Preeclampsia complicated by advanced maternal age: a registry-based study on primiparous women in Finland 1997–2008
Preeclampsia is a frequent syndrome and its cause has been linked to multiple factors, making prevention of the syndrome a continuous challenge. One of the suggested risk factors for preeclampsia is advanced maternal age. In the Western countries, maternal age at first delivery has been steadily increasing, yet few studies have examined women of advanced maternal age with preeclampsia. The purpose of this registry-based study was to compare the obstetric outcomes in primiparous and preeclamptic women younger and older than 35 years.
The registry-based study used data from three Finnish health registries: Finnish Medical Birth Register, Finnish Hospital Discharge Register and Register of Congenital Malformations. The sample contained women under 35 years of age (N = 15,437) compared with those 35 and over (N = 2,387) who were diagnosed with preeclampsia and had their first singleton birth in Finland between 1997 and 2008. In multivariate modeling, the main outcome measures were Preterm delivery (before 34 and 37 weeks), low Apgar score (5 min.), small-for-gestational-age, fetal death, asphyxia, Cesarean delivery, induction, blood transfusion and admission to a Neonatal Intensive Care Unit.
Women of advanced maternal age (AMA) exhibited more preeclampsia (9.4%) than younger women (6.4%). They had more prior terminations (<0.001), were more likely to have a body mass index (BMI) >25 (<0.001), had more in vitro fertilization (IVF) (<0.001) and other fertility treatments (<0.001) and a higher incidence of maternal diabetes (<0.001) and chronic hypertension (<0.001). Multivariate logistic regression indicated that women of AMA had higher rates of: preterm delivery before 37 weeks 19.2% (OR 1.39 CI 1.24 to 1.56) and before 34 weeks 8.7% (OR 1.68 CI 1.43 to 2.00) low Apgar scores at 5 min. 7.1% (OR 1.37 CI 1.00 to 1.88), Small-for-Gestational Age (SGA) 26.5% (OR 1.42 CI 1.28 to 1.57), Asphyxia 12.1% (OR 1.54 CI 1.34 to 1.77), Caesarean delivery 50% (OR 2.02 CI 1.84 to 2.20) and admission to a Neonatal Intensive Care Unit (NICU) 31.6% (OR 1.45 CI 1.32 to 1.60).
Preeclampsia is more common in women with advanced maternal age. Advanced maternal age is an independent risk factor for adverse outcomes in first-time mothers with preeclampsia.
- Benzies KM: Advanced maternal age: are decisions about the timing of child-bearing a failure to understand the risks? Can Med Assoc J 2008,178(2):183–184. CrossRef
- Bayrambour H, Heaman M: Advanced maternal age and the risk of Cesarean birth: a systematic review. Birth 2010,37(3):219–226. CrossRef
- The National Institute for Health and Welfare. 2010. Available at: http://www.stakes.fi/tilastot/tilastotiedotteet/2010/Tr26_10.pdf (retrieved April 14, 2011).
- Cleary-Goldman J: Impact of maternal age on obstetric outcome. Obstet Gynecol 2005,105(5):983–990. CrossRef
- Jacobsson B: Advanced Maternal age and adverse perinatal outcome. Obstet Gynecol 2004,104(4):727–733. CrossRef
- Jolly M, Sebire N, Harris J, Robinson S, Regan L: The risks associated with pregnancy in women aged 35 years or older. Hum Reproduction 2000, 15:2433–2437. CrossRef
- Ozalp S, Tanir HM, Sener T, Yaza S, Keskin AE: Health risks for early (or =35) childbearing. Arch Gynecol Obstet 2003,268(3):172–174. CrossRef
- Hsieh TT, Liou JD, Hsu JJ, Lo LM, Chen SF, Hung TH: Advanced maternal age and adverse perinatal outcomes in an Asian population. Eur J Obstet Gynecol Reprod Biol 2010, 148:21–26. CrossRef
- Joseph KS, Allen AC, Dodds L, Turner LA, Scott H, Liston R: The Perinatal effects of delayed childbearing. Obstet Gynecol 2005,105(6):1410–1418. CrossRef
- Bell JS: Can obstetric complications explain the high levels of obstetric interventions and maternity service use among older women? A retrospective analysis of routinely collected data. BJOG. An International Journal of Obstetrics and Gynaecology 2001,108(9):910–918.
