Elevated risks of pregnancy complications and adverse outcomes with increasing maternal age

University of Miami School of Nursing and Health Studies, Coral Gables, FL 33143, USA.
Human Reproduction (Impact Factor: 4.57). 06/2007; 22(5):1264-72. DOI: 10.1093/humrep/del522
Source: PubMed


In the USA, between 1980 and 2004, the proportion of all births increased 2-fold in women aged > or = 30, 3-fold in women aged > or = 35 and nearly 4-fold in women aged > or = 40. The objective of this study was to evaluate the risks of pregnancy complications and adverse outcomes with increasing maternal age using national vital statistics data.
The study population included 8,079,996 live births of singletons of > or = 20 weeks among women aged 30-54 from the 1995-2000 US Birth Cohort Linked Birth/Infant Death Data Set. Outcomes were modelled by maternal age and parity using multinomial logistic regression to calculate adjusted odds ratios (AORs) and 95% confidence intervals.
The risks for most outcomes paralleled increasing maternal age including prolonged and dysfunctional labour, excessive labour bleeding, breech and malpresentation and primary Caesarean delivery. The highest AORs among women aged > or = 45 versus 30-34 by parity (primiparas and multiparas, respectively) were for chronic hypertension (3.70, 4.89), diabetes (2.19, 2.58), primary Caesarean (3.14, 2.85), excessive labour bleeding (1.54, 1.49), pregnancy hypertension (1.55, 2.13) and birth <32 weeks (2.11, 1.77).
Increasing maternal age is associated with significantly elevated risks for pregnancy complications and adverse outcomes, which vary by parity.

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Available from: Barbara Luke, May 16, 2014
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    • "Stillbirths are complex and multifactorial in nature. Although maternal age is important, they can also be influenced by parity, weight at birth, and duration of gestation (Luke and Brown 2007). Weight and prematurity are recognized as the most important causes of stillbirth (Mohsin et al. 2006). "
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    ABSTRACT: BACKGROUND This analysis focuses on determining differences in the risk of stillbirth in Spain by comparing native and foreign mothers with regard to bio-demographic factors. METHODS The study is based on micro-data, one record per delivery for 2,869,329 births occurring from 2007 to 2012. RESULTS For a total of 2,287,819 single deliveries the average stillbirth rate for Spanish mothers (S) was 2.51 per 1000; for non-Spanish mothers (NS) it was 3.99 per 1000. Two multivariate Poisson regression models were applied to obtain adjusted stillbirth risk ratios (RR), one for S and another for NS mothers. For both groups the following variables were included in the model: Caesarean, mother’s age, birth weight, duration of gestation, and maternal education. Parity, however, was incorporated only for Spanish mothers, while for the non-Spanish the relationship status and the father’s nationality were included. The increase in RR is similar for certain variables, such as in cases where no Caesarean was performed (S: 3.356; NS: 3.439); while for other variables differences are observed with regard to maternal origin, for example weight at birth <1500g in relation to  2500g (S: 4.154; NS: 21.367). CONCLUSIONS Immigration, together with differential reproductive maternal characteristics, had an influence on RR. Maternal education, as an indicator of socioeconomic conditions, is one of the most important socio-cultural variables in this respect. Certain reproductive and socio-cultural maternal variables affected RR differently in Spanish and foreign women, suggesting the benefit of implementing policies to achieve a decrease in the risk of stillbirths in the NS group.
    Demographic Research 10/2014; 31:889-912. DOI:10.4054/DemRes.2014.31.29 · 1.20 Impact Factor
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    • "In other words, elongation of TTP may be led to idea of infertility. Results of various studies have shown that longer TTP correlates with preterm labor, abortion, and EP.[6] Significant relationship has also been reported between twin pregnancy and lower TTP.[4] "
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    ABSTRACT: Background: Studies have shown significant correlation between time to pregnancy (TTP) and pregnancy outcomes. But understanding of these mechanisms may not be facilitated. The aim of this study was to determine the relation between TTP and pregnancy outcome. Materials and Methods: This study was a case cohort study that was done in Shahid Beheshti Educational Hospital during 2006-2007. Women aged 18-35 years, who had only one pregnancy without using any contraception method before pregnancy and delivered their first child, were enrolled in this study. Thus, 801 women were selected and followed up for pregnancy outcome and TTP until the end of pregnancy. All the participants filled in a special questionnaire. Finally the collected data were entered into computer and analyzed by SPSS ver. 20 software. Results: The frequency distribution of TTP-based pregnancy outcome showed that TTP >48 weeks was higher in normal delivery than in abnormal delivery (5.6% vs. 19.4%). According to Chi-square test, the frequency distribution of pregnancy outcome was related to TTP (P < 0.001). Conclusion: According to the results of this study, there is a significant relationship between TTP and pregnancy outcome, and TTP may lead to unwanted complications such as ectopic pregnancy, preterm labor, and abortion. Thus, all women with a long time of contraception, especially in the rural areas, mast be controlled.
    08/2014; 3:175. DOI:10.4103/2277-9175.139411
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    • "The only background variable that differed between women diagnosed with prolonged labour or not was parity, with more primiparas subjected to prolonged labour, a finding similar to other studies [9,46]. Other well-known characteristics of women with prolonged labour, such as high body mass index [44] or high maternal age [47], were not confirmed in the present study. "
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    ABSTRACT: Background: Prolonged labour very often causes suffering from difficulties that may have lifelong implications. This study aimed to explore the prevalence and treatment of prolonged labour and to compare birth outcome and women's experiences of prolonged and normal labour. Method: Women with spontaneous onset of labour, living in a Swedish county, were recruited two months after birth, to a cross-sectional study. Women (n = 829) completed a questionnaire that investigated socio-demographic and obstetric background, birth outcome and women's feelings and experiences of birth. The prevalence of prolonged labour, as defined by a documented ICD-code and inspection of partogram was calculated. Four groups were identified; women with prolonged labour as identified by documented ICD-codes or by partogram inspection but no ICD-code; women with normal labour augmented with oxytocin or not. Results: Every fifth woman experienced a prolonged labour. The prevalence with the documented ICD-code was (13%) and without ICD-code but positive partogram was (8%). Seven percent of women with prolonged labour were not treated with oxytocin. Approximately one in three women (28%) received oxytocin augmentation despite having no evidence of prolonged labour. The length of labour differed between the four groups of women, from 7 to 23 hours.Women with a prolonged labour had a negative birth experience more often (13%) than did women who had a normal labour (3%) (P <0.00). The factors that contributed most strongly to a negative birth experience in women with prolonged labour were emergency Caesarean section (OR 9.0, 95% CI 1.2-3.0) and to strongly agree with the following statement 'My birth experience made me decide not to have any more children' (OR 41.3, 95% CI 4.9-349.6). The factors that contributed most strongly to a negative birth experience in women with normal labour were less agreement with the statement 'It was exiting to give birth' (OR 0.13, 95% CI 0.34-0.5). Conclusions: There is need for increased clinical skill in identification and classification of prolonged labour, in order to improve care for all women and their experiences of birthing processes regardless whether they experience a prolonged labour or not.
    BMC Pregnancy and Childbirth 07/2014; 14(1):233. DOI:10.1186/1471-2393-14-233 · 2.19 Impact Factor
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