Adverse perinatal outcomes for advanced maternal age: a cross-sectional study of Brazilian births

Almeida, Núbia Karla O.; Almeida, Renan M.V.R.; Pedreira, Carlos Eduardo

doi:10.1016/j.jped.2014.12.002

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ORIGINAL ARTICLES • J. Pediatr. (Rio J.) 91 (5) • Sep-Oct 2015 • https://doi.org/10.1016/j.jped.2014.12.002 copy

Adverse perinatal outcomes for advanced maternal age: a cross-sectional study of Brazilian births^☆ ☆ Please cite this article as: Almeida NK, Almeida RM, Pedreira CE. Adverse perinatal outcomes for advanced maternal age: a cross-sectional study of Brazilian births. J Pediatr (Rio J). 2015;91:493-8

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVES:

To investigate the risk of adverse perinatal outcomes in women aged ≥41 years relatively to those aged 21-34.

METHODS:

Approximately 8.5 million records of singleton births in Brazilian hospitals in the period 2004-2009 were investigated. Odds ratios were estimated for preterm and post-term births, for low Apgar scores at 1 min and at 5 min, for asphyxia, for low birth weight, and for macrosomia.

RESULTS:

For pregnant women ≥41, increased risks were identified for preterm births, for post-term births (except for primiparous women with schooling ≥12 years), and for low birth weight. When comparing older vs. younger women, higher educational levels ensure similar risks of low Apgar score at 1 min (for primiparous mothers and term births), of low Apgar score at 5 min (for term births), of macrosomia (for non-primiparous women), and of asphyxia.

CONCLUSION:

As a rule, older mothers are at higher risk of adverse perinatal outcomes, which, however, may be mitigated or eliminated, depending on gestational age, parity, and, especially, on the education level of the pregnant woman.

Keywords:
Maternal age; Adverse perinatal outcome; Risk factors; Educational level

Variables	Categories	Frequency (%) Age 21–34 n = 8,207,745	≥41 n = 180,203
Maternal schooling (years)	<12	81.7	80.5
Maternal schooling (years)	≥12	18.3	19.5

Primiparity	Yes	33.6	12.9
Primiparity	No	66.4	87.1

Number of previous live births	0	35.6	14.5
Number of previous live births	≥1	64.4	85.6

Number of previous stillbirths	0	89.3	78.3
Number of previous stillbirths	≥1	10.7	21.7

Number of prenatal visits	0–6	37.6	39.7
Number of prenatal visits	≥7	62.4	60.3

Gestational age (weeks)	<37: Preterm	5.6	9.0
	37–41: Term	93.6	90.2
	>41: Post-term	0.8	0.8

Apgar score at 1 min	0–3	1.5	2.3
Apgar score at 1 min	≥4	98.5	97.7

Apgar score at 5 min	0–4	0.5	0.7
	≥5	99.5	99.3
	0–6	1.2	1.8
	≥7	98.8	98.2

Birth weight (g)	<2500	6.5	11.2
	2500–4000	88.3	82.9
	>4000	5.2	5.9

Outcome	Odds ratios (95% CI) All pregnancies			Term pregnancies
	All women	Primiparous	Non-primiparous	All women	Primiparous	Non-primiparous
Preterm	1.66 (1.63–1.69)	1.91 (1.83–1.99)	1.74 (1.71–1.77)	–	–	–
Post-Term	1.09 (1.03–1.15)	0.86 (0.72–1.03)	1.06 (1.01–1.12)	–	–	–
Low Apgar: 1 min	1.58 (1.53–1.63)	1.40 (1.29–1.52)	1.73 (1.67–1.79)	1.44 (1.39–1.50)	1.15 (1.03–1.29)	1.62 (1.55–1.69)
Asphyxia	1.38 (1.31–1.46)	1.28 (1.09–1.50)	1.38 (1.30–1.46)	1.27 (1.18–1.36)	1.12 (0.90–1.41)	1.25 (1.16–1.35)
Low Apgar: 5 min	1.49 (1.44–1.55)	1.30 (1.17–1.43)	1.55 (1.50–1.61)	1.40 (1.34–1.46)	1.09 (0.95–1.25)	1.47 (1.40–1.54)
Low birth weight	1.83 (1.80–1.86)	2.03 (1.96–2.11)	1.94 (1.91–1.97)	1.76 (1.73–1.80)	1.85 (1.76–1.95)	1.86 (1.82–1.91)
Macrosomia	1.22 (1.19–1.24)	0.92 (0.85–0.99)	1.13 (1.11–1.16)	1.22 (1.20–1.25)	0.93 (0.86–1.00)	1.14 (1.12–1.16)

