The Association between Advanced Maternal Age and Adverse Hypertensive and Diabetic Complications During Pregnancy: A Six-year Retrospective Cohort Study in Metro Atlanta, USA Open Access

Kitami, Momoko (2015)

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OBJECTIVE: To investigate the effects of advanced maternal age on adverse hypertensive and diabetic complications of pregnancy, in relation to other major risk factors.

METHODS: A retrospective cohort study using Kaiser Permanente Georgia electronic health data of pregnant women receiving prenatal care in 12 Kaiser-affiliated Obstetrics and Gynaecology facilities between January 1, 2005 and August 31, 2011, with linked Georgia Birth Certificate data. Women were divided into two age groups: 1) reference group who were 35-39 years old, and 2) advanced maternal age (AMA) group who were 40 years and older. Adjusted risk ratios (aRR) were calculated after adjusting for correlation among women with multiple pregnancies, and relevant confounders (maternal race, obesity, infertility, gravidity, maternal education, marital status, and pre-existing medical conditions) using log-Binomial or log-Poisson regression analysis.

RESULTS: A total of 1181 pregnancies of 1096 women (939 women in reference group, 157 in AMA group) were included in the study. Risk of chronic hypertension was significantly higher in the AMA group (adjusted risk ratio [aRR], 2.05; 95%CI, 1.48-2.86), but risk of transient hypertension (aRR, 1.07; 95%CI, 0.51-2.22), mild preeclampsia (aRR 1.31; 95%CI, 0.61-2.81), severe preeclampsia/eclampsia (aRR 0.87; 95%CI, 0.26-2.86), chronic diabetes (aRR 0.74; 95%CI, 0.37-1.50), and gestational diabetes (aRR 0.97; 95%CI, 0.59-1.59) were not significantly increased in the AMA group. When risk of having any hypertensive complications was evaluated separately for white and black maternal race, AMA remained a significant risk factor among blacks (p=0.002), but note whites (p=0.15). Although risk of having preeclampsia or eclampsia was more fully explained by history of chronic hypertension and marital status than AMA, no significant risk factor was identified for transient hypertension. Obesity, primigravida, and Asian maternal race were identified as more significant risk factors for gestational diabetes compared to AMA.

CONCLUSION: Advanced maternal age is an important risk factor for chronic hypertension, but other risk factors such as obesity, maternal race, gravidity, and pre-existing medical conditions may play a larger role in the development of preeclampsia, eclampsia, and gestational diabetes. Strength of association of these risk factors may vary depending on maternal race.

Table of Contents

Chapter 1. Literature Review. 1

I. Introduction. 1

II. Methods. 7

III. Findings. 7

Study design, size, and demographic characteristics. 7

Pre-existing medical conditions. 9

Over 35 years old as the advanced maternal age group. 10

Over 40 years old as the advanced maternal age group. 11

Over 45 years old as the advanced maternal age group. 12

Outcome. 13

Results of population-based cohort studies. 17

IV. Discussion. 19

Limitations. 20

Conclusion. 21

References. 22

Tables. 31

Chapter 2. Thesis Manuscript. 37

I. Introduction. 38

II. Methods. 41

Hypotheses and objectives. 41

Data collection. 41

Data analysis. 49

III. Results. 52

IV. Discussion. 59

Strengths. 63

Limitations. 63

Future directions. 64

References. 66

Tables. 72

Appendices. 94

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