Advanced Maternal Age Pregnancy Research Articles

Advanced maternal age alters cardiac functional and structural adaptations to pregnancy in rats.

A significant number of pregnancies occur at advanced maternal age (>35 yr), which is a risk factor for pregnancy complications. Healthy pregnancies require massive hemodynamic adaptations, including an increased blood volume and cardiac output. There is growing evidence that these cardiovascular adaptations are impaired with age, however, little is known about maternal cardiac function with advanced age. We hypothesized that cardiac adaptations to pregnancy are impaired with advanced maternal age. Younger (4 mo; ∼early reproductive maturity in humans) and aged (9 mo; ∼35 yr in humans) pregnant Sprague-Dawley rats were assessed and compared with age-matched nonpregnant controls. Two-dimensional echocardiographic images were obtained (ultrasound biomicroscopy; under anesthesia) on gestational day 19 (term = 22 days) and compared with age-matched nonpregnant rats (n = 7-9/group). Left ventricular structure and function were assessed using short-axis images and transmitral Doppler signals. During systole, left ventricular anterior wall thickness increased with age in the nonpregnant rats, but there was no age-related difference between the pregnant groups. There were no significant pregnancy-associated differences in left ventricular wall thickness. Calculated left ventricular mass increased with age in nonpregnant rats and increased with pregnancy only in young rats. Compared with young pregnant rats, the aortic ejection time of aged pregnant rats was greater and Tei index was lower. Overall, the greater aortic ejection time and lower Tei index with age in pregnant rats suggest mildly altered cardiac adaptations to pregnancy with advanced maternal age, which may contribute to adverse outcomes in advanced maternal age pregnancies.NEW & NOTEWORTHY We demonstrated that even before the age of reproductive senescence, rats show signs of age-related alterations in cardiac structure that suggests increased cardiac work. Our data also demonstrate, using an in vivo echocardiographic approach, that advanced maternal age in a rat model is associated with altered cardiac function and structure relative to younger pregnant controls.

Obstetric and neonatal outcomes of pregnancy in advanced maternal age

Obstetric and neonatal outcomes of pregnancy in advanced maternal age

PREGNANCY OUTCOME IN ADVANCED MATERNAL AGE IN COMPARISON WITH YOUNGER PREGNANT WOMEN – A COMPARATIVE STUDY IN CENTRAL REFERRAL HOSPITAL, GANGTOK, SIKKIM

Objectives: The aim of the study was to compare maternal and neonatal outcome in pregnancy in advanced maternal age (>35 years) in comparison with pregnancy outcome in younger mothers of age 20–34 years. Methods: This was a retrospective and comparative study conducted in the Department of Obstetrics and Gynecology of Central Referral Hospital, Gangtok, Sikkim. Institutional ethical committee approved the study. One thousand three hundred and thirty-five women were included in this study. Data of these mothers were retrieved from the MRD records and reviewed. Pregnancy outcomes were studied in terms of antenatal, intranatal, and postpartum complications. Each adverse obstetrical outcome was assessed if it has made a significant association with maternal age. Perinatal outcome was also compared. Results: The mean maternal age was significantly higher in Group A (38.2±0.66) as compared to Group Y (25.85±4.41) and the difference was found to be statistically highly significant (p<0.0001). LSCS rate was more in advanced maternal age group as compared to patients <35 years and the difference was statistically significant (p=0.0009). Comparison for both the groups for gestational diabetes, gestational hypertension, anemia, preterm labor, prelabor rupture of membranes, and postpartum hemorrhage shows these pathologies to be more common in Group A. In Group A, the common causes of LSCS were patient request (41.39%) followed by FGR with abnormal Doppler (26.01%) whereas in Group Y common indications for LSCS included previous LSCS (36.56%) patient request (27.56%). Group A had a higher incidence of low birth weight (52 vs. 65, p<0.0001), large-for-gestational-age babies (>4 kg) (15 vs. 12, p<0.0001), NICU admission due to low APGAR score (35 vs. 42, p<0.0001), and pre-term births (43 vs. 10, p<0.0001). Conclusion: Advanced maternal age pregnancies are associated with increased incidence of maternal medical disorders, cesarean section, and postpartum haemorrhage as well as adverse perinatal outcome.

Maternal age extremes and adverse pregnancy outcomes in low-resourced settings.