	Schooling < 12 (n = 6,416,096)
Preterm	1.67 (1.64–1.70)	1.99 (1.89–2.10)	1.74 (1.71–1.78)	–	–	–
Post-Term	1.16 (1.10–1.23)	1.12 (0.92–1.36)	1.13 (1.07–1.20)	–	–	–
Low Apgar: 1 min	1.64 (1.59–1.70)	1.59 (1.44–1.75)	1.79 (1.73–1.86)	1.51 (1.45–1.57)	1.32 (1.16–1.51)	1.69 (1.61–1.77)
Asphyxia	1.44 (1.36–1.52)	1.44 (1.20–1.74)	1.44 (1.36–1.54)	1.35 (1.25–1.46)	1.46 (1.15–1.87)	1.33 (1.23–1.44)
Low Apgar: 5 min	1.56 (1.50–1.62)	1.45 (1.28–1.63)	1.63 (1.57–1.69)	1.48 (1.41–1.55)	1.26 (1.08–1.48)	1.56 (1.49–1.64)
Low birth weight	1.87 (1.84–1.90)	2.15 (2.05–2.25)	1.98 (1.94–2.01)	1.81 (1.77–1.85)	2.00 (1.88–2.14)	1.91 (1.86–1.96)
Macrosomia	1.25 (1.22–1.28)	1.00 (0.91–1.10)	1.17 (1.14–1.19)	1.26 (1.23–1.29)	1.01 (0.92–1.11)	1.18 (1.15–1.20)

	Schooling ≥ 12 (n = 1,431,296)
Preterm	1.61 (1.56–1.68)	1.77 (1.67–1.89)	1.72 (1.65–1.80)	–	–	–
Post-Term	0.71 (0.60–0.84)	0.48 (0.31–0.73)	0.70 (0.58–0.84)	–	–	–
Low Apgar: 1 min	1.30 (1.19–1.41)	1.23 (1.05–1.44)	1.44 (1.30–1.60)	1.12 (1.00–1.26)	0.99 (0.79–1.23)	1.29 (1.13–1.48)
Asphyxia	1.11 (0.95–1.30)	1.13 (0.83–1.53)	1.06 (0.88–1.27)	0.81 (0.64–1.03)	0.59 (0.34–1.04)	0.81 (0.62–1.06)
Low Apgar: 5 min	1.16 (1.04–1.28)	1.20 (0.99–1.45)	1.15 (1.02–1.30)	0.96 (0.83–1.11)	0.92 (0.69–1.22)	0.97 (0.82–1.15)
Low birth weight	1.70 (1.64–1.76)	1.96 (1.84–2.07)	1.84 (1.76–1.92)	1.57 (1.49–1.66)	1.76 (1.61–1.93)	1.71 (1.60–1.83)
Macrosomia	1.07 (1.02–1.13)	0.85 (0.75–0.96)	0.97 (0.91–1.02)	1.08 (1.03–1.14)	0.86 (0.76–0.97)	0.98 (0.92–1.04)

Outcome	Odds ratios (95% CI) Primiparous			Non-primiparous
	All women n = 1,940,267	Schooling < 12 n = 1,230,289	Schooling ≥ 12 n = 638,715	All women n = 3,029,136	Schooling < 12 n = 2,507,515	Schooling ≥ 12 n = 521,621
Low Apgar: 1 min	1.10 (0.96–1.26)	1.26 (1.07–1.48)	1.02 (0.81–1.29)	1.60 (1.51–1.70)	1.68 (1.58–1.79)	1.40 (1.21–1.62)
Asphyxia	1.01 (0.75–1.35)	1.39 (1.01–1.92)	0.54 (0.28–1.05)	1.20 (1.07–1.35)	1.29 (1.13–1.46)	0.95 (0.72–1.27)
Low Apgar: 5 min	1.04 (0.87–1.23)	1.17 (0.95–1.45)	0.99 (0.73–1.33)	1.38 (1.29–1.48)	1.49 (1.38–1.60)	1.07 (0.89–1.30)
Low birth weight	1.93 (1.82–2.06)	2.09 (1.92–2.26)	1.87 (1.70–2.06)	1.83 (1.77–1.89)	1.89 (1.82–1.96)	1.74 (1.61–1.87)
Macrosomia	0.91 (0.84–0.99)	0.99 (0.89–1.11)	0.88 (0.77–1.00)	1.12 (1.09–1.15)	1.16 (1.13–1.20)	0.99 (0.93–1.06)

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[1] *Corresponding author. E-mail: renan@peb.ufrj.br(R.M.V.R. Almeida).