Impact of extreme maternal age on neonatal outcomes

Authors

  • Rina J. Rasamoelison Department of Neonatalogy, Befelatanana Maternity, Antananarivo, Madagascar http://orcid.org/0000-0003-4099-0312
  • Setra H. Rambeloson Department of Neonatalogy, Tsaralalana Mother-Child Universitary Hospital, Antananarivo, Madagascar
  • Hanitriniaina S. C. Samena Department of Pediatrics, Tsaralalana Mother-Child Universitary Hospital, Antananarivo, Madagascar
  • Annick L. Robinson Department of Pediatrics, Tsaralalana Mother-Child Universitary Hospital, Antananarivo, Madagascar Faculty of Medicine, Antananarivo, Madagascar

DOI:

https://doi.org/10.18203/2349-3291.ijcp20222760

Keywords:

Maternal age, Neonates, Outcomes, Relative risk

Abstract

Background: Pregnancies at extreme ages of reproductive life are considered to be at high risk for mother and neonate. The aim of the study was to determine neonatal risks associated with extreme maternal age.

Methods: A retrospective cohort study was conducted at Befelatanana Maternity covering the period from 1 January to 31 December 2018. Data was collected from neonate’s medical files.

Results: Of 789 neonates from mothers with extreme age included, 64.7% were from mothers under the age of 18, and 35.3% from mothers aged 40 and over. They were compared to 519 neonates from mothers aged 20-30. Maternal age under 18 was a risk factor for Apgar index below 7 at the 5th minute RR 1.69 (95% CI 1.17, 2.44), preterm birth RR 2.19 (95% CI 1.70, 2.80), low birthweight RR 2.03 (95% CI 1.53, 2.53) and admission to neonatalogy RR 2.64 (95% CI 2.20, 3.16). Also, the neonatal risks of pregnancy after 40 years were fetal death in utero RR 2.97 (95% CI 1.51, 5.85), low birthweight RR 2.47 (95% CI 1.97, 3.10), preterm birth RR 2.85 (95% CI 2.21, 3.68), and admission to Neonatalogy RR 3.06 (95% CI 2.54, 3.68).

Conclusions: The extreme age of the mother is therefore a risk of neonatal adverse outcomes. Rigorous prenatal follow-up is needed for these high-risk pregnancies.

References

Machado CJ. Impact of maternal age on birth outcomes: a population-based study of primiparous Brazilian women in the city of São Paulo. J Biosoc Sci. 2006;38(4):523-35.

Chen X-K, Wen SW, Fleming N, Demissie K, Rhoads GG, Walker M. Teenage pregnancy and adverse birth outcomes: a large population based retrospective cohort study. Int J Epidemiol. 2007;36(2):368-73.

Bouzaglou A, Aubenas I, Abbou H, Rouanet S, Carbonnel M, Pirtea P, et al. Pregnancy at 40 years Old and Above: Obstetrical, Fetal, and Neonatal Outcomes. Is Age an Independent Risk Factor for Those Complications?. Front Med. 2020;7:208.

Van Katwijk C, Peeters LLH. Clinical aspects of pregnancy after the age of 35 years: a review of the literature. Hum Reprod. 1998;4:185-94.

Bateman BT, Simpson LL. Higher rate of stillbirth at the extremes of reproductive age: a large nationwide sample of deliveries in the United States. Am J Obstet Gynecol. 2006;194(3):840-5.

World Health Organization. Adolescent health. Available at: https://apps.who.int/gb/ebwha/pdf_files/ WHA68/A68_15-en.pdf. Accessed on 16 December 2019

Yakam JCT. For a comprehensive approach to reproductive health of adolescents in Africa. Nat Sci Soc. 2009;17(1):18-28.

National Institute of Statistics of Madagascar. Madagascar Demographic and Health Survey 2008-2009. INSTAT. 2010. Available at: https://www.dhsprogram.com/pubs/pdf/FR236/FR236.pdf. Accessed on 16 December 2019.

Rakotomalala NZ, Rakotozanany B, Razafindraibe AF, Ramarokoto MPM, Rafamatanantsoa JF, Kapche WE, et al. Pregnancy and childbirth in women aged 40 and over at befelatanana maternity, Madagascar. Arch Pathol Clin Res. 2019;3(1):22-7.

Gravena AAF, Paula MG de, Marcon SS, Carvalho MDB de, Pelloso SM. Maternal age and factors associated with perinatal outcomes. Acta Paul Enferm. 2013;26(2):130-5.

