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Impact of aging on obstetric outcomes: defining advanced maternal age in Barcelona.
BMC Pregnancy Childbirth. 2019 Sep 23; 19(1):342.BP

Abstract

BACKGROUND

Women of advanced maternal age (AMA) are a growing population, with higher obstetric risks. The Mediterranean population has specific characteristics different from other areas. Thus, the objective of this study was to establish a cut-off to define AMA in a selected mediterranean population coming from a tertiary referral private/mutual health hospital in Barcelona.

METHODS

Retrospective cohort of euploid singleton pregnancies delivered from January 2007 to June 2017. Main maternal outcomes were: gestational diabetes, preeclampsia, placenta previa, c-section and prolonged hospitalization (≥ 7 days). Main adverse perinatal outcomes were: stillbirth, prematurity, preterm prelabor rupture of membranes, low birth weight, need of admission at a neonatal intensive care unit and perinatal mortality. Adjustment for confounding factors (smoking, previous comorbilities, parity, assisted reproductive techniques (ART) and obesity) was performed.

RESULTS

A total of 25054 pregnancies were included. Mean maternal age was 34.7 ± 4.2 years, with 2807 patients in the group of age between 40 and 44 years (11.2%) and 280 patients ≥45 years (1.1%). Women at AMA had higher incidence of previous comorbilities (compared to the reference group of women < 30 years): prior c-section, chronic hypertension and obesity. In addition, they were more likely to use ART. After adjusting for confounding factors, maternal age was an independent and statistically significant risk factor for gestational diabetes (OR 1.66/2.80/3.14) for ages 30-39, 40-44 and ≥ 45 years respectively, c-section (OR 1.28/2.41/7.27) and placenta previa (OR 2.56/4.83) for ages 40-44 and ≥ 45 years respectively, but not for preeclampsia (neither early-onset nor late-onset). Risk of emergency c-section was only increased in women ≥45 years (OR, 2.03 (95% CI, 1.50-2.74). In the other groups of age, the increase in c-section rate was because of elective indications. Age ≥ 45 years was associated with iatrogenic prematurity < 37 weeks (OR 2.62, 95% CI 1.30-5.27). No other relevant associations between AMA and maternal or neonatal outcomes were found.

CONCLUSIONS

Maternal age is an independent risk factor for adverse obstetric outcomes. Age ≥ 40 years was associated to relevant increased risks and reveals to be an adequate cut-off to define AMA in our population.

Authors+Show Affiliations

Department of Obstetrics, Gynecology and Reproduction, Dexeus Mujer, Hospital Universitari Quiron Dexeus, Barcelona, Spain. marcla@dexeus.com.BCNatal, Hospital Clínic of Barcelona and Hospital Sant Joan de Déu, Barcelona, Spain.Department of Epidemiology and Statistics, Dexeus Mujer, Hospital Universitari Quiron Dexeus, Barcelona, Spain.Department of Obstetrics, Gynecology and Reproduction, Dexeus Mujer, Hospital Universitari Quiron Dexeus, Barcelona, Spain.Director of Obstetrics Department, Dexeus Mujer, Hospital Universitari Quiron Dexeus, Barcelona, Spain.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31547808

Citation

Claramonte Nieto, Marta, et al. "Impact of Aging On Obstetric Outcomes: Defining Advanced Maternal Age in Barcelona." BMC Pregnancy and Childbirth, vol. 19, no. 1, 2019, p. 342.
Claramonte Nieto M, Meler Barrabes E, Garcia Martínez S, et al. Impact of aging on obstetric outcomes: defining advanced maternal age in Barcelona. BMC Pregnancy Childbirth. 2019;19(1):342.
Claramonte Nieto, M., Meler Barrabes, E., Garcia Martínez, S., Gutiérrez Prat, M., & Serra Zantop, B. (2019). Impact of aging on obstetric outcomes: defining advanced maternal age in Barcelona. BMC Pregnancy and Childbirth, 19(1), 342. https://doi.org/10.1186/s12884-019-2415-3
Claramonte Nieto M, et al. Impact of Aging On Obstetric Outcomes: Defining Advanced Maternal Age in Barcelona. BMC Pregnancy Childbirth. 2019 Sep 23;19(1):342. PubMed PMID: 31547808.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of aging on obstetric outcomes: defining advanced maternal age in Barcelona. AU - Claramonte Nieto,Marta, AU - Meler Barrabes,Eva, AU - Garcia Martínez,Sandra, AU - Gutiérrez Prat,Mireia, AU - Serra Zantop,Bernat, Y1 - 2019/09/23/ PY - 2019/01/18/received PY - 2019/07/18/accepted PY - 2019/9/25/entrez PY - 2019/9/25/pubmed PY - 2019/9/25/medline KW - Advanced maternal age KW - C-section KW - Gestational diabetes KW - Outcomes KW - Placenta previa KW - Preeclampsia KW - Prematurity SP - 342 EP - 342 JF - BMC pregnancy and childbirth JO - BMC Pregnancy Childbirth VL - 19 IS - 1 N2 - BACKGROUND: Women of advanced maternal age (AMA) are a growing population, with higher obstetric risks. The Mediterranean population has specific characteristics different from other areas. Thus, the objective of this study was to establish a cut-off to define AMA in a selected mediterranean population coming from a tertiary referral private/mutual health hospital in Barcelona. METHODS: Retrospective cohort of euploid singleton pregnancies delivered from January 2007 to June 2017. Main maternal outcomes were: gestational diabetes, preeclampsia, placenta previa, c-section and prolonged hospitalization (≥ 7 days). Main adverse perinatal outcomes were: stillbirth, prematurity, preterm prelabor rupture of membranes, low birth weight, need of admission at a neonatal intensive care unit and perinatal mortality. Adjustment for confounding factors (smoking, previous comorbilities, parity, assisted reproductive techniques (ART) and obesity) was performed. RESULTS: A total of 25054 pregnancies were included. Mean maternal age was 34.7 ± 4.2 years, with 2807 patients in the group of age between 40 and 44 years (11.2%) and 280 patients ≥45 years (1.1%). Women at AMA had higher incidence of previous comorbilities (compared to the reference group of women < 30 years): prior c-section, chronic hypertension and obesity. In addition, they were more likely to use ART. After adjusting for confounding factors, maternal age was an independent and statistically significant risk factor for gestational diabetes (OR 1.66/2.80/3.14) for ages 30-39, 40-44 and ≥ 45 years respectively, c-section (OR 1.28/2.41/7.27) and placenta previa (OR 2.56/4.83) for ages 40-44 and ≥ 45 years respectively, but not for preeclampsia (neither early-onset nor late-onset). Risk of emergency c-section was only increased in women ≥45 years (OR, 2.03 (95% CI, 1.50-2.74). In the other groups of age, the increase in c-section rate was because of elective indications. Age ≥ 45 years was associated with iatrogenic prematurity < 37 weeks (OR 2.62, 95% CI 1.30-5.27). No other relevant associations between AMA and maternal or neonatal outcomes were found. CONCLUSIONS: Maternal age is an independent risk factor for adverse obstetric outcomes. Age ≥ 40 years was associated to relevant increased risks and reveals to be an adequate cut-off to define AMA in our population. SN - 1471-2393 UR - https://www.unboundmedicine.com/medline/citation/31547808/Impact_of_aging_on_obstetric_outcomes:_defining_advanced_maternal_age_in_Barcelona_ L2 - https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-019-2415-3 DB - PRIME DP - Unbound Medicine ER -
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