Maternal Morbidity Rises Sharply in Older Mothers

Troy Brown, RN

May 31, 2017

The risk for potentially life-threatening maternal morbidity, including renal failure, shock, amniotic fluid embolism, and cardiac morbidity, rises sharply among mothers older than 39 years, a new study has found. Moreover, for women 49 years or older, the rate of severe maternal morbidity may be higher than the rate of mortality or serious morbidity among their offspring.

"Counselling of older mothers should include information on both fetal/neonatal risks and maternal risks. Health care providers should be aware of the severe morbidities that can arise among older mothers and that can impact obstetrical care delivery and resource utilization during labor, delivery, and postpartum," the researchers write.

Sarka Lisonkova, MD, PhD, from the Department of Obstetrics and Gynaecology at the University of British Columbia in Vancouver, Canada, and colleagues report their findings in an article published online May 30 in PLOS Medicine.

The population-based retrospective cohort study included 828,269 singleton births among women aged 15 to 60 years residing in Washington State between January 1, 2003, and December 31, 2013. The researchers analyzed data from two linked population databases: live birth/fetal death certificates, which include data on demographics and pregnancy and birth characteristics, and hospitalization files, which include specific maternal and infant morbidity data.

They compared age-specific rates of maternal mortality and severe morbidity among women aged 15 to 19 years, 20 to 24 years, 25 to 29 years (reference category), 30 to 34 years, 35 to 39 years, 40 to 44 years, and 45 to 49 years. The investigators adjusted for potential confounders including parity, body mass index, and assisted conception.

The adjusted risk difference in overall severe maternal morbidity climbed as women got older compared with mothers aged 25 to 29 years: 0.9% (95% confidence interval [CI], 0.7% - 1.2%) for mothers aged 40 to 44 years, 1.6% (95%, CI 0.7% - 2.8%) for mothers aged 45 to 49 years, and 6.4% for mothers aged 50 years and older (95% CI, 1.7% - 18.2%).

"The absolute rates and [odds ratios] were lower after adjustment for demographic and pre-pregnancy factors but remained elevated for sepsis among teenage mothers and for all other morbidities among older women," the researchers write.

With respect to specific adverse outcomes, the adjusted analysis showed that mothers aged 35 to 39 years had increased rates of obstetric shock compared with mothers aged 25 to 29 years (adjusted odds ratios [AOR], 2.6; 95% CI 1.5 - 4.5), whereas mothers aged 40 to 44 years had increased rates of amniotic fluid embolism (AOR, 8.0; 95% CI, 2.7 - 23.7).

Mothers aged 45 to 49 years had higher rates of renal failure (AOR, 15.9; 95% CI, 4.8 - 52), complications of obstetric interventions (AOR, 4.7; 95% CI, 2.3 - 9.5), and intensive care unit admission (AOR, 4.8; 95% CI, 2.0 - 11.9).

In addition, the rate of maternal sepsis was significantly higher among teenaged mothers compared with that among mothers aged 25 to 29 years (AOR, 1.2; 95% CI, 1.1 - 1.4).

"Young healthy women can compensate and mask symptoms such as decreased level of consciousness and pathologic hypotension," the authors explain. "These findings warrant further research into specific risk factors, etiopathogeneses, and compensatory mechanisms among young mothers. They also warrant increased clinical vigilance and a reduced threshold for considering early antibiotics in young mothers presenting with possible signs of infection."

They continue, "The association between teenage motherhood and most adverse perinatal outcomes disappeared after adjustment for maternal demographic factors, with the exception of the neonatal death rate, which remained 50% higher."

One author reports receiving an honorarium as a speaker from USB in the last 5 years and receiving a Meeting Grant from the Canadian Hypertension Society. The remaining authors have disclosed no relevant financial relationships.

PLOS Med. Published online May 30, 2017. Full text

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