Canan UNAL, Atakan TANACAN, Erdem FADILOĞLU, Nurhayat HALİS, Murat CAGAN, M.sinan BEKSAC

A CUT OFF VALUE FOR ADVANCED MATERNAL AGE IN PREDICTING ADVERSE OBSTETRIC AND NEONATAL OUTCOMES IN SPONTANEOUS PREGNANCIES

Amaç: 40 yaşın üzerindeki spontan gebeliklerde olumsuz obstetrik ve neonatal sonuçları tahmin etmek için anne yaşı için bir eşik değer tanımlamak. Yöntem: 40 yaş ve üzeri 359 gebelik retrospektif olarak değerlendirildi. Gebeler grup 1 (40-43) ve grup 2 (≥44) olmak üzere iki gruba ayrıldı. Çalışma gruplarının obstetrik ve neonatal sonuçları karşılaştırıldı. Ayrıca maternal yaş açısından olumsuz obstetrik ve neonatal sonuçları tahmin etmek için ROC eğrisi analizi yapıldı. Bulgular: Obstetrik komplikasyon oranı grup 2'de (% 80.5) grup 1'den (% 36.5) anlamlı olarak daha yüksekti (p <0.001). Preeklampsi oranı da grup 2'de anlamlı olarak daha fazlaydı (p: 0.001). NICU'ya yatış oranları, grup 2'de (% 77.1) grup 1'e (% 28.7) göre istatistiksel olarak anlamlı derecede yüksekti (p <0.001). ROC eğrisi analizi, 41.5 yaşın olumsuz yenidoğan sonuçlarını ve NICU’ya ihtiyacı tahmin etmek için bir eşik değeri olarak bulundu (AUC: 0.607,0.566 sırasıyla). Sonuç: Doktorlar ileri anne yaşı gebeliklerinin yönetiminde özellikle ≥41,5 yaş grubunda olan annelerde daha dikkatli olmalıdırlar. Background: To define a cut off value for maternal age to predict adverse obstetric and neonatal outcomes in spontaneous pregnancies ≥40 years of age. Methods: We retrospectively evaluated 359 pregnant women ≥40 years of age. Patients were enrolled into two groups as Group 1 (40-43) and Group 2 (≥44). We compared the obstetric and neonatal adverse outcomes of the study groups. We also performed ROC curve analysis to predict adverse obstetric and neonatal outcomes in terms of maternal age. Results: Composite obstetric complication rate was significantly higher in group 2 (80.5%) than in group 1 (36.5%) (p < 0.001). Preeclampsia rate was also significantly more common in group 2 (p: 0.001). Admission to NICU was statistically significantly higher in group 2 (77.1%) compared to group 1 (28.7%) (p < 0.001). ROC curve analysis revealed 41.5 years of age as a cut-off value for predicting adverse neonatal outcomes and NICU admission (AUC: 0.607 and 0.566, respectively). Conclusion: Physicians should be cautious in the management of advence maternal age (AMA) pregnancies especially in patients with maternal age of ≥41.5 years.

Anahtar Kelimeler:

Advanced maternal age, , adverse obstetric outcome, , adverse neonatal outcome, , high risk pregnancy, , pregnancy

