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Pregnancy outcome in late maternal age in a high-income developing country

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Hind Alshami at Al Ain Hospital
Hind Alshami
Anjali R Kadasne at Al Ain Hospital
Anjali R Kadasne
Muna Khalfan
Muna Khalfan
Muna Khalfan
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Saima Z Iqbal
Saima Z Iqbal
Saima Z Iqbal
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Abstract

This study aimed to compare the pregnancy outcome at maternal age 35 years and above with those aged between 20 and 34 years in a high-income developing country. In this prospective study, pregnant women that delivered at Al-Ain Hospital from the 1st April 2009 till 30th September 2009 were included. The obstetrical and perinatal outcome of mothers aged between 20 and 34 years and those aged 35 years old and above was compared. There were a total of 888 patients. 699/888 (78.7%) were aged between 20 and 34 years and 189 (21.3%) were aged 35 years and above. Advanced maternal age was significantly associated with a higher incidence of type II diabetes mellitus (p = 0001), hypothyroidism (p = 0.02), history of miscarriages (p = 0.0001), GDM (p = 0.0001), placenta previa p = 0.04, induction of labor (p = 0.04), and Cesarean section (p = 0.009). Pregnant women at 35 years and above have higher incidence of gestational diabetes mellitus, placenta previa, and operative delivery. However, perinatal outcome are comparable to younger mothers.
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PREGNANCY OUTCOME IN LATE MATERNAL AGE IN A HIGH-INCOME DEVELOPING COUNTRY
Hind A. A. AlShami · Anjali R. Kadasne · Muna Khalfan · Saima Z. Iqbal , Hisham M. Mirghani
Women’s Health Department, Al Ain Hospital, H. M. Mirghani Department of Obstetrics and Gynecology,
Faculty of Medicine and Health Sciences, UAE University , Al-Ain , United Arab Emirates
Introduction
• World wide there is an increasing prevalence of advanced
maternal age (AMA) at marriage and first birth which is
associated with higher obstetrical and perinatal
complications .
• Various studies showed controversial results with higher
rates of adverse pregnancy outcome mainly seen in those
40 years and above rather than the cut-off 35 years.
• United Arab Emirates has a multiethnic community where
they are of good general health, socioeconomic status and
low smoking rate.
• This study aimed to compare the pregnancy out come
among those delivered at age of 35 years and above
versus those aged 20-34 years.
Materials and methods
•  Setting :Al Ain Hospital, Al Ain District, United Arab
Emirates.
•  Type Of Study: Prospective study
•  Time : April 1st 2009 - Sep. 30th 2009
•  Questionnaire sheets were filled on a daily basis. Collected
data included parity, delivery gestational age, presence of
consanguinity and infertility, past medical, past and current
obstetric history, intrapartum events, mode of delivery,
pregnancy outcome (birth weight, gender, Apgar score, and
admission to special care baby unit) and post partum course
(postpartum hemorrhage, infection, and deep venous
thrombosis).
•  Statistical analysis, using SPSS package, was performed to
compare outcome using the Chi-square test, Fisher exact two-
tailed test, and Spearman bivariate correlation. The confidence
interval (CI) at 95% was calculated. Level of significance was
set at
p value <0.05.
Results
• The total number of patients included were 888 women, 699
(78.7%) were between 20 and 34 years , 189 (21.3%) were
35 years and above.
• UAE nationals constituted one third of the study group
(Figure 1).
• Pregnant women at 35 years and above had a significantly
higher incidence of type 2 diabetes mellitus (p=0.001),
hypothyroidism (P=0.02), and history of miscarriage
(p=0.0001).
• Advanced maternal age is significantly associated with higher
incidence of GDM (p= 0.0001), placenta previa (p=0.04),
induction of labor (p=0.04), and Cesarean section (p=0.009)
(Figure 2) .
0"
5"
10"
15"
20"
25"
30"
GDM"
PP"
IOL"
CS"
20‐34"years"
35"&"above"
Conclusion
Pregnancy at the age of 35 years and above
has a higher incidence of GDM, placenta
previa, induction of labor, and cesarean
section.
However, perinatal outcomes are comparable
to younger mothers.
