Birth outcomes across the spectrum of maternal age: dissecting aging effect versus confounding by social and medical determinants

Bolanle Olapeju, Xiumei Hong, Guoying Wang, Amber Summers, Irina Burd, Tina L Cheng, Xiaobin Wang, Bolanle Olapeju, Xiumei Hong, Guoying Wang, Amber Summers, Irina Burd, Tina L Cheng, Xiaobin Wang

Abstract

Background: Given the trend of increasing maternal age and associated adverse reproductive outcomes in the US, this study aimed to assess whether this association is due to an independent aging or confounded by sociodemographic, biomedical, or behavioral determinants in a predominantly Black US population.

Methods: Data was from 8509 women enrolled in the Boston Birth Cohort. Adverse reproductive outcomes included spontaneous preterm delivery, cesarean delivery, and low birth weight. Covariates included sociodemographic (parity, race/ethnicity, education, marital status, income, receipt of public assistance, nativity); biomedical (obesity, hypertensive disorders, diabetes mellitus); and behavioral (consistent intake of multivitamin supplements, support from father of baby, support from family, major stress in pregnancy, cigarette smoking, alcohol intake). Analysis included Lowess and marginal probability plots, crude and adjusted sequential logistic regression models to examine age-outcome associations and to what degree the association can be explained by the above covariables.

Result: Overall, the study sample had high levels of spontaneous preterm birth (18%), cesarean delivery (33%) and low birth weight (26%). Unadjusted models showed no significant difference odds of spontaneous preterm birth by maternal age but higher odds of cesarean section (aOR: 1.77, 95% CI: 1.60, 1.95) and low birth weight (aOR: 1.15, 95% CI: 1.04, 1.28) among women 30 years or older. Adjustment for sociodemographic factors, biomedical conditions and behavioral factors revealed higher odds of spontaneous preterm birth: (aOR: 1.30, 95% CI: 1.14, 1.49), cesarean section deliveries (aOR: 1.68, 95% CI: 1.51, 1.87) and low birth weight (aOR: 1.36, 95% CI: 1.21, 1.53). Across all ages, optimal BMI status and consistent multivitamin supplement intake were protective of spontaneous preterm birth and low birth weight.

Conclusion: In this high-risk minority population, we demonstrated that the association between increasing maternal age and adverse pregnancy outcomes was due to an independent aging effect and the presence of confounding by sociodemographic, biomedical, and behavioral factors. Some modifiable risk factors to counteract aging effect, include optimizing BMI and consistent intake of multivitamin supplement. A fundamental change in how care is provided to women, particularly low income Black women, is needed with emphasis on the protective role of optimal nutritional status.

Trial registration: ClinicalTrials.gov Identifier: NCT03228875.

Keywords: Age; Cesarean section; High-risk; Low birth weight; Minority; Preterm birth; Race.

Conflict of interest statement

The authors declare that they have no competing interests

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Lowess smoothing plots showing prevalence of adverse outcomes (spontaneous preterm birth, cesarean delivery, and low birth weight) by maternal age in total sample and stratified by racial groups
Fig. 2
Fig. 2
Lowess smoothing plots showing selected covariables (hypertensive disorders, BMI, and consistent multivitamin intake) by maternal age in total sample and stratified by racial groups
Fig. 3
Fig. 3
Marginal Probabilities of Adverse Outcomes after Adjusting for Sociodemographic, Biomedical, and Behavioral Factors by Maternal Age Overall and among Black Women only

