6 research outputs found
Maternal age and severe maternal morbidity: A population-based retrospective cohort study
<div><p>Background</p><p>One of the United Nationsβ Millennium Development Goals of 2000 was to reduce maternal mortality by 75% in 15 y; however, this challenge was not met by many industrialized countries. As average maternal age continues to rise in these countries, associated potentially life-threatening severe maternal morbidity has been understudied. Our primary objective was to examine the associations between maternal age and severe maternal morbidities. The secondary objective was to compare these associations with those for adverse fetal/infant outcomes.</p><p>Methods and findings</p><p>This was a population-based retrospective cohort study, including all singleton births to women residing in Washington State, US, 1 January 2003β31 December 2013 (<i>n = </i> 828,269).</p><p>We compared age-specific rates of maternal mortality/severe morbidity (e.g., obstetric shock) and adverse fetal/infant outcomes (e.g., perinatal death). Logistic regression was used to adjust for parity, body mass index, assisted conception, and other potential confounders. We compared crude odds ratios (ORs) and adjusted ORs (AORs) and risk differences and their 95% CIs.</p><p>Severe maternal morbidity was significantly higher among teenage mothers than among those 25β29 y (crude OR = 1.5, 95% CI 1.5β1.6) and increased exponentially with maternal age over 39 y, from OR = 1.2 (95% CI 1.2β1.3) among women aged 35β39 y to OR = 5.4 (95% CI 2.4β12.5) among women aged β₯50 y. The elevated risk of severe morbidity among teen mothers disappeared after adjustment for confounders, except for maternal sepsis (AOR = 1.2, 95% CI 1.1β1.4). Adjusted rates of severe morbidity remained increased among mothers β₯35 y, namely, the rates of amniotic fluid embolism (AOR = 8.0, 95% CI 2.7β23.7) and obstetric shock (AOR = 2.9, 95% CI 1.3β6.6) among mothers β₯40 y, and renal failure (AOR = 15.9, 95% CI 4.8β52.0), complications of obstetric interventions (AOR = 4.7, 95% CI 2.3β9.5), and intensive care unit (ICU) admission (AOR = 4.8, 95% CI 2.0β11.9) among those 45β49 y. The adjusted risk difference in severe maternal morbidity compared to mothers 25β29 y was 0.9% (95% CI 0.7%β1.2%) for mothers 40β44 y, 1.6% (95% CI 0.7%β2.8%) for mothers 45β49 y, and 6.4% for mothers β₯50 y (95% CI 1.7%β18.2%). Similar associations were observed for fetal and infant outcomes; neonatal mortality was elevated in teen mothers (AOR = 1.5, 95% CI 1.2β1.7), while mothers over 29 y had higher risk of stillbirth. The rate of severe maternal morbidity among women over 49 y was higher than the rate of mortality/serious morbidity of their offspring. Despite the large sample size, statistical power was insufficient to examine the association between maternal age and maternal death or very rare severe morbidities.</p><p>Conclusions</p><p>Maternal age-specific incidence of severe morbidity varied by outcome. Older women (β₯40 y) had significantly elevated rates of some of the most severe, potentially life-threatening morbidities, including renal failure, shock, acute cardiac morbidity, serious complications of obstetric interventions, and ICU admission. These results should improve counselling to women who contemplate delaying childbirth until their forties and provide useful information to their health care providers. This information is also useful for preventive strategies to lower maternal mortality and severe maternal morbidity in developed countries.</p></div
The association between maternal age and severe maternal morbidity and adverse birth outcomes among singleton births, Washington State, US, 2003β2013.
<p>The association between maternal age and severe maternal morbidity and adverse birth outcomes among singleton births, Washington State, US, 2003β2013.</p
Maternal age-specific labor and delivery characteristics, singleton births, Washington State, US, 2003β2013.
<p>Maternal age-specific labor and delivery characteristics, singleton births, Washington State, US, 2003β2013.</p
Maternal mortality and severe maternal morbidity and rate per 10,000 singleton births, Washington State, US, 2003β2013.
<p>Maternal mortality and severe maternal morbidity and rate per 10,000 singleton births, Washington State, US, 2003β2013.</p
Age-specific rates of severe maternal morbidity and perinatal mortality/severe neonatal morbidity.
<p>(A) Unadjusted rates and (B) rates adjusted for demographic and pre-pregnancy factors; singleton births, Washington State, US, 2003β2013. Bars show 95% CIs.</p
Supplemental material for Canadian Stroke Best Practice Consensus Statement: <i>Acute Stroke Management during pregnancy</i>
<p>Supplemental material for Canadian Stroke Best Practice Consensus Statement: <i>Acute Stroke Management during pregnancy</i> by Noor Niyar N Ladhani, Richard H Swartz, Norine Foley, Kara Nerenberg, Eric E Smith, Gord Gubitz, Dariush Dowlatshahi, Jayson Potts, Joel G Ray, Jon Barrett, Cheryl Bushnell, Simerpreet Bal, Wee-Shian Chan, Radha Chari, Meryem El Amrani, Shital Gandhi, Michael D Hill, Andra James, Thomas Jeerakathil, Albert Jin, Adam Kirton, Sylvain Lanthier, Andrea Lausman, Lisa Rae Leffert, Jennifer Mandzia, Bijoy Menon, Aleksandra Pikula, Alexandre Poppe, Gustavo Saposnik, Mukul Sharma, Sanjit Bhogal, Elisabeth Smitko and M Patrice Lindsay; on behalf of the Heart and Stroke Foundation Canadian Stroke Best Practice and Quality Advisory Committees; in collaboration with the Canadian Stroke Consortium in International Journal of Stroke</p