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Maternal age, multiple birth, and extremely low birth weight infants
Betty R Vohr1, Jon E Tyson, Linda L Wright
1Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
The Journal of Pediatrics
|December 30, 2008
Summary
Advanced maternal age (40+ years) in extremely low birth weight (ELBW) infants did not increase the risk of death or neurodevelopmental impairment. However, multiple births were associated with higher adverse outcomes for ELBW infants.
Area of Science:
- Neonatal research
- Maternal-fetal medicine
- Developmental pediatrics
Background:
- Advanced maternal age (AMA), defined as maternal age 40 years or older, is associated with increased obstetric complications.
- The impact of AMA on outcomes for extremely low birth weight (ELBW) infants requires further investigation, particularly concerning neurodevelopmental impairment and mortality.
- Previous studies have not consistently evaluated the combined effects of AMA and multiple births on ELBW infant outcomes.
Purpose of the Study:
- To compare the rates of adverse neurodevelopmental outcome or death at 18 to 22 months among ELBW infants born to mothers aged 40 years or older versus younger mothers.
- To quantify the relative risks of maternal age and multiple birth for death or adverse neurodevelopmental outcome in ELBW infants.
Main Methods:
- Prospective evaluation of a large cohort of live extremely low birth weight (ELBW) infants.
- Infants categorized by maternal age groups: <20, 20-29, 30-39, and ≥40 years.
- Statistical analysis to determine relative risks of maternal age and multiple birth for composite outcomes.
Main Results:
- The study included 14,671 live ELBW births. Mothers aged ≥40 years had higher rates of obstetric interventions and medical morbidities.
- ELBW infants born to mothers ≥40 years showed a 22% increased likelihood of survival and a 13% decreased risk of neurodevelopmental impairment or death compared to infants of mothers <20 years.
- Multiple birth was associated with a 10% greater risk of neurodevelopmental impairment or death, irrespective of maternal age.
Conclusions:
- Despite higher pregnancy-related morbidities in mothers aged ≥40 years, there was no overall increased risk of death or neurodevelopmental impairment in their ELBW infants.
- Multiple birth emerged as a significant predictor of adverse outcomes, including death and neurodevelopmental impairment, across all maternal age groups.
- These findings suggest that advanced maternal age alone is not a risk factor for adverse outcomes in ELBW infants, but multiple gestation is.
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