References
1. Heffner LJ (2004) Advanced maternal age—how old is too old? N Engl J Med 351:1927–1929
2. Green KE, Smith DE (2007) Change and continuity: childbirth and parenting across three
generations of women in the United Arab Emirates. Child Care Health Dev 33:266–274
3- Diejomaoh MF, Al-Shamali IA, Al-Kandari F, Al-Qenae M, Mohd AT (2006) The reproductive
performance of women at 40 years and over. Eur J Obstet Gynecol Reprod Biol 126:33–38
4- Carter AO, Saadi HF, Reed RL, Dunn EV (2004) Assessment of obesity, lifestyle, and
reproductive health needs of female citizens of Al Ain, United Arab Emirates. J Health Popul
Nutr 22:75–83
Figure 2. Maternal Complications
PP; placenta previa, IOL; induction of labor, CS; Cesarean section
Figure 1. Distribution of ethnic groups
0"
5"
10"
15"
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25"
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Arabs"
Indian"Sub."
others"
20‐34"years"
35"&"above"
... 2,3 Risk factors for PFDs including, high body mass index (BMI), number of vaginal deliveries, rate of fetal macrosomia, and lack of awareness of pelvic floor muscles exercise in the perinatal period are common in the Eastern Mediterranean region. [4][5][6][7] Therefore, a higher prevalence of PFDs in comparison to other regions in the world may be anticipated. ...
Prevalence of pelvic floor disorders in the Eastern Mediterranean region: A meta-analysis
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Objectives: High prevalence of risk factors for pelvic floor disorders (PFD) in the Eastern Mediterranean may result in higher rates of prevalence of PFD in comparison to other regions. Despite individual studies, there are no clear statistics on the cumulative prevalence of PFDs in the East Mediterranean region. The aim of this study was to investigate the prevalence of PFDs in the Eastern Mediterranean region. Methods: A literature search without language restriction was conducted in PubMed, Cochrane database and Web of Science from 2016 to 01 June 2022. Cross-sectional and cohort studies that reported prevalence of urinary incontinence (UI), constipation, fecal incontinence (FI) and pelvic organ prolapse (POP) among women in the Eastern Mediterranean region were included. Study quality was assessed according to the Joanna Briggs Institute critical appraisal tool. Data were pooled and meta-analysed using a random effects model. Prospero: CRD42021283127 RESULTS: The search yielded 390 articles, from which 12 studies containing 9905 patients were included. Five studies were high quality and seven were low quality. The prevalence of POP (12 studies, 9905 participants), UI (5 studies, 2340 participants), constipation (4 studies, 2045 participants) and FI (1 study, 166 participants) was 39% (95% CI 21-57; I2 99.8%), 48% (95% CI 16-80; I2 99.7%), 39% (CI 17-60; I2 99.1%) and 14% (95% CI 9-20) respectively. Conclusion: In meta-analysis pooling studies of mixed quality, a high prevalence of PFDs was seen in the Eastern Mediterranean region.PROSPERO No.: CRD42021283127.
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... [11,12] Given the high incidence of diabetes in pregnancy, high birth weight, raised body mass index, and lack of pelvic floor muscles exercise awareness during and after delivery among Emirati women in the UAE, a high prevalence rate of UI can be expected compared with developed countries. [13] UI in pregnancy may be under-reported because of the cultural belief that the condition is a normal part of carrying a baby inside the abdomen. This subject of UI in pregnancy has been infrequently evaluated in prospective studies in the region. ...
Risk factors for urinary incontinence during pregnancy among nulliparous women in the United Arab Emirates
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  • Jan 2023
  • MEDICINE
Urinary incontinence (UI), which affects the quality of life, is associated with different risk factors during pregnancy. We aimed to study the risk factors related to UI during pregnancy among nulliparous women in the UAE. This is a prospective descriptive survey, which included all nulliparous women after the first 24 weeks' gestation from 2012 to 2014 in a teaching hospital in the UAE. Participants were interviewed face-to-face, using a structured and pre-tested questionnaire and divided into 2 groups: those with UI and those without it. Factors which were statistically significant (P < .05) between the 2 groups were entered into an logistic regression backward logistic regression model to define the factors predicting UI. Five hundred one participants were interviewed. UI occurred in 106/501 (21.2%). The 2-sample comparison analysis showed that urinary tract infection (UTI) (47.2% vs 34.4%, P = .018) and its number of attacks (P = .007), chronic cough (28.3% vs 13.9%, P < .001) and chronic constipation (34.9% vs 19%, P < .001) were statistically significant between those who had UI and those who did not. The logistic regression backward logistic regression model showed that the risk factors which predicted UI were chronic constipation (P = .003), chronic cough (P = .008), and the number of UTI attacks (P = .036). UI affects one-fifth of nulliparous women in the UAE. Chronic cough, constipation, and repeated UTI infection, significantly increase the odds of UI during pregnancy. Addressing these risk factors may reduce the risk of UI.
