Asocierea unor caracteristici medico-sociale cu vârsta maternă avansată

Rodica Scutelnic

doi:10.52673/18570461.24.3-74.03

Authors

Rodica Scutelnic Nicolae Testemițanu State University of Medicine and Pharmacy https://orcid.org/0009-0006-1081-3429

DOI:

https://doi.org/10.52673/18570461.24.3-74.03

Abstract

Over recent decades, there has been a significant change in population dynamics and perceptions of reproductive age. Improved educational and professional opportunities for women, together with social and cultural changes, medical progress and expanded access to effective contraception are factors that have contributed to delayed childbearing, with advanced maternal age being associated with poorer maternal and fetal outcomes. In a contemporary society, decisions regarding the timing of conception should be informed, with awareness and acceptance of the risks involved. The objective of this study is to evaluate the medical and social characteristics of pregnancies and childbirths in women of advanced maternal age and the association of these characteristics with age. A selective cross-sectional descriptive observational study (n=528) was conducted, examining the reciprocal relationship between medical-social variables associated with advanced reproductive age. Data were analyzed and summarized using descriptive statistics and inferential statistics (Chi-square), with significance established for the 95% confidence interval. Statistically significant differences were identified among several medical and social variables associated with advanced maternal age, such as preexisting chronic diseases, parity, and awareness on the risks related to advanced maternal age. The results of the study can serve as a foundation for future research aimed at identifying effective interventions to ensure risk management, prevent pregnancy and childbirth complications, and improve maternal-fetal outcomes in this category of women

References

1. United Nations Population Division D of E and SA. World fertility patterns 2015 – data booklet (ST/ESA/SER. A/370).

2. Hamilton, B.E., Martin, J.A., Osterman, M.J.K. Births: provisional data for 2019. In: NVSS Vital Stat Rapid Release. 2020;8:1-10.

3. Gagauz, O., Oceretnîi, A., Lupușor, A., Chistruga-Sînchevici, I., Spinei, L., Ciubotaru, V. Raportul Studiului Generații și Gen. Ch.: UNFPA, 2022. 476 p.

4. Ye, X., Baker, P.N., & Tong, C. The updated understanding of advanced maternal age. In: Fundamental Research, 2023 December, doi: https://doi.org/10.1016/j.fmre.2023.09.013

5. Bromer, J.G., Patrizio, P. Preservation and postponement of female fertility. In: Placenta, 2008 Oct;29 Suppl B:200-5, https://doi.org/10.1016/j.placenta.2008.07.005

6. Cooke, A., Mills, T.A., Lavender T. Advanced maternal age: delayed childbearing is rarely a conscious choice a qualitative study of women’s views and experiences. In: Int J Nurs Stud. Jan 2012;49(1):30-9, https://doi.org/10.1016/j.ijnurstu.2011.07.013

7. Cooke, A., Mills, T.A., Lavender, T. Informed and uninformed decision making’-women’s reasoning, experiences and perceptions with regard to advanced maternal age and delayed childbearing: a meta-synthesis. In: Int J Nurs Stud. 2010 Oct;47(10):1317-29, https://doi.org/10.1016/j.ijnurstu.2010.06.001

8. Mills, M., Rindfuss, R.R., McDonald, P., te Velde, E. ESHRE Reproduction and Society Task Force. Why do people postpone parenthood? Reasons and social policy incentives. In: Hum Reprod Update. 2011 Nov-Dec;17(6):848-60, https://doi.org/10.1093/humupd/dmr026

9. Chambers, G.M., Hoang, V.P., Illingworth, P.J. Socioeconomic disparities in access to ART treatment and the differential impact of a policy that increased consumer costs. In: Hum Reprod. 2013 Nov;28(11):3111-7, https://doi.org/10.1093/humrep/det302

10. van Roode, T., Sharples K., Dickson N., Paul C. Life-Course Relationship between Socioeconomic Circumstances and Timing of First Birth in a Birth Cohort. In: PLoS One. January 13, 2017;12(1), https://doi.org/10.1371/journal.pone.0170170

11. Carolan, M. The graying of the obstetric population: implications for the older mother. In: J Obstet Gynecol Neonatal Nurs., 2003 Jan-Feb;32(1):19-27, https://doi.org/10.1177/0884217502239797

12. Ales, K.L., Druzin, M.L., Santini, D.L. Impact of advanced maternal age on the outcome of pregnancy. In: Surg Gynecol Obstet. September 1990;171(3):209-16.

