Do Hypertensive Disorders of Pregnancy and Abnormal Placentation Mediate the Association between Advanced Maternal Age and Adverse Perinatal Outcomes?
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Abstract
Background: A tertiary-hospital-based retrospective study (2011-2019) was conducted to determine the mediating role of hypertensive disorders of pregnancy and abnormal placentations between advanced maternal age and adverse neonatal outcomes.
Methods: Data from a tertiary-hospital-based retrospective study (n= 23051) was used and conducted regression-based mediation analysis to assess the mediating role of hypertensive disorders of pregnancy and abnormal placentation between the advanced maternal age and adverse neonatal outcomes.
Results: After adjusting for confounding factors, the indirect effect of advanced maternal age on preterm births, perinatal mortality, and low birth weight mediated by hypertensive disorders of pregnancy was [aOR 4.95 (95% CI: 4.05, 5.85)], [aOR 2.82 (95% CI: 1.78, 3.86)], and [aOR 5.90 (95% CI: 4.93, 6.87)], respectively. The indirect effect of advanced maternal age on preterm births and low birth weight mediated by abnormal placentation was [aOR 6.83 (95% CI: 5.70, 7.97)] and [aOR 4.18 (95% CI: 3.26, 5.11)]. About, 23%, 37%, and 17% of the effect of advanced maternal age on preterm births, perinatal mortality, and low birth weight was mediated by hypertensive disorders of pregnancy, respectively. Furthermore, abnormal placentation mediates the association between advanced maternal age and preterm births by 18% and low birth weight by 23%.
Conclusion: Hypertensive disorders of pregnancy and abnormal placentation partially mediate the association between advanced maternal age and adverse neonatal outcomes.
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14. Ananth CV, Berkowitz GS, Savitz DA, Lapinski RH (1999). Placental abruption and adverse perinatal outcomes. JAMA, 282:1646-1651.
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24. Battaglia FC, Lubchenco LO (1967). A practical classification of newborn infants by weight and gestational age. J Pediatr, 71:159-163.
25. Casey BM, McIntire DD, Leveno KJ (2001). The continuing value of the Apgar score for the assessment of newborn infants. N Engl J Med, 344:467-471.
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27. Yu M, Ping Z, Zhang S, He Y, Dong R, Guo X (2015). The survey of birth defects rate based on birth registration system. Chin Med J, 128:7.
28. Preacher KJ, Kelley K (2011). Effect size measures for mediation models: quantitative strategies for communicating indirect effects. Psychol Methods, 16:93.
29. Baron RM, Kenny DA (1986). The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. J Pers Soc Psychol, 51:1173.
30. Hafeman DM (2009). “Proportion explained”: a causal interpretation for standard measures of indirect effect? Am J Epidemiol, 170:1443-1448.
31. Imai K, Keele L, Tingley D (2010). A general approach to causal mediation analysis. Psychol Methods, 15:309.
32. Nawsherwan, Mubarik S, Ghulam N, Suqing W, Cuifang F (2020). 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.
33. Wogu AF, Loffredo CA, Bebu I, Luta G (2014). Mediation analysis of gestational age, congenital heart defects, and infant birth-weight. BMC Res Notes, 7:1-6.
34. Mendola P, Mumford SL, Männistö TI, Holston A, Reddy UM, Laughon SK (2015). Controlled direct effects of preeclampsia on neonatal health after accounting for mediation by preterm birth. Epidemiology (Cambridge, Mass.), 26:17.
35. Ananth CV, VanderWeele TJ (2011). Placental abruption and perinatal mortality with preterm delivery as a mediator: disentangling direct and indirect effects. Am J Epidemiol, 174:99-108.
36. Yu Y, Liew Z, Wang A, Arah OA, Li J, Olsen J, Cnattingius S, Qin G, Obel C, Fu B (2019). Mediating roles of preterm birth and restricted fetal growth in the relationship between maternal education and infant mortality: A Danish population-based cohort study. PLoS Med, 16:e1002831.
37. Callaghan WM, MacDorman MF, Rasmussen SA, Qin C, Lackritz EM (2006). The contribution of preterm birth to infant mortality rates in the United States. Pediatrics, 118:1566-1573.
