Abstract
Background
Both young and advanced maternal age pregnancies have strong associations with adverse pregnancy outcomes; however, there is limited understanding of how these associations present in an urban environment in China. This study aimed to analyze the associations between maternal age and pregnancy outcomes among Chinese urban women.
Methods
We performed a population-based study consisting of 60,209 singleton pregnancies of primiparous women whose newborns were delivered after 20 weeks’ gestation between January 2012 and December 2015 in urban areas of China. Participants were divided into six groups (19 or younger, 20–24, 25–29, 30–34, 35–39, 40 or older). Pregnancy outcomes include gestational diabetes mellitus (GDM), preeclampsia, placental abruption, placenta previa, premature rupture of membrane (PROM), postpartum hemorrhage, preterm birth, low birthweight, small for gestational age (SGA), large for gestational age (LGA), fetal distress, congenital microtia, and fetal death. Logistic regression models were used to assess the role of maternal age on the risk of adverse pregnancy outcomes with women aged 25–29 years as the reference group.
Results
The risks of GDM, preeclampsia, placenta previa, and postpartum hemorrhage were decreased for women at a young maternal age and increased for women with advanced maternal age. Both young and advanced maternal age increased the risk of preterm birth and low birthweight. Young maternal age was also associated with increased risk of SGA (aOR 1.64, 95% CI 1.46–1.83) and fetal death (aOR 2.08, 95% CI 1.35–3.20). Maternal age over 40 years elevated the odds of placental abruption (aOR 3.44, 95% CI 1.47–8.03), LGA (aOR 1.47, 95% CI 1.09–1.98), fetal death (aOR 2.67, 95% CI 1.16–6.14), and congenital microtia (aOR 13.92, 95% CI 3.91–49.57). There were positive linear associations between maternal age and GDM, preeclampsia, placental abruption, placenta previa, PROM, postpartum hemorrhage, preterm birth, LGA and fetal distress (all P for linear trend < .05), and a negative linear association between maternal age and SGA (P for linear trend < .001). The analysis of the associations between maternal age and adverse fetal outcomes showed U-shape for preterm birth, low birth weight, SGA, fetal death and congenital microtia (all P for quadratic trend < .001).
Conclusions
Advanced maternal age predisposes women to adverse obstetric outcomes. Young maternal age manifests a bidirectional effect on adverse pregnancy outcomes. The findings may contribute to improving women’s antenatal care and management.
Acknowledgements
We are grateful to Swadhin Pradhan for his linguistic assistance during the preparation of this manuscript. The authors would like to extend our thanks to all data collectors, experts in the selected hospitals and study subjects who participated in the study.
Authors’ contributions
WJ and JHL designed the study. JHL and JLY contributed to the information collection, data analysis and interpretation. JHL drafted the manuscript and WJ revised the final version and are guarantors of this manuscript. All authors reviewed and approved the final manuscript.
Ethical approval
Ethical approval in this study was obtained from the Ethics Committee of Nanning Maternal and Child Health Care Hospital.
Patient consent
Informed written consent was waived due to the retrospective and observational design.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Data availability statement
The data used and analyzed during the current study are available from the corresponding author upon reasonable request.