Preeclamapsia Preeclampsia Mediates the Association between Advanced Maternal Age and Adverse Pregnancy Outcomes: A Structural Equation Modeling Approach
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.
2. Shan D, Qiu PY, Wu YX, et al (2018). Preg-nancy outcomes in women of advanced maternal age: a retrospective cohort study from China. Scientific Reports, 8:12239.
3. Hamilton BE, Martin JA, Osterman MJK, et al (2015). Births: final data for 2014. Natl Vital Stat Rep, 64(12):1–64.
4. Jacobsson B, Ladfors L, Milsom I (2004). Advanced maternal age and adverse peri-natal outcome. Obstet Gynecol, 104:727–33.
5. Waldenstrom U, Cnattingius S, Vixner L, et al (2017). Advanced maternal age increas-es the risk of very preterm birth, irrespec-tive of parity: a population based register study. BJOG, 124(8):1235–1244.
6. Cnattingius S, Forman MR, Berendes HW, et al (1992). Delayed childbearing and risk of adverse perinatal outcome. a popula-tion-based study. JAMA, 268(7):886-90.
7. Almeida NK, Almeida RM, Pedreira CE (2015). Adverse Perinatal outcomes for advanced maternal age: a cross-sectional study of Brazilian births. J Pediatr (Rio J), 91(5):493-8.
8. Koo YJ, Ryu HM, Yang JH, et al (2012). Pregnancy outcomes according to in-creasing maternal age. Taiwan J Obstet Gy-necol, 51(1):60-5.
9. Lamminpaa R, Julkunen KV, Gissler M, et al (2012). Preeclampsia complicated by ad-vanced maternal age: a registry-based study on primiparous women in Finland 1997-2008. BMC Pregnancy Childbirth, 12:47.
10. Londero AP, Rossetti E, Pittini C, et al (2019). Maternal age and the risk of ad-verse pregnancy outcomes: a retrospec-tive cohort study. BMC Pregnancy and Childbirth, 19(261): 2-10.
11. Rasmussen S, Irgens LM (2003). Fetal growth and body proportion in preeclampsia. Obstet Gynecol, 101(3):575-83.
12. Nawsherwan, Khan A, Begum N, et al (2020). Low birth weight, and low pon-deral index mediates the association be-tween preeclampsia, placenta previa, and neonatal mortality. Iran J Public Health, 49(4):654-662.
13. Kang H (2013). The prevention and han-dling of the missing data. Korean J Anesthe-siol, 64(5): 402-406.
14. Hossin MH, Koupil I, Falkstedt D (2019). Early life socioeconomic position and mortality from cardiovascular diseases: an application of causal mediation analysis in the Stockholm Public Health Cohort. BMJ Open, 9:e026258.
15. Hu Lt, Bentler PM (1999). Cutoff criteria for fit indexes in covariance structure analy-sis: conventional criteria versus new alter-natives. Struct Equ Modeling, 6:1–55.
16. Kelly R, Holzman C, Senagore P, et al (2009). Placental vascular pathology find-ings and pathways to preterm delivery. Am J Epidemiol, 170:148–158.
17. Norwitz ER, Caughey AB (2011). Progester-one supplementation and the prevention of preterm birth. Rev Obstet Gynecol, 4(2):60–72.
18. Driul L, Londero AP, Bertozzi S, et al (2010). Pregnancy outcome and neonatal health by mothers aged 40 years and over. JMMS, 1:148-155.
19. Tabcharoen C, Pinjaroen S, Suwanrath C, et al (2009). Pregnancy outcome after age 40 and risk of low birth weight. J Obstet Gynaecol, 29:378-83.
20. Aldous MB, Edmonson MB (1993). Mater-nal age at first childbirth and risk of low birth weight and preterm delivery in Washington State. JAMA, 270(21):2574–7.
21. Althabe F, Moore JL, Gibbons L, et al (2015). Adverse maternal and perinatal outcomes in adolescent pregnancies: The global Network’s maternal newborn health registry study. Reprod Health, 12(2):S8.
22. Alemu T, Umeta M (2015). Prevalence and determinants of small size babies in Ethiopia: Results from in-depth analyses of the Ethiopian Demographic and Health Survey-2011. Fam Med Med Sci Res, 4(171):2.
23. Restrepo-Mendez MC, Lawlor DA, Horta BL, et al (2015). The association of ma-ternal age with birthweight and gestation-al age: a cross-cohort comparison. Paedi-atr Perinat Epidemiol, 29:31-40.
24. Davies EL, Bell JS, Bhattacharya S (2016). Preeclampsia and preterm delivery: A population based case–control study. Hy-pertens Pregnancy, 35(4):510-519.
25. Martius J, Steck T, Oehler M, et al (1998). Risk factors associated with preterm (<37+0 weeks) and early preterm (<32+0 weeks): univariate and multivariate analy-sis of 106 345 singleton births from the 1994 statewide perinatal survey of Bavar-ia. Eur J Obstet Gynecol Reprod Biol, 80(2):183-9.
26. Maiti S, Kanrar P, Karmakar C, et al (2014). Maternal and perinatal outcome in rural Indian women with placenta previa. Br Biomed Bull, 2(4):714-718.
27. Mayo K, Melamed N, Vandenberghe H (2015). The impact of adoption of the in-ternational association of diabetes in pregnancy study group criteria for the screening and diagnosis of gestational di-abetes. Am J Obstet Gynecol, 212(2):224.e1-9.
28. Waldenstrom U, Aasheim V, Nilsen ABV, et al (2014). Adverse pregnancy outcomes related to advanced maternal age com-pared with smoking and being over-weight. Obstet Gynecol, 123 (1) 104-12.
29. Gant NF, Worley RT (1980). Hypertension in pregnancy: Concepts and management. In: Chesley LC (ed) Hypertension in pregnancy. Appleton Century Crofts, New York, 199-204.
|Issue||Vol 49 No 9 (2020)|
|Advanced maternal age; Preeclampsia Adverse pregnancy outcomes Structural equation modeling|
|Rights and permissions|
|This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.|