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The Effect of Very Advanced Maternal Age on Maternal and Neonatal Outcomes: A Systematic Review

Published:April 19, 2018DOI:https://doi.org/10.1016/j.jogc.2017.10.027

      Abstract

      Objective

      To summarize information on the maternal and perinatal outcomes among pregnant women with a maternal age greater or equal to 45 years old compared with women with a maternal age of less than 45.

      Methods

      A comprehensive systematic search of online databases from January 1946 through June 2015 was completed. The maternal outcomes were: fetal loss, preterm birth, full-term birth, complications of pregnancy, the type of delivery, and periconception hemorrhage. The fetal outcomes were: intrauterine growth restriction/LGA, fetal anomalies, APGAR score, and neonatal death.

      Results

      Twenty articles were included in the systematic review and 15 included in the meta-analysis. There was a 2.60 greater likelihood of fetal loss (I2 = 99%). Newborns of women of a very advanced maternal age were 2.49 more likely to have a concerning 5-minute APGAR score. Very advanced maternal age women had a 3.32 greater likelihood of pregnancy complications (I2 = 91%). There was a 1.96 greater likelihood of preterm birth at very advanced maternal age (I2 = 91%) and a 4 times greater likelihood of having to deliver through Caesarean section (I2 = 97%).

      Conclusion

      This systematic review showed an increased risk of adverse maternal and perinatal outcomes. The large amount of heterogeneity among most outcomes that were investigated suggest results must be interpreted with caution.

      Résumé

      Objectif

      Résumer et comparer les issues maternelles et périnatales des femmes de 45 ans et plus à celles des femmes de moins de 45 ans.

      Méthodologie

      Nous avons mené des recherches systématiques exhaustives dans des bases de données en ligne pour la période allant de janvier 1946 à juin 2015. Les issues maternelles retenues étaient : la perte fœtale, l'accouchement prématuré, l'accouchement à terme, les complications durant la grossesse, le type d'accouchement et les hémorragies. Les issues fœtales retenues étaient : le retard de croissance intra-utérin, le fait d'être gros pour l'âge gestationnel, les anomalies fœtales, l'indice d'Apgar et le décès néonatal.

      Résultats

      Au total, 20 articles ont été retenus pour la revue systématique, et 15 pour la méta-analyse. Les femmes dont l'âge maternel était très avancé couraient un risque 2,60 fois plus élevé de perte fœtale (I2 = 99 %) que l'autre groupe, et leurs nouveau-nés couraient un risque 2,49 fois plus élevé de présenter un indice d'Apgar inquiétant à cinq minutes de vie. Elles présentaient également un risque 3,32 fois plus élevé de complications durant la grossesse (I2 = 91 %), un risque 1,96 fois plus élevé d'accouchement prématuré (I2 = 91 %) et un risque 4 fois plus élevé de césarienne (I2 = 97 %).

      Conclusion

      Cette revue systématique a montré que les femmes d'âge maternel très avancé courent un risque accru d'issues maternelles et périnatales indésirables. Les résultats doivent toutefois être interprétés avec prudence, en raison de la grande hétérogénéité observée pour la plupart des issues à l'étude.

      Key Words

      Abbreviations:

      ART (assisted reproductive technologies), IUGR (intrauterine growth restriction), VAMA (very advanced maternal age)
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