In the Journals

Mothers 45 and older at highest risk for severe morbidity, mortality

Older maternal age was associated with increased risks for severe maternal morbidity and mortality, particularly in those 45 years or older, according to a study pushed in JAMA Network Open.

“In many high-income countries, adolescent (age range, 10-19 years) birthrates are declining, whereas there has been a trend toward increasing maternal age,” Kazuyoshi Aoyama, MD, PhD, of the department of anesthesia and pain medicine at the Hospital for Sick Children, the Program in Child Health Evaluative Sciences, Sick Kids Research Institute and the Institute of Health Policy, Management and Evaluation at the University of Toronto, Canada, and colleagues wrote.

Researchers conducted a population-based study of all pregnant and postpartum women and adolescents who presented at an acute care hospital in Canada between April 1, 2004, and Mar. 31, 2015.

A total of 3,162,303 new pregnancies occurred during the study period. Among those, 54,219 instances of severe maternal morbidity were identified (17.7 cases per 1,000 deliveries).

Between 2004-2005 and 2014-2015, researchers identified a 9.8% relative increase in cases of severe maternal morbidity. They saw a similar increase in the number of pregnancies in mothers aged 40 years and older.

Researchers found that patients aged 19 years and younger and those aged 30 years and older had elevated risks for maternal mortality. However, those aged 45 years and older had the greatest risk for both severe maternal morbidity (OR = 2.69; 95% CI, 2.34-3.06) and maternal mortality (OR = 4.39; 95% CI, 1.01-19.1) compared with age 20 to 24 years.

In addition to maternal age, the presence of maternal comorbidities, low income and transferring between hospitals were also associated with increased risks for severe maternal morbidity and mortality.

“Outreach to disadvantaged communities and individuals, early recognition and appropriate management of acute illness, facilitation of transfer to tertiary care for high-risk pregnant mothers, and interventions to detect and prevent progression of illness in at-risk mothers are important considerations for primary and specialist clinicians,” Aoyama and colleagues wrote. – by Erin Michael

Disclosures: Aoyama reported receiving grants from the Canadian Institutes for Health Research and fellowship funding from the Canadian Institutes for Health Research to pursue the PhD stream of Clinical Epidemiology & Health Care Research at the Institute of Health Policy, Management and Evaluation at the University of Toronto. Please see study for all other authors’ relevant financial disclosures.

Older maternal age was associated with increased risks for severe maternal morbidity and mortality, particularly in those 45 years or older, according to a study pushed in JAMA Network Open.

“In many high-income countries, adolescent (age range, 10-19 years) birthrates are declining, whereas there has been a trend toward increasing maternal age,” Kazuyoshi Aoyama, MD, PhD, of the department of anesthesia and pain medicine at the Hospital for Sick Children, the Program in Child Health Evaluative Sciences, Sick Kids Research Institute and the Institute of Health Policy, Management and Evaluation at the University of Toronto, Canada, and colleagues wrote.

Researchers conducted a population-based study of all pregnant and postpartum women and adolescents who presented at an acute care hospital in Canada between April 1, 2004, and Mar. 31, 2015.

A total of 3,162,303 new pregnancies occurred during the study period. Among those, 54,219 instances of severe maternal morbidity were identified (17.7 cases per 1,000 deliveries).

Between 2004-2005 and 2014-2015, researchers identified a 9.8% relative increase in cases of severe maternal morbidity. They saw a similar increase in the number of pregnancies in mothers aged 40 years and older.

Researchers found that patients aged 19 years and younger and those aged 30 years and older had elevated risks for maternal mortality. However, those aged 45 years and older had the greatest risk for both severe maternal morbidity (OR = 2.69; 95% CI, 2.34-3.06) and maternal mortality (OR = 4.39; 95% CI, 1.01-19.1) compared with age 20 to 24 years.

In addition to maternal age, the presence of maternal comorbidities, low income and transferring between hospitals were also associated with increased risks for severe maternal morbidity and mortality.

“Outreach to disadvantaged communities and individuals, early recognition and appropriate management of acute illness, facilitation of transfer to tertiary care for high-risk pregnant mothers, and interventions to detect and prevent progression of illness in at-risk mothers are important considerations for primary and specialist clinicians,” Aoyama and colleagues wrote. – by Erin Michael

Disclosures: Aoyama reported receiving grants from the Canadian Institutes for Health Research and fellowship funding from the Canadian Institutes for Health Research to pursue the PhD stream of Clinical Epidemiology & Health Care Research at the Institute of Health Policy, Management and Evaluation at the University of Toronto. Please see study for all other authors’ relevant financial disclosures.