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... By 37 years of age, more than 95% of oocytes present at birth have undergone apoptosis. At 40 years, the fertility rate is 50% compared to a woman aged 30 years [9]. In addition, premenopausal BC patients are mostly more than 35 years old, so it is physiologically susceptible to infertility. ...
Embryo Cryopreservation as an Alternative to Treat Infertility in Breast Cancer Survivors in Reproductive Age: Case Reports
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Introduction: Chemotherapy has been shown to reduce breast cancer (BC) mortality significantly. However, several types of chemotherapy drugs affect the reproductive system. As BC has become increasingly prevalent, many young women are diagnosed during their reproductive years. As a result, overcoming chemotherapy-related infertility is becoming increasingly important. Hence, in-vitro fertilization (IVF) with embryo cryopreservation before chemotherapy is considered a way to preserve future reproductive potential. For this reason, this paper aims to report the cases of safe pregnancy in BC survivors through pre-chemotherapy IVF followed by embryo cryopreservation.Case Presentation: Two women, aged 35 and 29, respectively, were treated for BC by surgery, chemotherapy, and tamoxifen. They performed in-vitro fertilization (IVF) with embryo cryopreservation before chemotherapy. Their pregnancy was completed without complications, and they gave birth to healthy babies. Their last oncological visit also showed no signs of cancer recurrence, showing disease-free intervals of seven and eight years, respectively.Conclusions: Pre-chemotherapy IVF followed by embryo cryopreservation can be an alternative to treat infertility in BC survivors of reproductive age who are receiving chemotherapy.
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... According to the current study, low birth weight is not significantly associated with maternal age. is finding is consistent with studies done in high-income developing countries which stated that there is no significant difference in low birth weight between AMA and nonexposed group [22]. e studies done in Yaoundé, Cameroon [12], and prospective cohort study in Ghana [1], however, concluded that neonates from women of the AMA group are at increased risk of low birth weight. ...
Risk of Selected Fetal Adverse Pregnancy Outcomes at Advanced Maternal Age: A Retrospective Cohort Study in Debre Markos Referral Hospital, Northwest Ethiopia
Article
Full-text available
  • Oct 2021
Introduction. Pregnancy at an advanced maternal age is defined as pregnancy at 35 years or older. Today, women postpone pregnancy due to different socioeconomic and personal reasons. However, there was limited evidence on fetal adverse outcomes' association with pregnancy at an advanced maternal age in Ethiopia and particularly in the study area. is study was aimed at assessing the effect of pregnancy at an advanced age on selected neonatal adverse pregnancy outcomes in Debre Markos Referral Hospital, Ethiopia, 2019. Methods. Institution-based retrospective cohort study was conducted on 303 exposed (35 years and older) and 604 nonexposed (20-34 years old) immediate postpartum women who delivered at Debre Markos Referral Hospital after 28 weeks of gestation. All exposed women who fulfilled the inclusion criteria were sampled, and systematic random sampling was employed for those in the nonexposed group. e data were collected from 1st of July to 30th of December, 2019, by face-to-face interview and extraction from maternal chart using a structured questionnaire and data extraction checklist, respectively. Binary logistic regression (bivariate and multivariable) model was fitted, and wealth index was analyzed by principal component analysis. Adjusted relative risk with respect to 95% confidence interval was employed for the strength and directions of association between advanced maternal age and selected adverse pregnancy outcomes, respectively. P-value of <0.05 was used to declare statistical significance. Results. e incidence of adverse neonatal outcomes including stillbirth, preterm birth, and low birth weight in the advanced maternal age group was 13.2%, 19.8%, and 16.5%, respectively. e incidence of stillbirth, preterm birth, and low birth weight in the nonexposed group was 3.1%, 8.4%, and 12.4%, respectively. e advanced maternal age group had three times the risk of stillbirth compared with the nonexposed group (ARR = 3.14 95% CI (1.30-7.00)). e advanced maternal age group had 2.66 times the risk of delivering preterm fetus (ARR = 2.66 95% CI (1.81-3.77)) compared with the younger counterparts. Low birth weight was not significantly associated with pregnancy at an advanced maternal age. Conclusion. Fetal adverse outcomes including stillbirth and preterm birth were significantly associated with pregnancy at an advanced maternal age.
