Maternal Age Risk Research Articles

A Situational Overview of Prenatal Screening Services in Bhutan

ABSTRACTPrenatal genetic testing is to determine the possibility of the fetus having a genetic aberration or birth defect. Prenatal screening consists of serum analytes screening with or without nuchal translucency (NT) scanning or with cell‐free DNA (CfDNA) screening. Prenatal screening is recommended for all pregnant women regardless of the duration of pregnancy and maternal age or baseline risk. It is not advisable to screen with serum analytes and CfDNA concurrently to avoid discordant results. In developed countries, prenatal testing has been a part of routine antenatal care for a long time with adopting newer methods of screening and testing. In Bhutan, since the integration of the Safe Motherhood Program into primary healthcare in 1994, there has been an unprecedented improvement in obstetric care services. Almost all pregnant women attend antenatal and postnatal care, and 98.5% of deliveries are attended by trained health workers. The maternal mortality has reduced to 53 in 2023 from 770 per 100,000 live births in 1984 and the neonatal dealth has reduced to 15.2 per 1000 live births in 2023. However, despite improvements in the care of pregnant women, many babies are detected with congenital anomalies, syndromes, and birth defects during the postnatal period. Bhutan, being an underdeveloped country, could not initiate any form of prenatal testing program except for the anatomical scanning performed at 18–22 weeks of gestation. Early ultrasound dating scans, limited anomaly scanning, and growth scanning are offered to all pregnant women. There is a need to start centralized prenatal testing services in Bhutan to provide a comprehensive package of obstetric care to pregnant women. In addition, legal rights for parents to terminate severely deformed fetuses or severe genetic diseases before 24 weeks of pregnancy need to be established.

P-688 Fertility and age at childbirth in polycystic ovary syndrome: results from a longitudinal population-based cohort study

Abstract Study question How does fertility differ between women with and without polycystic ovary syndrome (PCOS), and which factors are associated with advanced maternal age? Summary answer Women with PCOS have less births. PCOS was associated with advanced maternal age, with later diagnosis associated with double the rate of advanced maternal age. What is known already PCOS affects 12% or 140 million women globally. Women with PCOS have broad features including ovulatory disturbances and increased infertility; however, few studies have explored reproductive outcomes in PCOS at the end of reproductive age. In the general population advanced maternal age, defined as giving birth after age 35 years, is associated with increased risk of pregnancy complications and reduced fertility. A recent register-based study found increased risk of advanced maternal age in women with PCOS, yet PCOS prevalence was underreported, and the study did not adjust for important confounders. Study design, size, duration Prospective cohort study. Women with (n = 981) and without (n = 13 266) self-reported PCOS diagnosis were compared during a 25-year follow-up. Participants/materials, setting, methods Women randomly selected from the general population and included in the prospective Australian Longitudinal Study on Women’s Health were assessed with surveys every third year from 1996 (age 18-23 years) to 2021 (age 43-48 years). Main results and the role of chance Overall 9.9% of women reported having PCOS and by 43-48 years, those with PCOS had less births (1.7 ±1.3 vs. 1.9 ±1.2, p < 0.001), and more were nulliparous, 23% vs. 18%, p = 0.003. They were older than women without PCOS at their first, and second childbirth (29.5 ±5.49 vs. 28.8 ±5.48 years and 32.1 ±5.16 vs. 31.1 ±5.00 years, p < 0.001 for both). PCOS was associated with increased odds of advanced maternal age at first childbirth, adjusted odds ratio (aOR) 1.34 (95% confidence interval 1.04-1.75), whereas type 2 diabetes (aOR 0.68 (0.61-1.10)) or hypertension (aOR 0.82 (0.61-1.10)) were not associated with advanced maternal age. Within the PCOS group, a late PCOS diagnosis was associated with increased odds of advanced maternal age, aOR 2.05 (1.24-3.40). Limitations, reasons for caution All outcomes were self-reported. Wider implications of the findings Women with PCOS have lower parity. Later diagnosis is associated with increased odds of advanced maternal age at first childbirth. Given poor reproductive outcomes with increased maternal age, we highlight the importance of earlier diagnosis, patient education and implementation of a reproductive life-plan to optimize attainment of aspirational family size. Trial registration number not applicable

278 Is age just a number? advanced maternal age and stillbirth risk

278 Is age just a number? advanced maternal age and stillbirth risk

Maternal age and the risk of fetal aneuploidy: A nationwide cohort study of more than 500 000 singleton pregnancies in Denmark from 2008 to 2017.

