Advanced maternal age and pregnancy outcomes: a multicountry assessment

Abstract

Objective To assess the association between advanced maternal age (AMA) and adverse pregnancy outcomes.Design Secondary analysis of the facility-based, cross-sectional data of the WHO Multicountry Survey on Maternal and Newborn Health.Settings A total of 359 health facilities in 29 countries in Africa, Asia, Latin America, and the Middle East.Sample A total of 308 149 singleton pregnant women admitted to the participating health facilities.Methods We estimated the prevalence of pregnant women with advanced age (35 years or older). We calculated adjusted odds ratios of individual severe maternal and perinatal outcomes in these women, compared with women aged 20-34 years, using a multilevel, multivariate logistic regression model, accounting for clustering effects within countries and health facilities. The confounding factors included facility and individual characteristics, as well as country (classified by maternal mortality ratio level).Main outcome measures Severe maternal adverse outcomes, including maternal near miss (MNM), maternal death (MD), and severe maternal outcome (SMO), and perinatal outcomes, including preterm birth (<37 weeks of gestation), stillbirths, early neonatal mortality, perinatal mortality, low birthweight (<2500 g), and neonatal intensive care unit (NICU) admission.Results The prevalence of pregnant women with AMA was 12.3% (37 787/308 149). Advanced maternal age significantly increased the risk of maternal adverse outcomes, including MNM, MD, and SMO, as well as the risk of stillbirths and perinatal mortalities.Conclusions Advanced maternal age predisposes women to adverse pregnancy outcomes. The findings of this study would facilitate antenatal counselling and management of women in this age category.

Neonatal near miss and mortality: factors associated with life-threatening conditions in newborns at six public maternity hospitals in Southeast Brazil

“…Criteria for definition of life-threatening conditions, namely gestational age less than 32 weeks, birth weight less than 1,500g, or five-minute Apgar score less than seven (pragmatic criteria for definition of near miss 9 ), correspond to adverse perinatal outcomes and are associated with sociodemographic variables 13 reproductive history, risk behavior 1,18 , and prenatal, delivery, and neonatal care 2,9,19 . Our results corroborated previous studies on factors associated with adverse neonatal outcomes.…”

“…Infants born to older mothers showed a nearly twofold risk of neonatal near miss, compared to mothers aged 20 to 34. In the World Health Organization multi-country survey on maternal and newborn health 13 , advanced maternal age was also associated with adverse outcomes such as gestational age less than 37 weeks, birth weight less than 2,500g, and five-minute Apgar less than seven. These characteristics are similar, although more sensitive (higher cutoff points for gestational age and birth weight) than those adopted as pragmatic criteria for the definition of near miss in the present study.…”

Treatment and preservation at the extremes of reproductive age: a case report outlining the ethical dilemmas

“…As well as the risks of ovarian stimulation and oocyte collection, studies are consistent as to the increase in perinatal (pre-eclampsia, maternal hypertension, preterm labour, perinatal mortality) and maternal risks (operative delivery and maternal morbidity and mortality) with advanced maternal age at delivery (50 years and 3 months in this case [15][16][17][18]). Specifically assessing the more extremes of maternal age, Laopaiboon et al [15] demonstrated adjusted odds ratios of 3.7 for a severe maternal adverse outcome (defined as a maternal death or a maternal near-miss up to 7 days after giving birth) and 1.6, 1.9 and 2.1 for a low Apgar score at delivery, perinatal mortality and stillbirth in women 45 or over at delivery.…”

“…Specifically assessing the more extremes of maternal age, Laopaiboon et al [15] demonstrated adjusted odds ratios of 3.7 for a severe maternal adverse outcome (defined as a maternal death or a maternal near-miss up to 7 days after giving birth) and 1.6, 1.9 and 2.1 for a low Apgar score at delivery, perinatal mortality and stillbirth in women 45 or over at delivery. Schimmel et al [16] demonstrated a significant increase in maternal hypertension (7.3 vs. 4.7 %), maternal diabetes (11.7 vs. 1.2 %), emergency operative delivery (0.9 vs. 0.3 %) and preterm delivery (5.2 vs. 4.0 %) in those between 43 and 47 compared to those 24-27.…”

Effect of parity on obstetric outcomes in advanced maternal age pregnancies

“…Eskiden, 40 yaş ve üzeri kadınlar pek çok plansız çocuğa sahip olmaya meyilli iken, bugün ileri yaşlarda ilk doğum yapan kadınların oranı artmaktadır. İleri anne yaşı maternal ve perinatal risklerde artışa neden olmaktadır (5,6) .…”