Adverse Birth Outcomes Among Women of Advanced Maternal Age With and Without Health Conditions in Maryland

Berger, Blair O.; Wolfson, Carrie; Reid, Lawrence D.; Strobino, Donna M.

doi:10.1016/j.whi.2020.08.008

Cited by 17 publications

(13 citation statements)

References 40 publications

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“…This study reaffirms maternal age and race disparities in low birth weight demonstrated in the literature [ 26 ]. Racial disparities are typically explored without taking age groups into account, despite age being an important biologic factor for several outcomes.…”

Section: Discussionsupporting

confidence: 89%

Birth outcomes across the spectrum of maternal age: dissecting aging effect versus confounding by social and medical determinants

Olapeju

Hong

Wang

et al. 2021

BMC Pregnancy Childbirth

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Background Given the trend of increasing maternal age and associated adverse reproductive outcomes in the US, this study aimed to assess whether this association is due to an independent aging or confounded by sociodemographic, biomedical, or behavioral determinants in a predominantly Black US population. Methods Data was from 8509 women enrolled in the Boston Birth Cohort. Adverse reproductive outcomes included spontaneous preterm delivery, cesarean delivery, and low birth weight. Covariates included sociodemographic (parity, race/ethnicity, education, marital status, income, receipt of public assistance, nativity); biomedical (obesity, hypertensive disorders, diabetes mellitus); and behavioral (consistent intake of multivitamin supplements, support from father of baby, support from family, major stress in pregnancy, cigarette smoking, alcohol intake). Analysis included Lowess and marginal probability plots, crude and adjusted sequential logistic regression models to examine age-outcome associations and to what degree the association can be explained by the above covariables. Result Overall, the study sample had high levels of spontaneous preterm birth (18%), cesarean delivery (33%) and low birth weight (26%). Unadjusted models showed no significant difference odds of spontaneous preterm birth by maternal age but higher odds of cesarean section (aOR: 1.77, 95% CI: 1.60, 1.95) and low birth weight (aOR: 1.15, 95% CI: 1.04, 1.28) among women 30 years or older. Adjustment for sociodemographic factors, biomedical conditions and behavioral factors revealed higher odds of spontaneous preterm birth: (aOR: 1.30, 95% CI: 1.14, 1.49), cesarean section deliveries (aOR: 1.68, 95% CI: 1.51, 1.87) and low birth weight (aOR: 1.36, 95% CI: 1.21, 1.53). Across all ages, optimal BMI status and consistent multivitamin supplement intake were protective of spontaneous preterm birth and low birth weight. Conclusion In this high-risk minority population, we demonstrated that the association between increasing maternal age and adverse pregnancy outcomes was due to an independent aging effect and the presence of confounding by sociodemographic, biomedical, and behavioral factors. Some modifiable risk factors to counteract aging effect, include optimizing BMI and consistent intake of multivitamin supplement. A fundamental change in how care is provided to women, particularly low income Black women, is needed with emphasis on the protective role of optimal nutritional status. Trial registration ClinicalTrials.gov Identifier: NCT03228875

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Section: Discussionsupporting

confidence: 89%

Birth outcomes across the spectrum of maternal age: dissecting aging effect versus confounding by social and medical determinants

Olapeju

Hong

Wang

et al. 2021

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

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“…Although ENM is a composite outcome of multiple clinical factors, we were not able to directly capture factors driving the patterns observed in this cohort as it was based on national database with limited information. However, maternal age-related factors that are known to be associated with perinatal death, such as congenital birth defect 14 , preterm birth 18 , and preeclampsia 26 , and these factors are likely to be more severe in each category for > 40 years 7,17 . Thus, it can be carefully speculated that the reason ENM remained still high in the mothers over 40 years of age despite the degree of social support, may be accountable to congenital anomalies, chromosomal abnormality and extremely preterm or very low birth weight complicating neonates.…”

Section: Discussionmentioning

confidence: 99%

Maternal age and risk of early neonatal mortality: a national cohort study

Kim

Choi

Kim

et al. 2021

Sci Rep

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Advanced maternal age (AMA) is a growing trend world-wide and is traditionally defined as childbearing in women over 35 years of age. The purpose of our study was to determine the maternal age group within the Korean population, in which the risk of early neonatal mortality is increased. Korean birth and mortality data from 2011 to 2015 were used to estimate the influence of maternal age on the risk of early neonatal mortality. A Poisson regression was used for the analysis of multiple clinical variables such as year of delivery, maternal age, gestational age, infant gender, birth weight, multiple birth, parity, and socioeconomic variables. Furthermore, a generalized additive model was used to determine the maternal age at which the risk for neonatal mortality increases. We included 2,161,908 participants and found that 49.4% of mothers were 30–34 years of age at delivery. The proportion of mothers aged 35 and above increased over the 5-year analysis period. A maternal age lower than 29 years or higher than 40 years was associated with a relatively higher risk of early neonatal mortality. The trend and magnitude of the age-related risk on early neonatal mortality were independent of maternal socioeconomic factors such as living in an obstetrically underserved area, education level, and employment status. Furthermore, we showed that the risk for early neonatal mortality was higher until the maternal age of 28. However, there were no significant changes in the risk between the age of 35 and 40 years. According to recent national-wide data, age-related risk for early neonatal mortality is only apparent for mothers ≥ 40 years old whereas, age between 35 and 39 are not at increased risk for early neonatal mortality, despite being classified as AMA.

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“…Maternal characteristics, such as older age 13,14 and obesity 15 , have been linked with various adverse pregnancy outcomes, including complications during pregnancy and delivery leading to increased morbidity in the newborn. In our study, maternal age and maternal parity did not differ, and maternal weight prior to conception and weight gain during pregnancy were similar for mothers of infants with CH as for those in the general population.…”

Section: Discussionmentioning

confidence: 99%

Congenital Hypothyroidism Can Dictate the Mode of Delivery and Intra-Labor Medication Usage

Rosen

Lavie

Yackobovitch‐Gavan

et al. 2021

Thyroid

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Pregnancy and parturition reflect the complex interaction between physiologic conditions of the mother and her offspring, and fetal health characteristics may affect maternal health throughout pregnancy and delivery. We investigated the characteristics of the mother-infant dyad of term infants detected by the National Newborn Screening Program as having congenital hypothyroidism (CH) (131 out of 108,717; 0.12%). Three years of surveillance in our Pediatric Endocrine Clinic revealed that 65 had transient CH and 66 had permanent CH.A higher proportion of deliveries of CH infants required vacuum assistance, and more infants with CH were born through a cesarean section compared to the general population (p<0.001).Medication during labor also differed, with higher rates of oxytocin (p<0.001) and antibiotics (p=0.008) administered to mothers of CH infants. A multivariate logistic regression model revealed an increased demand for oxytocin administration during the labor of a CH infant in a hypothyroidism severity-dependent manner, expressed as a threefold risk associated with permanent but not transient CH. Our findings of increased utilization of medical interventions during the labor and delivery of CH infants suggest that the prenatal fetal thyroid function affects the development and progress of labor and delivery, in response to oxytocin.

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Adverse Birth Outcomes Among Women of Advanced Maternal Age With and Without Health Conditions in Maryland

Cited by 17 publications

References 40 publications

Birth outcomes across the spectrum of maternal age: dissecting aging effect versus confounding by social and medical determinants

Birth outcomes across the spectrum of maternal age: dissecting aging effect versus confounding by social and medical determinants

Maternal age and risk of early neonatal mortality: a national cohort study

Congenital Hypothyroidism Can Dictate the Mode of Delivery and Intra-Labor Medication Usage

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