Pregnancy outcomes of overweight and obese women aged 35 years or older – A registry-based study in Finland

Abstract

SummaryObjective: To compare pregnancy outcomes of overweight and obese pregnant women aged 35 years or older to women aged less than 35 years old. Methods: A registry-based study covering years 2004-2008 including data on women ≥35 years (N = 45,718) compared to those <35 years (N = 203,930) and their prepregnancy body mass index (BMI) (<25, 25-29 and ≥30). In multivariable modelling, the main outcome measures were preterm delivery (<28 weeks, 28-31weeks and 32-36 weeks), low Apgar scores at 5 min, small-for-gestational age (SGA), foetal death, asphyxia, Caesarean section, induction, preeclampsia, blood transfusion, admission to a neonatal intensive care unit (NICU), shoulder dystocia, and large for gestational age (LGA). Results: Maternal overweight and obesity along with advanced maternal age (AMA) significantly increased the risks of preterm delivery, preeclampsia, foetal death, LGA and Caesarean as compared to women of average weight aged <35 years. When comparing overweight and obese women aged ≥35 years to normal weight women * Corresponding author. Tel.: +358 503816972. E-mail address: reeta.lampinen@uef.fi (R. Lamminpää). of the same age, the rates of preeclampsia, preterm delivery <28 weeks, LGA and low Apgar score were significantly increased. When observing overweight and obese women <35 years as a reference group, the risks of preterm delivery and foetal death were significantly increased. Conclusions: The risks were increased by maternal age ≥ 35 years and both obesity and overweight. The combined effect of AMA and either overweight or obesity appeared to be a high risk state particularly for stillbirth and preterm delivery.

Advanced maternal age and its association with placenta praevia and placental abruption: a meta-analysis

“…In this meta-analysis, studies with OR adjusted to previous c-section and previous PP showed a greater magnitude of association with PP (35)(36)(37)(38)(39) 4.36, 95%CI: 3.08-6.17) compared to those that were not adjusted. This finding shows that, when logistic regression is made and adjusted for important factors, one gets closer to the actual contribution of old age to the outcome of PP.…”

“…We considered 35 years or older as the cutoff point for separation between young and older women. Most articles subdivided advanced maternal age into 35-39 years and ≥ 40 years 10,11,12,13,14,15,16,19,20,33,34,35 , others used ≥ 35 years 21,25,36,37,38,39,40 , and some only considered AMA age ≥ 40 years 41,42,43,44 . Regarding the definition of the age range for the comparison group, the studies were very different, with most using 20 to 34 years (30.4%), followed by < 35 years (21.1%), 25 to 29 years (17.4%), and others (26.1%).…”

Maternal prepregnancy obesity and the risk of shoulder dystocia: a meta‐analysis

“…A total of 20 articles (19 cohort studies and 1 case–control studies) involving 2 153 898 participants were included in this meta‐analysis. For obesity (including all obesity classes), 16 articles (15 cohort studies and 1 case–control studies) involving 1 308 888 participants met the inclusion criteria.…”

“…However, the conclusions of several epidemiological studies are inconsistent with regard to a link between obesity and shoulder dystocia. Three studies link shoulder dystocia with obesity but another three do not substantiate the link.…”

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).…”