GIVE IT TIME

Study shows co­re­la­tion be­tween ma­ter­nal age and pre­ma­ture labour; ages 30-34 be­ing at least risk

Mother & Baby - - CONTENTS - Dr Bindhu K S, con­sul­tant ob­ste­tri­cian and gy­nae­col­o­gist, Apollo Hos­pi­tals, Navi Mumbai

Im­pact of ad­vanced ma­ter­nal age on preterm birth

Preg­nancy nor­mally lasts about 40 weeks, and ba­bies born after 37 weeks are con­sid­ered full term. In the weeks im­me­di­ately after birth, preterm ba­bies of­ten have dif­fi­culty in breath­ing and di­gest­ing food. They can also en­counter longterm chal­lenges such as im­paired vision, hear­ing and cog­ni­tive skills, as well as so­cial and be­havioural prob­lems. Preterm ba­bies have higher risks of heart de­fects, lung dis­or­ders, cere­bral palsy, and de­layed devel­op­ment. Ac­cord­ing to WHO sta­tis­tics, every year, an es­ti­mated 15 mil­lion ba­bies are born preterm and this num­ber is ris­ing. Com­pli­ca­tions due to preterm births are the lead­ing cause of death among chil­dren less than five years. Across 184 coun­tries, the rate of preterm birth ranges from 5 per cent to 18 per cent . QUARISMA study, a large Cana­dian ran­domised con­trolled trial, which col­lected data from 184,000 births in 32 hos­pi­tals, showed that the trend of risk of pre­ma­ture de­liv­ery fol­lows a U-shaped dis­tri­bu­tion: It is higher be­fore 30 years and after 40 years, and at its low­est be­tween 30 and 34. Women be­tween 20 and 24 years had 6.8 per cent chance of preterm de­liv­ery, the like­li­hood was 6 per cent for moth­ers be­tween 25 and 29, 6.3% for moth­ers be­tween 35 and 39 and 7.8 per cent for women over 40 years. Women be­tween 30 and 34 had the low­est risk for a preterm de­liv­ery, at 5.7 per cent. Over­all, women in their 30’s have a lower risk of giv­ing birth pre­ma­turely than women in their 20’s. This of­fers fresh ev­i­dence that age is an in­de­pen­dent risk fac­tor for preterm births, the re­searchers con­cluded in PLoS One. Preg­nancy in teenage and very young women is gen­er­ally con­sid­ered to be at very high-risk be­cause these women are phys­i­cally and psy­cho­log­i­cally im­ma­ture for re­pro­duc­tion. In ad­di­tion, there are some ex­trin­sic fac­tors such as in­ad­e­quate pre­na­tal care, il­lit­er­acy and poor so­cioe­co­nomic con­di­tions that af­fect the out­come of preg­nancy. Sev­eral med­i­cal com­pli­ca­tions like preterm birth, poor ma­ter­nal weight gain, preg­nancy-in­duced hy­per­ten­sion, anaemia, and sex­u­ally trans­mit­ted dis­eases are strongly as­so­ci­ated with

teenage preg­nancy. It is sug­gested that these young women, who are still them­selves grow­ing, may com­pete with the foe­tus for nu­tri­ents, which may in turn im­pair foetal growth and re­sult in low birth­weight ba­bies or ba­bies who are small for their ges­ta­tional age. There is in­creased neona­tal mor­tal­ity as­so­ci­ated with young ma­ter­nal age. Life­style and so­ciode­mo­graphic fac­tors such as smok­ing, al­co­hol use, low body mass in­dex and so­cial de­pri­va­tion have all been shown to con­trib­ute to less favourable birth out­comes. It is also estab­lished that ado­les­cent moth­ers in high-in­come coun­tries are at higher risk of ex­hibit­ing these char­ac­ter­is­tics. The un­der­util­i­sa­tion of an­te­na­tal care by ado­les­cent mother is again an im­por­tant fac­tor which de­ter­mines the out­come of teenage preg­nancy. Ac­cord­ing to the above men­tioned study, stress may also have con­trib­uted to the higher risk of preterm birth ob­served in women who had mul­ti­ple births at a young age (20–24 years). Com­pared with the ref­er­ence group (25–29 years), these women were more ex­posed to fac­tors re­lated to so­cial vul­ner­a­bil­ity in­clud­ing low level of ed­u­ca­tion, coun­try of birth, and smok­ing. The preterm birth in the 20-24 year age group was mainly spon­ta­neous rather than that in­duced for med­i­cal com­pli­ca­tions of preg­nancy. There has been a con­sid­er­able trend in the so­ci­ety nowa­days with women opt­ing for ma­ter­nity in their late 30s. Free ac­cess to abor­tion and bet­ter con­tra­cep­tives have made it a lot eas­ier for women to choose when they want chil­dren and how many. Also, more ed­u­ca­tion and em­ploy­ment op­por­tu­ni­ties have given women greater eco­nomic in­de­pen­dence. Other so­ci­etal changes, such as in­creas­ing women’s lib­er­a­tion and broader ac­cep­tance of co­hab­i­ta­tion also con­trib­ute largely to these changes. Ad­vanced ma­ter­nal age in­creased the risks of both spon­ta­neous and in­di­cated very preterm births. In­creased ma­ter­nal age may con­trib­ute to the pla­cen­tal and vas­cu­lar prob­lems as­so­ci­ated with preterm birth. Hy­per­ten­sion com­pli­cat­ing preg­nancy and small ba­bies are as­so­ci­ated with vas­cu­lar dis­or­ders and de­creased utero pla­cen­tal blood flow. Pro­ges­terone is im­por­tant for preg­nancy main­te­nance and this hor­mone lev­els de­cline with ma­ter­nal age which might be again an­other fac­tor re­spon­si­ble for the preterm births. Preterm in­fant sur­vival is high nowa­days, and the sur­vival rate has also in­creased for those born ex­tremely preterm. But very preterm in­fants is one of the most re­source de­mand­ing in hos­pi­tal pa­tient groups and the fi­nal out­come is not al­ways full health. To chal­lenge these is­sues, in­creased pro­fes­sional and po­lit­i­cal knowl­edge as well as parental and pub­lic in­for­ma­tion on the in­creased risk for preterm birth is war­ranted.

In­creased ma­ter­nal age may con­trib­ute to the pla­cen­tal and vas­cu­lar prob­lems as­so­ci­ated with preterm birth

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