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The study confirmed that women over 40 do have the highest risk of
preterm births: 7.8 percent of pregnancies in this age group
resulted in preterm births and 1 percent ended in extremely
premature deliveries. Women age 30 to 34 had the lowest risk: 5.7
percent of pregnancies involved preterm deliveries and 0.6 percent
resulted in extremely early arrivals.
Compared with women age 30 to 34, the over-40 mothers were 14
percent more likely to have a spontaneous preterm delivery and 31
percent more likely to have early deliveries because of labor
induction, cesarean births or other interventions. This offers fresh
evidence that age is an independent risk factor for preterm births,
researchers conclude in PLoS One.
“A common hypothesis is that the increased risk of preterm birth
among aged mothers is largely explained by early labor induction for
medical conditions,” said Dr. Antonio Simone Lagana of the Filippo
Del Ponte Hospital and the University of Insubria in Varese, Italy.
“However, this study found that advanced maternal age (40 years and
over) was associated with an increased risk of preterm birth even
after adjustment for known confounders, such as placenta previa,
gestational diabetes, medical history, use of assisted reproduction
technologies and occurrence of invasive procedures that are all more
common in older mothers,” Lagana, who wasn’t involved in the study,
said by email.
The oldest mothers in the study had a higher risk of going into
early labor on their own and also of having a premature delivery
induced for medical reasons. This suggests that not all of the
increased risk of premature deliveries can be explained by decisions
doctors make in the delivery room, said Dr. Alice Goisis of the
London School of Economics.
“The association cannot be entirely attributed to medical
interventions alone,” Goisis, who wasn’t involved in the study, said
by email.
In the weeks immediately after birth, preemies often have difficulty
breathing and digesting food. They can also encounter longer-term
challenges such as impaired vision, hearing and cognitive skills, as
well as social and behavioral problems.
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Pregnancy normally lasts about 40 weeks, and babies born after 37
weeks are considered full term. The study focused on preterm babies
delivered during weeks 32 to 36 of pregnancy, as well as on
extremely premature infants delivered before 32 weeks’ gestation.
The study by Dr. Florent Fuchs of CHU Sainte Justine in Montreal and
colleagues examined data on 184,000 births in 32 hospitals in
Quebec, Canada. Fuchs didn’t respond to emails seeking comment.
Women over 40 in the study were more likely to have many risk
factors for prematurity such as obesity, pregnancy-related diabetes
or high blood pressure, and a complication known as placenta previa,
when the placenta nourishing the baby separates from the uterine
wall.
One limitation of the study is that data on weight was missing for
28 percent of participants. Researchers also lacked data on several
factors that can influence the chances of a preterm birth including
socioeconomic status.
Even so, the results add to the evidence that advanced maternal age
can make a preterm birth more likely, said Dr. Ali Khashan of the
School of Public Health and INFANT Center at University College Cork
in Ireland.
But all women, including older women, can take steps to reduce their
odds of a preterm birth, Khashan, who wasn’t involved in the study,
said by email.
“Women who are planning pregnancy, especially after age 40, should
optimize their health pre-pregnancy, maintain a healthy weight, and
engage with health services early in pregnancy,” Khashan advised.
SOURCE: http://bit.ly/2BQMA03 PLoS One, online January 31, 2018.
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