Maternal Perinatal Outcomes Related to Advanced Maternal Age in Preeclampsia Pregnant Women
Abstract
Objective: This study aims to analyze the effect of advanced maternal age (>35 years old) in maternal and perinatal outcomes of preeclampsia women.
Materials and methods: This is a retrospective cross-sectional study involved all women who were diagnosed with preeclampsia at Universitas Airlangga Hospital (Surabaya, Indonesia) between January 2016 until May 2017. The participant was divided into two groups based on maternal ages: the first group was women older than 35 years old (advanced maternal age - AMA), and the other group was
20-34 years old (reproductive age - RA). The primary outcomes of this study were the maternal and perinatal outcome.
Results: There were a total of 43 AMA preeclampsia women and 105 RA preeclampsia women. The AMA preeclampsia group had a higher proportion of poor maternal outcome (the occurence of any complication: pulmonary edema, HELLP syndrome, visual impairment, post partum hemorrhage, and eclampsia) compared to RA preeclampsia group (60,5% vs 33,3%, p = 0,002; OR 3,059, CI 1,469-6,371). There was no significant difference in the other maternal complications such as HELLP syndrome, pulmonary oedema, and eclampsia. The only difference was the occurrence of postpartum haemorrhage which was higher in the AMA group (16,3% vs 4,8%, p = 0,02; OR 3,889, CI 1,161-13,031). The prevalence of cesarean delivery was more common in AMA group (53,3% vs 28,6%,
p = 0,004; OR 2.825, CI 1.380-5.988). The AMA preeclampsia women also had poorer perinatal outcomes compared to the RA group (81,4% vs 59%, p = 0,009; OR 3.034 CI 1.283-7.177). AMA women had a higher risk of perinatal complication such as prematurity (OR 3.266 CI 1.269-8.406), IUGR (OR 4.474 CI 1.019-19.634), asphyxia (OR 4.263 CI 2.004-9.069), and infection (OR 2.138 CI 1.040-4.393).
Conclusion: Advanced maternal age increases the risk of poorer maternal and neonatal outcomes in preeclampsia patients. The addition of advanced maternal ages in preeclampsia should raise the awareness of the health provider, tighter monitoring, complete screening and early intervention if needed to minimize the risk of complications.
2. De Giacomi F, Vassallo R, Yi ES, Ryu JH. Acute Eosinophilic Pneumonia. Causes, Diagnosis, and Management. Am J Respir Crit Care Med 2018; 197: 728–36.
3. El-Sayed AAF. Preeclampsia: A review of the pathogenesis and possible management strategies based on its pathophysiological derangements. Taiwan J Obstet Gynecol 2017; 56: 593–8.
4. Tranquilli AL, Dekker G, Magee L, Roberts J, Sibai BM, Steyn W, et al. The classification, diagnosis and management of the hypertensivedisorders of pregnancy: A revised statement from the ISSHP. Pregnancy Hypertens 2014; 4: 97-104.
5. Dekker G, Sibai B. Primary, secondary, and tertiary prevention ofpre-eclampsia. Lancet. 2001; 357: 209-15.
6. Poon LC, Nicolaides KH. Early Prediction of Preeclampsia. Obstet Gynecol Int 2014; 2014: 297397.
7. Mustafa R, Ahmed S, Gupta A, Venuto RC. A comprehensive review of hypertension in pregnancy. J Pregnancy 2012; 2012: 105918.
8. Tessema GA, Tekeste A, Ayele TA. Preeclampsia and Associated Factors Among Pregnant Women Attending Antenatal Care in Dessie Referral Hospital, Northeast Ethiopia: A Hospital-Based Study. BMC Pregnancy Childbirth 2015; 15: 73.
9. Shan D, Qiu PY, Wu YX, Chen Q, Li AL, Ramadoss S, et al. Pregnancy Outcomes in Women of Advanced Maternal Age: a Retrospective Cohort Study from China. Sci Rep 2018; 8: 12239.
10. Ogawa K, Urayama KY, Tanigaki S, Sago H, Sato S, Saito S, et al.Association between very advanced maternal age and adverse pregnancy outcomes: a cross sectional Japanese study. BMC Pregnancy Childbirth 2017; 17: 349.
11. Lamminpää R, Vehviläinen-Julkunen K, Gissler M, Heinonen S. Preeclampsia complicated by advanced maternal age: a registry-based study on primiparous women in Finland 1997-2008. BMC Pregnancy Childbirth 2012; 12: 47.
12. Hsieh TT, Liou JD, Hsu JJ, Lo LM, Chen SF, Hung TH. Advanced maternal age and adverse perinatal outcomes in an Asian population. Eur J Obstet Gynecol Reprod Biol 2010; 148: 21-6.
13. Mills TA, Lavender T. Advanced maternal age. Obstetrics, Gynaecology and Reproductive Medicine 2014; 24: 85-9.
14. Weng YH, Yang CY, Chiu YW. Risk Assessment of Adverse Birth Outcomes in Relation to Maternal Age. PLoS One 2014; 9: e114843.
15. Khalil A, Syngelaki A, Maiz N, Zinevich Y, Nicolaides KH.Maternal age and adverse pregnancy outcome: a cohort study. Ultrasound Obstet Gynecol 2013; 42: 634-43.
16. Liu X, Zou L, Chen Y, Ruan Y, Liu Y, Zhang W. [Effects of maternal age on pregnancy: a retrospective cohort study]. Zhonghua Yi Xue Za Zhi. 2014; 94: 1984-8.
17. Callaway LK, Lust K, McIntyre HD. Pregnancy outcomes in women of very advanced maternal age. Aust N Z J Obstet Gynaecol 2005; 45: 12-6.