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... Communities within the Gulf countries are generally pronatal with high parity and short inter-pregnancy intervals. In addition, the proportion of macrosomic babies is high due to high prevalence of gestational diabetes [25]. Therefore, and since the prevalence of UI in multiparous women and women with macrosomic babies, is higher than the general population [26][27][28], this might be reflected on the prevalence of UI in the area compared to those reported from other parts of the world especially the West. ...
Prevalence, social impact and help-seeking behaviour among women with urinary incontinence in the Gulf countries: A systematic Review
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Full-text available
  • Oct 2021
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Background Urinary incontinence (UI) in women is a common problem worldwide. It has a major impact on the physical and social activities and interpersonal relationships. The societies in the Gulf countries are conservative and favours large families, high parity and short inter-pregnancy intervals. Moreover, there is a high prevalence of gestational diabetes with many macrosomic babies. This study aimed to review the published literature on UI among women in this region. Methods All published literature which investigated the prevalence, social impact and help-seeking behavior in women with UI in the Gulf countries was reviewed. Results Nine studies met the criteria and were very heterogeneous. None of them was a true population-based study and all except one, investigated subjects from healthcare facilities. The prevalence of UI ranged from 20.3% to 54.5%. Stress UI was the main type reported. The main predisposing factors were chronic respiratory diseases and constipation. There was a large impact on the quality of life with major interference with prayers (34-90%) and sexual relationships (18-57%). The main reasons for not seeking medical advice were embarrassment to see doctors especially male doctors and the belief that UI is common, normal or incurable disease. Conclusions There is a need for true whole population-based studies of UI in this region with the use of validated international questionnaires. UI was shown to have a major impact on the act of prayers and sexual relationships. A large proportion of women are still embarrassed to discuss the issue with doctors especially male doctors.
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Adverse Maternal and Perinatal Outcome of Women Aged 40 Years or Over: A Retrospective Study
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  • Jul 2022
BACKGROUND Advanced maternal age is traditionally described to be 35 years of age or over. In recent years, new trends have suggested that it may be 40 years of age or over; this occurs in Hungary. AIM The aim of this study was to determine the association between advanced maternal age and various adverse maternal and neonatal outcomes. METHODS A retrospective analysis was performed among women who delivered between 2015 and 2017. All women aged 40 years or over (cases) were involved into the analysis ( n = 374). The controls ( n = 378) were randomly selected from women aged 25 to 29 years who delivered during the same period considering the number of previous gestations and previous deliveries. The data collected from the medical records comprised the mothers’ demographic and obstetric characteristics and neonatal data. To assess the contribution of maternal age to various maternal and neonatal outcomes, multiple logistic regression analyses were used. RESULTS The logistic regression analyses showed higher odds of gestational diabetes (AOR, adjusted odds ratio: 2.81), preeclampsia (AOR: 13.05), threatened preterm delivery (AOR: 3.62), and cesarean section (AOR: 3.31) in mothers of higher age. The odds of low birth weight (AOR: 2.56) and intensive care (AOR: 2.03) were significantly higher in older vs. younger mothers, while no significant associations were between maternal age and fetal macrosomia and congenital malformations. CONCLUSIONS Considering our results, it is important to educate women about the consequences of delayed childbearing and the need of continuous observation within prenatal care.