Adolescent (<20 years) and advanced maternal age (>35 years) pregnancies carry adverse risks and warrant a critical review in low- and middle-income countries where the burden of adverse pregnancy outcomes is highest. To describe the prevalence and adverse pregnancy (maternal, perinatal, and neonatal) outcomes associated with extremes of maternal age across six countries. We performed a historical cohort analysis on prospectively collected data from a population-based cohort study conducted in the Democratic Republic of Congo, Guatemala, India, Kenya, Pakistan, and Zambia between 2010 and 2020. We included pregnant women and their neonates. We describe the prevalence and adverse pregnancy outcomes associated with pregnancies in these maternal age groups (<20, 20-24, 25-29, 30-35, and >35 years). Relative risks and 95% confidence intervals of each adverse pregnancy outcome comparing each maternal age group to the reference group of 20-24 years were obtained by fitting a Poisson model adjusting for site, maternal age, parity, multiple gestations, maternal education, antenatal care, and delivery location. Analysis by region was also performed. We analyzed 602,884 deliveries; 13% (78,584) were adolescents, and 5% (28,677) were advanced maternal age (AMA). The overall maternal mortality ratio (MMR) was 147 deaths per 100,000 live births and increased with advancing maternal age: 83 in the adolescent and 298 in the AMA group. The AMA groups had the highest MMR in all regions. Adolescent pregnancy was associated with an adjusted relative risk (aRR) of 1.07 (1.02-1.11) for perinatal mortality and 1.13 (1.06-1.19) for neonatal mortality. In contrast, AMA was associated with an aRR of 2.55 (1.81 to 3.59) for maternal mortality, 1.58 (1.49-1.67) for perinatal mortality, and 1.30 (1.20-1.41) for neonatal mortality, compared to pregnancy in women 20-24 years. This pattern was overall similar in all regions, even in the <18 and 18-19 age groups. The maternal mortality ratio in the LMICs assessed is high and increased with advancing maternal age groups. While less prevalent, AMA was associated with a higher risk of adverse maternal mortality and, like adolescence, was associated with adverse perinatal mortality with little regional variation.

Clinical efficacy and acceptability of remote fetal heart rate self-monitoring in Southern China

BackgroundCompared to traditional fetal heart rate monitoring (FHR) for the outpatients in clinic, remote FHR monitoring shows real-time assessment of fetal wellbeing at home. The clinical function of remote FHR monitoring in pregnant wome in outpatient is still unclear.ObjectiveTo explore the feasibility of remote FHR self-monitoring in singleton pregnant women from southern China.Study designThis prospective cohort study was conducted at one tertiary center in southern China. Pregnant women used a mobile cardiotocogram device to measure the FHR at least once a week until delivery in the remote group. For the control group, pregnant women underwent traditional FHR monitoring once a week in the outpatient clinic. The rate of cesarean section, risk of postpartum hemorrhage and adverse neonatal outcomes were compared between the two groups. All the pregnant women completed a questionnaire survey to evaluate their acquisition of remote FHR self-monitoring.ResultsApproximately 500 women were recruited in the remote FHR self-monitoring group (remote group), and 567 women were recruited in the traditional FHR monitoring group (control group). The women in the remote FHR monitoring group were more likely to be nulliparous (P < 0.001), more likely to have a higher education level (P < 0.001) and more likely to be at high risk (P = 0.003). There was no significant difference in the risk of cesarean section (P = 0.068) or postpartum hemorrhage (P = 0.836) between the two groups. No difference in fetal complications was observed across groups, with the exception of the incidence of NICU stays, which was higher in the remote group (12.0% vs. 8.3%, P = 0.044). The questionnaire survey showed that the interval time (P = 0.001) and cost (P = 0.010) of fetal heart rate monitoring were lower in the remote group. Regarding age, prepregnancy BMI, risk factors, education level, maternal risk and household income, senior high school (OR 2.86, 95% CI 1.67–4.90, P < 0.001), undergraduate (OR 2.96, 95% CI 1.73–5.06, P < 0.001), advanced maternal age (OR 1.42, 95% CI 1.07–1.89, P = 0.015) and high-risk pregnancy (OR 1.61, 95% CI 1.11–2.35, P = 0.013) were independent factors for pregnant women to choose remote fetal monitoring. Multiparty (OR 0.33, 95% CI 0.21–0.51, P < 0.001), full-time motherhood (OR 0.47, 95% CI 0.33–0.678, P < 0.001) and high household income (OR 0.67, 95% CI 0.50–0.88, P = 0.004) were negatively correlated with the choice of remote FHR self-monitoring.ConclusionRemote FHR self-monitoring technology has a lower cost and shows potential clinical efficacy for the outpatient setting in southern China. This approach does not increase the risk of cesarean section or adverse neonatal outcomes. It is acceptable among nulliparous pregnant women with a high education level, high household income or high risk. Further research is needed to assess the impact of this technology on obstetric outcomes in different health settings.

