Maternal age and the risk of gestational diabetes mellitus: A systematic review and meta-analysis of over 120 million participants.

This retrospective cohort study attempts to investigate pregnancy complications and adverse pregnancy outcomes in women of advanced maternal age (AMA). Data were extracted from electronic medical records system at West China Second University Hospital of Sichuan University from January 2013 to July 2016. The study cohort consisted 8 subgroups of women on 4 different age levels (20–29 years, 30–34 years, 35–39 years and ≥40 years) and 2 different parities (primiparity and multiparity). In the study period, 38811 women gave birth at our hospital, a randomized block was used to include 2800 women of singleton pregnancy >28 gestational weeks, with 350 patients in each subgroup. Maternal complications and fetal outcomes were collected and defined according to relevant guidelines. Confounding factors representing maternal demographic characteristics were identified from previous studies and analysed in multivariate analysis. There was an increasing trend for the risks of adverse pregnancy outcomes with increasing age, especially in AMA groups. Our study showed that AMA, primiparity, maternal overweight or obesity, lower educational level and residence in rural area increased pregnancy complications and adverse fetal outcomes. Increased professional care as well as public concern is warranted.

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Pregnancy Outcomes in Women of Advanced Maternal Age: a Retrospective Cohort Study from China

Most studies have shown that maternal age is associated with birth weight. However, the specific relationship between each additional year of maternal age and birth weight remains unclear. The study aimed to analyze the specific association between maternal age and birth weight. Raw data for all live births from 2015 to 2018 were obtained from the Medical Birth Registry of Xi’an, China. A total of 490,143 mother-child pairs with full-term singleton live births and the maternal age ranging from 20 to 40 years old were included in our study. Birth weight, gestational age, neonatal birth date, maternal birth date, residence and ethnicity were collected. Generalized additive model and two-piece wise linear regression model were used to analyze the specific relationships between maternal age and birth weight, risk of low birth weight, and risk of macrosomia. The relationships between maternal age and birth weight, risk of low birth weight, and risk of macrosomia were nonlinear. Birth weight increased 16.204 g per year when maternal age was less than 24 years old (95%CI: 14.323, 18.086), and increased 12.051 g per year when maternal age ranged from 24 to 34 years old (95%CI: 11.609, 12.493), then decreased 0.824 g per year (95% CI: -3.112, 1.464). The risk of low birth weight decreased with the increase of maternal age until 36 years old (OR = 0.917, 95%CI: 0.903, 0.932 when maternal age was younger than 27 years old; OR = 0.965, 95%CI: 0.955, 0.976 when maternal age ranged from 27 to 36 years old), then increased when maternal age was older than 36 years old (OR = 1.133, 95%CI: 1.026, 1.250). The risk of macrosomia increased with the increase of maternal age (OR = 1.102, 95%CI: 1.075, 1.129 when maternal age was younger than 24 years old; OR = 1.065, 95%CI: 1.060, 1.071 when maternal age ranged from 24 to 33 years old; OR = 1.029, 95%CI: 1.012, 1.046 when maternal age was older than 33 years old). For women of childbearing age (20–40 years old), the threshold of maternal age on low birth weight was 36 years old, and the risk of macrosomia increased with the increase of maternal age.

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Changing trends of birth weight with maternal age: a cross-sectional study in Xi'an city of Northwestern China

Nausea and Vomiting in Early Pregnancy of Adolescents: Relationship with Depressive Symptoms.

Background Asian-American subgroups are heterogeneous, but few studies had addressed differences on gestational weight gain (GWG) and perinatal outcomes related to GWG among this growing and diverse population. The purposes of this study were to examine whether Asian-American women are at higher risk of inadequate or excessive GWG and adverse perinatal outcomes than non-Hispanic White (NH-White) women, and to compare those risks among Asian-American subgroups. Methods This retrospective study included all singleton births to NH-Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnam, and NH-White women documented in 2009 Texas birth certificate data ( N  = 150,674). Data were analyzed using the χ 2 test, t test, multinomial logistic regression, and binary logistic regression. Chinese women were the reference group in the comparisons among Asian subgroups. Findings Asian women had a higher risk of inadequate GWG and gestational diabetes mellitus (GDM) than NH-White women. No difference in the odds of excessive GWG was found among Asian subgroups, although Japanese women had the highest risk of inadequate GWG. After adjusting for confounders, Korean women had the lowest risk of GDM (adjusted odds ratio [AOR], 0.49), whereas Filipino women and Asian Indian had the highest risks of gestational hypertension (AOR, 2.01 and 1.61), cesarean birth (AOR, 1.44 and 1.39), and low birth weight (AOR, 1.94 and 2.51) compared with Chinese women. Conclusions These results support the heterogeneity of GWG and perinatal outcomes among Asian-American subgroups. The risks of adverse perinatal outcomes should be carefully evaluated separately among Asian-American subpopulations.