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Trends in maternal age and the relationship between advanced age and adverse pregnancy outcomes: a population-based register study in Wuhan, China, 2010–2017
Article
  • May 2022
  • PUBLIC HEALTH
Objectives The aims of this study were to assess trends in maternal age in central China and to examine the relationship between maternal age and adverse pregnancy outcomes. Study design This was a retrospective and observational study. Methods Data were analysed from the Wuhan Maternal and Child Health Management Information System, which included all pregnant women who were at 24–42 weeks' gestation, with singleton pregnancies and who lived in Wuhan between 2010 and 2017. Joinpoint regression was used to analyse the trends in mean maternal age and the proportion of women with advanced maternal age. Adverse pregnancy outcomes, including pregnancy-induced hypertension (PIH) disorder, gestational diabetes mellitus (GDM), caesarean delivery, postpartum haemorrhage, preterm birth, small for gestational age, large for gestational age (LGA) and 5-min Apgar score <7 among women aged <20, 20–24, 30–35 and ≥40 years were compared with women aged 25–29 years using multivariate binary logistic regression analysis and stratified analysis. Results Among the 583,571 women included in this study, 1.2% were aged <20 years, 20.8% were aged 20–24 years, 47.9% were aged 25–29 years, 22.0% were aged 30–34 years, 6.9% were aged 35–39 years and 1.2% were aged ≥40 years. Between 2010 and 2017, the mean maternal age increased from 27.1 years to 29.7 years, and the proportion of women aged ≥35 years increased from 4.3% to 13.9%. Relative to women aged 25–29 years, women aged ≥30 years carried higher risks of PIH, GDM, caesarean delivery, preterm birth, LGA and 5-min Apgar score <7. Relative to older multiparous women, older nulliparous women were more likely to experience caesarean delivery, preterm birth and 5-min Apgar score <7. Conclusions The average maternal age and the proportion of advanced maternal age showed increasing trends between 2010 and 2017, which may be related to the relaxation of the one-child policy in China. Older maternal age (≥30 years) is independently associated with various adverse pregnancy outcomes. The risks of adverse pregnancy outcomes may occur earlier than the commonly used definition of advanced maternal age (≥35 years) and may also differ by parity. Ensuring age- and parity-specific clinical counselling, antenatal surveillance and health interventions may significantly improve pregnancy outcomes in older mothers.
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EBEVEYNLERİN ÇOCUK YETİŞTİRME TUTUMLARI VE ÇOCUK EBEVEYN ARASINDAKİ İLETİŞİM
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Full-text available
  • May 2021
Öz: Toplumsal bir varlık olan insan başka insanlarla iletişim kurduğunda evreni anlamaya ve anlamlandırmaya başlar. Ailede iyi iletişim becerisi kazanan çocuklar, dili daha verimli kullanarak kendilerini daha iyi ifade edebilmekte, duygu ve düşüncelerini karşı tarafa daha doğru bir şekilde aktarabilmekte ve böylece daha sağlıklı sosyal ilişkiler kurabilmektedir. Çocukların gelecekte nasıl bir insan olacağında ebeveynlerin çocuklarına yönelik tutum ve davranışlarının etkisi büyüktür. Bu çalışma çocuk yetiştirmeye ilişkin ebeveyn tutumu ile ebeveyn çocuk iletişimi arasındaki ilişkinin belirlenmesi amacıyla yapılmıştır. İlişkisel tarama modeline dayalı araştırma 55 gönüllü ebeveynle yürütülmüştür. Araştırmanın verilerinin toplanmasında ‘Birey Tanıtım Formu’, ‘Anne-Baba-Çocuk İletişimini Değerlendirme Aracı (ABÇİDA)’ ve ‘Anne Baba Çocuk Yetiştirme Tutumları Ölçeği (ABTÖ)-A Formu’ kullanılmıştır. Verilerin istatistiksel analizi sonucunda ABÇİDA ölçeğinde en düşük puanı dinleme boyutu alırken (3,03±0,32), en yüksek puanı ise empati boyutu (3,92±0,52) almıştır. ABTÖ’nün alt boyutu olan ‘demokratik tutum’ 66,71±5,57, ‘baskıcı ve otoriter tutum’ toplam puanı 39,98±5,65 ve ‘aşırı hoşgörülü tutum’ alt boyutu puan toplamı 27,11±5,29’dur. Ebeveyn iletişimi ve ebeveynlerin çocuk yetiştirmeye tutumları ile araştırmanın bağımsız değişkenleri arasında anlamlı fark bulunmamıştır (p>.05). Çocuğun birinci ve ikinci sırada doğması ile iletişimde konuşma ve dinleme alt boyutu ve demokratik ve aşırı hoşgörülü tutum arasında anlamlı fark bulunmuştur. Sonuç olarak ebeveynlerin iletişim boyutlarından aldıkları puan orta ve ortalamanın üzerinde olduğu, yüksek derecede demokratik tutum, orta düzeyde baskıcı ve otoriter tutum ve aşırı hoşgörülü tutum sergilediği görülmüştür. Anahtar Kelimeler: Ebeveyn tutumu, ebeveyn-çocuk iletişimi, okul öncesi.