Weng Y-H, Yang C-Y, Chiu Y-W. Risk Assessment of Adverse Birth Outcomes in Relation to Maternal Age. PloS One. 2014;9(12):e114843.

Tabcharoen S, Pinjaroen S, Suwanrath, Krisanapan O. Pregnancy outcome after age 40 and risk of low birth weight. J Obstet Gynaecol. 2009;29(5):378-83.

Aldous MB, Edmonson MB. Maternal age at first childbirth and risk of low birth weight and preterm delivery in Washington State. JAMA 1993;270:2574-7.

Jadhav CR, Srinivasamurthy BC, Bhat RV, Agrawal V, Kumar H. Placental pathology in low birth weight babies a prospective observational study. Indian J Pathol Oncol. 2018;5(2):178-83.

Lean SC, Heazell AEP, Dilworth MR, Mills TA, Jones RL. Placental Dysfunction Underlies Increased Risk of Fetal Growth Restriction and Stillbirth in Advanced Maternal Age Women. Sci Rep. 2017; 7(1):9677.

Aras RY. Is maternal age risk factor for low birth weight? Arch Med Health Sci. 2013;1(1):33-7.

Hayward CE, Greenwood SL, Sibley CP, Baker PN, Challis JRG, Jones RL. Effect of maternal age and growth on placental nutrient transport: potential mechanisms for teenagers’ predisposition to small-for-gestational-age birth? Am J Physiol Endocrinol Metab. 2012;302(2):E233-42.

Kassa GM, Arowojolu AO, Odukogbe, Yalew AW. Adverse neonatal outcomes of adolescent pregnancy in Northwest Ethiopia. PLoS One. 2019;14(6): e0218259.

Khoshnood B, Bouvier-Colle M-H, Leridon H, Blondel B. Impact of advanced maternal age on fecundity and women’s and children’s health. Revue Sage-Femme. 2008;37(8):733-47.

Joseph KS, Allen AC, Dodds L, Turner LA, Scott H, Liston R. The perinatal effects of delayed childbearing. Obstet Gynecol. 2005;105(6):1410-8.

Jahromi BN, Husseini Z. Pregnancy outcome at maternal age 40 and older. Taiwan J Obstet Gynecol. 2008;47(3):318-21.

Kampo MI, Sogoba S, Kassogué D, Konaté I, Ongoiba O, Sissoko D, et al. Maternal and perinatal prognosis of eclampsia at the Timbuktu Hospital in Mali. Pan Afr Med J. 2020;36:175.

Collange O, Launoy A, Kopf-Pottecher A, Dietemann JL, Pottecher T. Eclampsia. Ann Fr Anesth Reanim. 2010;29(4):e75-82.

Igboanugo S, Chen A, Mielke JG. Maternal risk factors for birth asphyxia in low-resource communities. A systematic review of the literature. J Obstet Gynaecol. 2020;40(8):1039-55.

Jido TA. Eclampsia: maternal and fetal outcome. Afr Health Sci. 2012;12(2):148-52.

Berhe YZ, Kebedom AG, Gebregziabher L, Assefa NE, Berhe LZ, Mohammednur SA, et al. Risk Factors of Birth Asphyxia Among Neonates Born in Public Hospitals of Tigray, Northern Ethiopia. Pediatric Health Med Ther. 2020;11:13-20.

Woday A, Muluneh A, St Denis C. Birth asphyxia and its associated factors among newborns in public hospital, northeast Amhara, Ethiopia. PLoS One. 2019;14(12):e0226891.

Tasew H, Zemicheal M, Teklay G, Mariye T, Ayele E. Risk factors of birth asphyxia among newborns in public hospitals of Central Zone, Tigray, Ethiopia 2018. BMC Res Notes. 2018;11(1):496.

Heinonen S, Saarikoski S. Reproductive risk factors of fetal asphyxia at delivery. J Clin Epidemiol. 2001;54(4):407-10.

Tebeu PM, Major AL, Ludicke F, Obama MT, Kouam L, Doh AS. Outcome of delivery at extreme ages of reproductive life. Rev Med Liège. 2004;59(7-8):455-9.

Jacobsson B, Ladfors L, Milsom I. Advanced maternal age and adverse perinatal outcome. Obstet Gynecol. 2004;104(4):727-33.

Reddy UM, Ko CW, Willinger M. Maternal age and the risk of stillbirth throughout pregnancy in the United States. Am J Obstet Gynecol. 2006;195(3):764-70.

Downloads

Published

2022-10-27

Issue

Section

Original Research Articles