In this register-based study of pregnancies in Denmark, we assessed the associations between maternal age and the risk of fetal aneuploidies (trisomy 21, trisomy 18, trisomy 13, triploidy, monosomy X and other sex chromosome aberrations). Additionally, we aimed to disentangle the maternal age-related effect on fetal aneuploidies by cases with translocation trisomies and mosaicisms. We followed a nationwide cohort of 542 375 singleton-pregnant women attending first trimester screening in Denmark between 2008 and 2017 until delivery, miscarriage or termination of pregnancy. We used six maternal age categories and retrieved information on genetically confirmed aneuploidies of the fetus and infant from the national cytogenetic register. We confirmed the known associations between advanced maternal age and higher risk of trisomy 21, 18, 13 and other sex chromosome aberrations, especially in women aged ≥35 years, whereas we found no age-related associations with triploidy or monosomy X. Cases with translocation trisomies and mosaicisms did not influence the overall reported association between maternal age and aneuploidies. This study provides insight into the accurate risk of fetal aneuploidies that pregnant women of advanced ages encounter.

Trends in Term Intrapartum Stillbirth in Norway

Fetal death during labor at term is a complication that is rarely studied in high-income countries. There is a need for large population-based studies to examine the rate of term intrapartum stillbirth in high-income countries and the factors associated with its occurrence. To evaluate trends in term intrapartum stillbirth over time and to investigate the association between the trends and term intrapartum stillbirth risk factors from 1999 to 2018 in Norway. This cohort study used data from the Medical Birth Registry of Norway from 1999 to 2018 to examine rates of term intrapartum stillbirth and risk factors associated with this event. A population of 1 021 268 term singleton pregnancies without congenital anomalies or antepartum stillbirths was included in analyses, which were performed from September 2022 to February 2023. The main exposure variable was time, which was divided into four 5-year periods: 1999 to 2003, 2004 to 2008, 2009 to 2013, and 2014 to 2018. The primary study outcome was term intrapartum stillbirth. Risk ratios were calculated, and multivariable logistic regression analyses were conducted to identify factors associated with secular trends of term intrapartum stillbirth. The study population consisted of 1 021 268 term singleton births (maternal mean [SD] age, 29.72 [5.01] years; mean [SD] gestational age, 39.69 [1.27] weeks). During the study period, there were 95 term intrapartum stillbirths (0.09 per 1000 births). Maternal age, the proportion of individuals born in a country other than Norway, and the prevalence of gestational diabetes, labor induction, operative vaginal delivery, and previous cesarean delivery increased over the course of the study period. Conversely, the prevalence of infants large for gestational age, hypertensive disorder in pregnancy, and spontaneous vaginal delivery and the proportion of individuals who smoked decreased. The term intrapartum stillbirth rate decreased by 87% (95% CI, 68%-95%) from 0.15 per 1000 births in 1999 to 2008 to 0.02 per 1000 births in 2014 to 2018. Three in 4 term intrapartum stillbirths (70 of 95) occurred during intrapartum operative deliveries. The increased prevalence of older maternal age and obstetric risk factors were not associated with the variation in intrapartum stillbirth rates among the time periods. The prevalence of term intrapartum stillbirth was higher for individuals who gave birth in maternity units with fewer than 3000 annual births (adjusted odds ratio, 1.67; 95% CI, 1.07-2.61) than for those who gave birth in units with 3000 or more annual births. Findings of this study suggest that, despite increases in maternal and obstetric risk factors, term intrapartum stillbirth rates substantially decreased during the study period. Reasons for this decrease may be due to improvements in intrapartum care.

Social disadvantage during pregnancy: effects on gestational age and birthweight

ObjectiveWhether psychosocial adversity during pregnancy impacts fetal health outcomes at birth remains underexplored. This is a critical issue given significant social disadvantage and psychosocial stress faced by pregnant women worldwide.Study designMeasures of social disadvantage and psychological factors, and medical/reproductive and nutritional health status in pregnant women were obtained at each trimester. Using Structural Equation Modeling (SEM), we investigated the relationship of forms of adversity to each other and to infant gestational age, and birthweight.ResultsAmong 399 singletons, Social Disadvantage significantly predicted gestational age (p = 0.003), and residual birthweight (p = 0.006). There was a 0.4 week decrease in gestational age and a 3% decrease in birthweight for each standard deviation increase in Social Disadvantage.ConclusionSignificant negative effects of social adversity on the developing fetus were found. Notably, these effects emerged despite good prenatal care and after accounting for maternal age and medical reproductive risk factors.

