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Women giving birth at an advanced age and their children: obstetric and neonatal outcomes, health and social support
Linköping University, Department of Biomedical and Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.ORCID iD: 0000-0002-3256-7859
2022 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Postponement of parenthood is an increasing trend in Western societies today. Delaying motherhood to a later time in life increases the use of assisted reproduction technology (ART), and the risk for adverse obstetric and neonatal outcomes. Along with postponement of motherhood, the number of women requesting treatment to become solo mothers has increased. The aim of the present thesis was to evaluate the obstetric outcomes and morbidity among mothers and their children, and the association of these outcomes with advanced maternal age, single status and the use of ART.

Data from the Medical Birth Register (MBR) pertaining to pregnancy, childbirth and neonatal outcomes were retrieved. In total, 37,558 mothers aged ≥ 40 years formed the index group, which was divided into two subgroups, mothers 40-44 years of age and mothers aged ≥ 45, and compared to a control group of 71,472 mothers age ≤ 39 years (Study I). To investigate the mothers’ morbidity up to five years prior to, and up to five years after childbirth (study II), and their children’s morbidity up to five years of age (study III), data from the MBR and the National Patient Register (NPR) on Swedish women giving birth during 2007-2008 and their children were retrieved. The index group comprised 8203 mothers ≥ 40 years, and the control group comprised 15,569 mothers ≤ 39 years and their children. Diagnosis and number of inpatient and outpatient visits in hospital specialized care units were studied as well as mode of conception i.e., using ART or spontaneously conceived. Civil status, defined as single or cohabiting/married, was also investigated. In study IV, 207 single women accepted for treatment with donor sperm were compared with 256 cohabiting women treated with IVF with their own gametes. The women’s sociodemographic data, their descriptions of their social networks, as well as self-assessment of their social support were investigated through a questionnaire.

The results showed an increased risk for an adverse pregnancy outcome in older mothers and the children were more often born preterm, with low birthweight or were small-for-gestational age. In addition, the older mothers had more often used ART, and were more likely to be single, to use less tobacco and to have a higher BMI compared to younger women. Also, the results indicated an increased risk for morbidity among older women, both before and after pregnancy, compared to the younger women. Women of both age groups who had used ART to conceive also had higher morbidity than women who conceived spontaneously. Among mothers and children, morbidity was significantly higher in both mother and child when the mother was single at the time of pregnancy. Children born to older mothers were more often diagnosed with conditions diagnosed in the perinatal period and with congenital malformations, deformations and chromosomal abnormalities compared with children born to younger mothers.

Solo women who were to be treated with sperm donation were older compared to cohabiting women. Solo women more often had a higher level of education and full-time employment, and were in a profession with a higher salary compared with cohabiting women. Solo women expected to receive much help, primarily from a parent but also from friends.

The significantly increased risk for adverse outcomes in pregnancy and childbirth associated with advanced maternal age and the diagnoses their children were more likely to receive during the first five years of life is perhaps small but will have an impact on the individual. Single parenthood is historically associated with social and economic disadvantages. The results are in part promising concerning the sociodemographic characteristics of solo-mothers-to-be and their high levels of perceived social support. However, the potential risk for long-term morbidity in children born to advanced aged mothers, in combination with maternal single civil status and use of ART, is important to follow closely to provide proper and adequate support and health care to these mothers and their children.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2022. , p. 82
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1803
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
URN: urn:nbn:se:liu:diva-182736DOI: 10.3384/9789179292317Libris ID: zd2fpc8gw921gz32ISBN: 9789179292300 (print)ISBN: 9789179292317 (electronic)OAI: oai:DiVA.org:liu-182736DiVA, id: diva2:1635701
Public defence
2022-03-11, Berzeliussalen, Building 463, Campus US, Linköping, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2022-02-07 Created: 2022-02-07 Last updated: 2022-03-24Bibliographically approved
List of papers
1. Evaluation of risk factors’ importance on adverse pregnancy and neonatal outcomes in women aged 40 years or older
Open this publication in new window or tab >>Evaluation of risk factors’ importance on adverse pregnancy and neonatal outcomes in women aged 40 years or older
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2019 (English)In: BMC Pregnancy and Childbirth, ISSN 1471-2393, E-ISSN 1471-2393, Vol. 19, article id 92Article in journal (Refereed) Published
Abstract [en]

Background

Women of advanced age (40 years or older) are generally, at risk for pregnancy and delivery related problems. In addition, there is limited knowledge on being of advanced age and having been given Assisted Reproductive Treatment (ART) and its association with negative obstetric outcomes. Therefore, data from the Swedish Medical Birth Register was used to investigate pregnancy and neonatal outcomes for women aged 40 or more who had given birth. The secondary aim was to compare the obstetric outcomes of women who had used ART and women who had not undergoneART while adjusting for marital status across the age groups.

Method

Women of advanced age who had given birth in Sweden during 2007–2012 formed the index group, n = 37,558; a reference group of women comprised 71,472 women under the age of 40. An additional subgroup of women aged 45 or older when giving birth was also formed, n = 2229. The obstetric and neonatal data for all the women was derived from national register data.