18. Dietl A, Farthmann J. Gestational hypertension and advanced maternal age. Lancet 2015; 386: 1627–8.
19. Broekhuijsen K, Groen H, van den Berg PP, Mol BW, Franssen MT, Langenveld J, et al. Gestational hypertension and advanced maternal age -Authors' reply. Lancet 2015; 386: 1628.
20. American College of Obstetricians and Gynecologists; Task Force on Hypertension in Pregnancy. Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol 2013; 122: 1122-31.
21. Tranquilli AL, Brown MA, Zeeman GG, Dekker G, Sibai BM. The definition of severe and early-onset preeclampsia. Statements from the International Society for the Study of Hypertension in Pregnancy (ISSHP). Pregnancy Hypertens 2013; 3: 44-7.
22. Fraser DM, Cooper MA.Myles’ Textbook for Midwives E-Book. Elsevier Health Sciences, Amsterdam. 14th ed. Jakarta: EGC 2009.
23. Sheldon WR, Blum J, Vogel JP, Souza JP, Gülmezoglu AM, Winikoff B; et al. Postpartum haemorrhage management, risks, and maternal outcomes: findings from the World Health Organization Multicountry Survey on Maternal and Newborn Health. BJOG 2014; 121 Suppl 1: 5-13.
24. Ballard JL, Khoury JC, Wedig K, Wang L, Eilers-Walsman BL ,Lipp R. New Ballard Score, expanded to include extremely premature infants. J Pediatr 1991; 119: 417–23.
25. Liu J, Yang N, Liu Y. High-risk factors of respiratory distress syndrome in term neonates: A retrospective case-control study. Balkan Med J 2014;31:64–8.
26. Simonsen KA, Anderson-Berry AL, Delair SF, Davies HD. Early-onset neonatal sepsis. Clin Microbiol Rev 2014; 27: 21-47.
27. Ng PC, Ma TP, Lam HS. The Use of Laboratory Biomarkers for Surveillance, Diagnosis and Prediction of Clinical Outcomes in Neonatal Sepsis and Necrotising Enterocolitis. Arch Dis Child Fetal Neonatal Ed 2015; 100: F448–52. 3
28. Papillon SC, Short SS, Ford H. Necrotizing enterocolitis. In: Newborn Surgery, Fourth Edition.CRC press publisher 2017: 653-9.
29. Szpecht D, Szymankiewicz M, Nowak I, Gadzinowski J. Intraventricular hemorrhage in neonates born before 32 weeks of gestation—retrospective analysis of risk factors. Child’s Nerv Syst 2016; 32: 1399–404.
30. Valsamakis G, Kyriazi EL, Mouslech Z, Siristatidis C, Mastorakos G. Effect of maternal obesity on pregnancy outcomes and long-term metabolic consequences. Hormones (Athens) 2015; 14: 345-57.
31. Lisonkova S, Sabr Y, Mayer C, Young C, Skoll A, Joseph KS. Maternal morbidity associated with early-onset and late-onset preeclampsia. Obstet Gynecol 2014; 124: 771-81.
32. Akbar MIA, Adibrata MA, Aditiawarman, Aryananda RA,Angsar MD,Dekker G.. Maternal and perinatal outcome related to severity of chronic hypertension in pregnancy. Pregnancy Hypertens 2019; 16: 154–60.
33. Mylonas I, Friese K. Indications for and Risks of Elective Cesarean Section . Dtsch Arztebl Int 2015; 112: 489–95.
34. ldika Akbar MI, Herdiyantini M, Aryananda RA, CIninta N, Wardhana MP, Gumilar KE, et al. Serum heme oxygenase 1 (HO-1),soluble FMS like tyrosine kinase (sFlt-1) level, and neonatal outcome in earlyonset, late onset preeclampsia, and normal pregnancy. Hypertens Pregnancy 2018; 37: 175-81.
35. Care AS, Bourque SL, Morton JS, Hjartarson EP, Davidge ST. Effect of advanced maternal age on pregnancy outcomes and vascular function in the rat. Hypertension 2015; 65: 1324-30.
36. Waldenström U, Cnattingius S, Vixner L, Norman M. Advanced maternal age increases the risk of very preterm birth, irrespective of parity: a population-based register study. BJOG 2017; 124: 1235-44.
37. Cavazos-Rehg PA, Krauss MJ, Spitznagel EL, Bommarito K, Madden T, Olsen MA, et al. Maternal age and risk of labor and delivery complications. Matern Child Health J 2015; 19: 1202-11.
38. Schimmel MS, Bromiker R, Hammerman C, Chertman L, Ioscovich A,Granovsky-Grisaru S, et al. The effects of maternal age and parity on maternal and neonatal outcome. Arch Gynecol Obstet 2015; 291: 793-8.
39. Odibo AO, Nelson D, Stamilio DM, Sehdev HM, Macones GA. Advanced maternal age is an independent risk factor for intrauterine growth restriction. Am J Perinatol 2006; 23: 325–8.
40. Boskabadi H, Ashrafzadeh F, Doosti H, Zakerihamidi M. Assessment of risk factors and prognosis in asphyxiated infants. Iran J Pediatr 2015; 25: e2006.
41. Cortese F, Scicchitano P, Gesualdo M, Filaninno A, De Giorgi E, Schettini F,et al. Early and Late Infections in Newborns: Where Do We Stand?A Review. Pediatr Neonatol 2016; 57: 265-73.
| Files | ||
| Issue | Vol 13, No 4 (December 2019) | |
| Section | Original Articles | |
| DOI | https://doi.org/10.18502/jfrh.v13i4.2646 | |
| Keywords | ||
| Advanced Maternal Age Preeclampsia Maternal Outcomes Perinatal Outcomes | ||
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