The role of maternal age on adverse pregnancy outcomes among primiparous women with singleton birth: a retrospective cohort study in urban areas of China

Background Both young and advanced maternal age pregnancies have strong associations with adverse pregnancy outcomes; however, there is limited understanding of how these associations present in an urban environment in China. This study aimed to analyze the associations between maternal age and pregnancy outcomes among Chinese urban women. Methods We performed a population-based study consisting of 60,209 singleton pregnancies of primiparous women whose newborns were delivered after 20 weeks’ gestation between January 2012 and December 2015 in urban areas of China. Participants were divided into six groups (19 or younger, 20–24, 25–29, 30–34, 35–39, 40 or older). Pregnancy outcomes include gestational diabetes mellitus (GDM), preeclampsia, placental abruption, placenta previa, premature rupture of membrane (PROM), postpartum hemorrhage, preterm birth, low birthweight, small for gestational age (SGA), large for gestational age (LGA), fetal distress, congenital microtia, and fetal death. Logistic regression models were used to assess the role of maternal age on the risk of adverse pregnancy outcomes with women aged 25–29 years as the reference group. Results The risks of GDM, preeclampsia, placenta previa, and postpartum hemorrhage were decreased for women at a young maternal age and increased for women with advanced maternal age. Both young and advanced maternal age increased the risk of preterm birth and low birthweight. Young maternal age was also associated with increased risk of SGA (aOR 1.64, 95% CI 1.46–1.83) and fetal death (aOR 2.08, 95% CI 1.35–3.20). Maternal age over 40 years elevated the odds of placental abruption (aOR 3.44, 95% CI 1.47–8.03), LGA (aOR 1.47, 95% CI 1.09–1.98), fetal death (aOR 2.67, 95% CI 1.16–6.14), and congenital microtia (aOR 13.92, 95% CI 3.91–49.57). There were positive linear associations between maternal age and GDM, preeclampsia, placental abruption, placenta previa, PROM, postpartum hemorrhage, preterm birth, LGA and fetal distress (all P for linear trend < .05), and a negative linear association between maternal age and SGA (P for linear trend < .001). The analysis of the associations between maternal age and adverse fetal outcomes showed U-shape for preterm birth, low birth weight, SGA, fetal death and congenital microtia (all P for quadratic trend < .001). Conclusions Advanced maternal age predisposes women to adverse obstetric outcomes. Young maternal age manifests a bidirectional effect on adverse pregnancy outcomes. The findings may contribute to improving women’s antenatal care and management.

Increased stiffness of omental arteries from late pregnant women at advanced maternal age.

Advanced maternal age (≥35 years) is a risk factor for poor pregnancy outcomes. Pregnancy requires extensive maternal vascular adaptations, and with age, our blood vessels become stiffer and change in structure (collagen and elastin). However, the effect of advanced maternal age on the structure of human resistance arteries during pregnancy is unknown. As omental resistance arteries contribute to blood pressure regulation, assessing their structure in pregnancy may inform on the causal mechanisms underlying pregnancy complications in women of advanced maternal age. Omental fat biopsies were obtained from younger (<35 years) or advanced maternal age (≥35 years) women during caesarean delivery (n = 7-9/group). Arteries (200-300 µm) were isolated and passive mechanical properties (circumferential stress and strain) assessed with pressure myography. Collagen (Masson's Trichrome) and elastin (Verhoff) were visualized histologically and % positively-stained area was assessed. Median maternal age was 32 years (range 25-34) for younger, and 38 years (range 35-42) for women of advanced maternal age. Circumferential strain was lower in arteries from advanced maternal age versus younger women but circumferential stress was not different. Omental artery collagen levels were similar, while elastin levels were lower with advanced maternal age versus younger pregnancies. The collagen:elastin ratio was greater in arteries from advanced maternal age versus younger women. In conclusion, omental arteries from women of advanced maternal age were less compliant with less elastin compared with arteries of younger controls, which may affect how vascular stressors are tolerated during pregnancy. Understanding how vascular aging affects pregnancy adaptations may contribute to better pregnancy outcomes.

