Maternal Age and Preeclampsia Outcomes during Delivery Hospitalizations

Abstract

Objective To characterize risk and temporal trends for preeclampsia and related outcomes by maternal age.

Study Design Deliveries to women aged 15 to 54 years in the 1998 to 2014 National Inpatient Sample who had a diagnosis of preeclampsia, eclampsia, or both were included in the analysis. Age was categorized as 15 to 17, 18 to 24, 25 to 29, 30 to 34, 35 to 39, 40 to 44, and 45 to 54 years. The primary outcome was temporal trends in preeclampsia based on maternal age. Secondary outcomes analyzed included risk for severe maternal morbidity.

Results The proportion of women with preeclampsia aged 15 to 24 years decreased from 42.3% in 1998 to 30.1% in 2014, while preeclampsia among those 30 to 54 years increased from 32.9 to 43.7%. Preeclampsia risk increased for all groups over the study period. Risk for severe morbidity by age group with and without transfusion was “U-shaped,” with risk highest for women 18 to 24 and 40 to 54 years. The risk for abruption, acute renal failure, acute heart failure or pulmonary edema, and stroke was lowest for women aged 15 to 24 years and increased in a “dose-dependent” manner with increasing maternal age. In contrast, eclampsia risk was highest for women aged 15 to 17 years.

Conclusion With a changing demographic profile of preeclampsia, older women accounted for an increasing proportion of preeclampsia and related adverse outcomes.

Keywords

advanced maternal age - preeclampsia - maternal - outcomes - severe maternal morbidity

Note

This study was presented at the 2019 Society for Maternal-Fetal Medicine Annual Meeting in Las Vegas, NV.

• References

• 1 Roberts JM, Bell MJ. If we know so much about preeclampsia, why haven't we cured the disease?. J Reprod Immunol 2013; 99 (1-2): 1-9
• 2 Callaghan WM. Overview of maternal mortality in the United States. Semin Perinatol 2012; 36 (01) 2-6
• 3 Creanga AA, Syverson C, Seed K, Callaghan WM. Pregnancy-related mortality in the United States, 2011-2013. Obstet Gynecol 2017; 130 (02) 366-373
• 4 Ananth CV, Keyes KM, Wapner RJ. Pre-eclampsia rates in the United States, 1980-2010: age-period-cohort analysis. BMJ 2013; 347: f6564
• 5 Wallis AB, Saftlas AF, Hsia J, Atrash HK. Secular trends in the rates of preeclampsia, eclampsia, and gestational hypertension, United States, 1987-2004. Am J Hypertens 2008; 21 (05) 521-526
• 6 American College of Obstetricians and Gynecologists and the Society for Maternal–Fetal Medicine, Kilpatrick SK, Ecker JL. Severe maternal morbidity: screening and review. Am J Obstet Gynecol 2016; 215: B17-B22
• 7 Centers for Disease Control and Prevention. Severe Maternal Morbidity in the United States. Available at: https://www.cdc.gov/reproductivehealth/maternalinfanthealth/severematernalmorbidity.html . Accessed May 8, 2019
• 8 Healthcare Cost and Utilization Project. Overview of the National (Nationwide) Inpatient Sample. Available at: https://www.hcup-us.ahrq.gov/nisoverview.jsp . Accessed March 30, 2019
• 9 Kuklina EV, Whiteman MK, Hillis SD. , et al. An enhanced method for identifying obstetric deliveries: implications for estimating maternal morbidity. Matern Child Health J 2008; 12 (04) 469-477
• 10 Klemmensen AK, Olsen SF, Osterdal ML, Tabor A. Validity of preeclampsia-related diagnoses recorded in a national hospital registry and in a postpartum interview of the women. Am J Epidemiol 2007; 166 (02) 117-124
• 11 Yasmeen S, Romano PS, Schembri ME, Keyzer JM, Gilbert WM. Accuracy of obstetric diagnoses and procedures in hospital discharge data. Am J Obstet Gynecol 2006; 194 (04) 992-1001
• 12 Lydon-Rochelle MT, Holt VL, Nelson JC. , et al. Accuracy of reporting maternal in-hospital diagnoses and intrapartum procedures in Washington State linked birth records. Paediatr Perinat Epidemiol 2005; 19 (06) 460-471
• 13 Metcalfe A, Lix LM, Johnson JA. , et al. Validation of an obstetric comorbidity index in an external population. BJOG 2015; 122 (13) 1748-1755