Is advanced maternal age an independent risk factor for uteroplacental insufficiency?

doi:10.1016/j.ajog.2005.02.050

American Journal of Obstetrics and Gynecology

Volume 192, Issue 6, June 2005, Pages 1974-1980

https://doi.org/10.1016/j.ajog.2005.02.050 Get rights and content

Objective

To determine whether maternal age 35 years or older is an independent risk factor for uteroplacental insufficiency and thus an independent indication for antepartum testing.

Study design

A retrospective cohort analysis was performed of all deliveries at Los Angeles County–University of Southern California Women's and Children's Hospital between August 1, 1995, and September 1, 2003. Women with documented indications for antepartum testing, fetal anomalies, or delivery prior to 34 weeks were excluded from analysis. Markers of uteroplacental insufficiency included stillbirth, birth weight less than the 10th percentile, fetal distress, cesarean section for fetal distress, oligohydramnios, meconium passage, and 5-minute Apgar score less than 7.

Results

Indications for antepartum testing were significantly more common in women 35 years or older (33.2% versus 27.0%). After excluding women with indications for antepartum testing, anomalous fetuses, and women delivering prior to 34 weeks, stillbirth was twice as common in women 35 years and older. However, among stillbirths, growth restriction occurred with similar frequency in the older (28.6%) and younger (25.0%) cohorts. Among live births, 2 markers of uteroplacental insufficiency, intrapartum fetal distress (5.7% versus 4.1%) and cesarean delivery for fetal distress (4.0% versus 2.4%) were significantly more common in the older cohort. All other markers of uteroplacental insufficiency were observed with similar frequency in the 2 groups.

Conclusions

After excluding women with other indications for antepartum testing, fetal anomalies, and delivery prior to 34 weeks, stillbirth was twice as common in women 35 years of age or older as in those younger than 35 years. The increased rate of stillbirth does not appear to be explained by a higher rate of uteroplacental insufficiency.

Section snippets

Material and methods

The study was approved by the Institutional Review Board of the Keck School of Medicine of the University of Southern California. A retrospective cohort analysis was performed for the 8-year period from August 1, 1995, through September 1, 2003, at Los Angeles County–University of Southern California Women's and Children's Hospital. All patients were managed by resident physicians under the supervision of fellows and attending staff. A computerized database was accessed for information about

Results

During the study period, 3759 women 35 years of age or older and 19,226 women younger than 35 years gave birth at Los Angeles County–University of Southern California Women's and Children's Hospital. Women 35 years and older accounted for 16.4% of all deliveries. Twenty-eight (7 per 1000) women 35 years or older and 102 (5 per 1000) women younger than 35 years were excluded from analysis because they gave birth prior to 20 gestational weeks or delivered a newborn weighing less than 500 grams.

Comment

Advanced maternal age is defined variously in the literature. Most reports use 35 years of age as the limit as recommended by the Council of the International Federation of Gynecology and Obstetrics in 1958.7, 13, 14 However, others have used age 40 years as the threshold.15, 16, 17, 18 Nongenetic adverse outcomes reported in association with advanced maternal age include increased risks of diabetes and hypertension,7, 14, 15 preterm birth,3, 4, 5 cesarean section,3, 5, 15, 17

Statistics usage

Statistical tests included χ² analysis and calculation of relative risks using Taylor series 95% confidence limits with Yates correction for dichotomous variables. For continuous variables, the Student t test was used for comparison of means. A 2-tailed P value of .05 was considered significant.

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Cited by (42)