Risk Factors of Low-Birth-Weight Baby in Indonesia

Introduction: LBW (Low Birth Weight) gets more intentions from many governments over the world because it is one of significant factors that may increase under-five mortality and infant mortality. The global prevalence of low birth weight (LBW) is still high (15.5%) where most of them (96.5%) are living in developing countries. Although In Indonesia the prevalence of LBW is considered low, it is steadily increasing should be considered: in 2007 5.4%; 5.7% in 2013, to 6.2 % in 2018. In 2020, the most common cause of neonatal death is low birth weight (LBW). BBLR in East Java reached 3.7%. Objection: To know the risk factors of LBW prevalence based on maternal age, number of pregnancy, gender, gestational age, fetal presentation, mode of delivery, SPE, PROM, and anemia in PKU Muhammadiyah Mojoagung public hospital, East Java. Method: This study is an retrospective cross-sectional study design study in PKU Muhammadiyah Mojoagung public hospital during Desember 2021 till November 2022. Purposive sampling method used to obtain the samples from medical records that fit to inclusion and exclusion criteria (n=100). Data was analyzed with SPSS statistics used chi-square, fisher, kruskal wallis, and logistic regression analytic method. Result: A total of 100 newborn were included during study period. The regression test showed significant result at maternal age <20/>35 years (p=0,000, OR 25.726, 95%CI 4.746-139.456) and anemia (p=0,002, OR 13.355, 95%CI 2.581-69.088) with LBW prevalence. Conclusion: maternal age and anemia risk factors that significant lead to LBW prevalence in PKU Muhammadiyah Mojoagung public hospital, East Java.

The Role of Dietary Polyphenols in Pregnancy and Pregnancy-Related Disorders.

Polyphenols are a group of phytochemicals with extensive biological functions and health-promoting potential. These compounds are present in most foods of plant origin and their increased widespread availability through the intake of nutritional supplements, fortified foods, and beverages, has also led to increased exposure throughout gestation. In this narrative review, we focus on the role of polyphenols in both healthy and pathological pregnancy. General information related to their classification and function is followed by an overview of their known effects in early-pregnancy events, including the current insights into molecular mechanisms involved. Further, we provide an overview of their involvement in some of the most common pregnancy-associated pathological conditions, such as preeclampsia and gestational diabetes mellitus. Additionally, we also discuss the estimated possible risk of polyphenol consumption on pregnancy outcomes. The consumption of dietary polyphenols during pregnancy needs particular attention considering the possible effects of polyphenols on the mechanisms involved in maternal adaptation and fetal development. Further studies are strongly needed to unravel the in vivo effects of polyphenol metabolites during pregnancy, as well as their role on advanced maternal age, prenatal nutrition, and metabolic risk of the offspring.

Parental Age and Childhood Risk for Cerebral Palsy in California

To investigate the associations between maternal or paternal age at the time of delivery and offspring's risk for cerebral palsy (CP) in California. We conducted a population-based, case-control study that included 8736 singleton CP cases and 90 250 singleton controls, matched by sex and birth year, selected from California birth certificate records from 1994 to 2010. We estimated OR and 95% CIs for CP diagnosis according to maternal and paternal age recorded on the birth certificates. Causal mediation analysis was performed to estimate direct and indirect effects of parental ages on CP with preterm delivery as a potential mediator. Children born to younger mothers (≤19years) or older mothers (35-39years; ≥40years) had a greater risk of CP compared with children of mothers aged 25-29years (ORs ranging from 1.13 to 1.59). Compared with paternal age 25-29years, older paternal age (40-44years; ≥45years) also was associated with an increased risk for CP independent of maternal age. When analyzing jointly using both parents of ages 20-34years as the reference, the greatest risk was estimated for older parents (≥35years). Preterm birth was estimated to mediate 19%-34% of the total effects between maternal or paternal age and offspring CP risk. Young maternal age and an older age in either or both parents were associated with a greater risk of CP in their children. Although preterm birth was a mediator, additional factors related to parental age need further exploration to explain risk of CP.