- Hutcheon JA, Lisonkiva S, Joseph KS: Epidemiology of pre-eclampsia and the other hypertensive disorder of pregnancy. Best Pract Res Clin Obstet Gynaecol 2011, 25:391–403. CrossRef
- Turner JA: Diagnosis and management of preeclampsia: an update. International Journal of Women’s Health 2010, 2:327–337. CrossRef
- Villar J, Carroli G, Wojdyla D, Abalos E, Giordano D, Ba’aqeel H, Farnot U, Bergsjo P, Bakketeig L, Lumbiganon P, Campodonico L, Al-Mazrou Y, Lindheimer M, Kramer M: Preeclampsia, gestational hypertension and intrauterine growth restriction, related or independent conditions? Am J Obstet Gynecol 2006, 194:921–931. CrossRef
- The National Institute for Health and Welfare 2010. Available at: http://www.stakes.fi/FI/tilastot/tausta/Laatuselosteet/syntymarekisteri.htm (retrieved April 14, 2011)
- The National Institute for Health and Welfare 2011. Available at: http://www.stakes.fi/FI/tilastot/tausta/Laatuselosteet/hilmoraportit.htm (retrieved April 14, 2011)
- The National Institute for Health and Welfare 2011. Available at: http://www.stakes.fi/FI/tilastot/tausta/Laatuselosteet/epamuodostumarekisteri.htm (retrieved April 14, 2011)
- Heinonen S, Taipale P, Saarikoski S: Weights for placentae from small-for-gestational age infants revisited. Placenta 2001, 22:399–404. CrossRef
- Hoffman NC, Jeffers S, Carter J, Duthely L, Cotter A, González-Quintero VH: Pregnancy at or beyond age 40 years is associated with an increased risk of fetal death and other adverse outcomes. Am J Obstet Gynecol 2007,196(5):e11-e13. CrossRef
- Nybo Andersen AM, Wohlfahrt J, Christens P, Olsen J, Melbye M: Maternal age and fetal loss: population-based register linkage study. Br Med J 2000, 320:1708. CrossRef
- Segev Y, Riskin-Mashiah S, Lavie S, Auslender R: Assisted reproductive technologies: medical safety issues in the older woman. J Womens Health 2011,20(6):853–861. CrossRef
- Ness RB, Zhang J, Bass D, Klebanoff MA: Interactions between smoking and weight in pregnancies complicated by preeclampsia and small-for-gestational-age birth. Am J Epidemiol 2008,168(4):427–433. CrossRef
- Luke B, Brown M: Elevated risks of pregnancy complications and adverse outcomes with increasing maternal age. Hum Reprod 2007,22(5):1264–1272. CrossRef
- Zeitlin JA, Ancel PY, Saurel-Cubizolles MJ, Papiernik E: Are risk factors the same for small for gestational age versus other preterm births? Am J Obstet Gynecol 2001,185(1):208–215. CrossRef
- McIntyre SF, Newburn-Cook CV, O’Brien B, Demianczuk NN: Effect of older maternal age on the risk of spontaneous preterm labor: a population based study. Health Care Women Int 2009, 30:670–689. CrossRef
- Newburn-Cook CV, Onyskiw JE: Is older maternal age a risk factor for preterm birth and fetal growth restriction? A systematic review. Health Care Women Int 2005, 26:852–875. CrossRef
- Miranda M, Swamy G, Edwards S, Maxson P, Gelfand A, James S: Disparities in maternal hypertension and pregnancy outcomes: evidence from North Carolina, 1994–2003. Public Health Rep 2010, 125:579–587.
- Cunningham FG, Leveno KJ: N Engl J Med. 1995,333(15):1002–1003. CrossRef
- Gissler M, Haukka J: Finnish health and social welfare registers in epidemiological research. Norsk Epidemiologi 2004,14(1):113–120.
- Lain S, Hadfield R, Raynes-Greenow C, Ford J, Mealing N, Algert C, Roberts C: Quality of data in perinatal population health databases: a systematic review. Medical Care 2012,50(4):7–20. CrossRef
- Gruslin A, Lemyre B: Pre-eclampsia: Fetal assessment and neonatal outcomes. Best Pract Res Clin Obstet Gynaecol 2011, 25:491–507. CrossRef
- Conde-Agudelo A: Supplementation with vitamins C and E during pregnancy for the prevention of preeclampsia and other adverse maternal and perinatal outcomes: a systematic review and meta-analysis. Am J Obstet Gynecol 2011,204(6):503–512. CrossRef
- Bujold E, Roberge S, Lacasse Y, Bureau M, Audibert F, Marcoux S, Forest J, Giquére Y: Prevention of preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy: a meta-analysis. Obstet Gynecol 2010,116(1):402–414. CrossRef
- The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2393/12/47/prepub
- Preeclampsia complicated by advanced maternal age: a registry-based study on primiparous women in Finland 1997–2008
- Open Access
- Available under Open Access This content is freely available online to anyone, anywhere at any time.
BMC Pregnancy and Childbirth
- Online Date
- June 2012
- Online ISSN
- BioMed Central
- Additional Links
- Author Affiliations
- 1. Department of Nursing Science, University of Eastern Finland, PO. Box. 1627, Kuopio, 70211, Finland
- 2. Department of Nursing Science, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
- 3. National Institute for Health and Welfare (THL), Gothenburg, Sweden
- 4. Nordic School for Public Health, Helsinki, Finland
- 5. Department of Obstetrics and Gynaecology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland