Abstract
BackgroundTo determine the effects of maternal age at first cesarean on maternal complications and adverse outcomes of pregnancy with the second cesarean.MethodsThis was a multicenter, historical, cross-sectional cohort study involving singleton pregnancies ≥28 gestational weeks, with a history of 1 cesarean delivery, and who underwent a second cesarean between January and December 2017 at 11 public tertiary hospitals in 7 provinces of China. We analyzed the effects of maternal age at first cesarean on adverse outcomes of pregnancy in the second cesarean using multivariate logistic regression analysis.ResultsThe study consisted of 10,206 singleton pregnancies. Women were at first cesarean between 18 and 24, 25–29, 30–34, and ≥ 35 years of age; and numbered 2711, 5524, 1751, and 220 cases, respectively. Maternal age between 18 and 24 years at first cesarean increased the risk of placenta accreta spectrum (aOR, 1.499; 95% CI, 1.12–2.01), placenta previa (aOR, 1.349; 95% CI, 1.07–1.70), intrahepatic cholestasis of pregnancy (aOR, 1.947; 95% CI, 1.24–3.07), postpartum hemorrhage (aOR, 1.505; 95% CI, 1.05–2.16), and blood transfusion (aOR, 1.517; 95% CI, 1.21–1.91) in the second cesarean compared with the reference group (aged 25–29 years). In addition, maternal age ≥ 35 years at first cesarean was a risk factor for premature rupture of membranes (aOR, 1.556; 95% CI, 1.08–2.24), placental abruption (aOR, 6.464, 95% CI, 1.33–31.51), uterine rupture (aOR, 7.952; 95% CI, 1.43–44.10), puerperal infection (aOR, 6.864; 95% CI, 1.95–24.22), neonatal mild asphyxia (aOR, 4.339; 95% CI, 1.53–12.32), severe asphyxia (aOR, 18.439; 95% CI, 1.54–220.95), and admission to a neonatal intensive care unit (aOR, 2.825; 95% CI, 1.54–5.17) compared with the reference group (aged 25–29 years).ConclusionsMaternal age between 18 and 24 years or advanced maternal age at first cesarean was an independent risk factor for adverse maternal outcomes with the second cesarean. Advanced maternal age at the first cesarean specifically increased adverse neonatal outcomes with the second. Therefore, decisions as to whether to perform a first cesarean at a young or advanced maternal age must be critically evaluated.
Highlights
To determine the effects of maternal age at first cesarean on maternal complications and adverse outcomes of pregnancy with the second cesarean
The associations between maternal age at first cesarean delivery (CD) and each outcome were investigated by logistic regression analysis in 2 models: model 1 was adjusted for possible confounders—including gravidity, parity, Body mass index (BMI), assisted reproductive technology, and interval months; and with model 2 we explored possible explanations of the findings by adding mediating factors—i.e., maternal age at the second CD [19]
The compositional ratio of CD indications was similar for different age groups, and scarred uterus was the primary indication for a second CD
Summary
To determine the effects of maternal age at first cesarean on maternal complications and adverse outcomes of pregnancy with the second cesarean. Advanced maternal age (AMA) is currently defined as maternal age 35 years or older at the time of delivery [6], some investigators define AMA as over 40 years [7, 8]. This trend is partially attributed to women’s pursuit of higher education, desire to have successful careers, and wish to attain financial stability [7, 9]. Developments in assisted reproductive technology, and multiparous women have driven a shift toward postponing motherhood or bearing an additional child at a more advanced age [11]. The risks to women and newborns associated with AMA have recently undergone greater scrutiny
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