Alon Ben-David1, Saralee Glasser2, Eyal Schiff3, Aliza Segev Zahav3, Valentina Boyko4, Liat Lerner-Geva1,4. 1. Sackler Faculty of Medicine, School of Public Health, Tel Aviv University, Tel Aviv, Israel. 2. Women and Children's Research Unit, Gertner Institute for Epidemiology and Health Policy Research, Chaim Sheba Medical Center, 52621, Tel Hashomer, Ramat Gan, Israel. saraleeg@gertner.health.gov.il. 3. The Joseph Buchman Gynecology and Maternity Center, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel. 4. Women and Children's Research Unit, Gertner Institute for Epidemiology and Health Policy Research, Chaim Sheba Medical Center, 52621, Tel Hashomer, Ramat Gan, Israel.
Abstract
OBJECTIVES: In light of the potential physical and emotional costs to both woman and child, this study was conducted to assess pregnancy complications and birth outcomes in primiparae at very advanced maternal age (VAMA, aged ≥45) compared to younger primiparae. METHODS: Retrospective cohort study comparing 222 VAMA primiparae and a reference group of 222 primiparae aged 30-35, delivering at Sheba Medical Center from 2008 through 2013. RESULTS: VAMA primiparae were more likely than younger primiparae to be single, to have chronic health conditions, and higher rates of gestational diabetes mellitus (GDM), gestational-hypertension (GHTN) and preeclampsia-eclampsia. VAMA primiparae conceived mostly by oocyte donation. They were more likely to be hospitalized during pregnancy, to deliver preterm and by cesarean birth. Infants of VAMA primiparae were at greater risk for low birthweight and Neonatal Intensive Care Unit admission. There were no differences in outcomes between VAMA primiparae with or without preexisting chronic conditions, or between those aged 45-49 and ≥50. In multivariable analysis VAMA was an independent risk factor for GDM, GHTN and preeclamsia-eclampsia, with adjusted odds ratio of 2.38 (95 % CI 1.32, 4.29), 5.80 (95 % CI 2.66, 12.64) and 2.45 (95 % CI 1.03, 5.85); respectively. The effect of age disappeared in multiple pregnancies. CONCLUSIONS: Primiparity at VAMA holds a significant risk for adverse pregnancy and birth outcomes. The absence of chronic medical conditions or the use of a young oocyte donor does not improve these outcomes. Multiple pregnancies hold additional risk and may diminish the effect of age. Primiparity at an earlier age should be encouraged.
OBJECTIVES: In light of the potential physical and emotional costs to both woman and child, this study was conducted to assess pregnancy complications and birth outcomes in primiparae at very advanced maternal age (VAMA, aged ≥45) compared to younger primiparae. METHODS: Retrospective cohort study comparing 222 VAMA primiparae and a reference group of 222 primiparae aged 30-35, delivering at Sheba Medical Center from 2008 through 2013. RESULTS: VAMA primiparae were more likely than younger primiparae to be single, to have chronic health conditions, and higher rates of gestational diabetes mellitus (GDM), gestational-hypertension (GHTN) and preeclampsia-eclampsia. VAMA primiparae conceived mostly by oocyte donation. They were more likely to be hospitalized during pregnancy, to deliver preterm and by cesarean birth. Infants of VAMA primiparae were at greater risk for low birthweight and Neonatal Intensive Care Unit admission. There were no differences in outcomes between VAMA primiparae with or without preexisting chronic conditions, or between those aged 45-49 and ≥50. In multivariable analysis VAMA was an independent risk factor for GDM, GHTN and preeclamsia-eclampsia, with adjusted odds ratio of 2.38 (95 % CI 1.32, 4.29), 5.80 (95 % CI 2.66, 12.64) and 2.45 (95 % CI 1.03, 5.85); respectively. The effect of age disappeared in multiple pregnancies. CONCLUSIONS: Primiparity at VAMA holds a significant risk for adverse pregnancy and birth outcomes. The absence of chronic medical conditions or the use of a young oocyte donor does not improve these outcomes. Multiple pregnancies hold additional risk and may diminish the effect of age. Primiparity at an earlier age should be encouraged.
Entities:
Keywords:
Birth outcome; Pregnancy complications; Primiparity; Very advanced maternal age
Authors: E A Sullivan; F Zegers-Hochschild; R Mansour; O Ishihara; J de Mouzon; K G Nygren; G D Adamson Journal: Hum Reprod Date: 2013-02-26 Impact factor: 6.918
Authors: S Antinori; G H Gholami; C Versaci; F Cerusico; L Dani; M Antinori; C Panci; N Nauman Journal: Reprod Biomed Online Date: 2003-03 Impact factor: 3.828
Authors: Richard J Paulson; Robert Boostanfar; Peyman Saadat; Eliran Mor; David E Tourgeman; Cristin C Slater; Mary M Francis; John K Jain Journal: JAMA Date: 2002-11-13 Impact factor: 56.272
Authors: Lianlian Wang; Xianglong Xu; Philip Baker; Chao Tong; Lei Zhang; Hongbo Qi; Yong Zhao Journal: Int J Environ Res Public Health Date: 2016-07-07 Impact factor: 3.390
Authors: Bianca F Nicolosi; Renato T Souza; Jussara Mayrink; Francisco E Feitosa; Edilberto A Rocha Filho; Débora F Leite; Janete Vettorazzi; Maria H Sousa; Maria L Costa; Philip N Baker; Louise C Kenny; Jose G Cecatti; Iracema M Calderon Journal: PLoS One Date: 2020-05-13 Impact factor: 3.240
Authors: Enoch Odame Anto; William K B A Owiredu; Samuel Asamoah Sakyi; Cornelius Archer Turpin; Richard K D Ephraim; Linda Ahenkorah Fondjo; Christian Obirikorang; Eric Adua; Emmanuel Acheampong Journal: PLoS One Date: 2018-07-17 Impact factor: 3.240