13. European Commission: eurostat. Fertility statistics, [online] https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Fertility_statistics (consultat: 10.03.2024).

14. Magnus, M.C., Wilcox, A.J., Morken, N.H., Weinberg, C.R., Håberg, S.E. Role of maternal age and pregnancy history in risk of miscarriage: prospective register based study. In: BMJ, 2019 Mar 20;364, https://doi.org/10.1136/bmj.l869

15. Frederiksen, L.E., Ernst, A., Brix N., et al. Risk of adverse pregnancy outcomes at advanced maternal age. In: Obstet Gynecol. March 2018;131(3):457-463, https://doi.org/10.1097/AOG.0000000000002504

16. Sheen, J.J., Wright J.D., Goffman, D., Kern-Goldberger, A.R., Booker W., Siddiq, Z., et al. Maternal age and risk for adverse outcomes. In: Am J Obstet Gynecol. 2018;219:390.e1-390.e15. https://doi.org/10.1016/j.ajog.2018.08.034

17. Rydahl, E., Declercq, E., Juhl M., Maimburg, R.D. Cesarean section on a rise – Does advanced maternal age explain the increase? A population register-based study. In: PLoS One. January 24, 2019;14(1), https://doi.org/10.1371/journal.pone.0210655

18. Koo, Y.J., Ryu, H.M., Yang, J.H., et al. Pregnancy outcomes according to increasing maternal age. In: Taiwan J Obstet Gynecol. 2012;51(1):60-65, https://doi.org/10.1016/j.tjog.2012.01.012

19. Ogawa, K., Urayama, K.Y., Tanigaki, S., et al. Association between very advanced maternal age and adverse pregnancy outcomes: a cross sectional Japanese study. In: BMC Pregnancy Childbirth. 2017;17:349, https://doi.org/10.1186/s12884-017-1540-0

20. Walsh, T., Barr, P.J., Thompson, R., Ozanne, E., O’Neill, C., Elwyn, G. Undetermined impact of patient decision support interventions on healthcare costs and savings: systematic review. In: BMJ. 2014 Jan 23;348, https://doi.org/10.1136/bmj.g188

21. O’Connor, A., O’Brien-Pallas, L.L. Decisional conflict. In: Mcfarlane GK, Mcfarlane EA, editors. Nursing diagnosis and intervention. Toronto: Mosby, 1989, 486-96.

22. Kowalewski, M., Jahn, A., Kimatta, S.S. Why do atrisk mothers fail to reach referral level? Barriers beyond distance and cost. In: Afr J Reprod Health, 2000; 4(1):100-109.

23. Gray, B.A. Hospitalization history and differences in self-rated pregnancy risk. In: West J Nurs Res. 2006;28(2):216-233, https://doi.org/10.1177/0193945905282305

24. Carolan, M.C. Towards understanding the concept of risk for pregnant women: some nursing and midwifery implications. In: J Clin Nurs. 2009;18(5):652-658, https://doi.org/10.1111/j.1365-2702.2008.02480.x

25. Heaman, M., Gupton, A., Gregory, D. Factors influencing pregnant women’s perceptions of risk. In: MCN Am J Matern Child Nurs. 2004 Mar;29(2):111-116, https://doi.org/10.1097/00005721-200403000-00010

26. Lee, S., Ayers S., Holden, D. A metasynthesis of risk perception in women with high risk pregnancies. In: Midwifery. 2014 Apr;30(4):403-411, https://doi.org/10.1016/j.midw.2013.04.010

27. Aref-Adib, M., Freeman-Wang, T., Ataullah, I. The older obstetric patient. In: Obstetr Gynaecol Reprod Med. 2008;18:43-8.