Obstetric Care Consensus #11, Pregnancy at age 35 years or older
2023, American Journal of Obstetrics and Gynecology
Centers for Disease Control and Prevention data from 2020 demonstrate the continued upward trend in the mean age of pregnant individuals in the United States. Observational studies demonstrate that pregnancy in older individuals is associated with increased risks of adverse pregnancy outcomes—for both the pregnant patient and the fetus—that might differ from those found in younger pregnant populations, even in healthy individuals with no other comorbidities. There are several studies that suggest that advancing age at the time of pregnancy is associated with greater disparities in severe maternal morbidity and mortality. This document seeks to provide evidence-based clinical recommendations for minimizing adverse outcomes associated with pregnancy with anticipated delivery at an advanced maternal age. The importance and benefits of accessible health care from prepregnancy through postpartum care for all pregnant individuals cannot be overstated. However, this document focuses on and addresses the unique differences in pregnancy-related care for women and all those seeking obstetrical care with anticipated delivery at the age of 35 years or older within the framework of routine pregnancy care. This Obstetric Care Consensus document was developed using an a priori protocol in conjunction with the authors listed above.
Pregnancy outcomes according to increasing maternal age
2012, Taiwanese Journal of Obstetrics and Gynecology
Citation Excerpt :
In our investigation, we found that even women aged 30–34 years at delivery had higher risks for adverse outcomes such as preterm delivery, LGA, NICU transfer, GDM, placenta previa, cesarean delivery, and induction failure than those of women aged 20–29 years. Furthermore, most of these risks increased with maternal age, so it is inappropriate to declare 35 years or 40 years to be the clear cutoff age of elderly pregnancy [21,22]. There were some limitations in our study.
To investigate the risks of increasing maternal age on the perinatal and obstetric outcomes.
Information about 29,760 singleton pregnancies delivered between 2005 and 2008 was extracted from our database. Patients were categorized into four groups according to age: 20–29 years, 30–34 years, 35–39 years, and ≥40 years. Multivariable logistic regression analysis was used to evaluate the adjusted odd ratios (AORs) of adverse pregnancy outcomes according to maternal age after adjusting for parity, body mass index, medical history and use of in vitro fertilization.
The majority of adverse perinatal outcomes were associated with a maternal age ≥35 years as follows: low birth weight (AOR 1.2 and 1.6 for women aged 35–39 years and ≥40 years, respectively); Apgar score < 7 at 1 minute (AOR: 1.7 and 1.8); and chromosomal anomaly (AOR: 2.7 and 12.3). However, women aged ≥30 years also had greater risks for adverse maternal outcomes such as: gestational diabetes (AOR: 2.0, 3.6 and 5.1 for women aged 30–34 years, 35–39 years and ≥40 years, respectively); placenta previa (AOR: 1.6, 2.1 and 3.6); and cesarean delivery (AOR: 1.5, 2.3, and 4.1), as well as adverse fetal outcomes such as: preterm delivery (AOR: 1.2, 1.4 and 1.8) and neonatal intensive care unit transfer (AOR: 1.1, 1.2, and 1.6).
Increasing maternal age is an independent and substantial risk factor for adverse perinatal and obstetric outcomes. These adverse outcomes become more common as increasing maternal age without a clear cutoff age.
Advanced maternal age and adverse perinatal outcome: A review of the evidence
2011, Midwifery
Citation Excerpt :
Of eight reviewed studies considering this association, seven found advanced maternal age (35–39/40 years) to be an independent risk factor for stillbirth and perinatal/neonatal death. This is similar to findings in the broader literature of a clear association between advanced maternal age (35–39 years) and increased rates of stillbirth/perinatal/neonatal death (Fretts and Usher, 1997; Nybo-Anderson et al., 2000; Miller, 2005; Montan, 2007). Although the association is established, the exact relationship is not yet well understood, and recently, a range of authors have attempted to explain the mechanisms by which advanced maternal age impacts on stillbirth rates.
to examine the evidence in relation to advanced maternal age (35–39 years), physiological risk and adverse perinatal outcome (stillbirth, low birth weight, preterm birth) in high-income countries.
this review was conducted against a background of increasing maternal age (>35 years) and concerns for fetal and maternal welfare among this group. Consequent to these concerns, increasing trends of birth intervention such as caesarean section and instrumental birth are seen. Although evidence justifies a high rate of intervention among women aged more than 40 years, the evidence for such intervention in women aged 35–39 years is sketchy and often contradictory.
a systematic review was conducted of studies in English, that were published between 2000 and 2010. Studies were included if they had extractable data on maternal age (35–39 years) and perinatal outcomes. Of 102 retrieved publications, nine met these criteria.
evidence from this review suggests that rates of adverse perinatal outcome, such as stillbirth, are linked to maternal age 35–39 years. However, rates of increase are modest until 40 years of age or more. The impact of changing maternal socio demographics appears to be of importance but is not yet well understood.
although risk and rates of adverse perinatal outcome are increased among women aged 35–39 years, midwives and women should also be aware that perinatal outcomes are generally favourable for this group. There is also some suggestion in the literature that social advantage may ameliorate some of the effect of advanced maternal age on perinatal outcome. Further research is required to evaluate the soundness and strength of this association.
Obstetric complications and advanced maternal age
2023, Revista Peruana de Ginecologia y Obstetricia
Pregnancy at Age 35 Years or Older: ACOG Obstetric Care Consensus No. 11
2022, Obstetrics and Gynecology
Effect of maternal age on maternal and perinatal outcomes including cesarean delivery following induction of labor in uncomplicated elderly primigravidae
2021, Medicine (United States)

View all citing articles on Scopus

Presented at the 71st Annual Meeting of the Pacific Coast Obstetrical and Gynecological Society, October 19-24, 2004, Phoenix, Arizona.

Reprints not available from the authors.

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Transactions from the 71st Annual Meeting of the Pacific Coast Obstetrical and Gynecological SocietyIs advanced maternal age an independent risk factor for uteroplacental insufficiency?

Objective

Study design

Results

Conclusions

Section snippets

Material and methods

Results

Comment

Statistics usage

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Final natality statistics, 1978, Monthly Vital Statistics Report. Vol 29(Suppl)

Births: preliminary data for 2002. National Vital Statistics Reports. Vol 51, no. 11

Relation of the mother's age to obstetric performance

Obstet Gynecol

The problem of the older primipara

Obstet Gynecol

Pregnancy outcomes in black women aged 35 and older

Obstet Gynecol

Delayed childbearing and the outcome of pregnancy

N Engl J Med

Transactions from the 71^st Annual Meeting of the Pacific Coast Obstetrical and Gynecological Society
Is advanced maternal age an independent risk factor for uteroplacental insufficiency?