAg carrier status and neonatal adverse outcomes: meta-analysis

Objective: We conducted a meta-analysis to evaluate whether maternal hepatitis B virus (HBV) carrier status increases the risk of neonatal complications.

Methods: Publications addressing the association between maternal HBV carrier status and neonatal outcomes were selected from the PubMed, EMBASE, Web of Science, Cochrane Library and China National Knowledge Infrastructure. Publication bias and heterogeneity across studies were evaluated and summary odds ratios, weighted mean difference or standardized mean difference and 95% confidence intervals were calculated and compared between groups.

Results: Eighteen studies and 7600 pregnant HBV carriers were selected for analyses. A statistically association with maternal HBV carrier status was demonstrated for premature birth and asphyxia, with no difference found among perinatal mortality, gestational age, small for gestational age, large for gestational age, birth weight, low birth weight, macrosomia, Apgar sore at 1?min, jaundice and congenital anomaly. Heterogeneity across studies was found, and no publication bias was detected.

Conclusion: Our analysis suggests that maternal hepatitis B carrier status is significantly associated with premature birth and asphyxia. Large-scale prospective studies are still warranted.     

The association between maternal height and pregnancy outcomes in twin gestations

Objective: We sought to assess the association between maternal height and the risk of preterm birth, fetal growth restriction and mode of delivery in twin gestations.

Study design: Cohort study of patients with twin pregnancies delivered from 2005 to 2014. We compared pregnancy outcomes between patients of short stature?≤159?cm to those of normal stature?≥160?cm. Patients with monoamniotic twins and major fetal anomalies were excluded. Pearson’s correlation, Chi-square and Student’s t-test were used as appropriate.

Results: Six hundred and sixty-six patients were included, 159 (23.9%) of whom had short stature (mean height 155.8?±?2.5?cm) and 507 (76.1%) of whom had normal stature (mean height 167.2?±?5.5?cm). There were no differences in outcomes between the groups in regards to preterm birth, gestational age (GA) at delivery, birth weight of either twin, preeclampsia, gestational diabetes or cesarean section rate. Results were similar when the groups were stratified by parity. As a continuous variable, maternal height did not correlate with GA at delivery (p=?0.388), cesarean delivery (p?=?0.522) nor the birth weight of the larger (p?=?0.206) or smaller (p?=?0.307) twin.

Conclusion: In twin pregnancies, maternal short stature is not associated with preterm birth, fetal growth restriction or cesarean section rate. This suggests that although anthropometric measurements have long been used to counsel patients in regards to outcomes, patients of short stature should be reassured that their height does not appear to lead to adverse twin pregnancy outcomes.     

The association between maternal factors and perinatal outcomes in triplet pregnancies

OBJECTIVE: The purpose of this study was to evaluate the associations between maternal factors and outcomes in triplet pregnancies. STUDY DESIGN: This was a historic cohort study of 194 triplet pregnancies of >or=24 weeks of gestation that were delivered from 1983 through 2001 from five medical centers. RESULTS: In analyses that were limited to pregnancies with all live-born triplets (178 pregnancies), women with a previous good outcome (>2500 g + >37 weeks of gestation) had longer gestations (+7.9 days, P =.03), better rates of fetal growth (+4.9 g/wk, P <.0001), and higher birth weights (+153 g, P <.0001). Maternal weight gains of <36 pounds by 24 weeks of gestation were associated with lower birth weights (-197 g, P <.0001), and fetal growth rates at 相似文献