What is the Contribution of Maternal Age Compared to Fetal Number When it Comes to Hypertensive Disorders in Pregnancy?
BACKGROUND AND PURPOSE:
Gestational hypertension and preeclampsia rates have increased
Maternal age and multifetal pregnancies have also increased during the same time frame
There is limited data on the effects of maternal age in the context of multifetal gestation
Smith et al. (American Journal of Perinatology 2018) compared the differential contribution and the interaction of fetal number and maternal age to the risk of hypertensive disorders of pregnancy (HDP)
Secondary analyses of the NICHD cesarean registry
Well designed, prospective, multicentered cohort
Participants: Women who had a previous primary cesarean section with singleton, twin, or triplet gestations
Patients were assorted into groups based on
The primary outcome was HDP
HDP: Gestational hypertension, preeclampsia, eclampsia, or HELLP
Incidence of HDP was compared with the reference group and within exposure groups
Logistic regression was used to adjust for confounders
70,417 women were included in the study
HDP occurred in 8,079 (12%) women
The frequency of HDP among the comparison groups ranged from 11 to 38%
When compared with the young maternal age (<35 years) group, the risk of HDP did not increase with maternal age when fetal number was similar until ≥ 40 years
Twin and triplet gestations increased risk for HDP, irrespective of maternal age
Highest risk groups
Advanced maternal age (>35 years) women with twins (OR: 2.0; 95% CI: 1.62–2.57; p < 0.0001)
Advanced maternal age triplets (OR: 2.5; 95% CI: 1.24–5.15; p = 0.012)
Women > 40 years with twins (OR: 3.1; 95% CI: 1.9–4.99; p < 0.0001)
Women > 40 years with triplets (OR: 5.6; 95% CI: 1.32–23.37; p = 0.019)
The authors recognize that they were unable to adjust for nulliparity due to original study design (prior history of cesarean section) which is a significant risk for HDP
The risk of HDP did not significantly increase with maternal age until >40 years of age
Larger number of fetuses per pregnancy increased risk for HDP
This information may be helpful in counseling women
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