Clinical Outcomes in High-Risk Pregnancies Due to Advanced Maternal Age

Abstract

Although the influence of advanced maternal age (AMA) and delayed childbearing on adverse maternal and perinatal outcomes has been studied extensively, no universal consensus on the definition of AMA exists. This terminology currently refers to the later years of a woman's reproductive life span and generally applies to women age ‡35 years. AMA increases the risk of pregnancy complications, including ectopic pregnancy, spontaneous abortion, fetal chromosomal abnormalities, congenital anomalies, placenta previa and abruption, gestational diabetes, preeclampsia, and cesarean delivery. Such complications could be the cause of preterm birth and increase the risk of perinatal mortality. For women who have a chronic illness, pregnancy may lead to additional risk that demands increased monitoring or surveillance. The management of pregnant women of AMA requires understanding the relationship between age and preexisting comorbidities. The outcomes from pregnancy in AMA may have a negative impact on women's health as they age because of both the changes from the pregnancy itself and the increased risk of pregnancy-related complications. Postpartum depression affects women of AMA at higher rates. Links between preeclampsia and the risk of future development of cardiovascular disease require follow-up surveillance. The association between hypertensive pregnancy disorders and cognitive and brain functions needs further investigation of sex-specific risk factors across the life span. Educating providers and women of AMA is crucial to facilitate clinical decision making and such education should consider cultural influences, risk perception, and women's health literacy, as well as providers' biases and system issues.

Summary and Conclusion: Framing a New Research Agenda on Maternal Morbidities and Mortality in the United States

“…Even for populations that have been studied more extensively, such as women of advanced maternal age 9 or African American women, 10 much remains unknown about the root causes of their increased morbidity and mortality risk. Chinn et al 10 discuss how various social and historical factors—including slavery, institutionalized racism, and gender discrimination—shape the distinct social experience of Black womanhood in America.…”

“…Several articles [5][6][7][8][9][10] in this special issue focus on vulnerable populations that are at greater risk of maternal morbidities and mortality. How little we know about some vulnerable populations is troubling.…”

“…Similarly, Brown et al 8 pointed out that '' [d]espite the wealth of research on calcium, iron, and folate and their effects on women's health outcomes, most studies conducted in the United States either included only White women or, when mixed ethnic/racial groups were included, the studies lacked adequate representation of specific groups that would allow appropriate subgroup analyses.'' Even for populations that have been studied more extensively, such as women of advanced maternal age 9 or African American women, 10 much remains unknown about the root causes of their increased morbidity and mortality risk. Chinn et al 10 discuss how various social and historical factors-including slavery, institutionalized racism, and gender discrimination-shape the distinct social experience of Black womanhood in America.…”

Different Methods for Termination of Mid-trimester Pregnancy With Placenta Previa 

“…Advanced maternal age (age greater than 35 years old), multiparity, smoking, history of curettage, assisted reproductive technology, prior cesarean section, and prior placenta previa may increase the incidence of placenta previa [13][14][15] . The common complications of placenta previa include placenta accrete spectrum (PAS), uncontrolled antepartum/postpartum hemorrhage, so blood transfusion, hysterectomy, ICU care may need [16,17] .…”

“…In our study, the average gestation age of pregnant women was 22.3 weeks, if the pregnancy continues, the position of placenta may change to normal in the third trimester. Second, with the beginning of China's universal two-child policy, more and more multiparous women with advanced maternal age, prior cesarean section, history of curettage have more chance to terminate pregnancy for stillbirth, fetal malformation, serious maternal complications [13] . Last, our birth center is a maternal emergency center, pregnant women with high risk of placenta previa are more likely to choose our hospital.…”