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

BACKGROUND: Advanced maternal age (AMA; ≥35 years) is an increasing trend and is reported to be associated with various pregnancy complications. OBJECTIVE: To determine the risk of stillbirth and other adverse pregnancy outcomes in women of AMA. SEARCH STRATEGY: Embase, Medline (Ovid), Cochrane Data...

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Autores principales: Lean, Samantha C., Derricott, Hayley, Jones, Rebecca L., Heazell, Alexander E. P.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5645107/
https://www.ncbi.nlm.nih.gov/pubmed/29040334
http://dx.doi.org/10.1371/journal.pone.0186287
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author Lean, Samantha C.
Derricott, Hayley
Jones, Rebecca L.
Heazell, Alexander E. P.
author_facet Lean, Samantha C.
Derricott, Hayley
Jones, Rebecca L.
Heazell, Alexander E. P.
author_sort Lean, Samantha C.
collection PubMed
description BACKGROUND: Advanced maternal age (AMA; ≥35 years) is an increasing trend and is reported to be associated with various pregnancy complications. OBJECTIVE: To determine the risk of stillbirth and other adverse pregnancy outcomes in women of AMA. SEARCH STRATEGY: Embase, Medline (Ovid), Cochrane Database of Systematic Reviews, ClinicalTrials.gov, LILACS and conference proceedings were searched from ≥2000. SELECTION CRITERIA: 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. DATA COLLECTION AND ANALYSIS: 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). MAIN RESULTS: 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. CONCLUSIONS: 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.
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spelling pubmed-56451072017-10-30 Advanced maternal age and adverse pregnancy outcomes: A systematic review and meta-analysis Lean, Samantha C. Derricott, Hayley Jones, Rebecca L. Heazell, Alexander E. P. PLoS One Research Article BACKGROUND: Advanced maternal age (AMA; ≥35 years) is an increasing trend and is reported to be associated with various pregnancy complications. OBJECTIVE: To determine the risk of stillbirth and other adverse pregnancy outcomes in women of AMA. SEARCH STRATEGY: Embase, Medline (Ovid), Cochrane Database of Systematic Reviews, ClinicalTrials.gov, LILACS and conference proceedings were searched from ≥2000. SELECTION CRITERIA: 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. DATA COLLECTION AND ANALYSIS: 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). MAIN RESULTS: 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. CONCLUSIONS: 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. Public Library of Science 2017-10-17 /pmc/articles/PMC5645107/ /pubmed/29040334 http://dx.doi.org/10.1371/journal.pone.0186287 Text en © 2017 Lean et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Lean, Samantha C.
Derricott, Hayley
Jones, Rebecca L.
Heazell, Alexander E. P.
Advanced maternal age and adverse pregnancy outcomes: A systematic review and meta-analysis
title Advanced maternal age and adverse pregnancy outcomes: A systematic review and meta-analysis
title_full Advanced maternal age and adverse pregnancy outcomes: A systematic review and meta-analysis
title_fullStr Advanced maternal age and adverse pregnancy outcomes: A systematic review and meta-analysis
title_full_unstemmed Advanced maternal age and adverse pregnancy outcomes: A systematic review and meta-analysis
title_short Advanced maternal age and adverse pregnancy outcomes: A systematic review and meta-analysis
title_sort advanced maternal age and adverse pregnancy outcomes: a systematic review and meta-analysis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5645107/
https://www.ncbi.nlm.nih.gov/pubmed/29040334
http://dx.doi.org/10.1371/journal.pone.0186287
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