How does IVF conception affect pregnancy complications in an older cohort of women, at least 38years of age? Study of a population database.

To compare perinatal outcomes in in-vitro fertilization (IVF) pregnancies versus spontaneous conceptions in woman of advanced maternal age (AMA), and to evaluate the effect of increasing age on IVF pregnancies' outcomes. A retrospective population-based cohort study including pregnant women who delivered between 2008-2014 in the US. First, we included women aged 38-43years and compared those with IVF conceptions (cases) to women with spontaneous conceptions (controls). Thereafter, we compared IVF pregnancies in women aged 38-43years to IVF pregnancies at < 38years of age. Multivariate logistic regression was performed to compare both groups regarding pregnancy,delivery, and neonatal outcomes after adjusting for plausible confounders. Three hundred nine thousand five hundred sixty-seven pregnant women aged 38-43years were identified, with 2,762 composing the IVF group, and 306,805 composing the control group. After adjusting for confounders, the IVF group had a higher risk of several adverse obstetrical outcomes, including hypertensive disorders of pregnancy (aOR 1.31,95%CI 1.06-1.62), gestational diabetes (aOR 1.26,95%CI 1.13-1.41),preterm delivery (aOR 1.45,95%CI 1.16-1.81), cesarean section (CS) (aOR 1.84,95%CI 1.55- 2.19),postpartum hemorrhage (aOR 1.68,95%CI 1.27- 2.24), and maternal infection (aOR 1.90,95%CI 1.31-2.77), with comparable neonatal outcomes. For the second analysis, 9712 IVF pregnancies were included (n = 6950 < 38years, and n = 2762 ≥ 38years). Women ≥ 38years who underwent IVF were more likely to experience hypertensive disorders of pregnancy, CS, hysterectomy and blood transfusion, with comparable neonatal outcomes. IVF AMA pregnancies have a significant increase in myriad perinatal complications compared to spontaneous AMA pregnancies. Younger women undergoing IVF have mildly less complications than their older counterparts.

Outcomes for advanced aged (35 and older) versus younger aged pregnant trauma patients: A multicenter study

BackgroundEffects of advanced maternal age (AMA) pregnancies (defined as ≥35 years) on pregnant trauma patients (PTPs) are unknown. This study compared AMA versus younger PTPs, hypothesizing AMA PTPs have increased risk of fetal delivery (FD). MethodsA retrospective (2016–2021) multicenter study included all PTPs. Multivariable logistic regression was used to evaluate risk of FD after trauma. ResultsA total of 950 PTPs were included. Both cohorts had similar gestational age and injury severity scores. The AMA group had increased injuries to the pancreas, bladder, and stomach (p < 0.05). There was no difference in rate or associated risk of FD between cohorts (5.3% vs. 11.4%; OR 0.59, CI 0.19–1.88, p > 0.05). ConclusionCompared to their younger counterparts, some intra-abdominal injuries (pancreas, bladder, and stomach) were more common among AMA PTPs. However, there was no difference in rate or associated risk of FD in AMA PTPs, thus they do not require increased observation.

A Comparison of the Umbilical Artery Doppler Indices between Pregnancies with Advanced and Normal Maternal Age in the Second Trimester

