Abstract
BackgroundThe risk of fetal loss is higher among ≥35-year-olds than younger women. The present study aimed to explore the causes and factors influencing fetal loss in advanced maternal age (AMA).MethodsAMA women with singleton fetuses (< 14 gestational weeks) who underwent their first prenatal examination in the Obstetrics Department of Fujian Maternity and Child Health Hospital from December 2018 to June 2020 were included in this cohort study. Those who terminated the pregnancy before 14 gestational weeks were excluded. A baseline survey was conducted, and follow-up was carried out until the termination of the pregnancy. Clinical data were extracted to analyse the causes of fetal loss among them. In the nested case-control study, the AMA women with fetal loss were enrolled as the case group, and women without fetal loss in the same period were enrolled as the control group, in a 1:2 ratio matched by age and gestational weeks. Logistic regression models were used to analyse the factors influencing fetal loss.ResultsA total of 239 women with fetal loss and 478 controls were enrolled. The causes of fetal loss were most often fetal factors, followed by maternal factors, umbilical cord factors, and placental factors. Multivariate logistic regression analysis indicated that junior high school education and below (adjusted odds ratio (aOR) = 5.13, 95% confidence interval (CI): 2.19–12.02), senior high school education (aOR = 4.91, 95% CI: 2.09–11.54), residence in a rural area (aOR = 2.85, 95% CI: 1.92–4.25), unemployment (aOR = 1.81, 95% CI: 1.20–2.71), spontaneous abortion history (aOR = 1.88, 95% CI: 1.26–2.80), preterm birth history (aOR = 11.08, 95% CI: 2.90–42.26), hypertensive disorders of pregnancy (aOR = 7.20, 95% CI: 2.24–23.12), and preterm premature rupture of membranes (aOR = 4.12, 95% CI: 1.53–11.11) were risk factors for fetal loss.ConclusionsLow educational level, unemployment, abnormal pregnancy/labor history, and pregnancy complications were correlated with the incidence of fetal loss in AMA. Thus, early identification as well as a targeted intervention, should be conducted.
Highlights
The risk of fetal loss is higher among ≥35-year-olds than younger women
General information From December 2018 to June 2020, 5210 advanced maternal age (AMA) women with singleton fetuses who were still pregnant at 13 gestational weeks 6 days since their first prenatal examination, were enrolled in this AMA cohort study
There were no significant differences between the two groups in maternal age, race, or paternal age (Table 1)
Summary
The risk of fetal loss is higher among ≥35-year-olds than younger women. The present study aimed to explore the causes and factors influencing fetal loss in advanced maternal age (AMA). An increasing trend in maternal childbearing age has been observed worldwide [1]. The increase in average pregnancy age could be attributed to the increase in the number of women aged ≥35 years attempting to conceive. Advanced maternal age (AMA) is defined as a maternal age of ≥35 years at the expected delivery time [2]. In the USA, the birth rates among AMA women increased by 12% from 2007 to 2016 [3]. AMA has been associated with high academic and career pursuit, delayed conception due to infertility, and prolonged life expectancy [4]. Zhang et al [5] found that the prevalence of AMA was 15.82% in 2017 in Zhejiang Province, China
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