28. Newburn-Cook, C.V., Onyskiw, J.E. Is older maternal age a risk factor for preterm birth and fetal growth restriction? A systematic review. In: Health Care Women Int. 2005 Oct;26(9):852-75, https://doi.org/10.1080/07399330500230912

29. Suplee, P.D., Dawley, K., Bloch, J.R. Tailoring peripartum nursing care for women of advanced maternal age. In: J Obstet Gynecol Neonatal Nurs. 2007 NovDec;36(6):616-23, https://doi.org/10.1111/j.1552-6909.2007.00197.x

30. Huang, L., Sauve, R., Birkett, N., Fergusson, D., van Walraven, C. Maternal age and risk of stillbirth: a systematic review. In: CMAJ. 2008 Jan 15;178(2):165-72, https://doi.org/10.1503/cmaj.070150

31. Aldrighi, J.D., Wall M.L., Souza, S.R., Cancela, F.Z. The experiences of pregnant women at an advanced maternal age: an integrative review. In: Rev Esc Enferm USP. 2016 MayJun;50(3):512-521, https://doi.org/10.1590/S0080-623420160000400019

32. Li, Y., Townend J., Rowe, R., Knight M., Brocklehurst, P., Hollowell, J. The effect of maternal age and planned place of birth on intrapartum outcomes in healthy women with straightforward pregnancies: secondary analysis of the Birthplace national prospective cohort study. In: BMJ Open. 2014 Jan 17;4(1), https://doi.org/10.1136/bmjopen-2013-004026

33. Pettersson, M.L., Nedstrand, E., Bladh., M., Svanberg, A.S., Lampic, C., Sydsjö, G. Mothers who have given birth at an advanced age health status before and after childbirth. In: Sci Rep. 2020 Jun 16;10(1):9739, https://doi.org/10.1038/s41598-020-66774-4

34. Sauer, M.V. Reproduction at an advanced maternal age and maternal health. In: Fertil Steril. 2015 May;103(5):1136-1143, https://doi.org/10.1016/j.fertnstert.2015.03.004

35. Brehmer, L., Alexanderson, K., Schytt, E. Days of sick leave and inpatient care at the time of pregnancy and childbirth in relation to maternal age. In: Scand J Public Health. 2017;45:222-229, https://doi.org/10.1177/1403494817693456

36. Aasheim, V., Waldenström, U., Rasmussen, S., Espehaug, B., Schytt, E. Satisfaction with life during pregnancy and early motherhood in first-time mothers of advanced age: a population-based longitudinal study. In: BMC Pregnancy Childbirth. 2014 Feb 25;14:86, https://doi.org/10.1186/1471-2393-14-86

37. Aasheim, V., Waldenström, U., Hjelmstedt, A., Rasmussen, S., Pettersson, H., Schytt, E. Associations between advanced maternal age and psychological distress in primiparous women, from early pregnancy to 18 months postpartum. In: BJOG. 2012 Sep;119(9):1108-1116, https://doi.org/10.1111/j.1471-0528.2012.03411.x

38. Wang, Y., Tanbo, T., Abyholm, T., Henriksen, T. The impact of advanced maternal age and parity on obstetric and perinatal outcomes in singleton gestations. In: Arch Gynecol Obstet. 2011 Jan;284(1):31-37, https://doi.org/10.1007/s00404-010-1587-x

39. Figuerêdo, E.D., Lamy, Filho F., Lamy, Z.C., da Silva, A.A. Maternal age and adverse perinatal outcomes in a birth cohort (BRISA) from a Northeastern Brazilian city. In: Rev Bras Ginecol Obstet. 2014 Dec;36(12):562-568, https://doi.org/10.1590/so100-720320140005161

40. Joseph, K.S., Allen, A.C., Dodds, L., Turner, L.A., Scott, H., Liston, R. The perinatal effects of delayed childbearing. In: Obstet Gynecol. 2005 Jun;105(6):1410-1418, https://doi.org/10.1097/01.AOG.0000163256.83313.36

41. Schimmel, M.S., Bromiker, R., Hammerman, C., et al. The effects of maternal age and parity on maternal and neonatal outcome. In: Arch Gynecol Obstet. 2015 Apr;291(4):793-798, https://doi.org/10.1007/s00404-014-3469-0

42. Kotelchuck, M. Safe mothers, healthy babies: reproductive health in the twentieth century. In: Ward JW, Warren C, editors. Silent victories: the history and practice of public health in twentieth century America. Oxford: Oxford University Press; 2007:105-134.

43. WHO. Trends in Maternal Mortality: 1990–2013. Estimates by WHO, UNICEF, UNFPA, The World Bank and the United Nations Population Division. Geneva: World Health Organisation; 2014.