Objective: To compare the pulsatile index (UA-PI), resistance index (UA-RI), and systolic/diastolic ratio (UA-S/D) of the umbilical artery between pregnant women with advanced maternal age (AMA) and normal maternal age. Materials and Methods: Participants were pregnant women who attended antenatal care at the maternal-fetal medicine unit at Bhumibol Adulyadej Hospital, Royal Thai Air Force, Bangkok, Thailand. The present study was conducted between February and December 2022. Participants who met inclusion criteria were classified as study for the patients aged 35 years and older, and control groups for the patients younger than 35 years old. All participants underwent ultrasonography for umbilical artery Doppler velocimetry measurement including UA-PI, UA-RI, and UA-S/D. Demographic characters of both study and control groups were included for statistical calculation. Results: Five hundred pregnant women with gestational age between 18 and 24 weeks were enrolled. The mean age of the study and the control group were 37.9 and 26.0 years, respectively. Participants in the study group have higher BMI than the control group. The study and the control group had comparable diastolic and systolic blood pressure. The mean (standard deviation) of UA-PI, UA-RI, and S/D ratio of the study/control group were 1.33±0.21/1.27±0.22, 0.77±0.1/0.74±0.09, and 4.24±0.98/3.95±0.97, respectively, with statistical significance. The study group had a significantly higher number of large for gestational age (LGA), pregnancy induced hypertension (PIH), and gestational diabetes mellitus (GDM) than the control group. Conclusion: AMA pregnancy had higher UA-PI, UA-RI, UA-S/D, incidence of PIH, GDM, and LGA than those age less than 35 years. Keywords: Advanced maternal age; Umbilical artery Doppler indices; Second trimester

Low Birth Weight among Deliveries, and Adolescent and Advanced Maternal Age Pregnancy.

We did this study to evaluate the prevalence of low birth weight among deliveries, adolescent pregnancy and advanced maternal age pregnancy. We also assessed the factors affecting the low birth weight among institutional deliveries at the level of primary hospital. A hospital-based retrospective cross-sectional study was done in Grahun Primary Hospital of Syangja, Nepal using data maintained in register book over last five years. We excluded all those deliveries with multiple pregnancy and incomplete records, and included 2473 participants in final analysis using convenient sampling. The relevant information was filled up in Microsoft Excel 2019 v16.0 and descriptive and inferential statistics was calculated using statistical package for social sciences, IBM SPSS® v21 (IBM, Armonk, New York). The prevalence of low birth weight at Grahun Primary Hospital was 11.08%. The prevalence of adolescent pregnancy and advanced maternal age pregnancy was 18.03% and 02.18% respectively. Male newborns had significantly higher mean birth weight as compared to the female newborns (3101.48 ± 506.60 v/s 2967.53 ± 484.97, P-value <0.001). Female newborns had higher odds of low birth weight as compared to those male newborns (11.99% v/s 8.29%, AOR=1.56, 95% CI= 1.17-2.07). Pregnant women with lower gestational age (<37 weeks or preterm) had a higher odds of low birth weight as compared to pregnant women with normal gestational age (37-42 weeks) (AOR = 11.59, 95% CI 8.49-15.83). The low birth weight depends upon gestational age of mother and gender of newborn. Local organizations should work to bring down low birth weight, and adolescent pregnancy and advanced maternal age pregnancy of mother.

Recent Status of Pregnancies at an Advanced Maternal Age at a Japanese Perinatal Center.

Objective We compared the recent obstetric outcomes of women aged 40 and over as advanced maternal age (AMA) to those with AMA more than 10 years ago. Methods This was a retrospective study of primiparous singleton pregnancies who delivered at ≥22 weeks of gestation managed at Japanese Red Cross Katsushika Maternity Hospital between 2003-2007 and 2013-2017. Results The percentage of primiparous women aged with AMA who delivered at ≥22 weeks of gestation increased from 1.5 to 4.8% (p<0.01) due to the increase in the pregnancy conceived by in vitro fertilization (IVF). In the pregnancies with AMA, the percentage of cesarean delivery decreased from 51.7 to 41.0% (p=0.01), while the prevalence of postpartum hemorrhage increased from 7.5 to 14.9% (p=0.01). The latter was associated with an increased rate of in vitro fertilization (IVF) use. Conclusions The percentage of AMA pregnancies significantly increased with the development of assisted reproductive technology, and the prevalence of postpartum hemorrhage also increased in AMA pregnancies.

Incidence of Pregnancy-Associated Venous Thromboembolism: Second Nationwide Study.