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ÇOCUK GELİŞİMİ ÖĞRENCİLERİNİN ETKİNLİK PLANLARINDAKİ DEĞERLER
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  • May 2021
Öz: Okul öncesi eğitimin tanımı, amacı, içeriği ve temel ilkelerine bakıldığında değerler eğitiminin yer aldığını görülmektedir. Aileyle başlayan kazanımların eğitim kurumlarında okul öncesi dönemden itibaren verilmeye başlanması gerekmektedir. Bu durum göz önüne alındığında okul öncesi programındaki etkinliklerde değer vurgusunu belirlemek önemlidir. Araştırmanın amacı çocuk gelişimi programı öğrencilerinin etkinlik planlarındaki değerlerin incelenmesidir. Bu araştırma nitel araştırma modeli ile tasarlanmış bir durum çalışmasıdır. Araştırmada verilerin toplanmasında doküman incelemesi kullanılmıştır. Amaçlı örnekleme yapılarak bir üniversitenin çocuk gelişimi programında öğrenim gören ve uygulama dersi alan ikinci sınıf öğrencilerinin anaokulu uygulaması için hazırladıkları etkinlik planları değerlendirilmiştir. 40 öğrencinin etkinlik planlarındaki okul öncesi döneme ilişkin MEB tarafından önerilen 8 değer (sevgi, saygı, hoşgörü, sabır, iş birliği, sorumluluk, yardımlaşma ve paylaşma) üzerinden içerik analizi yapılmıştır. Öğrencilerin etkinlik planlarında toplamda 41 kez okul öncesine ait değerle karşılaşılmıştır. Değerler sırasıyla; sabır (n=9), saygı (n=7), sevgi (n=6), sorumluluk (n=6), hoşgörü (n=4), paylaşma (n=4), işbirliği (n=3) ve yardımlaşma (n=2) şeklindedir. Öğrencilerin etkinlik planlarındaki bazı değerlerin öğretimine ilişkin bir örnek şu şekildedir: “Öğretmen çocuklarla hayvanlar hakkında sohbet eder. Çocuklara en çok hangi hayvanı sevdiklerini, evde hayvan besliyor musunuz gibi sorular sorar…. Zürafa üzgün evine giderken arkadaşlarının aklına şahane bir fikir gelmiş: tüm hayvanlar atkılarından birer parça verirse Zürafa için ona uygun bir çorap yapılabilirmiş… Zürafanın hayvan dostları ise “Bizim atkılarımız yeterince uzun ama senin çorapların fazlasıyla kısaydı. Hem sen üşürken biz nasıl yardım etmezdik ki?” (sevgi, paylaşma, yardımlaşma). Sonuç olarak, çocuk gelişimi önlisans öğrencilerinin okul öncesine yönelik değerler konusunda bilinçli oldukları, fakat kazanılması hedeflenen değerleri etkinliklerinde daha fazla vermeye ihtiyaçları olduğu görülmüştür.
