Does advanced maternal age confer a survival advantage to infants born at early gestation?

Sarka Lisonkova, Emmanuelle Pare, K. S. Joseph

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: Recent studies have shown that older mothers who deliver at preterm gestation have lower neonatal mortality rates compared with younger mothers who deliver at preterm gestation. We examined the effect of maternal age on gestational age-specific perinatal mortality.Methods: We compared fetal, neonatal and perinatal mortality rates among singleton births in the United States, 2003-2005, to mothers aged ≥35 versus 20-29 years. The analysis was stratified by gestational age and perinatal mortality rates were contrasted by maternal age at earlier (22-33 weeks) and later gestation (≥34 weeks). Gestational age-specific perinatal mortality rates were calculated using the traditional perinatal formulation (deaths among births at any gestation divided by total births at that gestation) and also the fetuses-at-risk model (deaths among births at any gestation divided by fetuses-at-risk of death at that gestation).Logistic regression was used to estimate adjusted odds ratios (AOR) for perinatal death.Results: Under the traditional approach, fetal death rates at 22-33 weeks were non-significantly lower among older mothers (AOR 0.97, 95% confidence interval [CI] 0.91-1.03), while rates were significantly higher among older mothers at ≥34 weeks (AOR 1.66, 95% CI 1.56-1.76). Neonatal death rates were significantly lower among older compared with younger mothers at 22-33 weeks (AOR=0.93, 95% CI 0.88-0.98) but higher at ≥34 weeks (AOR 1.26, 95% CI 1.21-1.31). Under the fetuses-at-risk model, both rates were higher among older vs younger mothers at early gestation (AOR for fetal and neonatal mortality 1.35, 95% CI 1.27-1.43 and 1.31, 95% CI 1.24-1.38, respectively) and late gestation (AOR for fetal and neonatal mortality 1.66, 95% CI 1.56-1.76) and 1.21, 95% CI 1.14-1.29, respectively).Conclusions: Although the traditional prognostic perspective on the risk of perinatal death among older versus younger mothers varies by gestational age at birth, the causal fetuses-at-risk model reveals a consistently elevated risk of perinatal death at all gestational ages among older mothers.

Original languageEnglish (US)
Article number87
JournalBMC Pregnancy and Childbirth
Volume13
DOIs
StatePublished - Apr 8 2013
Externally publishedYes

Fingerprint

Maternal Age
Pregnancy
Confidence Intervals
Odds Ratio
Gestational Age
Perinatal Mortality
Mothers
Infant Mortality
Fetal Mortality
Parturition
Mortality
Fetus
Fetal Death
Logistic Models
Perinatal Death

Keywords

  • Advanced maternal age
  • Birth outcomes
  • Fetuses-at-risk
  • Perinatal mortality

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Medicine(all)

Cite this

Does advanced maternal age confer a survival advantage to infants born at early gestation? / Lisonkova, Sarka; Pare, Emmanuelle; Joseph, K. S.

In: BMC Pregnancy and Childbirth, Vol. 13, 87, 08.04.2013.

Research output: Contribution to journalArticle

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title = "Does advanced maternal age confer a survival advantage to infants born at early gestation?",
abstract = "Background: Recent studies have shown that older mothers who deliver at preterm gestation have lower neonatal mortality rates compared with younger mothers who deliver at preterm gestation. We examined the effect of maternal age on gestational age-specific perinatal mortality.Methods: We compared fetal, neonatal and perinatal mortality rates among singleton births in the United States, 2003-2005, to mothers aged ≥35 versus 20-29 years. The analysis was stratified by gestational age and perinatal mortality rates were contrasted by maternal age at earlier (22-33 weeks) and later gestation (≥34 weeks). Gestational age-specific perinatal mortality rates were calculated using the traditional perinatal formulation (deaths among births at any gestation divided by total births at that gestation) and also the fetuses-at-risk model (deaths among births at any gestation divided by fetuses-at-risk of death at that gestation).Logistic regression was used to estimate adjusted odds ratios (AOR) for perinatal death.Results: Under the traditional approach, fetal death rates at 22-33 weeks were non-significantly lower among older mothers (AOR 0.97, 95{\%} confidence interval [CI] 0.91-1.03), while rates were significantly higher among older mothers at ≥34 weeks (AOR 1.66, 95{\%} CI 1.56-1.76). Neonatal death rates were significantly lower among older compared with younger mothers at 22-33 weeks (AOR=0.93, 95{\%} CI 0.88-0.98) but higher at ≥34 weeks (AOR 1.26, 95{\%} CI 1.21-1.31). Under the fetuses-at-risk model, both rates were higher among older vs younger mothers at early gestation (AOR for fetal and neonatal mortality 1.35, 95{\%} CI 1.27-1.43 and 1.31, 95{\%} CI 1.24-1.38, respectively) and late gestation (AOR for fetal and neonatal mortality 1.66, 95{\%} CI 1.56-1.76) and 1.21, 95{\%} CI 1.14-1.29, respectively).Conclusions: Although the traditional prognostic perspective on the risk of perinatal death among older versus younger mothers varies by gestational age at birth, the causal fetuses-at-risk model reveals a consistently elevated risk of perinatal death at all gestational ages among older mothers.",
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AU - Pare, Emmanuelle

AU - Joseph, K. S.