44. Myrskylä, M., Barclay, K., Goisis, A. Advantages of later motherhood. In: Gynakologe. 2017 Oct;50(10):767772, https://doi.org/10.1007/s00129-017-4124-1

45. Lee, C.S., Zhu S., Wu, Q., et al. Independent and joint associations of age, pre-pregnancy BMI, and gestational weight gain with adverse pregnancy outcomes in gestational diabetes mellitus. In: Diabetes Ther. 2023 Feb;14(2):363375, https://doi.org/10.1007/s13300-022-01352-7

46. Guarga, Montori, M., Álvarez, Martínez, A., Luna, Álvarez, C., Abadía, Cuchí, N., Mateo, Alcalá, P., Ruiz-Martínez, S. Advanced maternal age and adverse pregnancy outcomes: A cohort study. In: Taiwan J Obstet Gynecol 2021 Jan;60(1):119-124, https://doi.org/10.1016/j.tjog.2020.11.018

47. Li, H., Nawsherwan, Khan, A., Haq, I.U., Mei, S.Y. Do Hypertensive Disorders of Pregnancy and Abnormal Placentation Mediate the Association between Advanced Maternal Age and Adverse Perinatal Outcomes? In: Iran J Public Health 2022 May;51(5):1057-1066, https://doi.org/10.18502/ijph.v51i5.9421

48. Brown, H.K., McKnight A., Aker A. Association between pre-pregnancy multimorbidity and adverse maternal outcomes: A systematic review. In: J Multimorb Comorb 2022 Apr 30;12:26335565221096584, https://doi.org/10.1177/26335565221096584

49. Lu, L., Li, J.H., Dai, X.F., Wei, J.B., Chen, L.H., Hu, J.F. Impact of advanced maternal age on maternal and neonatal outcomes in preterm birth. In: Ginekol Pol 2022 Feb;93(2):134-141, https://doi.org/10.5603/GP.a2021.0224

50. Correa-de-Araujo, R., Yoon, S.S.S. Clinical outcomes in high-risk pregnancies due to advanced maternal age. In: J Womens Health (Larchmt) 2021 Feb;30(2):160-167, https://doi.org/10.1089/jwh.2020.8860

51. Mehari, M.A., Maeruf, H., Robles, C.C., et al. Advanced maternal age pregnancy and its adverse obstetrical and perinatal outcomes in Ayder comprehensive specialized hospital, Northern Ethiopia, 2017: a comparative cross-sectional study. In: BMC Pregnancy Childbirth. 2020 Jan 30;20(1):60, https://doi.org/10.1186/s12884-020-2740-6

52. Khalil, A., Syngelaki, A., Maiz N., Zinevich, Y., Nicolaides, K.H. Maternal age and adverse pregnancy outcome: a cohort study. In: Ultrasound Obstet Gynecol. 2013 Jun;42(6):634-643, https://doi.org/10.1002/uog.12494

53. Lim, C.C., Mahmood, T. Obesity in pregnancy. In: Best Pract Res Clin Obstet Gynaecol 2015 Mar;29(3):309319, https://doi.org/10.1016/j.bpobgyn.2014.10.008

54. Alwash, S.M., McIntyre, H.D., Mamun, A. The association of general obesity, central obesity and visceral body fat with the risk of gestational diabetes mellitus: Evidence from a systematic review and meta-analysis. In: Obes Res Clin Pract 2021 Sep;15(5):425-430, https://doi.org/10.1016/j.orcp.2021.07.005

55. Rasmussen, K.M., Yaktine, A.L., Institute of Medicine (US) and National Research Council (US) Committee to Reexamine IOM Pregnancy Weight Guidelines, eds. Weight gain during pregnancy: reexamining the guidelines. Washington, DC: National Academies Press; 2009.