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References 1. Khalil A, Syngelaki A, Maiz N, Zinevich Y, Nicolaides KH. Maternal age and adverse pregnancy outcome: a cohort study. Ultrasound in Obstetrics & Gynecology. 2013;42(6):634-43.
2. Laopaiboon M, Lumbiganon P, Intarut N, Mori R, Ganchimeg T, Vogel J, et al. Advanced maternal age and pregnancy outcomes: a multicountry assessment. BJOG: An International Journal of Obstetrics & Gynaecology. 2014;121:49-56.
3. Organization WH. Atlas of health in Europe: WHO Regional Office Europe; 2003.
4. Hamilton BE, Martin JA, Ventura SJ. National vital statistics reports. National Vital Statistics Reports. 2009;57(12).
5. Bushnik T, Garner R. The children of older first-time mothers in Canada: their health and development: Statistics Canada Ottawa, Canada; 2008.
6. Cooke A, Mills TA, Lavender T. Advanced maternal age: Delayed childbearing is rarely a conscious choice: A qualitative study of women's views and experiences. International journal of nursing studies. 2012;49(1):30-9.
7. Nybo Andersen AM, Wohlfahrt J, Christens P, Olsen J, Melbye M. Maternal age and fetal loss: population based register linkage study. BMJ (Clinical research ed). 2000;320(7251):1708-12.
8. Savva GM, Walker K, Morris JK. The maternal age-specific live birth prevalence of trisomies 13 and 18 compared to trisomy 21 (Down syndrome). Prenat Diagn. 2010;30(1):57-64.
9. Fox NS, Rebarber A, Silverstein M, Roman AS, Klauser CK, Saltzman DH. The effectiveness of antepartum surveillance in reducing the risk of stillbirth in patients with advanced maternal age. European journal of obstetrics, gynecology, and reproductive biology. 2013;170(2):387-90.
10. ACOG committee opinion no. 561: Nonmedically indicated early-term deliveries. Obstet Gynecol. 2013;121(4):911-5.
11. Nicholson JM, Kellar LC, Kellar GM. The impact of the interaction between increasing gestational age and obstetrical risk on birth outcomes: evidence of a varying optimal time of delivery. Journal of perinatology : official journal of the California Perinatal Association. 2006;26(7):392-402.
12. Jacobsson B, Ladfors L, Milsom I. Advanced maternal age and adverse perinatal outcome. Obstet Gynecol. 2004;104(4):727-33.
13. Delbaere I, Verstraelen H, Goetgeluk S, Martens G, De Backer G, Temmerman M. Pregnancy outcome in primiparae of advanced maternal age. European journal of obstetrics, gynecology, and reproductive biology. 2007;135(1):41-6.
14. Cnattingius S, Forman MR, Berendes HW, Isotalo L. Delayed childbearing and risk of adverse perinatal outcome. A population-based study. Jama. 1992;268(7):886-90.
15. Beksaç MS, Aydın E, Tuğral M, Karaağaoğlu E. An obstetrics index for the assessment of risk levels of “high risk pregnancy” groups. Gynecology Obstetrics & Reproductive Medicine. 2016;21(1):10-3.
16. Kanmaz AG, İnan AH, Beyan E, Ögür S, Budak A. Effect of advanced maternal age on pregnancy outcomes: a single-centre data from a tertiary healthcare hospital. Journal of Obstetrics and Gynaecology. 2019;39(8):1104-11.
17. Hollenbach S, Miller LA, Olson-Chen C, Li D, Dye T, Thornburg L. Impact of Extremely Advanced Maternal Age on Pregnancy Outcomes [35H]. Obstetrics & Gynecology. 2017;129(5):91S.
18. Favilli A, Pericoli S, Acanfora MM, Bini V, Di Renzo GC, Gerli S. Pregnancy outcome in women aged 40 years or more. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstet. 2012;25(8):1260-3.
19. Schimmel MS, Bromiker R, Hammerman C, Chertman L, Ioscovich A, Granovsky-Grisaru S, et al. The effects of maternal age and parity on maternal and neonatal outcome. Arch Gynecol Obstet. 2015;291(4):793-8.
20. Lean SC, Derricott H, Jones RL, Heazell AE. Advanced maternal age and adverse pregnancy outcomes: A systematic review and meta-analysis. PloS one. 2017;12(10):e0186287.
21. Kraiem S, Souilem L, Toumi D, Bouchahda H. Obstetric and Perinatal Outcomes in Women≥ 40 Years of Age: A Retrospective Study About 421 Cases in Mahdia. Gynecology Obstetrics & Reproductive Medicine. 2019:1-4.