38. Anil K, Basel PL, Singh S (2020). Low birth weight and its associated risk factors: Health facility-based case-control study. PLoS One, 15:e0234907.
39. Moore KA, Fowkes FJ, Wiladphaingern J, et al (2017). Mediation of the effect of malaria in pregnancy on stillbirth and neonatal death in an area of low transmission: observational data analysis. BMC Med, 15:1-11.
2. Liu L, Lu Y, Zhang P, Sun Y, Li Y (2020). The Risk of Advanced Maternal Age: Causes and Overview. J Gynecol Res Obstet, 6:019-023.
3. Shan D, Qiu PY, Wu YX, et al (2018). Pregnancy outcomes in women of advanced maternal age: a retrospective cohort study from China. Sci Rep, 8:1-9.
4. Goisis A, Remes H, Barclay K, Martikainen P, Myrskylä M (2017). Advanced maternal age and the risk of low birth weight and preterm delivery: a within-family analysis using Finnish population registers. Am J Epidemiol, 186:1219-1226.
5. Londero AP, Rossetti E, Pittini C, Cagnacci A, Driul L (2019). Maternal age and the risk of adverse pregnancy outcomes: a retrospective cohort study. BMC Pregnancy Childbirth, 19:261.
6. Timofeev J, Reddy UM, Huang C-C, Driggers RW, Landy HJ, Laughon SK (2013). Obstetric complications, neonatal morbidity, and indications for cesarean delivery by maternal age. Obstet Gynecol, 122:1184.
7. Cleary-Goldman J, Malone FD, Vidaver J, Ball RH, Nyberg DA, Comstock CH, Saade GR, Eddleman KA, Klugman S, Dugoff L (2005). Impact of maternal age on obstetric outcome. Obstet Gynecol, 105:983-990.
8. Luke B, Brown MB (2007). Elevated risks of pregnancy complications and adverse outcomes with increasing maternal age. Hum Reprod, 22:1264-1272.
9. Endeshaw G, Berhan Y (2015). Perinatal outcome in women with hypertensive disorders of pregnancy: a retrospective cohort study. Int Sch Res Notices, 2015:20804.
10. Berhe AK, Ilesanmi AO, Aimakhu CO, Mulugeta A (2020). Effect of pregnancy induced hypertension on adverse perinatal outcomes in Tigray regional state, Ethiopia: a prospective cohort study. BMC Pregnancy Childbirth, 20:7.
11. Ludford I, Scheil W, Tucker G, Grivell R (2012). Pregnancy outcomes for nulliparous women of advanced maternal age in S outh A ustralia, 1998–2008. Aust N Z J Obstet Gynaecol, 52:235-241.
12. Vahanian SA, Lavery JA, Ananth CV, Vintzileos A (2015). Placental implantation abnormalities and risk of preterm delivery: a systematic review and metaanalysis. Am J Obstet Gynecol, 213:S78-S90.
13. Ananth CV, Demissie K, Smulian JC, Vintzileos AM (2001). Relationship among placenta previa, fetal growth restriction, and preterm delivery: a population-based study. Obstet Gynecol, 98:299-306.
14. Ananth CV, Berkowitz GS, Savitz DA, Lapinski RH (1999). Placental abruption and adverse perinatal outcomes. JAMA, 282:1646-1651.
15. Kang H (2013). The prevention and handling of the missing data. Korean J Anesthesiol, 64:402.
16. Program NHBPE (2000). Report of the national high blood pressure education program working group on high blood pressure in pregnancy. Am J Obstet Gynecol, 183:s1-s22.
17. Xiong X, Demianczuk NN, Saunders LD, Wang F-L, Fraser WD (2002). Impact of preeclampsia and gestational hypertension on birth weight by gestational age. Am J Epidemiol, 155:203-209.
18. Schroeder BM (2002). ACOG practice bulletin on diagnosing and managing preeclampsia and eclampsia. Am Fam Physician, 66:330.
19. Kancherla V, Räisänen S, Gissler M, Kramer MR, Heinonen S (2015). Placenta previa and risk of major congenital malformations among singleton births in Finland. Birth Defects Res A Clin Mol Teratol, 103:527-535.
20. Tikkanen M (2011). Placental abruption: epidemiology, risk factors and consequences. Acta Obstet Gynecol Scand, 90:140-149.
