• About Us
    • Contact Us
    • Login
    • ObGFirst
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • COVID-19
About Us Contact Us Login ObGFirst
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • COVID-19
Grand Rounds

Advanced Maternal Age and Associated Severe Maternal Morbidity

image_pdfFavoriteLoadingFavorite

BACKGROUND AND PURPOSE:

  • Maternal age is increasing in developed countries
  • Aoyama et al. (JAMA Netw. Open, 2019) examined the association between maternal age and severe maternal morbidity (SMM) as well as maternal death

METHODS:

  • Nationwide population-based cohort study (2004 to 2015)
  • Participants
    • All antepartum, peripartum, and postpartum women and adolescents seen at Canadian acute care hospitals
  • Exposures
    • Maternal age at the index delivery
  • Risk adjustment: Maternal Comorbidity Index used to adjust for differing baseline characteristics (only preexisting conditions included)
  • ART data was not available for this study
  • Primary outcomes (during pregnancy and within 6 weeks after termination of pregnancy)
    • Severe maternal morbidity | Maternal death

RESULTS:

  • 3,162,303 pregnancies
    • Mean maternal age: 29.5 years
    • 3,533,259 related hospital admissions
  • Severe maternal morbidity episodes: 17.7 cases per 1000 deliveries
    • 9.8% relative increase from 2004-2005 to 2014-2015
    • Increasing proportion of pregnancies were to older mothers
    • 2.4% events were antepartum period, including ectopic pregnancies
    • Most common causes: PPH | Sepsis | Cardiac failure  

Severe maternal morbidity: Independent patient-level factors

  • Increasing Maternal Comorbidity Index
  • Maternal age: ≤19 years or ≥30 years
  • Greatest patient-level risk factors for severe morbidity
    • Maternal age ≥45 years vs 20 to 24 years: Odds ratio (OR) 2.69 (95% CI, 2.34 to 3.06)
    • Lowest income quintile vs highest income quintile: OR 1.19 (95% CI, 1.14 to 1.22)
  • On subgroup analysis, parity did not alter the above findings

Maternal mortality: Independent patient-level factors

  • Increasing Maternal Comorbidity Index
  • Age 40 to 44 years vs 20-24 years: OR, 3.39 (95% CI, 1.68 to 6.82)
  • Greatest patient-level risk factors for mortality
    • ≥45 years vs 20 to 24 years: OR 4.39 (95% CI, 1.01 to 19.10)
    • Lowest income quintile vs highest income quintile: OR, 4.14 (95% CI, 2.03 to 8.50)

Note: Hospital-level factors associated with maternal morbidity included province of residence and risk factors for mortality included lowest hospital pregnancy volume

CONCLUSION:

  • Maternal age and severe maternal morbidity have increased over the past 10 years in Canada and authors note similar trends in the US (although lower rates for maternal mortality)
  • This study supports comorbidities, income level and maternal age, especially ≥45 years, as independent risk factors for severe maternal morbidity and mortality
  • The authors state

While not the most common causes of SMM, respiratory illness and cardiac illness are associated with a high risk of harm and death and should be an important focus for quality improvement initiatives, especially in older mothers (aged ≥35 years).

Learn More – Primary Sources:

Association of Maternal Age With Severe Maternal Morbidity and Mortality in Canada

Now You Can Get ObG Clinical Research Summaries Direct to Your Phone, with ObGFirst

Learn More  »

image_pdfFavoriteLoadingFavorite
< Previous
All Grand Rounds Posts
Next >

Related ObG Topics:

Maternal Age: What is the Impact on Stillbirth and Other Adverse Pregnancy Outcomes?
Maternal Age 45 and Over – What is the Impact on Maternal and Newborn Health?
How Do Maternal Age and Pregnancy History Affect Risk of Miscarriage?

Sections

  • Alerts
  • OB
  • GYN
    • GYN
    • Sexual Health
  • 2T US Atlas
  • The Genome
  • Primary Care
  • Your Practice
  • Grand Rounds
  • My Bookshelf
  • COVID-19

Are you an
ObG Insider?

Get specially curated clinical summaries delivered to your inbox every week for free

  • Site Map/
  • © ObG Project/
  • Terms and Conditions/
  • Privacy/
  • Contact Us/
© ObG Project
SSL Certificate


  • Already an ObGFirst Member?
    Welcome back

    Log In

    Want to sign up?
    Get guideline notifications
    CME Included

    Sign Up

Sign In

Lost your password?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

ObGFirst Free Trial

Already a Member of ObGFirst®?

Please log in to ObGFirst to access the 2T US Atlas

Password Trouble?

Not an ObGFirst® Member Yet?

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!
ObGFirst Free Trial

Media - Internet

Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Jointly provided by

NOT ENOUGH CME HOURS

It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan

Subscribe

JOIN OBGFIRST AND GET CME/CE CREDITS

One of the benefits of an ObGFirst subscription is the ability to earn CME/CE credits from the ObG entries you read. Tap the button to learn more about ObGFirst

Learn More
Leaving ObG Website

You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site