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Risk Factors for Peripartum Blood Transfusion in Women with Placenta Previa: A Retrospective Analysis
Article
Full-text available
  • Jun 2008
The incidence of placenta previa has been increasing. It is of a great importance to determine the clinical risk factors for peripartum blood transfusion in women with placenta previa in an effort to anticipate cases of severe hemorrhage. A total of 129 consecutive cases of placenta previa (64 cases of complete placenta previa and 65 cases of marginal placenta previa), including 43 cases requiring blood transfusion, were retrospectively analyzed. Maternal and neonatal clinical data were examined with univariate and multivariate logistic regression analyses for potential risk factors for peripartum blood transfusion. The independent risk factors for blood transfusion were maternal age greater than 34 years (adjusted odds ratio [OR]=3.7; 95% confidence interval [CI]=1.5-7.5, p<0.05), history of having undergone dilatation and curettage more than once (adjusted OR=4.8; 95% CI=1.1-26.2, p<0.05), and complete placenta previa (adjusted OR=2.6, 95% CI=1.2-5.9, p<0.05). Body mass index, gravidity, parity, previous cesarean section, antepartum hemorrhage, use of tocolytic agents, gestational age at delivery, preoperative anemia, emergent surgery, birth weight, and Apgar score were not associated with the incidence of blood transfusion. Risk factors for blood transfusion in women with placenta previa are advanced maternal age, repeat dilatation and curettage, and complete placenta previa. Women with placenta previa who are at risk for blood transfusion should be carefully managed with sufficient preparation for blood transfusion.
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Advanced Maternal Age. Part II: Long-Term Consequences
Article
Full-text available
  • Dec 2008
  • AM J PERINAT
In addition to the possible association between pregnancy in women with advanced maternal age and increased rates of obstetric and perinatal complications, those women and their children might suffer from long-term sequelae. In this review, the long-term consequences of delayed motherhood on the offspring and the possible association between advanced maternal age and the development of certain cancers are discussed.
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Pregnancy Outcome at Maternal Age 40 and Older
Article
Full-text available
  • Sep 2008
This case-control study was performed to compare the pregnancy outcomes of women aged 40 years and older with those of 20- to 30-year-old women. Among 28,507 women who delivered in the Zeinabieh and Hafez hospitals affiliated to Shiraz University of Medical Sciences between September 2001 and October 2004, 574 women (2.01%) were 40 years old or older at the time of delivery. Eight cases were excluded because of multifetal pregnancies. From the 566 remaining cases, 200 women (case group) were selected by simple random sampling and their hospital admission charts were retrospectively reviewed. They were compared with 200 20- to 30-year-old mothers (control group). The mean age for the case group was 41.56 +/- 2.06 years and that for the control group was 24.63 +/- 2.89 years. The mean birth weight was 2,869 +/- 848 g for the case group and 2,895 +/- 834 g for the control group (p = 0.75). The incidences of preeclampsia, gestational hypertension, cesarean delivery, abruptio placenta, preterm delivery, and 5-minute Apgar scores < 7 were significantly higher in the older group (p < 0.05). Some complications such as diabetes, chronic hypertension and perinatal mortality were more common in the older mothers, but the differences were not statistically significant. A comparison of complications with respect to parity showed that preterm birth (p = 0.002) and low birth weight (p = 0.04) occurred more frequently in primiparous older women. However, preeclampsia (p = 0.002) and abruptio placenta (p = 0.012) were more common in multiparous older women. Maternal and neonatal complications increased in women aged 40 years and above, but neonatal outcomes were similar to those in the younger age group.
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Pregnancy outcome at extremely advanced maternal age. Am J Obstet Gynecol 203:558e1-558e7
Article
  • Oct 2010
The purpose of this study was to evaluate pregnancy outcome in women at extremely advanced maternal age (≥ 45 years). We compared the condition of women aged ≥ 45 years (n = 177) in a 10:1 ratio (20-29, 30-39, and 40-44 years.). Subgroup analysis compared the condition of women aged 45-49 years with those women aged ≥ 50 years. The rates of gestational diabetes mellitus and hypertensive complications were higher for the study group, compared with the whole group (17.0% vs 5.6% and 19.7% vs 4.5%, respectively; P < .001), as was the rate of preterm delivery at <37 and <34 weeks of gestation (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.2-3.6 and OR, 3.5; 95% CI, 1.4-9.0, respectively). The rates of cesarean delivery (OR, 31.8; 95% CI, 18.0-56.1), placenta previa, postpartum hemorrhage, and adverse neonatal outcome were significantly higher among the study group. The risk for gestational diabetes mellitus, preeclampsia toxemia, preterm delivery, and neonatal intensive care unit admission was increased for women aged ≥ 50 years. Pregnancy at extreme advanced maternal age is associated with increased maternal and fetal risk.