References

    1. Martin JA, Hamilton BE, Osterman MJ, Driscoll AK. Births: final data for 2018. 2019.
    1. Mathews T, Hamilton BE. Mean age of mother, 1970–2000. Natl Vital Stat Rep. 2002;51(1):1–13.
    1. Martin JA, Hamilton BE, Osterman MJ. Births: Provisional data for 2019. USA: Services USDoHaH, Prevention CfDCa, Statistics NCfH, System NVS; 2020.
    1. Duncan GJ, Lee KT, Rosales-Rueda M, Kalil A. Maternal age and child development. Demography. 2018;55(6):2229–2255. doi: 10.1007/s13524-018-0730-3.
    1. Medicine PCotASfR Female age-related fertility decline. Committee opinion no. 589. Obstet Gynecol. 2014;123(3):719–721. doi: 10.1097/01.AOG.0000444440.96486.61.
    1. Mathews TJ, Hamilton BE. Mean age of mothers is on the rise: United States, 2000-2014. USA: NCHS data brief. 2016(232):1–8.
    1. 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. doi: 10.1371/journal.pone.0186287.
    1. Lisonkova S, Potts J, Muraca GM, Razaz N, Sabr Y, Chan W-S, et al. Maternal age and severe maternal morbidity: a population-based retrospective cohort study. PLoS Med. 2017;14(5):e1002307. doi: 10.1371/journal.pmed.1002307.
    1. Callaghan WM, Creanga AA, Kuklina EV. Severe maternal morbidity among delivery and postpartum hospitalizations in the United States. Obstet Gynecol. 2012;120(5):1029–1036. doi: 10.1097/AOG.0b013e31826d60c5.
    1. Azeez O, Kulkarni A, Kuklina EV, Kim SY, Cox S. Peer reviewed: hypertension and diabetes in non-pregnant women of reproductive age in the United States. Prev Chronic Dis. 2019;16. 10.5888/pcd16.190105.
    1. Campbell KH, Savitz D, Werner EF, Pettker CM, Goffman D, Chazotte C, et al. Maternal morbidity and risk of death at delivery hospitalization. Obstet Gynecol. 2013;122(3):627–633. doi: 10.1097/AOG.0b013e3182a06f4e.
    1. Hinkle SN, Sharma AJ, Kim SY, Park S, Dalenius K, Brindley PL, et al. Prepregnancy obesity trends among low-income women, United States, 1999–2008. Matern Child Health J. 2012;16(7):1339–1348. doi: 10.1007/s10995-011-0898-2.
    1. Petersen EE, Davis NL, Goodman D, Cox S, Syverson C, Seed K, et al. Racial/ethnic disparities in pregnancy-related deaths—United States, 2007–2016. Morb Mortal Wkly Rep. 2019;68(35):762. doi: 10.15585/mmwr.mm6835a3.
    1. Amjad S, MacDonald I, Chambers T, Osornio-Vargas A, Chandra S, Voaklander D, et al. Social determinants of health and adverse maternal and birth outcomes in adolescent pregnancies: a systematic review and meta-analysis. Paediatr Perinat Epidemiol. 2019;33(1):88–99. doi: 10.1111/ppe.12529.
    1. Margerison-Zilko CE, Li Y, Luo Z. Economic conditions during pregnancy and adverse birth outcomes among singleton live births in the United States, 1990-2013. Am J Epidemiol. 2017;186(10):1131–1139. doi: 10.1093/aje/kwx179.
    1. Biney AAE, Nyarko P. Is a woman's first pregnancy outcome related to her years of schooling? An assessment of women's adolescent pregnancy outcomes and subsequent educational attainment in Ghana. Reprod Health. 2017;14(1):123. doi: 10.1186/s12978-017-0378-2.
    1. Kassa GM, Arowojolu AO, Odukogbe AA, Yalew AW. Adverse neonatal outcomes of adolescent pregnancy in Northwest Ethiopia. PLoS One. 2019;14(6):e0218259. doi: 10.1371/journal.pone.0218259.
    1. Leftwich HK, Alves MV. Adolescent Pregnancy. Pediatr Clin N Am. 2017;64(2):381–388. doi: 10.1016/j.pcl.2016.11.007.
    1. Narukhutrpichai P, Khrutmuang D, Chattrapiban T. The obstetrics and neonatal outcomes of teenage pregnancy in Naresuan University Hospital. J Med Assoc Thail. 2016;99(4):361–367.
    1. Lemoine M-E, Ravitsky V. Sleepwalking into infertility: the need for a public health approach toward advanced maternal age. Am J Bioeth. 2015;15(11):37–48. doi: 10.1080/15265161.2015.1088973.
