Abstract
Objective: To investigate the effect of parity and interpregnancy interval (IPI) on perinatal outcomes in advanced maternal age (AMA) parturients. Methods: A population-based retrospective cohort study of all women older than 40 years, who had a singleton live birth after 24 weeks in the United States in 2017 Women were categorized to three groups by parity and interval from last delivery: primiparas, multiparas with IPI ≤ 5 years, and multiparas with IPI > 5 years. Primary outcome was composite adverse neonatal outcome (preterm delivery <34 weeks, birthweight <2000 g, neonatal seizure, neonatal intensive care unit admission, Apgar score <7 at 5 min, or assisted ventilation >6 h). Secondary outcome was composite adverse maternal outcome and other adverse perinatal outcomes. Univariate and multivariate analysis were used to compare between groups. Results: During 2017, 3,864,754 deliveries were recorded into the database. Following exclusion, 109,564 AMA gravidas entered analysis. Of them, 24,769 (22.6%) were nulliparas, 39,933 (36.4%) were multiparas with IPI ≤ 5 years, and 44,862 (40.9%) were multiparas with IPI > 5 years. Composite neonatal outcome was higher in nulliparas and in multiparas with IPI > 5 years, in comparison to multiparas with IPI ≤ 5 years (16% vs. 13% vs. 10%, respectively, p < 0.05). Maternal composite outcome was similar between groups. In the multivariable analysis, relative to nulliparas, only multiparity with IPI ≤ 5 years had a protective effect against the composite neonatal outcome (aOR 0.97, 95% CI 0.95–0.99, p < 0.001). Conclusion: Among AMA gravidas, multiparity with IPI ≤ 5 years has a significant protective effect against adverse neonatal outcomes when compared to nulliparas. Multiparity with IPI > 5 years is no longer protective.
Highlights
During the last few decades, there has been an increasing trend for child bearing in the later reproductive years, in high-income countries [1]
Of them, maternal age was older than 40 years at the time of delivery
We aimed to evaluate the combined effect of parity and interpregnancy interval (IPI) on perinatal outcomes in advanced maternal age parturients
Summary
During the last few decades, there has been an increasing trend for child bearing in the later reproductive years, in high-income countries [1]. As age is a continuum rather than a categorical variable, the definition of advanced maternal age is not solid, and most studies refer to women over 35 to 40 years as such. Advanced maternal age gravidas have higher rates of adverse pregnancy outcomes including: pre-eclampsia, gestational diabetes mellitus, preterm birth, fetal growth restriction, cesarean delivery, stillbirth, and more [2,3,4,5,6]. Data suggests that interpregnancy interval (IPI), whether short (below 18 months) or long (above 60 month) has an impact on both maternal and neonatal outcome [9,10,11,12,13,14,15]. It is thought that following prolonged IPI, the maternal, physiologic, and anatomical pregnancy adaptations gradually decline and become comparable to those at their first pregnancy [9]
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