Effect of Maternal Age and Fetal Number on the Risk of Hypertensive Disorders of Pregnancy

Abstract

Objective Our primary objective was to compare the differential contribution of fetal number and maternal age to the risk of hypertensive disorders of pregnancy (HDP).

Study Design This was a secondary analysis of a large study of primary cesarean delivery. Women with singleton, twin, or triplet gestations were included. Women were divided into groups based on fetal number and maternal age. The primary outcome was HDP. A logistic regression model was fit to adjust for confounders. The incidence of HDP was compared with the reference group and within exposure groups.

Results Of the 70,417 women included, HDP occurred in 8,079 (12%) women. The frequency of HDP among the comparison groups ranged from 11 to 38%. Nearly all groups had significantly increased risk of HDP compared with young maternal age singletons. Twin and triplet gestations increased the risk of HDP over singletons irrespective of maternal age after adjusting for baseline disease and race. The risk of HDP did not significantly increase with maternal age when fetal number was similar.

Conclusion Fetal number significantly increased the risk of HDP and contributed more to that risk than maternal age. Maternal age became significant in groups with age greater than 40 years.

Keywords

gestational hypertension - preeclampsia - advanced maternal age - multiple gestation - multifetal gestation - twins - triplets - hypertensive disorders of pregnancy

Note

Poster (No. 480) entitled “Effect of Maternal Age and Fetal Number on the Risk of Gestational Hypertensive Disease” was presented at the 36th Annual Pregnancy Meeting of the Society for Maternal–Fetal Medicine, held at Atlanta, Georgia from February 1–6, 2016.

• References

• 1 de Swiet M. Maternal mortality: confidential enquiries into maternal deaths in the United Kingdom. Am J Obstet Gynecol 2000; 182 (04) 760-766
• 2 Cantwell R, Clutton-Brock T, Cooper G. , et al. Saving Mothers' Lives: reviewing maternal deaths to make motherhood safer: 2006-2008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG 2011; 118 (Suppl. 01) 1-203
• 3 Ananth CV, Keyes KM, Wapner RJ. Pre-eclampsia rates in the United States, 1980-2010: age-period-cohort analysis. BMJ 2013; 347: f6564
• 4 Ben-David A, Glasser S, Schiff E, Zahav AS, Boyko V, Lerner-Geva L. Pregnancy and birth outcomes among primiparae at very advanced maternal age: at what price?. Matern Child Health J 2016; 20 (04) 833-842
• 5 Hansen JP. Older maternal age and pregnancy outcome: a review of the literature. Obstet Gynecol Surv 1986; 41 (11) 726-742
• 6 Saftlas AF, Olson DR, Franks AL, Atrash HK, Pokras R. Epidemiology of preeclampsia and eclampsia in the United States, 1979-1986. Am J Obstet Gynecol 1990; 163 (02) 460-465
• 7 Paré E, Parry S, McElrath TF, Pucci D, Newton A, Lim KH. Clinical risk factors for preeclampsia in the 21st century. Obstet Gynecol 2014; 124 (04) 763-770
• 8 Walker MC, Murphy KE, Pan S, Yang Q, Wen SW. Adverse maternal outcomes in multifetal pregnancies. BJOG 2004; 111 (11) 1294-1296
• 9 Day MC, Barton JR, O'Brien JM, Istwan NB, Sibai BM. The effect of fetal number on the development of hypertensive conditions of pregnancy. Obstet Gynecol 2005; 106 (5 Pt 1): 927-931
• 10 Landon MB, Hauth JC, Leveno KJ. , et al; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. N Engl J Med 2004; 351 (25) 2581-2589
• 11 Taddei S, Virdis A, Ghiadoni L, Versari D, Salvetti A. Endothelium, aging, and hypertension. Curr Hypertens Rep 2006; 8 (01) 84-89