Journal Article

Advanced maternal age and adverse pregnancy outcomes: A systematic review and meta-analysis

Lean, Samantha C., Jones, Rebecca L., Heazell, Alexander E. P., Derricott, Hayley

2017

Overview

Advanced maternal age (AMA; ≥35 years) is an increasing trend and is reported to be associated with various pregnancy complications. To determine the risk of stillbirth and other adverse pregnancy outcomes in women of AMA. Embase, Medline (Ovid), Cochrane Database of Systematic Reviews, ClinicalTrials.gov, LILACS and conference proceedings were searched from ≥2000. Cohort and case-control studies reporting data on one or more co-primary outcomes (stillbirth or fetal growth restriction (FGR)) and/or secondary outcomes in mothers ≥35 years and <35 years. The effect of age on pregnancy outcome was investigated by random effects meta-analysis and meta-regression. Stillbirth rates were correlated to rates of maternal diabetes, obesity, hypertension and use of assisted reproductive therapies (ART). Out of 1940 identified titles; 63 cohort studies and 12 case-control studies were included in the meta-analysis. AMA increased the risk of stillbirth (OR 1.75, 95%CI 1.62 to 1.89) with a population attributable risk of 4.7%. Similar trends were seen for risks of FGR, neonatal death, NICU unit admission restriction and GDM. The relationship between AMA and stillbirth was not related to maternal morbidity or ART. Stillbirth risk increases with increasing maternal age. This is not wholly explained by maternal co-morbidities and use of ART. We propose that placental dysfunction may mediate adverse pregnancy outcome in AMA. Further prospective studies are needed to directly test this hypothesis.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adult / Age / Age factors / Analysis / Biology and Life Sciences / Births / Case studies / Complications / Data collection / Data processing / Developmental biology / Diabetes / Diabetes mellitus / Diabetes, Gestational - epidemiology / Diabetes, Gestational - physiopathology / Epidemiology / Female / Fetuses / Gynecology / Health aspects / Health risk assessment / Hospitals / Humans / Hypertension / Infant, Newborn / Maternal Age / Medical research / Medicine / Medicine and Health Sciences / Meta-analysis / Middle Aged / Morbidity / Mortality / Neonates / Obstetrics / Physical Sciences / Placenta / Preeclampsia / Pregnancy / Pregnancy complications / Pregnancy Complications - epidemiology / Pregnancy Complications - physiopathology / Pregnancy Outcome / Pregnant women / Regression analysis / Reproduction / Reproductive technologies / Research and Analysis Methods / Reviews / Risk analysis / Stillbirth / Stillbirth - epidemiology / Studies / Trends / Womens health