Analysis of the factors influencing positive predictive value of noninvasive prenatal testing for chromosome aneuploidies

Objective: To investigate the influence of Z-score and different risk factors on positive predictive value (PPV) of noninvasive prenatal testing (NIPT) for chromosome aneuploidies. Methods: A total of 81 838 NIPT samples from January 1, 2016 to May 31, 2021 in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. Invasive prenatal diagnosis was applied to verify the diagnosis of NIPT-positive results and the corresponding PPV was calculated. The PPV of the samples with different Z-score were compared. The women were divided into high-risk group and non-high-risk group: high-risk group (n=39 114) included those with ultrasound soft index abnormalities, advanced maternal age or high risk for maternal serum screening, while non-high-risk group (n=42 724) included those with intermediate risk for maternal serum screening or no indications. The differences of the PPV between these two groups were compared. Finally, the comprehensive influence of Z-score and different risk factors on PPV were analyzed. Results: A total of 471 high-risk cases were detected by NIPT results, including 362 cases of trisomy 21, 77 cases of trisomy 18 and 32 cases of trisomy 13. For trisomy 21, trisomy 18 and trisomy 13, there were 226 cases, 46 cases and 6 cases which were confirmed via invasive prenatal diagnosis respectively. The corresponding PPV were 79.3% (226/285), 82.1% (46/56) and 27.3% (6/22), respectively. PPV of trisomy 21 and trisomy 18 were positively correlated with the corresponding Z-score (r=0.92, 0.62, all P<0.05), while trisomy 13 could not be analyzed due to the small sample size. The PPV of high-risk group was 85.2% (207/243), which was higher than that of the non-high-risk group with PPV of 59.2%(71/120, χ2=30.30, P<0.01). When the Z-score was between 3-<4 and 4-<5, the PPV of the high-risk group were 46.2%(12/26)and 62.5%(15/24) respectively, which were higher than those of the non-high-risk group [16.0%(4/25) and 14.3%(3/21), χ2=4.10, 8.90, all P<0.05]. With the increase of Z-score, there was no significant difference in PPV between the two groups (all P>0.05). Conclusions: The PPV of trisomy 21 and trisomy 18 are positively correlated with Z-score. The PPV of high-risk group is higher than that of non-high-risk group. The combination of Z-score and other risk factors may provide more accurate genetic counseling for those with NIPT positive results.

Non-linear Relationship of Maternal Age With Risk of Spontaneous Abortion: A Case-Control Study in the China Birth Cohort.

BackgroundSpontaneous abortion is one of the prevalent adverse reproductive outcomes, which seriously threatens maternal health around the world.ObjectiveThe current study is aimed to evaluate the association between maternal age and risk for spontaneous abortion among pregnant women in China.MethodsThis was a case-control study based on the China Birth Cohort, we compared 338 cases ending in spontaneous abortion with 1,352 controls resulting in normal live births. The main exposure indicator and outcome indicator were maternal age and spontaneous abortion, respectively. We used both a generalized additive model and a two-piece-wise linear model to determine the association. We further performed stratified analyses to test the robustness of the association between maternal age and spontaneous abortion in different subgroups.ResultsWe observed a J-shaped relationship between maternal age and spontaneous abortion risk, after adjusting for multiple covariates. Further, we found that the optimal threshold age was 29.68 years old. The adjusted odds ratio (95% confidence interval) of spontaneous abortion per 1 year increase in maternal age were 0.97 (0.90–1.06) on the left side of the turning point and 1.25 (1.28–1.31) on the right side. Additionally, none of the covariates studied modified the association between maternal age and spontaneous abortion (P > 0.05).ConclusionsAdvanced maternal age (>30 years old) was significantly associated with increased prevalence of spontaneous abortion, supporting a J-shaped association between maternal age and spontaneous abortion.

Maternal age and miscarriage: A unique association curve in Sudan.

This study's aim was to estimate the prevalence and maternal age and other risk factors of miscarriage among Sudanese women. A cross-sectional study was conducted at the Saad Abuelela Tertiary Hospital in Khartoum, Sudan, from February to December 2019. Sociodemographic, obstetric and clinical data were collected. A multivariate logistic regression analysis was performed. Four hundred thirteen (20.5%) women reported experiencing a miscarriage. Risk factors included older age, high parity, histories of caesarean delivery, and obesity. Logistic regression showed that the lowest risk for women aged less than 20 years (adjusted odds ratio [AOR], 0.33) or 20 to 24 years (AOR, 0.57), primiparas (AOR, 0.42) and women educated below the secondary level (AOR, 0.78). Unlike the global age-associated risk of miscarriage, the risk of miscarriage among Sudanese women follows a unique curve in relation to maternal age. Interestingly, the curve showed a lower risk for women less than 20 years and at 40 years.

