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Older maternal age increases risk of severe morbidity
The risk for potentially life-threatening morbidity increases rapidly among mothers aged older than 39 years; among women more than 50 years old, the rate of severe maternal morbidity may be higher than the rate of mortality/serious morbidity of their offspring.
The data were published in PLOS Medicine.
“The current counseling with respect to delayed childbearing focuses mainly on increased fertility problems, risk for miscarriage, fetal and newborn death and neonatal morbidity. And while severe adverse conditions in mothers are rare, they do increase with age more rapidly at childbirth in late forties or later. It is important to counsel women about all potential risks and our study provides detailed information,” Sarka Lisonkova, MD, PhD, from the department of obstetrics and gynecology and the School of Population and Public Health at the University of British Columbia, told Healio Family Medicine.
In this population-based, retrospective cohort study, researchers compared age-specific rates of maternal mortality/severe morbidity with those for adverse fetal/infant outcomes using data from all singleton births among women living in Washington state between 2003 and 2013. Using logistic regression, adjusted for parity, BMI, assisted conception and other confounders, they measured crude ORs, adjusted ORs and risk differences.
Analysis showed that severe maternal morbidity increased exponentially with maternal age older than 39 years. Compared with women aged 35 to 39 years (crude OR = 1.2; 95% CI, 1.2-1.3), the odds of maternal morbidity among those aged 50 years and older increased significantly (OR = 5.4; 95% CI, 2.4-12.5).
After adjustment for confounders, the elevated risk for severe morbidity among teenage mothers disappeared, excluding maternal sepsis; however, the risk remained high among mothers aged 35 years and older, especially the rates of amniotic fluid embolism, obstetric shock, renal failure, complication of obstetric interventions and ICU admission. Compared with mothers aged 25 to 29 years, the adjusted risk difference in severe maternal morbidity was 0.9% (95% CI, 0.7–1.2) for those aged 40 to 44 years, 1.6% (95% CI 0.7–2.8) for those aged 45 to 49 years and 6.4% for those aged 50 years and older (95% CI 1.7–18.2). Assessment of fetal and infant outcomes showed similar associations. Neonatal mortality was higher in teen mothers (aOR = 1.5; 95% CI, 1.2–1.7) and mothers aged older than 29 years had increased risk of stillbirth. Also among teenage mothers, severe morbidity was higher than those aged 25 to 29 years (OR = 1.5; 95% CI, 1.5-1.6).
“Our study adds new information on maternal age-specific rates of severe morbidities that have a high case-fatality rate, lead to organ damage, or have serious health implications such as hysterectomy,” Lisonkova told Healio Family Medicine. “Our study also adds the information on the rates of any severe adverse birth outcome — for baby or mom — in the association with maternal age, which is important for counseling.” – by Savannah Demko
Disclosures: Lisonkova reports no relevant financial disclosures. Please see the full study for a complete list of all other authors’ relevant financial disclosures.