Pregnancy is a transient risk factor for venous thromboembolism (VTE). This second nationwide study aimed to inspect trend changes in the incidence rate of pregnancy-associated VTE (PA-VTE) during the study period (2014-2018) compared with that reported in a previous study (2006-2010). Using the Korean Health Insurance Review and Assessment Service database, we retrospectively identified all PA-VTE events using both diagnostic and medication codes. Of the 124,228 VTE events, 510 (0.4%) cases of PA-VTE were identified in 499 women (median age: 34 years; range: 20-49 years). The incidence rate of PA-VTE/10,000 deliveries (PA-VTE/104D) in this second study (2.62) was 3.2 times higher than that in the first study (0.82). In the second study, the PA-VTE/104D ratio of women in their 40s (5.46) was three times higher than that of women in their 20s (1.80) (relative risk: 3.03; 95% confidence interval: 2.04-4.51; p < 0.01). The incidence rate for women in their 40s in the second study was 2.3 times higher than that in the first study. PA-VTE/104D cases occurred more frequently in multiparous than in primiparous women, in cesarean section cases compared with vaginal delivery, and in multiple rather than single pregnancies. Most PA-VTE cases occurred during the postpartum period (321/510, 62.9%), of which pulmonary embolism was the most frequently occurring type (231/321, 72%). Advanced maternal age, cesarean section, multiparity, and multifetal pregnancies increased the risk of PA-VTE. Obstetricians need to be cautious of VTE, particularly during the postpartum period, in high-risk pregnant patients.

The effects of advanced maternal age on perinatal mortality in Ethiopia: A systematic review and meta-analysis.

Pregnancy in women over the age of 35 years is considered advanced maternal age. The relationship between advanced maternal age and the risk of perinatal mortality is still controversial. As a result, this systematic review and meta-analysis were carried out to clarify the relationship between advanced maternal age and perinatal mortality in Ethiopia. The following electronic databases were used for this systematic review and meta-analysis: PubMed, Web of Science, Scopus, Science Direct, Google Scholar, HINARI, and African Journals Online up to March 2022. Addis Ababa, Gondor, and Jimma University research repositories were also searched. A random-effects model was used to pool study-specific odds ratios. A total of 18 articles, including a total of 45,541 participants, were included in the meta-analysis. A total of 11 cross-sectional, 2 case-control, and 5 cohort studies were included. The overall pooled estimate indicates that women with advanced maternal age had a 1.58 higher risk of perinatal mortality compared to women in the younger age group (odds ratio = 1.58; 95% Confidence Interval: 1.13-2.03). The subgroup analysis also revealed that there were differences in the effect size as the geographical region differed. The result showed that the odd of perinatal mortality was highest in the Oromia region and lowest in the Southern Nations Nationalities and Peoples' Region. The overall pooled estimate indicates that women with advanced maternal age had a 1.58-fold higher risk of perinatal mortality. Even though this risk could also be increased with other comorbid diseases, it is important for healthcare providers and other concerned stakeholders to be aware of the increased risks associated with advanced maternal age and provide different intervention programs designed to create awareness and provide counseling services to couples who seek to have a child in their later ages about the risks of advanced maternal age pregnancy on perinatal mortality and other adverse pregnancy outcomes.

A Literature Review of Advanced Maternal Age in Pregnant Women with COVID-19

Background: During pregnancy, the risk of severe manifestation of COVID-19 with a worse maternal outcome can become higher because of the alteration in the immune system and physiological function. In COVID-19 infection, several studies also stated the increased risk of severe disease in advanced maternal age (AMA). Considering that the death and severe case rates in advanced-aged pregnant women with COVID-19 were high, special attention should be focused on this matter. There was still little study that focused on the outcome of COVID-19 in pregnant women with advanced age as well. Therefore, this study aims to evaluate the risks and the outcomes of advanced maternal age-pregnancy with COVID-19. Method: The method used in this paper is the Literature Review which aspires to analyze the risk and the outcome of COVID-19 in advanced maternal-age pregnancy. The databases used in the source search are PubMed, Google Scholar, JAMA, and AJOG. The keywords for the search were advanced maternal age, COVID-19, and pregnancy. Results: The mortality and morbidity of AMA who had COVID-19 were higher than non-AMA pregnant women. Severe conditions of COVID-19 were increased in AMA patients. They were at risk of having ICU admission and intubation. Advanced-aged mothers were more likely to have comorbidity including obesity. They also had a higher risk of adverse pregnancy outcomes. Conclusion: The adverse maternal aged-pregnant women with COVID-19 had higher risks of having comorbidities, severe conditions of COVID-19, adverse pregnancy outcomes, and mortality. Therefore, early risk identification needs to be done to identify the special management for the patients

