Maternal Age, Multiple Birth, and Extremely Low Birth Weight Infants

doi:10.1016/j.jpeds.2008.10.044

The Journal of Pediatrics

Volume 154, Issue 4, April 2009, Pages 498-503.e2

https://doi.org/10.1016/j.jpeds.2008.10.044 Get rights and content

Objectives

To compare the rates of adverse neurodevelopmental outcome or death at 18 to 22 months among extremely low birth weight (ELBW) infants born to mothers ≥40 years to the corresponding rates among infants of younger mothers.

Study design

Prospective evaluation of ELBW infants to quantify the relative risks of maternal age and multiple birth for death or adverse neurodevelopmental outcome.

Results

The sample consisted of 14 671 live ELBW births divided into maternal age groups: <20, 20 to 29, 30 to 39, and ≥40 years. Of infants born to mothers ≥40 years, 20% were multiples. Mothers ≥40 years had high rates of obstetric interventions and medical morbidities compared with mothers <40 years. ELBW live births of mothers ≥40 years were 22% more likely to survive and had a 13% decreased risk of neurodevelopmental impairment or death compared with mothers <20. Multiple birth, however, was associated with a 10% greater risk of neurodevelopmental impairment or death.

Conclusion

Although mothers ≥40 years had high pregnancy-related morbidities, we found no overall increased risk of the composite outcome of death or NDI. Multiple birth, however, was a predictor of all adverse outcomes examined, regardless of maternal age.

Section snippets

Methods

Maternal and neonatal characteristics and morbidities were collected prospectively by trained research personnel to 120 days or day of discharge.¹⁸ The following definitions were used: early-onset sepsis was defined as a positive blood culture ≤72 hours, late-onset sepsis was positive blood cultures >72 hours, preterm premature rupture of membranes (PPROM) was ROM >18 hours before delivery, and maternal hypertension was systolic blood pressure >140 mm Hg or a diastolic blood pressure >90 mm Hg

Results

Table I shows the maternal characteristics of the 13 441 mothers whose live-born ELBW infants were cared for at one of the NICHD Neonatal Network centers from January 1, 1995, to December 30, 2003. Compared with mothers <20 and 20 to 29 years, mothers ≥40 years were more likely to be white, married, and have higher education and private health insurance than were mothers <20 years. They were less likely to be primiparous and more likely to be delivered by C-section than all other maternal age

Discussion

Our hypothesis that mothers ≥40 years would have higher rates of multiple births among ELBW infants was not confirmed. Although mothers ≥40 years had significantly more triplets compared with mothers <20 years, they did not differ from the other study groups in the rate of twin delivery.

Mothers ≥40 years did, however, have increased rates of pregnancy-related morbidities, including diabetes, hypertension, and PPROM; the rate of diabetes was 9 times greater for mothers ≥40 years compared with

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: The National Institutes of Health and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) provided grant support (Appendix 2; available at www.jpeds.com) for the NICHD Neonatal Research Network's Generic Database Study (Recruitment: 1995-2003) and Follow-up Study. The funding agencies provided overall oversight for study conduct, but all data analyses and interpretation were independent of the funding agencies.

: No reprints offered.

^⁎: List of members of the NICHD Neonatal Research Network is available at www.jpeds.com (Appendix 1).

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Original articleMaternal Age, Multiple Birth, and Extremely Low Birth Weight Infants

Objectives

Study design

Results

Conclusion

Section snippets

Methods

Results

Discussion

Obstet Gynecol

Int J Gynaecol Obstet

Obstet Gynecol

Fertil Steril

Fertil Steril

Obstet Gynecol

Annual summary of vital statistics—2003

Pediatrics

Births: preliminary data for 2004

Natl Vital Stat Rep

Annual summary of vital statistics: 2005

Pediatrics

Delayed childbearing by education level in the United States, 1969-1994

Matern Child Health J

Underappreciated risks of the elderly multipara

Am J Obstet Gynecol

Clinical aspects of pregnancy after the age of 35 years: a review of the literature

Hum Reprod Update

Pregnancy in the sixth decade of life: obstetric outcomes in women of advanced reproductive age

JAMA

Maternal and perinatal outcome in nulliparous women aged 35 and older

Gynecol Obstet Invest

Original article
Maternal Age, Multiple Birth, and Extremely Low Birth Weight Infants