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Maternal age and risk for adverse outcomes

American Journal of Obstetrics and Gynecology Aug 30, 2018

Sheen JJ, et al. - Researchers performed this retrospective cohort analysis to characterize the risk for severe maternal morbidity and other pregnancy complications by maternal age during delivery hospitalizations. Findings suggested differential risk across maternal age categories. During delivery hospitalizations, the highest risk for a broad range of adverse outcomes was noted for women 45 and older.

Methods

  • The Perspective database was utilized to characterize the risk for adverse maternal outcomes from 2006 to 2015 based on maternal age.
  • Division of women into seven categories based on maternal age was performed: 15-17 years of age, 18-24, 25-29, 30-34, 35-39, 40-44 and 45-54.
  • Severe maternal morbidity, as defined by the Centers for Disease Control and Prevention, was assessed as the primary outcome.
  • In this study, the secondary outcomes assessed were
    • (i) Overall comorbid risk,
    • (ii) Risk for pregnancy complications such as postpartum hemorrhage, gestational diabetes, preeclampsia, and cesarean delivery, and
    • (iii) Risk for individual severe morbidity diagnoses such as stroke, embolism, eclampsia and hysterectomy.
  • Researchers fitted adjusted models to assess factors associated with severe morbidity with adjusted risk ratios (aRR) and 95% confidence intervals (CI) as measures of effect.
  • They applied population weights to create national estimates.

Results

  • Researchers included 36,944,292 deliveries; of these, 2.5% occurred among women aged 15-17 (n=921,236), 29.1% to women 18-24 (n=10,732,715), 28.6% to women 25-29 (n=10,564,850), 24.9% to women 30-34 (n=9,213,227), 12.1% to women 35-39 (n=4,479,236), 2.6% to women 40-44 (n=974,289), and 0.2% to women aged 45-54 (n=58,739).
  • In unadjusted analyses, more than three times higher (risk ratio (RR) 3.33, 95% CI 3.03-3.66) severe morbidity was observed for women 45-54 compared to women 25-29.
  • Increased risk was also evident for women aged 40-44, 35-39 and 15-17 (RR 1.83, 95% CI 1.77-1.89; RR 1.36, 95% CI 1.33-1.39; RR 1.39, 95% CI 1.34-1.45, respectively).
  • In the adjusted model, the highest relative risk was noted for the 45-54 year old group (aRR 3.46, 95% CI 3.15-3.80) followed by 40-44 (aRR 1.90, 95% CI 1.84-1.97), 35-39 (aRR 1.43, 95% CI 1.40-1.47), and 15-17 (aRR 1.20, 95% CI 1.15-1.24).
  • Among women aged 45-54, cesarean delivery, preeclampsia, postpartum hemorrhage and gestational diabetes were most common, as were thromobosis and hysterectomy.

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