Risk of morbidity and mortality in preterm infants born to advanced maternal age pregnancies

Background: Little is known about the effect of advanced maternal age on preterm morbidity and mortality. This study aimed to evaluate the possible relationship between maternal age and morbidity and mortality in premature infants born at a gestational age ≤32 weeks.Methods: Premature infants born at ≤32 weeks of gestation and admitted to the neonatal intensive care unit were divided into three groups by maternal age: &amp;lt;35, 35-39, and ≥40 years. Infant and maternal demographic and clinical characteristics, and preterm morbidity and mortality were compared between the groups.Results: A total of 827 preterm infants were included. Their distribution by maternal age was as follows: 659 infants in the &amp;lt;35 years group, 120 in the 35-39 years group, and 48 in the ≥40 years age group. Older maternal age was associated with higher gravidity, frequency of assisted reproductive technology use, preeclampsia, gestational diabetes mellitus, and caesarean delivery (P=0.004, P&amp;lt;0.001, P=0.007, P=0.004, and P&amp;lt;0.001, respectively). Respiratory distress syndrome, patent ductus arteriosus, and necrotising enterocolitis were significantly more frequent in preterm infants aged ≥35 years (P=0.014, P=0.029, and P&amp;lt;0.001, respectively).Conclusions: In addition to the maternal risks associated with pregnancy at older ages, some prematurity morbidities may also increase in frequency. Although this novel study presents important results, further studies are needed to evaluate the relationship between advanced maternal age and preterm morbidity.

Pre-BMI and Lipid Profiles in Association with the Metabolic Syndrome in Pregnancy with Advanced Maternal Age.

We aimed to explore the association of BMI in pre-pregnant women with metabolic syndrome in pregnancy in advanced maternal age. A total of 229 maternal women and 536 maternal women participated in this study. Pregnancy women underwent a 75 g-oral glucose tolerance test and maternal lipid profile test between 24 and 28 weeks. Data about biological and sociodemographic characteristics were recorded for each case. The metabolic equivalent (Met) was 9.6% in the maternal age ≥35 group, 5.4% in the age 20–34 group (P = 0.027), and 6.7% in all pregnant women. Results also demonstrated that gestational diabetes mellitus (GDM) and MetS were more likely to appear in the maternal age ≥35 years group than the maternal age 20–34 years group (41.5% vs. 30.6%; P = 0.001, 9.6% vs. 5.4%, P = 0.027). Risk for preterm delivery and eclampsia were increased with raised MetS (RR 3.434 and RR 1.800); MetS in women aged ≥35 years had the largest area under the curve (AUC) (AUC 0.925, 95% CI 0.885–0.965), and its optimal cutoff point was ≥24.998 kg/m2, and the optimal cutoff point for total cholesterol (TC) (AUC 0.686, 95% CI 0.571–.802) predicting MetS was ≥4.955 mmol/l. MetS in pregnancy are associated with the occurrence of preterm delivery and eclampsia, and pre-BMI and TC can predict MetS in the maternal age ≥35 group.

Women With Advanced Maternal Age Have Gastric Volume Similar to That of Nonpregnant Women: A Prospective Pilot Study Using Preoperative Gastric Ultrasound

(J Clin Anesth. 2021;72:110270) Contrary to conventional wisdom, previous studies have established the similarity of the gastric volume (GV) of women with full-term pregnancies to that of nonpregnant women. This finding is relevant to assessing the risk threshold for receiving anesthesia based on preoperative ultrasound determination of the quantity of gastric contents. Cut-off values for measurements of the antral cross-sectional area (CSA) indicate reliably if the stomach contents are too great for safe anesthesia administration. Incidence of advanced maternal age (AMA) pregnancy is also increasing, and with it the caseload of elective cesarean deliveries (CD) in the world-wide AMA population. Although it is not fully understood why, AMA pregnant women have lower GV than their younger counterparts. Further investigation is merited to assess the necessity of longer preoperative fasting times in AMA women undergoing CD. This study compares GV in nonpregnant women to women with AMA pregnancy to determine if there is elevated risk of aspiration as assessed by gastric ultrasound.