Results

Women of advanced age were more often single, had undergone ART, and more often experienced adverse obstetric outcomes than did younger women. The neonate’s health was also more often adversely affected expressed as being born with low birth weight and Small for Gestational Age (SGA), having lower Apgar scores, and having more health problems during the first week compared to the reference group.

Conclusions

Women who are approaching the upper limit of fecundity are at greater risk for having children who are preterm and SGA. The adverse effects of being preterm and SGA may have negative long-term effects, not only on the children but also on the mothers. This needs to be addressed more frequently in a clinical setting when advising women of all ages on pregnancy and ART treatment.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Advanced maternal age; Pregnancy; Delivery; Neonate status
National Category
Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:liu:diva-155894 (URN)10.1186/s12884-019-2239-1 (DOI)000461291500002 ()30866838 (PubMedID)2-s2.0-85062845776 (Scopus ID)
Note

Funding Agencies|Research Council in the southeast of Sweden, FORSS

Available from: 2019-04-03 Created: 2019-04-03 Last updated: 2024-01-10Bibliographically approved
2. Mothers who have given birth at an advanced age - health status before and after childbirth
Open this publication in new window or tab >>Mothers who have given birth at an advanced age - health status before and after childbirth
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2020 (English)In: Scientific Reports, E-ISSN 2045-2322, Vol. 10, no 1, article id 9739Article in journal (Refereed) Published
Abstract [en]

Women postpone childbirth to an age when morbidity is higher and fertility has decreased and yet the knowledge of mothers morbidity related to age remains scarce. Swedish national register data from the Medical Birth Register and National Patient Register was used to investigate the incidence of diseases listed in the International Classification of Diseases, version 10 (ICD-10) in women who gave birth 2007-8. The index group consisted of women 40 years of age or older (n=8 203) were compared to a control group of women, younger than 40 years (n=15 569) at childbirth. The period studied was five years before childbirth to five years after. The main outcome measures were incidence of disease diagnosed in specialized hospital care. Demographical data and use of assisted reproduction (ART) were adjusted for. The results showed that older women were more likely to be single; less frequently used tobacco; were educated on a higher level; had a higher BMI and more often had used ART to become pregnant. The older women showed a higher morbidity rate. In the diagnostic groups: Neoplasms, Blood and immune system, Eye and adnexa, Ear and mastoid, Circulatory, Digestive, Skin and subcutaneous tissue, Musculoskeletal and connective tissue, and Genitourinary. The results add to the body of knowledge of a number of specific risks faced by older mothers and may be used to identify preventive actions concerning fertility and morbidity both before and after childbirth.

Place, publisher, year, edition, pages
NATURE PUBLISHING GROUP, 2020
National Category
General Practice
Identifiers
urn:nbn:se:liu:diva-169261 (URN)10.1038/s41598-020-66774-4 (DOI)000560498700015 ()32546715 (PubMedID)
Note

Funding Agencies|Research Council in the southeast of Sweden, FORSS; Linkoping University

Available from: 2020-09-12 Created: 2020-09-12 Last updated: 2024-01-10
3. Maternal advanced age, single parenthood, and ART increase the risk of child morbidity up to five years of age
Open this publication in new window or tab >>Maternal advanced age, single parenthood, and ART increase the risk of child morbidity up to five years of age
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2022 (English)In: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 22, no 1, article id 39Article in journal (Refereed) Published
Abstract [en]

Background Advanced maternal age, single status and use of assisted reproductive technology (ART) are increasing in mothers in high-income countries, and all are known risk factors for negative obstetric outcomes. Less is known about their long-term consequences for childhood morbidity. Thus, the aim of this study was to investigate morbidity up to five years of age, in the children of older, single, and/or ART-treated mothers. Methods A cross-sectional using Swedish registers was performed comprising 23 772 children. The prevalence of diagnosis and the number of hospital visits for specialist care, were compared and analyzed in relation to maternal age at childbirth, maternal civil status, and mode of conception. The odds ratio for specialized care within each ICD-chapter were estimated using single and multiple logistic regression. Results Children born to single mothers and children conceived using ART had significantly more outpatient visits for specialist care and significantly more diagnoses compared to children with married/cohabiting mothers, and spontaneously conceived children. Children born to mothers of advanced maternal age (>= 40) had fewer in- and outpatient visits. However, they were significantly more often diagnosed within ICD-chapters XVI, XVII i.e., they experienced more morbidity in the neonatal period. Conclusion The results indicate that children born to single mothers and children of ART-treated mothers have a higher morbidity and consume more specialist care than children of married/cohabiting and spontaneously pregnant mothers. We conclude that the use of ART, maternal single status and advanced maternal age are risk factors of importance to consider in pediatric care and when counseling women who are considering ART treatment.

Place, publisher, year, edition, pages
BMC, 2022
Keywords
Child morbidity; Advanced maternal age; Single status; Assisted reproductive technology
National Category
Pediatrics
Identifiers
urn:nbn:se:liu:diva-182498 (URN)10.1186/s12887-021-03103-2 (DOI)000742656600002 ()35031006 (PubMedID)
Note

Funding Agencies|Linkoping University; Research Council in the southeast of Sweden, FORSS

Available from: 2022-01-26 Created: 2022-01-26 Last updated: 2024-01-10

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