56. Deputy, N.P., Sharma, A.J., Kim, S.Y., Hinkle, S.N. Prevalence and characteristics associated with gestational weight gain adequacy. In: Obstet Gynecol. 2015 Apr;125(4):773-781, https://doi.org/10.1097/AOG.0000000000000739

57. Johnson, J.L., Farr, S.L., Dietz, P.M., Sharma, A.J., Barfield, W.D., Robbins C.L. Trends in gestational weight gain: the Pregnancy Risk Assessment Monitoring System, 2000-2009. In: Am J Obstet Gynecol 2015 Jun;212(6):806. e1-806.e8068, https://doi.org/10.1016/j.ajog.2015.01.030

58. Frick, A.P. Advanced maternal age and adverse pregnancy outcomes. In: Best Pract Res Clin Obstet Gynaecol 2021 Jul;70:92-100, https://doi.org/10.1016/j.bpobgyn.2020.07.005

59. Lin, L., Lu C., Chen, W., Li C., Guo, V.Y. Parity and the risks of adverse birth outcomes: a retrospective study among Chinese. In: BMC Pregnancy Childbirth 2021 Mar;21(1):257, https://doi.org/10.1186/s12884-021-03718-4

60. Vandekerckhove, M., Guignard, M., Civadier, M.S., Benachi, A., Bouyer, J. Impact of maternal age on obstetric and neonatal morbidity: a retrospective cohort study. In: BMC Pregnancy Childbirth 2021 Oct;21(1):732, https://doi.org/10.1186/s12884-021-04177-7

61. Shechter-Maor, G., Sadeh-Mestechkin, D., Ganor Paz, Y., Sukenik Halevy, R., Markovitch, O., Biron-Shental, T. Does parity affect pregnancy outcomes in the elderly gravida? In: Arch Gynecol Obstet. 2020;301(1):85-91, https://doi.org/10.1007/s00404-019-05386-4

62. Muniro, Z., Tarimo, C.S., Mahande, M.J., Maro, E., Mchome, B. Grand multiparity as a predictor of adverse pregnancy outcome among women who delivered at a tertiary hospital in Northern Tanzania. In: BMC Pregnancy Childbirth. 2019 Jul 2;19(1):222, https://doi.org/10.1186/s12884-019-2377-5

63. Ben-David, A., Glasser, S., Schiff, E., Zahav, A.S., Boyko, V., Lerner-Geva, L. Pregnancy and birth outcomes among primiparae at very advanced maternal age: at what price? In: Matern Child Health J. 2016 Apr;20(4):833-842, https://doi.org/10.1007/s10995-015-1914-8

64. Glasser, S., Segev-Zahav, A., Fortinsky, P., Gedal-Beer, D., Schiff, E., Lerner-Geva, L. Primiparity at very advanced maternal age (≥ 45 years). In: Fertil Steril. 2011 Aug;95(8):2548-2551, https://doi.org/10.1016/j.fertnstert.2011.02.031

65. Usta, I.M., Nassar, A.H. Advanced maternal age. Part I: obstetric complications. In: Am J Perinatol. 2008 Aug;25(8):521-534, https://doi.org/10.1055/s-0028-1085620

66. Cohen, W. Does maternal age affect pregnancy outcome? In: BJOG. 2014 Mar;121(3):252-254, https://doi.org/10.1111/1471-0528.12563

67. Tyer-Viola, L.A., Lopez R.P. Pregnancy with chronic illness. In: J Obstet Gynecol Neonatal Nurs. 2014 Jan;43(1):25-37, https://doi.org/10.1111/1552-6909.12275

68. Jolly, M., Sebire, N., Harris, J., Robinson, S., Regan, L. The risks associated with pregnancy in women aged 35 years or older. In: Hum Reprod. 2000 Nov;15(11):24332437, https://doi.org/10.1093/humrep/15.11.2433

69. Cleary-Goldman, J., Malone, F.D., Vidaver, J., et al. Impact of maternal age on obstetric outcome. In: Obstet Gynecol. 2005 May;105(5 Pt 1):983-990, https://doi.org/10.1097/01.AOG.0000158118.75532.51

70. Schummers, L., Hutcheon, J.A., Hernandez-Diaz, S., et al. Association of short interpregnancy interval with pregnancy outcomes according to maternal age. In: JAMA Intern Med. 2018 Dec 1;178(12):1661-1670, https://doi.org/10.1001/jamainternmed.2018.4696

71. Dulitzki, M., Soriano D., Schiff, E., Chetrit, A., Mashiach, S., Seidman, D.S. Effect of very advanced maternal age on pregnancy outcome and rate of cesarean delivery. In: Obstet Gynecol. 1998 Jun;92(6):935-939, https://doi.org/10.1016/s0029-7844(98)00335-4