Trends in Gestational Diabetes Mellitus by Race and Ethnicity Among Women With Advanced Maternal Age [A146

INTRODUCTION: Advanced maternal age (AMA), defined as maternal age 35 years or older, is becoming more common, with simultaneously increasing adverse outcomes. We aim to determine if gestational diabetes mellitus (GDM) is becoming more common in AMA pregnancies, and if racial disparities exist. METHODS: This was a retrospective cohort study of singleton, non-anomalous deliveries with a gestational age ≥20 weeks and maternal age ≥35 in the United States from 2014 to 2018. Patients with chronic diabetes mellitus were excluded. Our analysis was stratified by maternal race/ethnicity, including non-Hispanic White, non-Hispanic Black, non-Hispanic American Indian/Alaskan Native (AI/AN), non-Hispanic Asian or Native Hawaiian or Pacific Islander (NHPI), non-Hispanic multiracial, and Hispanic. We performed multivariable logistic regression followed by calculation of adjusted predicted probabilities to estimate the proportion of deliveries effected by GDM. Confounders adjusted for include age, BMI, parity, cigarette use, educational attainment, and insurance type. All analyses were conducted using STATA 17. RESULTS: This study included 3,093,536 AMA deliveries. Non-Hispanic Asian and NHPI women had the highest probability of developing GDM, followed by Non-Hispanic AI/AN women. Non-Hispanic Black patients had the lowest rates of GDM. The predicted probability of developing GDM increased in all racial and ethnic groups between 2014 and 2018 but was most pronounced in Non-Hispanic Asian and NHPI patients, increasing from 19.0% to 21.0% over the four-year period. CONCLUSION: In the United States, GDM has increased among all groups in the AMA population from 2014 to 2018. However, the predicted probability of GDM still varies greatly by maternal race and ethnicity.

Advanced Maternal Age Impairs Uterine Artery Remodelling in the Pregnant Rat

Advanced maternal age (AMA, ≥35 years) pregnancies are increasingly common, and are at increased risk for pregnancy complications. We previously showed that ex vivo uterine artery constriction due to increasing intraluminal pressures (myogenic tone) was greater in arteries of AMA vs. young pregnant rats. Aging impairs vascular reactivity and increases vascular stiffness via structural changes (e.g. increased collagen), however, the impact of AMA on adaptations to pregnancy in the uterine artery is unknown. We hypothesized that functional and structural uterine artery adaptations to pregnancy are impaired in aged compared with young rats.Pregnant young (4 months) and aged (9 months; ~35 years in humans) rats were studied on gestational day 20 (term=22 days) with age‐matched non‐pregnant rats. Uterine arteries were isolated and mounted in a pressure myograph. Active tone (calcium present in buffer, n=6‐10) and mechanical properties (circumferential stress and strain; calcium absent, n=10‐24) were assessed. Myogenic tone, circumferential stress and strain were calculated from active and passive curves. Collagen and elastin in the tunica media and intima (combined) were visualized with Masson’s trichrome (collagen) or Verhoeff’s (elastin) stains (n=4‐6). Data are mean area under the curve (AUC, myography) or % positive area (histology) ± SEM; analyzed by two‐way ANOVA with Sidak post‐hoc tests (significance: p&lt;0.05).Between 4‐100 mmHg, myogenic tone did not change with age or pregnancy. However, arteries from young pregnant rats displayed forced vasodilation at higher pressures (100‐160 mmHg) that did not occur in arteries from other groups (p&lt;0.0001). Circumferential stress and strain (Figure 1) increased with pregnancy (p&lt;0.0001) but was significantly lower in arteries from pregnant AMA compared to young pregnant dams (p&lt;0.05). Collagen and elastin (% positive areas) did not change with age or pregnancy overall, however, arteries from young non‐pregnant rats had greater collagen:elastin ratios than those from aged non‐pregnant rats (p=0.021). Arteries from aged non‐pregnant, young pregnant and AMA rats had similar ratios.This study illustrates that aging impacts both structural and functional adaptations of uterine arteries during pregnancy. The lower compliancy of arteries from AMA rats may be due to increased crosslinking of the existing collagen within the artery, as it was not explained by collagen:elastin ratio. These structural differences may contribute to the functional differences, potentially reducing uteroplacental blood supply. Thus, impaired uterine artery adaptations may increase the risk of pregnancy complications in women of advanced age.