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Obstetric Complications, Neonatal Morbidity, and Indications for Cesarean Delivery by Maternal Age

Timofeev, Julia MD; Reddy, Uma M. MD, MPH; Huang, Chun-Chih PhD; Driggers, Rita W. MD; Landy, Helain J. MD; Laughon, S. Katherine MD, MS

doi: 10.1097/AOG.0000000000000017
Contents: Cesarean Delivery: Original Research

OBJECTIVE: To delineate adverse obstetric and neonatal outcomes as well as indications for cesarean delivery by maternal age in a contemporaneous large national cohort.

METHODS: This was a retrospective analysis of electronic medical records from 12 centers and 203,517 (30,673 women aged 35 years or older) women with singleton gestations stratified by maternal age. Logistic regression was performed to investigate maternal and neonatal outcomes for each maternal age strata (referent group, age 25.0–29.9 years), adjusting for race, parity, body mass index, insurance, pre-existing medical conditions, substance and tobacco use, and site. Documented indications for cesarean delivery were analyzed.

RESULTS: Neonates born to women aged 25.0–29.9 years had the lowest risk of birth weight less than 2,500 g (7.2%; P<.001), admission to neonatal intensive care unit (11.5%; P<.001), and perinatal mortality (0.7%; P<.001). Hypertensive disorders of pregnancy were higher in women aged 35 years or older (cumulative rate 8.5% compared with 7.8%; 25.0–29.9 years; P<.001). Previous uterine scar was the leading indication for cesarean delivery in women aged 25.0 years or older (36.9%; P<.001). For younger women, failure to progress or cephalopelvic disproportion (37.0% for those younger than age 20.0 years and 31.1% for those aged 20.0–24.9-years; P<.001) and nonreassuring fetal heart tracing (28.7% for those younger than 20.0 years and 21.2% for those aged 20.0–24.9-years; P<.001) predominated as indications. Truly elective cesarean delivery rate was 20.2% for women aged 45.0 years or older (adjusted odds ratio 1.85 [99% confidence interval 1.03–3.32] compared with the referent age group of 25.0–29.9 years).

CONCLUSIONS: Maternal and obstetric complications differed by maternal age, as did rates of elective cesarean delivery. Women aged 25.0–29.9 years had the lowest rate of serious neonatal morbidity.

LEVEL OF EVIDENCE: II

Maternal and obstetric complications, as well as elective cesarean delivery, vary by maternal age; women aged 25.0–29.9 years have the lowest rate of serious neonatal morbidity.

Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, MedStar Washington Hospital Center, Washington, DC; the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, and the Department of Biostatistics and Epidemiology, MedStar Health Research Institute, Hyattsville, Maryland.

Corresponding author: Julia Timofeev, MD, Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, 110 Irving Street NW, 5B-63, Washington, DC 20010; e-mail: jtimofe1@jhmi.edu.

For a list of institutions involved in the Consortium on Safe Labor, see the Appendix online at http://links.lww.com/AOG/A448.

The Consortium on Safe Labor was funded by the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, through Contract No. HHSN267200603425C. Funded in part with Federal funds (grant # UL1RR031975) from the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through the Clinical and Translational Science Awards Program, a trademark of Department of Health and Human Services, part of the Roadmap Initiative, “Re-Engineering the Clinical Research Enterprise.”

The named authors alone are responsible for the views expressed in this article, which does not necessarily represent the decisions or the stated policy of the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2013 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.