Preeclamapsia Preeclampsia Mediates the Association between Advanced Maternal Age and Adverse Pregnancy Outcomes: A Structural Equation Modeling Approach

  • . Nawsherwan Mail 1. Department of Preventive Medicine, School of Health Sciences, Wuhan University, Wuhan, Hubei, China
  • Sumaira Mubarik Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan, Hubei, China
  • Ghulam Nabi Key Laboratory of Animal Physiology, Biochemistry and Molecular Biology of Hebei Province, College of Life Sciences, Hebei Normal University, Shijiazhuang, China
  • Suqing Wang Department of Preventive Medicine, School of Health Sciences, Wuhan University, Wuhan, Hubei, China
  • Cuifang Fan Department of Obstetrics and Gynecology, Renmin Hospital, Wuhan University, Wuhan, Hubei, China
Advanced maternal age;, Preeclampsia, Adverse pregnancy outcomes, Structural equation modeling


Background: Advanced maternal age (AMA) is considered a risk factor associated with preeclampsia and adverse pregnancy outcomes. We aimed to assess the mediating role of preeclampsia between AMA and adverse pregnancy outcomes.

Methods: A sample of 14646 pregnant women from the tertiary hospital of Hubei Province, China, during the years 2011-2017 were included in this study. Pregnant women were divided into 4 groups according to their age at delivery. Mediated effect of preeclampsia with relation to AMA and adverse pregnancy outcomes was measured using structural equation modeling.

Results: Women in the highest age group were significantly associated with preterm delivery [RR 1.37 (95% CI 1.24 - 1.49)] and low birth weight [RR 1.28 (95% CI 1.11 - 1.45)] compared with women in the lowest age group. The indirect effect (mediated effect) of AMA on preterm delivery and low birth weight mediated by preeclampsia was [β 0.053 (95% CI: 0.047, 0.060)], and [β 0.045 (95% CI: 0.038, 0.052)], respectively. The estimated mediation proportion of the effect of AMA due to mediated effect of preeclampsia was (35.5%) for preterm delivery and (23.5%) for low birth weight.

Conclusion: Preeclampsia partially mediates the association between AMA and adverse pregnancy outcomes.


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How to Cite
Nawsherwan ., Mubarik S, Nabi G, Wang S, Fan C. Preeclamapsia Preeclampsia Mediates the Association between Advanced Maternal Age and Adverse Pregnancy Outcomes: A Structural Equation Modeling Approach. Iran J Public Health. 49(9):1727-1733.
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