Preeclampsia complicated by advanced maternal age: a registry-based study on primiparous women in Finland 1997–2008

Abstract

BackgroundPreeclampsia is a frequent syndrome and its cause has been linked to multiple factors, making prevention of the syndrome a continuous challenge. One of the suggested risk factors for preeclampsia is advanced maternal age. In the Western countries, maternal age at first delivery has been steadily increasing, yet few studies have examined women of advanced maternal age with preeclampsia. The purpose of this registry-based study was to compare the obstetric outcomes in primiparous and preeclamptic women younger and older than 35 years.MethodsThe registry-based study used data from three Finnish health registries: Finnish Medical Birth Register, Finnish Hospital Discharge Register and Register of Congenital Malformations. The sample contained women under 35 years of age (N = 15,437) compared with those 35 and over (N = 2,387) who were diagnosed with preeclampsia and had their first singleton birth in Finland between 1997 and 2008. In multivariate modeling, the main outcome measures were Preterm delivery (before 34 and 37 weeks), low Apgar score (5 min.), small-for-gestational-age, fetal death, asphyxia, Cesarean delivery, induction, blood transfusion and admission to a Neonatal Intensive Care Unit.ResultsWomen of advanced maternal age (AMA) exhibited more preeclampsia (9.4%) than younger women (6.4%). They had more prior terminations (<0.001), were more likely to have a body mass index (BMI) >25 (<0.001), had more in vitro fertilization (IVF) (<0.001) and other fertility treatments (<0.001) and a higher incidence of maternal diabetes (<0.001) and chronic hypertension (<0.001). Multivariate logistic regression indicated that women of AMA had higher rates of: preterm delivery before 37 weeks 19.2% (OR 1.39 CI 1.24 to 1.56) and before 34 weeks 8.7% (OR 1.68 CI 1.43 to 2.00) low Apgar scores at 5 min. 7.1% (OR 1.37 CI 1.00 to 1.88), Small-for-Gestational Age (SGA) 26.5% (OR 1.42 CI 1.28 to 1.57), Asphyxia 12.1% (OR 1.54 CI 1.34 to 1.77), Caesarean delivery 50% (OR 2.02 CI 1.84 to 2.20) and admission to a Neonatal Intensive Care Unit (NICU) 31.6% (OR 1.45 CI 1.32 to 1.60).ConclusionsPreeclampsia is more common in women with advanced maternal age. Advanced maternal age is an independent risk factor for adverse outcomes in first-time mothers with preeclampsia.

Socio-Demographic and Other Risk Factors of Pre Eclampsia at a Tertiary Care Hospital, Karnataka: Case Control Study

“…We found that pre eclampsia is 4 times likely if a woman was pregnant before 20y of age. A similar retrospective study done in Finland also concluded with the same result [13]. This might either be due to the age itself or may be due to inadequate antenatal care given to a teenage pregnant girl.…”

“…This has been conclusively found in various studies [13,15], but the incidence of pre eclampsia in women less than 20y of age is an area that has not been given much importance. Nulliparity is associated with increased risk of pre -eclampsia and eclampsia by two folds.…”

“…It is estimated that worldwide 13% of maternal mortality is due to hypertensive disorders of pregnancy but it is much higher in developing countries where the estimates are between 20-80% in Asia [12,13].…”

Comparison of Bcl-xL protein expression in placental trophoblast cells between pregnancy complicated by severe preeclampsia and normotensive pregnancy

“…Advanced maternal age is an independent risk factor for adverse outcomes in first-time mothers with preeclampsia. 8,9 Mean gestational age in severe preeclamptic group was significantly lower than normotensive group indicating an inhomogenous distribution in research samples. This result was in accordance with a study by Zhang et al 7 which found that mean gestasional age in severe preeclamptic group was significantly lower than control group.…”

Smoking and Related Factors during Pregnancy

“…Moreover, in univariate analysis, we found that smoking until birth was associated with advanced maternal age (Table 3). Pregnant women aged older than 35 years are considered to be at a higher risk for adverse perinatal outcomes (12,13). Smoking during pregnancy for this age group could add burden and worsen adverse perinatal outcomes (11).…”