Gestational weight gain and perinatal outcomes of subgroups of Asian-American women, Texas, 2009.

Objective: To determine the pregnancy outcomes related with maternal age in China. Methods: A total of 110 450 cases were selected and divided into 6 age groups at intervals of 5 years. The clinical data were collected from 39 hospitals in mainland China. All deliveries were after 28 weeks of completed gestation in 2011. The unadjusted binary-logistic regression was employed for statistics. Results: The mean age of all pregnant women was 28 ± 5 at the time of delivery. The advanced age groups (35 - 39 yr and =40 yr) had higher risks than the 25-29 age group for pregestational diabetes [odds ratio (OR) 2.2 and 3.8] chronic hypertension (OR 4.6 and 6.5) leiomyoma (OR 4.2 and 5.8) gestational diabetes (OR 2.6 and 3.5) preeclampsia (OR 2.5 and 3.6) postpartum hemorrhage (OR 1.5 and 1.7) premature delivery (OR 1.8 and 2.4) placenta previa (OR 2.7 and 4.0) placental abruption (OR 1.4 and 2.5) cesarean delivery (OR 2.1 and 2.5) macrosomia (OR 1.2 and 1.2) low birth weight neonates (OR 1.6 and 2.3) and perinatal mortality (OR 1.6 and 3.7). The adolescent group had higher risks than the 25 - 29 age group for anemia (OR 1.4) preeclampsia (OR 1.6) preterm birth (OR 2.1) low birth weight neonates (OR 2.3) and perinatal mortality (OR 3.6). Conclusion: Maternal and neonatal risks are higher during both the adolescent and advanced maternal ages. And the age group of 20 - 30 years has the lowest risk for pregnancy and delivery.

[Effects of maternal age on pregnancy: a retrospective cohort study].

Objective
To explore the current status of maternal age and hypertensive disorders in pregnancy related to maternal age in China.


Methods
The clinical data were collected from 39 hospitals in mainland China. All deliveries were performed after 28 weeks of completed gestation between January 1 and December 31, 2011. A total of 110 450 cases were enrolled and divided into 6 groups at 5-year intervals according to maternal age. The 25-29 age group was selected as a reference group. The odds ratio (OR) and 95% confidence interval (CI) were calculated by unadjusted binary-Logistic regression as appropriate.


Results
The mean age of pregnant women at the time of delivery was 28.18±4.70 (14-52) years. The risk of hypertensive disorders in pregnancy increased in the 3 age groups above 30 years (OR: 30-34 age group=1.3, 35-39 age group=2.3, ≥40 age group=3.3). The risks of chronic hypertension and pregnancy-induced hypertension increased gradually with maternal age. The risks of preeclampsia and severe preeclampsia showed a U-type distribution. The risk was the lowest in the 25-29 age group and the highest in the ≥40 age group (OR=3.6 and 3.4). The rate of eclampsia was 0 in the ≥40 age group and the highest in the teenage group (OR=8.7). And it was higher in the 20-24 age group (OR=2.6). No significant difference existed between other age groups and the 25-29 age group.


Conclusion
The risk of hypertensive disorders in pregnancy increases gradually with age in pregnant women aged over 35 years. And the risks of preeclampsia and eclampsia rise in teenage pregnancy. Better management helps to reduce the incidence of eclampsia and improve the outcomes of pregnancy in pregnant women with advanced maternal age and teenages.


Key words: 
Hypertensive disorders in pregnancy; Preeclampsia; Eclampsia; Maternal age

Xiaoli Liu

Papers

[Effects of maternal age on pregnancy: a retrospective cohort study].

Relationship between maternal age and hypertensive disorders in pregnancy