Hypertensive Disorders and Perinatal Outcomes According to Age Groups at Advanced Maternal Age

Öz

The aim of this study was to conduct a comparative analysis of hypertensive disorders, pregnancy complications, and perinatal outcomes in advanced maternal age pregnancies. The study was conducted using a retrospective cohort design, including 4203 pregnant women of advanced maternal age who delivered between 2010 and 2024. Patients were divided into three age groups: 35–39 years (n=3501), 40–44 years (n=608), and ≥45 years (n=94). Demographic characteristics, hypertensive disorders, pregnancy complications and perinatal outcomes were examined. Data were obtained retrospectively from the electronic record system and used in intergroup comparisons. The prevalence of hypertensive disorders increased significantly with age: 9.8% in the 35–39 age group, 16.7% in the 40–44 age group, and 27.6% in the ≥45 age group (p<0.001). Preeclampsia and superimposed hypertension were particularly prevalent. Preeclampsia was significantly higher in the ≥45 age group. From a perinatal perspective, the rates of preterm birth (12.4%, 18.5%, and 27.7%), IUGR (6.1%, 9.8%, and 15.9%), and SGA (7.2%, 10.3%, and 18.1%) gradually increased with age. Mean birth weight decreased from 3150 g to 2890 g, and the NICU admission rate increased from 9.3% to 22.3%. Perinatal mortality was also highest in the ≥45 age group at 3.1%. Hypertensive disorders and perinatal complications increase with age in pregnancies of advanced maternal age. The ≥45 age group, in particular, should be considered high-risk. Therefore, close antenatal monitoring, risk assessment, and implementation of appropriate prophylactic measures in advanced maternal age pregnancies are critical to reducing maternal and perinatal complications.

Anahtar Kelimeler

• Advanced Maternal Age
• Hypertensive Disorders
• Perinatal Outcomes
• Pregnancy Complications

İleri Anne Yaşında Yaş Gruplarına Göre Hipertansif Bozukluklar ve Perinatal Sonuçlar

Öz

Bu çalışmanın amacı, ileri anne yaşı gebeliklerinde hipertansif bozukluklar, gebelik komplikasyonları ve perinatal sonuçların karşılaştırmalı analizini yapmaktır. Çalışma, 2010-2024 yılları arasında doğum yapan ileri anne yaşındaki 4.203 gebeyi içeren retrospektif kohort tasarımında yürütülmüştür. Hastalar üç yaş grubuna ayrılmıştır: 35-39 yaş (n=3501), 40-44 yaş (n=608) ve ≥45 yaş (n=94). Demografik özellikler, hipertansif bozukluklar, gebelik komplikasyonları ve perinatal sonuçlar incelenmiştir. Veriler elektronik kayıt sisteminden retrospektif olarak elde edilmiştir. Hipertansif bozuklukların yaygınlığı yaşla birlikte önemli ölçüde arttı: 35-39 yaş grubunda %9.8, 40-44 yaş grubunda %16.7 ve ≥45 yaş grubunda %27.6 (p<0.001). Preeklampsi ve üst üste binen hipertansiyon özellikle yaygındı. Preeklampsi ≥45 yaş grubunda önemli ölçüde daha yüksekti. Perinatal açıdan, preterm doğum (%12.4, %18.5 ve %27.7), IUGR (%6.1, %9.8 ve %15.9) ve SGA (%7.2, %10.3 ve %18.1) oranları yaşla birlikte kademeli olarak arttı. Ortalama doğum ağırlığı 3150 g'dan 2890 g'a düştü ve NICU'ya yatış oranı %9.3'ten %22.3'e yükseldi. Perinatal mortalite de %3.1 ile ≥45 yaş grubunda en yüksekti. Hipertansif bozukluklar ve perinatal komplikasyonlar, ileri anne yaşı olan gebeliklerde yaşla birlikte artmaktadır. Özellikle ≥45 yaş grubu yüksek riskli grup olarak değerlendirilmelidir. Bu nedenle, ileri anne yaşı olan gebeliklerde yakın antenatal takip, risk değerlendirmesi ve uygun profilaktik önlemlerin uygulanması, maternal ve perinatal komplikasyonları azaltmada kritik öneme sahiptir.

Anahtar Kelimeler

• İleri Anne Yaşı
• Hipertansif Bozukluklar
• Perinatal Sonuçlar
• Gebelik Komplikasyonları

Kaynakça

1. Montori VM, Smithson R, Lazzari R, et al. Advanced maternal age and adverse pregnancy outcomes: a systematic review. Am J Obstet Gynecol. 2021;225(2):123–132.
2. Smithson R, Brown A, Davis K, et al. Pregnancy outcomes in very advanced maternal age women: a population-based cohort study. BJOG. 2022;129(5):822–830.
3. Lazzari R, Conti P, Rossi M, et al. Maternal age, body mass index and hypertensive disorders of pregnancy: a multicenter analysis. Pregnancy Hypertens. 2022; 32:101–109.
4. Ghosh G, Patel R, Ahmed S, et al. Pathophysiological links between advanced maternal age and hypertensive disorders of pregnancy. J Glob Health. 2023; 13:04161.Thein SL. Genetic association studies in β-hemoglobinopathies. 1st edn. ASH Education Program Book, pp 354-361, 2013
5. Lean SC, Derricott H, Jones RL, Heazell AEP. Advanced maternal age and adverse pregnancy outcomes: a systematic review and meta-analysis. PLoS One. 2017;12(10):e0186287.Higgs DR, Engel JD, Stamatoyannopoulos G. Thalassaemia. Lancet. 2012;379(9813):373-83.
6. Laopaiboon M, Lumbiganon P, Intarut N, et al. Advanced maternal age and pregnancy outcomes: a multicountry assessment. BJOG. 2014;121 Suppl 1:49–56.Kohlhase J, Altmann M, Archangelo L, et al. Genomic cloning, chromosomal mapping, and expression analysis of msal-2. Mamm Genome. 2000;11(1):64-8.
7. Khalil A, Rezende J. Maternal age and vascular dysfunction in pregnancy: pathophysiological perspectives. Placenta. 2020;101:45–52.
8. Sibai BM. Etiology and management of hypertension in pregnancy: current concepts. Obstet Gynecol. 2012;119(2 Pt 1):341–357.

9. Reddy M, Thomas A, Singh R, et al. Hypertensive disorders of pregnancy in women of advanced age: a prospective cohort. Hypertens Pregnancy. 2018;37(1):15–22.
10. Sheen JJ, Wright JD. Maternal age and hypertension in pregnancy: epidemiology and clinical outcomes. Curr Hypertens Rep. 2019;21(12):94.
11. Montan S. Increased risk of preterm birth in older mothers: evidence and clinical implications. Acta Obstet Gynecol Scand. 2017;86(4):477–483.
12. Joseph KS, Kramer MS, Allen AC, et al. Maternal age and risk of growth restriction: a population-based study. BMC Pregnancy Childbirth. 2005;5:7.
13. Jacobsson B, Ladfors L, Milsom I. Advanced maternal age and adverse perinatal outcome. BJOG. 2004;111(6):610–617.
14. Lamminpää R, Vehviläinen-Julkunen K, Gissler M, et al. Advanced maternal age and risk of stillbirth and neonatal death. Acta Obstet Gynecol Scand. 2012;91(3):316–322.
15. Huang L, Tao F, Zhou W, et al. Pregnancy outcomes among women of very advanced maternal age: a retrospective cohort study from China. Sci Rep. 2020;10:20684.