The role of maternal age in twin pregnancy outcomes

Abstract

Background There is limited data on how maternal age is related to twin pregnancy outcomes. Objective To assess the relationship between maternal age and risk for preterm birth, fetal death, and neonatal death in the setting of twin pregnancy. Study design This population-based study of US birth, fetal death, and period linked birth-infant death files from 2007–2013 evaluated neonatal outcomes for twin pregnancies. Maternal age was categorized as 15 to 17, 18 to 24, 25 to 29, 30 to 34, 35 to 39, and ≥40 years of age. Twin live births and fetal death delivered at 20 to 42 weeks were included. Primary outcomes included preterm birth (<34 weeks and <37 weeks), fetal death, and neonatal death at <28 days of life. Analyses of preterm birth at <34 and <37 weeks were adjusted for demographic and medical factors, with maternal age modeled using restricted spline transformations. Results A total of 955,882 twin live births between 2007 and 2013 were included in the analysis. Preterm birth rates at <34 weeks and <37 weeks were highest for women 15 to 17 years of age, decreased across subsequent maternal age categories, nadired for women age 35– 39 and then increased slightly for women 40 or over. Risk for fetal death generally decreased across maternal age categories. Risk for fetal death was 39.9 per 1,000 live births for women age 15 to 17, 24.2 for women age 18 to 24, 17.8 for women age 25 to 29, 16.4 for women age 30 to 34, 17.2 for women age 35 to 39 and, and 15.8 for women 40 or older. Risk for neonatal death <28 days was highest for neonates born to women age 15 to 17 (10.0 per 1,000 live births), decreased to 7.3 for women 18 to 24 and 5.5 for women 25 to 29, and ranged from 4.3 to 4.6 for all subsequent maternal age categories. In adjusted models, risk for preterm birth at <34 to <37 weeks was not elevated for women in their mid-to-late-thirties; however, risk was elevated for women <20 and increased progressively with age for women in their forties. Conclusion While twin pregnancy is associated with increased risk for most adverse perinatal outcomes, this analysis did not find advanced maternal age to be an additional risk factor for fetal death and infant death. Preterm birth risk was relatively low for women in their late thirties. Risks for adverse outcomes were higher among younger women and further research is indicated to improve outcomes for this demographic group. It may be reasonable to counsel women in their thirties that their age is not a major additional risk factor for adverse obstetric outcomes in the setting of twin pregnancy.

Obstetric and perinatal outcomes in women with multiple pregnancy in Altai region

“…Lennan и соавт. (2017), частота двоен у женщин после 40 лет составляет 6,9 %, 35 -39 лет -5 %, 4,1% -у женщин от 30 до 34 лет [6].…”

“…Истмико-цервикальная недостаточность и угрожающие преждевременные роды в 6 раз чаще выявлялись у пациенток с многоплодной беременностью по сравнению с женщинами с одноплодной беременностью (ОШ 6,4, 95% ДИ [4,5-9,3]), что подтверждается данными других исследований [7]. Анемия во втором триместре беременности также чаще регистрировалась у пациенток с многоплодием (ОШ 6, 0, 95% ДИ [3,[2][3][4][5][6][7][8][9][10][11]3]).…”

“…Анализ исходов родов в группах показал, что у пациенток с многоплодием в три раза чаще беременность заканчивалась преждевременно по сравнению c одноплодной (62,26% и 21,82% соответственно, p≤0,001, ОШ 5,9, 95% ДИ [4,[2][3][4][5][6][7][8]4]). По сроку гестации почти половину случаев составили роды в сроке до 33,6 недель, т.е.…”

Early birth is a key factor in educational disadvantage of twins: A data linkage study

“…As a complicating factor, twins are associated with maternal and socio‐demographic characteristics such as later maternal age, higher parity, ethnicity and use of assisted reproductive technology . While some of these characteristics may affect neurological development, evidence is not strong for others . Twin pregnancies are also known to be associated with some perinatal factors that are themselves independently associated with poorer child health and educational outcomes .…”

24-Hour Fetal/Maternal Monitoring System Based on Phonocardiogram Analysis

“…Despite all medical, scientific and technical achievements, the problem of maintaining fetus' life and health in normal conditions and in case of various pregnancy pathologies has not been solved completely yet [2][3][4]. The analysis of the most recent data (2016) shows that more than a half of the intrauterine fetal death (IUFD) episodes take place in home settings [2,5].…”