Prevalence of preterm birth and risk factors associated with it at different gestational ages: A multicenter retrospective survey in China.

Objectives:To investigate the prevalence of preterm birth (PTB) and the risk factors for different gestational age subgroups of preterm birth in China.Methods:We carried out a descriptive cross-sectional study encompassing all singleton live births (24+0 to 41+6 weeks) with completed data in 23 provinces in China from 2010 to 2017 during investigation period. We compared both the preterm group (24+0 to 36+6 weeks) and preterm subgroups (<32 weeks, 32+0 to 33+6 weeks, and 34+0 t0 36+6 weeks) with the term group (37+0 to 41+6 weeks). We collected information on maternal and fetal characteristics from medical records. Logistic regression was use.Results:The prevalence of PTB was 7.4% (15,833/215,254) in singleton births. After adjusting for maternal age, parity, and potential risk factors in univariate analysis, the high-risk factors for PTB at <32 weeks were placental abruption (aOR=41.52; 95% CI, 25.89–66.58), placenta previa (aOR=40.04; 95% CI, 32.00–50.09), chorioamnionitis (aOR=11.06; 95% CI, 8.738–14.02), and hypertension disorders in pregnancy (HDP) (aOR=3.564; 95% CI, 2.930–4.335). Intrahepatic cholestasis of pregnancy (ICP) was significantly associated with PTB at 34–36 weeks (aOR=5.763; 95% CI, 5.049–6.577), particularly with spontaneous PTB (aOR=10.04; 95% CI, 8.79–11.47). Gestational diabetes mellitus (GDM) was significantly associated with PTB at 34–36 weeks only (aOR=1.156; 95% CI, 1.054–1.267).Conclusion:Placental abruption, placenta previa, chorioamnionitis, and HDP were more predictive of early PTB; GDM and ICP were more predictive of late PTB.

Health Supervision for Children and Adolescents With Down Syndrome.

Health Supervision for Children and Adolescents With Down Syndrome.

OP028: At the intersection of technology and genetics: A pilot study exploring virtual assistant use with non-invasive prenatal screening result disclosure

The use of non-invasive prenatal screening (NIPS) is expanding rapidly. In August 2020, the American College of Obstetricians and Gynecologists (ACOG) in collaboration with the Society for Maternal-Fetal Medicine (SMFM), published a practice bulletin supporting prenatal screening, including NIPS, for all patients regardless of maternal age or baseline risk. This increased insurance coverage for NIPS and the number of providers offering NIPS to average-risk patients.

The Obstetric outcomes associated with advanced maternal age at the University Teaching Hospitals Women and Newborn Hospital in Lusaka, Zambia

Introduction: Pregnant women aged 35 years and above have traditionally been termed as of advanced maternal age. These women are considered to have a higher incidence of obstetric complications than younger ones&#x0D; Objectives: To investigate socio-demographic characteristics and obstetric outcomes in women of advanced age who delivered at the Women and Newborn Hospital, in Lusaka, Zambia.&#x0D; Methods: This was a cross-sectional study in which a total of 226 postnatal women, both of advanced (35 years and above) and optimal age (20 - 34 years), that met the eligibility criteria were recruited. Systematic random sampling was used to recruit study participants and data was collected using a structured questionnaire, review of patient's hospital records, and the labour ward delivery registers. Statistical analysis was performed using a statistical package for social sciences (SPSS) version 26 software.&#x0D; Results: The prevalence of advanced maternal age was 14.1%. The mean ages were 38years (range 35 - 46 years) and 28 years in advanced and optimal maternal age groups respectively. Socio­ demographic characteristics that were found to be significantly associated with advanced maternal age included; education (P=0.036), occupation (P= 0.015), the cultural belief of large families (P=0.003), and contraception use (P= 0.001). There were more married women among advanced age women 105 (92.9%) than among optimal age women 99 (87.2%), however, there was no significant difference between the two groups (P=0.262). Divorce (P=0.689), income (P=0.701), and history of subfertility P=0.291) were also not found to be different between the two groups. With regards to maternal outcomes, advanced maternal age was significantly associated with severe pre­ eclampsia (AOR 2.131; 95% CI 1.190 - 3.816; P=0.011), postpartum haemorrhage (AOR 1.400; 95% CI 0.187 - 0.855; P=0.018), caesarean deliveries (AOR 1.395; 95% CI 1.115 - 4.719; P=0.028) and antepartum haemorrhage (AOR 2.425; 95% CI 1.029 - 5.714; P=0.043). On foetal outcomes, advanced maternal age was significantly associated with NICU admissions (AOR 3.075; 95% CI 1.298 - 7.287; P=0.011). However, there was no association with APGAR score at 5 minutes (P=0.174), birth weight (P=l.000), gestation age at birth (P=0.676), and PROM (P=0.557)&#x0D; Conclusion: Generally, women of advanced maternal age were associated with more adverse obstetric outcomes than women of optimal childbearing age. Hence, there is a need to sensitise these women and their spouses on the risk of advanced maternal age on obstetric outcomes and the need for not postponing conception until the late 3rd decade of life.