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Thyroid dysfunction in patients with diabetes: Clinical implications and screening strategies
Article
Patients with diabetes mellitus are at an increased risk of thyroid disease. The frequency of thyroid dysfunction in diabetic patients is higher than that of the general population and up to a third of patients with type-1 diabetes (T1DM) ultimately develop thyroid dysfunction. Unrecognised thyroid dysfunction may impair metabolic control and add to cardiovascular disease risk in diabetic patients. Our aims were to review the current literature on the association between thyroid dysfunction and diabetes mellitus, to highlight relevant clinical implications, and to examine present thyroid disease screening strategies in routine diabetes care. The pleiotropic effects of thyroid hormones on various metabolic processes are now better understood. Uncontrolled hyperthyroidism in diabetic patients may trigger hyperglycaemic emergencies while recurrent hypoglycaemic episodes have been reported in diabetic patients with hypothyroidism. Furthermore, thyroid dysfunction may amplify cardiovascular disease risk in diabetic patients through inter-relationships with dyslipidaemia, insulin resistance and vascular endothelial dysfunction. However, the significance of subclinical degrees of thyroid dysfunction remains to be clarified. While these developments have implications for diabetic patients a consensus is yet to be reached on optimal thyroid screening strategies in diabetes management. The increased frequency of thyroid dysfunction in diabetic patients and its likely deleterious effects on cardiovascular and metabolic function calls for a systematic approach to thyroid disease screening in diabetes. Routine annual thyroid testing should be targeted at diabetic patients at risk of thyroid dysfunction such as patients with T1DM, positive thyroid autoantibodies or high-normal TSH concentrations.
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Obstetric complications in grand and great grand multiparous women
Article
To investigate pregnancy and labour outcomes in grand and great grand multiparous women. A retrospective population-based study was conducted between the years 1988 and 2007. Parturients were classified into three groups: multiparous; 2-5 deliveries, grand multiparous; 6-9 deliveries, and great grand multiparous; 10+ deliveries. Stratified analyses included multiple logistic regression models. A significant linear association was found between parity and adverse maternal and perinatal outcomes such as malpresentation, labour dystocia, caesarean delivery, postpartum haemorrhage, maternal anaemia (HB<10), congenital malformations and perinatal mortality. Using multivariable logistic regression models, grand multiparity was found an independent risk factor for labour dystocia, first stage (OR=1.5, P<0.001), and perinatal mortality (OR=2.0, P<0.001). Great grand multiparity was found an independent risk factor for labour dystocia, first stage (OR=2.6, P<0.001), labour dystocia, second stage (OR=2.1, P<0.001), and perinatal mortality (OR=2.5, P<0.001). Women with high birth order are at increased risk for adverse obstetric outcomes. The risk is higher for great grand multiparous women compared to grand multiparous women. Grand and great grand multiparity are independent risk factors for labour dystocia and perinatal mortality.
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Outcome of pregnancy in women 35 years of age and above
Article
  • Jan 2009
Pregnancy outcome among women in the age group of 35 years and more are considered to be less favorable than those of younger women. To observe those, this case control study was conducted in the department of Obstetrics & Gynaecology, Mymensingh Medical College Hospital during the period of 1st June 2003 to 31st May 2004. The study includes 100 patients of 35 years of age or above and 100 controls of 20-30 years of age. Observed complications during the pregnancy and delivery were increased incidence of placenta previa, malpresentation, intrauterine death, preterm labour, obstructed labour ruptured uterus etc. Pregnancy related complications were found significantly high (p<0.001) in case group (80%) compared to control group (51%). Rate of caesarian section was also more among the cases. Post delivery maternal complications were more in case group (53%) compared to control (30%) (p<0.001). Perinatal morbidity and mortality was significantly high. Cause of late fetal death in older women include, failure of the uterine vasculature in older women to adapt sufficiently to the increase haemodynamic demands of pregnancy, reduced fetal oxygenation with maternal age and also a rise in the frequency of preexisting hypertension with age. Maternal age is an important and independent risk in pregnancy outcome.
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