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N2 - Background: Recent studies have shown that older mothers who deliver at preterm gestation have lower neonatal mortality rates compared with younger mothers who deliver at preterm gestation. We examined the effect of maternal age on gestational age-specific perinatal mortality.Methods: We compared fetal, neonatal and perinatal mortality rates among singleton births in the United States, 2003-2005, to mothers aged ≥35 versus 20-29 years. The analysis was stratified by gestational age and perinatal mortality rates were contrasted by maternal age at earlier (22-33 weeks) and later gestation (≥34 weeks). Gestational age-specific perinatal mortality rates were calculated using the traditional perinatal formulation (deaths among births at any gestation divided by total births at that gestation) and also the fetuses-at-risk model (deaths among births at any gestation divided by fetuses-at-risk of death at that gestation).Logistic regression was used to estimate adjusted odds ratios (AOR) for perinatal death.Results: Under the traditional approach, fetal death rates at 22-33 weeks were non-significantly lower among older mothers (AOR 0.97, 95% confidence interval [CI] 0.91-1.03), while rates were significantly higher among older mothers at ≥34 weeks (AOR 1.66, 95% CI 1.56-1.76). Neonatal death rates were significantly lower among older compared with younger mothers at 22-33 weeks (AOR=0.93, 95% CI 0.88-0.98) but higher at ≥34 weeks (AOR 1.26, 95% CI 1.21-1.31). Under the fetuses-at-risk model, both rates were higher among older vs younger mothers at early gestation (AOR for fetal and neonatal mortality 1.35, 95% CI 1.27-1.43 and 1.31, 95% CI 1.24-1.38, respectively) and late gestation (AOR for fetal and neonatal mortality 1.66, 95% CI 1.56-1.76) and 1.21, 95% CI 1.14-1.29, respectively).Conclusions: Although the traditional prognostic perspective on the risk of perinatal death among older versus younger mothers varies by gestational age at birth, the causal fetuses-at-risk model reveals a consistently elevated risk of perinatal death at all gestational ages among older mothers.

AB - Background: Recent studies have shown that older mothers who deliver at preterm gestation have lower neonatal mortality rates compared with younger mothers who deliver at preterm gestation. We examined the effect of maternal age on gestational age-specific perinatal mortality.Methods: We compared fetal, neonatal and perinatal mortality rates among singleton births in the United States, 2003-2005, to mothers aged ≥35 versus 20-29 years. The analysis was stratified by gestational age and perinatal mortality rates were contrasted by maternal age at earlier (22-33 weeks) and later gestation (≥34 weeks). Gestational age-specific perinatal mortality rates were calculated using the traditional perinatal formulation (deaths among births at any gestation divided by total births at that gestation) and also the fetuses-at-risk model (deaths among births at any gestation divided by fetuses-at-risk of death at that gestation).Logistic regression was used to estimate adjusted odds ratios (AOR) for perinatal death.Results: Under the traditional approach, fetal death rates at 22-33 weeks were non-significantly lower among older mothers (AOR 0.97, 95% confidence interval [CI] 0.91-1.03), while rates were significantly higher among older mothers at ≥34 weeks (AOR 1.66, 95% CI 1.56-1.76). Neonatal death rates were significantly lower among older compared with younger mothers at 22-33 weeks (AOR=0.93, 95% CI 0.88-0.98) but higher at ≥34 weeks (AOR 1.26, 95% CI 1.21-1.31). Under the fetuses-at-risk model, both rates were higher among older vs younger mothers at early gestation (AOR for fetal and neonatal mortality 1.35, 95% CI 1.27-1.43 and 1.31, 95% CI 1.24-1.38, respectively) and late gestation (AOR for fetal and neonatal mortality 1.66, 95% CI 1.56-1.76) and 1.21, 95% CI 1.14-1.29, respectively).Conclusions: Although the traditional prognostic perspective on the risk of perinatal death among older versus younger mothers varies by gestational age at birth, the causal fetuses-at-risk model reveals a consistently elevated risk of perinatal death at all gestational ages among older mothers.

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KW - Birth outcomes

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KW - Perinatal mortality

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