The Obstetric outcomes associated with advanced maternal age at the University Teaching Hospitals Women and Newborn Hospital in Lusaka, Zambia

Introduction: Pregnant women aged 35 years and above have traditionally been termed as of advanced maternal age. These women are considered to have a higher incidence of obstetric complications than younger ones&#x0D; Objectives: To investigate socio-demographic characteristics and obstetric outcomes in women of advanced age who delivered at the Women and Newborn Hospital, in Lusaka, Zambia.&#x0D; Methods: This was a cross-sectional study in which a total of 226 postnatal women, both of advanced (35 years and above) and optimal age (20 - 34 years), that met the eligibility criteria were recruited. Systematic random sampling was used to recruit study participants and data was collected using a structured questionnaire, review of patient's hospital records, and the labour ward delivery registers. Statistical analysis was performed using a statistical package for social sciences (SPSS) version 26 software.&#x0D; Results: The prevalence of advanced maternal age was 14.1%. The mean ages were 38years (range 35 - 46 years) and 28 years in advanced and optimal maternal age groups respectively. Socio­ demographic characteristics that were found to be significantly associated with advanced maternal age included; education (P=0.036), occupation (P= 0.015), the cultural belief of large families (P=0.003), and contraception use (P= 0.001). There were more married women among advanced age women 105 (92.9%) than among optimal age women 99 (87.2%), however, there was no significant difference between the two groups (P=0.262). Divorce (P=0.689), income (P=0.701), and history of subfertility P=0.291) were also not found to be different between the two groups. With regards to maternal outcomes, advanced maternal age was significantly associated with severe pre­ eclampsia (AOR 2.131; 95% CI 1.190 - 3.816; P=0.011), postpartum haemorrhage (AOR 1.400; 95% CI 0.187 - 0.855; P=0.018), caesarean deliveries (AOR 1.395; 95% CI 1.115 - 4.719; P=0.028) and antepartum haemorrhage (AOR 2.425; 95% CI 1.029 - 5.714; P=0.043). On foetal outcomes, advanced maternal age was significantly associated with NICU admissions (AOR 3.075; 95% CI 1.298 - 7.287; P=0.011). However, there was no association with APGAR score at 5 minutes (P=0.174), birth weight (P=l.000), gestation age at birth (P=0.676), and PROM (P=0.557)&#x0D; Conclusion: Generally, women of advanced maternal age were associated with more adverse obstetric outcomes than women of optimal childbearing age. Hence, there is a need to sensitise these women and their spouses on the risk of advanced maternal age on obstetric outcomes and the need for not postponing conception until the late 3rd decade of life.

Impact of maternal age on perinatal outcomes in twin pregnancies: a systematic review and meta-analysis.