    1. Malabarey OT, Balayla J, Klam SL, Shrim A, Abenhaim HA. Pregnancies in young adolescent mothers: a population-based study on 37 million births. J Pediatr Adolesc Gynecol. 2012;25(2):98–102. doi: 10.1016/j.jpag.2011.09.004.
    1. Geronimus AT. Damned if you do: culture, identity, privilege, and teenage childbearing in the United States. Soc Sci Med. 2003;57(5):881–893. doi: 10.1016/S0277-9536(02)00456-2.
    1. Olapeju B, Saifuddin A, Wang G, Ji Y, Hong X, Raghavan R, et al. Maternal postpartum plasma folate status and preterm birth in a high-risk US population. Public Health Nutr. 2018;22:1281–1291.
    1. Ganchimeg T, Ota E, Morisaki N, Laopaiboon M, Lumbiganon P, Zhang J, et al. Pregnancy and childbirth outcomes among adolescent mothers: a World Health Organization multicountry study. BJOG Int J Obstet Gynaecol. 2014;121:40–48. doi: 10.1111/1471-0528.12630.
    1. Cohen W. Does maternal age affect pregnancy outcome? BJOG Int J Obstet Gynaecol. 2014;121(3):252–254. doi: 10.1111/1471-0528.12563.
    1. Berger BO, Wolfson C, Reid LD, Strobino DM. Adverse birth outcomes among women of advanced maternal age with and without health conditions in Maryland. Womens Health Issues. 2021;31(1):40–48. doi: 10.1016/j.whi.2020.08.008.
    1. Melnikas AJ, Romero D. Ideal age at first birth and associated factors among young adults in greater new York City: findings from the social position and family formation study. J Fam Issues. 2020;41(3):288–311. doi: 10.1177/0192513X19875762.
    1. Boakye E, Sharma G, Ogunwole SM, Zakaria S, Vaught AJ, Kwapong YA, et al. Relationship of preeclampsia with maternal place of birth and duration of residence among non-Hispanic black women in the United States. Circulation. 2021;14(2):e007546.
    1. Olapeju B, Ahmed S, Hong X, Wang G, Summers A, Cheng TL, et al. Maternal hypertensive disorders in pregnancy and postpartum plasma B vitamin and Homocysteine profiles in a high-risk multiethnic US Population. J Womens Health. 2020;29(12):1520–1529. doi: 10.1089/jwh.2020.8420.
    1. Wingate MS, Alexander GR. The healthy migrant theory: variations in pregnancy outcomes among US-born migrants. Soc Sci Med. 2006;62(2):491–498. doi: 10.1016/j.socscimed.2005.06.015.
    1. Alexander GR, Mor JM, Kogan MD, Leland NL, Kieffer E. Pregnancy outcomes of US-born and foreign-born Japanese Americans. Am J Public Health. 1996;86(6):820–824. doi: 10.2105/AJPH.86.6.820.
    1. Chan BC-P, Lao TT-H. Effect of parity and advanced maternal age on obstetric outcome. Int J Gynecol Obstet. 2008;102(3):237–241. doi: 10.1016/j.ijgo.2008.05.004.
    1. Salam RA, Hooda M, Das JK, Arshad A, Lassi ZS, Middleton P, et al. Interventions to improve adolescent nutrition: a systematic review and meta-analysis. J Adolesc Health. 2016;59(4):S29–S39. doi: 10.1016/j.jadohealth.2016.06.022.
    1. Gross SM, Augustyn M, Henderson JL, Baig K, Williams CA, Ajao B, et al. Integrating obstetrical care and WIC nutritional services to address maternal obesity and postpartum weight retention. Matern Child Health J. 2018;22(6):794–802. doi: 10.1007/s10995-018-2449-6.
    1. O'dea J. School-based interventions to prevent eating problems: first do no harm. Eat Disord. 2000;8(2):123–130. doi: 10.1080/10640260008251219.
    1. Reed JL, Prince SA, Elliott CG, Mullen K-A, Tulloch HE, Hiremath S, et al. Impact of workplace physical activity interventions on physical activity and cardiometabolic health among working-age women: a systematic review and meta-analysis. Circulation. 2017;10(2):e003516.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다