Pregnancy and Birth Outcomes Among Primiparae at Very Advanced Maternal Age: At What Price?
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ORIGINAL PAPER
Pregnancy and Birth Outcomes Among Primiparae at Very Advanced Maternal Age: At What Price? Alon Ben-David1 • Saralee Glasser2 • Eyal Schiff3 • Aliza Segev Zahav3 Valentina Boyko2 • Liat Lerner-Geva1,2
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Published online: 21 December 2015 Ó Springer Science+Business Media New York 2016
Abstract Objectives In light of the potential physical and emotional costs to both woman and child, this study was conducted to assess pregnancy complications and birth outcomes in primiparae at very advanced maternal age (VAMA, aged C45) compared to younger primiparae. Methods Retrospective cohort study comparing 222 VAMA primiparae and a reference group of 222 primiparae aged 30–35, delivering at Sheba Medical Center from 2008 through 2013.Results VAMA primiparae were more likely than younger primiparae to be single, to have chronic health conditions, and higher rates of gestational diabetes mellitus (GDM), gestational-hypertension (GHTN) and preeclampsia-eclampsia. VAMA primiparae conceived mostly by oocyte donation. They were more likely to be hospitalized during pregnancy, to deliver preterm and by cesarean birth. Infants of VAMA primiparae were at greater risk for low birthweight and Neonatal Intensive Care Unit admission. There were no differences in outcomes between VAMA primiparae with or without preexisting chronic conditions, or between those aged 45–49 and C50. In multivariable analysis VAMA was an independent risk factor for GDM, GHTN and preeclamsia-eclampsia, with adjusted odds ratio of 2.38 (95 % CI 1.32, 4.29), 5.80 (95 % CI 2.66, 12.64) and 2.45
& Saralee Glasser [email protected] 1
Sackler Faculty of Medicine, School of Public Health, Tel Aviv University, Tel Aviv, Israel
2
Women and Children’s Research Unit, Gertner Institute for Epidemiology and Health Policy Research, Chaim Sheba Medical Center, 52621 Tel Hashomer, Ramat Gan, Israel
3
The Joseph Buchman Gynecology and Maternity Center, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
(95 % CI 1.03, 5.85); respectively. The effect of age disappeared in multiple pregnancies. Conclusions Primiparity at VAMA holds a significant risk for adverse pregnancy and birth outcomes. The absence of chronic medical conditions or the use of a young oocyte donor does not improve these outcomes. Multiple pregnancies hold additional risk and may diminish the effect of age. Primiparity at an earlier age should be encouraged. Keywords Birth outcome Pregnancy complications Primiparity Very advanced maternal age
Significance What is already known on this subject? Delayed childbearing is on the rise and expected to rise further. It has been associated with adverse outcomes. However, existing information specifically regarding primiparity at the extreme ages of conception is limited. What this study adds? This study, focusing on primiparae aged C45, reveals exceptionally high rates of pregnancy complications and adverse birth outcomes, compared to younger primiparae, and demonstrates that the absence of chronic conditions or the use
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