Current evidence of the maternal, perinatal and neonatal outcomes in twin pregnancies among mothers with advanced age is unclear, especially for mothers with age above 40 years. A systematic search was conducted using the PubMed, Scopus, and Google Scholar databases. Studies that were observational in design or analysed retrospective data were considered for inclusion. The included studies had to be conducted in twin pregnancies and should have documented the effect of maternal age on obstetric and/or neonatal outcomes. Statistical analysis was performed using STATA software. A total of 20 studies were considered for inclusion. All the studies were based on retrospective data. Compared to mothers aged under 40 years, those with advanced age (≥40 years) had increased risk of caesarean delivery [RR 1.20, 95% CI: 1.05, 1.37], gestational hypertension [RR 2.71, 95% CI: 1.72, 4.27], gestational diabetes mellitus [RR 2.03, 95% CI: 1.28, 3.21], preterm birth [RR 2.47, 95% CI: 1.09, 5.80], neonatal admission to intensive care unit [RR 1.78, 95% CI: 1.21, 2.64] and perinatal and/or neonatal mortality [RR 5.76, 95% CI: 1.11, 29.7]. The risk of gestational diabetes mellitus [RR 1.52, 95% CI: 1.21, 1.90] and having caesarean delivery [RR 1.19, 95% CI: 1.10, 1.28] was higher in mothers with ≥35 years of age, compared to those <35 years. There were no significant differences in the risk of adverse neonatal outcomes among the mothers with age ≥35 years. However, in these mothers, the risk of perinatal/neonatal mortality [RR 0.82, 95% CI: 0.76, 0.88] was comparatively lower than in mothers under 35 years of age. There appeared no significant risk of advanced maternal age for postpartum haemorrhage, hospitalization during pregnancy and premature rupture of membranes. The increased risk of maternal, neonatal and perinatal outcomes in mothers with advanced age highlights the need for close follow-up, early detection and management of medical complications in twin pregnancies.

Evaluation of obstetric and perinatal outcome of pregnancy with bad obstetric history

Background: Adverse perinatal outcome has always been a devastating experience for the mother. Advanced maternal age and other risk factors are independent risk factor for perinatal outcome. Therefore, aim of study is to compare the effect of these factor in different study group. Aims and Objectives: Case–control study has been conducted to evaluate obstetrics outcome, maternal morbidity, and perinatal outcome in patients with bad obstetric history. Materials and Methods: A prospective observational case–control study has been conducted in two groups; GROUP A: BOH group (n = 44) and GROUP B: Controls (n = 88) who fulfilled inclusion criteria in Department of Obstetrics and Gynaecology, GMERS Medical college, Sola during the period of August 2018 to August 2020. Statistical analysis was done by descriptive statistics and qualitative and quantitative method. Results: Incidence of hypertension in Group A was 25%, while in Group B incidence was 6.8%. Incidence of hypertension was 4.5 times higher in Group A than B which was statistically significant (P &lt; 0.05). Incidence of PROM, gestational diabetes mellitus, thyroid dysfunction was higher in Group A than Group B. Higher incidence of preterm delivery found in Group A than in Group B which was statistically significant (P &lt; 0.05). Conclusion: Among all BOH group, cases with previous history of preterm delivery, still birth, recognition of prior learning, and HTD were the major risk factors which could be responsible for adverse obstetric and perinatal outcome.

Mode of Delivery, Birth Characteristics, and Early-Onset Non-Hodgkin Lymphoma in a Population-Based Case-Control Study.

The etiology of non-Hodgkin lymphoma (NHL) in children and in adolescents and young adults (AYA) is not well understood. We evaluated potential associations between mode of delivery, birth characteristics, and NHL risk in a population-based case-control study, which included 3,064 cases of NHL [490 with Burkitt lymphoma, 981 with diffuse large B-cell lymphoma (DLBCL), and 978 with T-cell NHL) diagnosed at the age of 0 to 37 years in California during 1988 to 2015 and 153,200 controls frequency matched on year of birth. Odds ratios (OR) and 95% confidence intervals (CI) were estimated from an unconditional multivariable logistic regression model that included year of birth and birth characteristics. Individuals born via cesarean section had a decreased risk of pediatric Burkitt lymphoma (age 0-14 years; OR = 0.71, 95% CI: 0.51-0.99) and pediatric T-cell NHL (OR = 0.73, 95% CI: 0.55-0.97) compared with those born vaginally. Having a birth order of second (OR = 0.73, 95% CI: 0.57-0.93) or third or higher (OR = 0.76, 95% CI: 0.58-0.99) was associated with a lower risk of pediatric T-cell NHL compared with first-borns. AYA (age 15-37 years) with a heavier birthweight had an elevated risk of DLBCL (OR for each kg = 1.16, 95% CI: 1.00-1.35). Associations between other birth characteristics, including plurality, maternal age, maternal education, and NHL risk, also exhibited variations across subgroups based on age of diagnosis and histologic subtype. These findings support a role of mode of delivery and birth characteristics in the etiology of early-onset NHL. This study underscores the etiologic heterogeneity of early-onset NHL.