21. Blencowe H, Cousens S, Oestergaard MZ, Chou D, Moller A-B, Narwal R, Adler A, Garcia CV, Rohde S, Say L (2012). National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. The lancet, 379:2162-2172.
22. Cartlidge PH, Stewart JH (1995). Effect of changing the stillbirth definition on evaluation of perinatal mortality rates. The Lancet, 346:486-488.
23. Brown TM, Cueto M, Fee E (2006). A transição de saúde pública'internacional'para'global'e a Organização Mundial da Saúde. História, Ciências, Saúde-Manguinhos, 13:623-647.
24. Battaglia FC, Lubchenco LO (1967). A practical classification of newborn infants by weight and gestational age. J Pediatr, 71:159-163.
25. Casey BM, McIntire DD, Leveno KJ (2001). The continuing value of the Apgar score for the assessment of newborn infants. N Engl J Med, 344:467-471.
26. Landmann E, Reiss I, Misselwitz B, Gortner L (2006). Ponderal index for discrimination between symmetric and asymmetric growth restriction: percentiles for neonates from 30 weeks to 43 weeks of gestation. The Journal of Maternal-Fetal & Neonatal Medicine, 19:157-160.
27. Yu M, Ping Z, Zhang S, He Y, Dong R, Guo X (2015). The survey of birth defects rate based on birth registration system. Chin Med J, 128:7.
28. Preacher KJ, Kelley K (2011). Effect size measures for mediation models: quantitative strategies for communicating indirect effects. Psychol Methods, 16:93.
29. Baron RM, Kenny DA (1986). The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. J Pers Soc Psychol, 51:1173.
30. Hafeman DM (2009). “Proportion explained”: a causal interpretation for standard measures of indirect effect? Am J Epidemiol, 170:1443-1448.
31. Imai K, Keele L, Tingley D (2010). A general approach to causal mediation analysis. Psychol Methods, 15:309.
32. Nawsherwan, Mubarik S, Ghulam N, Suqing W, Cuifang F (2020). 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.
33. Wogu AF, Loffredo CA, Bebu I, Luta G (2014). Mediation analysis of gestational age, congenital heart defects, and infant birth-weight. BMC Res Notes, 7:1-6.
34. Mendola P, Mumford SL, Männistö TI, Holston A, Reddy UM, Laughon SK (2015). Controlled direct effects of preeclampsia on neonatal health after accounting for mediation by preterm birth. Epidemiology (Cambridge, Mass.), 26:17.
35. Ananth CV, VanderWeele TJ (2011). Placental abruption and perinatal mortality with preterm delivery as a mediator: disentangling direct and indirect effects. Am J Epidemiol, 174:99-108.
36. Yu Y, Liew Z, Wang A, Arah OA, Li J, Olsen J, Cnattingius S, Qin G, Obel C, Fu B (2019). Mediating roles of preterm birth and restricted fetal growth in the relationship between maternal education and infant mortality: A Danish population-based cohort study. PLoS Med, 16:e1002831.
37. Callaghan WM, MacDorman MF, Rasmussen SA, Qin C, Lackritz EM (2006). The contribution of preterm birth to infant mortality rates in the United States. Pediatrics, 118:1566-1573.
38. Anil K, Basel PL, Singh S (2020). Low birth weight and its associated risk factors: Health facility-based case-control study. PLoS One, 15:e0234907.
39. Moore KA, Fowkes FJ, Wiladphaingern J, et al (2017). Mediation of the effect of malaria in pregnancy on stillbirth and neonatal death in an area of low transmission: observational data analysis. BMC Med, 15:1-11.
| Files | ||
| Issue | Vol 51 No 5 (2022) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v51i5.9421 | |
| Keywords | ||
| Advanced maternal age Hypertensive disorders of pregnancy Abnormal placentation Adverse perinatal outcomes | ||
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How to Cite
1.
Li H, . N, Kkhan A, Haq I, Yuan Mei S. Do Hypertensive Disorders of Pregnancy and Abnormal Placentation Mediate the Association between Advanced Maternal Age and Adverse Perinatal Outcomes?. Iran J Public Health. 2022;51(5):1057-1066.
