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      EVOLUCION DE LA NATALIDAD Y DEL RIESGO REPRODUCTIVO EN MUJERES DE 40 O MAS AÑOS EN LA DECADA DE LOS 90

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          Abstract

          Se evalúa el riesgo reproductivo en mujeres chilenas de 40 o más años, comparadas con mujeres de 20 a 34 años, en el período 1990 _ 1999. El riesgo se evaluó según Odds Ratio con un intervalo de confianza del 95%. El riesgo de muerte materna (4,05; 3,13-5,23), fetal tardía (2,10; 1,94-2,27), neonatal (1,62; 1,50-1,75) e infantil (1,60; 1,51-1,70) fue más alto en las mujeres mayores. En el grupo estudio, los nacimientos aumentaron significativamente, mientras que en el grupo control el descenso fue significativo. En las mujeres mayores, la tasa de mortalidad materna y neonatal no presentaron cambios significativos, mientras que la tasa de mortalidad fetal tardía e infantil disminuyeron significativamente. Se concluye que el riesgo reproductivo en mujeres de 40 o más años es significativamente mayor que en mujeres menores, y el control de la natalidad es la estrategia básica para reducir los resultados adversos

          Translated abstract

          The reproductive risk in chilean women aged 40 and older, compared with women aged 20 to 34, from 1990 through 1999, is evaluated. The risk was assessed by Odds Ratio with a confidence interval of 95%. The risk of maternal (4.05; 3.13-5.23), late fetal (2.10; 1.94-2.27), neonatal (1.62; 1.50-1.75) and infant death (1.60; 1.51-1.70) was higher in older women. Births trend increased in the study group, while in the control group decreased significantly. In older women, the maternal and neonatal mortality rate presented no significative changes, while late fetal and infant mortality rate decreased significantly. It's concluded, that the reproductive risk in women aged 40 and older is significantly higher than in younger women and the fertility control is the basic strategy to reduce this adverse outcome

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          Most cited references29

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          Increased maternal age and the risk of fetal death.

          Although the fetal death rate has declined over the past 30 years among women of all ages, it is unknown whether particular characteristics of the mother, such as age, still affect the risk of fetal death. We undertook a study to determine whether older age, having a first child (nulliparity), or other characteristics of the mother are risk factors for fetal death. We used data from the McGill Obstetrical Neonatal Database to evaluate risk factors for fetal death among all deliveries at the Royal Victoria Hospital in Montreal (n = 94,346) from 1961 through 1993. Data were available for two time periods (1961 through 1974 and 1978 through 1993); data for 1975 through 1977 have not been entered into the data base and were therefore not included. Using logistic regression, we estimated the effect of specific maternal characteristics and complications of pregnancy on the risk of fetal death. The fetal death rate decreased significantly from 11.5 per 1000 total births (including live births and stillbirths) in the 1960s to 3.2 per 1000 in 1990 through 1993 (P < 0.001). Between these periods, the average maternal age at delivery increased from 27 to 30 years (P < 0.001), and the frequency of the diagnosis of diabetes and hypertension during pregnancy increased fivefold (P < 0.001). Nevertheless, after we controlled for these and other maternal characteristics, women 35 years of age or older continued to have a significantly higher rate of fetal death than their younger counterparts (odds ratio for women 35 to 39 years of age as compared with women < 30 years of age, 1.9; 95 percent confidence interval, 1.3 to 2.7; for those 40 or older, 2.4; 95 percent confidence interval, 1.3 to 4.5). Changes in maternal health and obstetrical practice have resulted in a 70 percent decline in the rate of fetal death among pregnant women of all ages since the 1960s. Advancing maternal age, however, continues to be a risk factor for fetal death.
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            Delayed childbearing and risk of adverse perinatal outcome. A population-based study.

            To investigate the effect of advancing maternal age on pregnancy outcome among healthy nulliparous women, after adjustment for demographic characteristics, smoking, history of infertility, and other medical conditions. A population-based cohort study was conducted with prospectively collected data from the Swedish Medical Birth Register. Nulliparous Nordic women (N = 173,715), aged 20 years and above, who delivered single births at Swedish hospitals from 1983 through 1987. Late fetal and early neonatal death rates; rates of very low birth weight (VLBW, less than 1500 g), moderately low birth weight (MLBW, 1500 through 2499 g), very preterm delivery (less than or equal to 32 weeks), moderately preterm delivery (33 through 36 weeks), and small-for-gestational-age (SGA) infants (less than -2 SDs). Compared with women aged 20 to 24 years, women aged 30 to 34 years had significantly higher adjusted odds ratios (ORs) of late fetal deaths (OR = 1.4); VLBW (OR = 1.2); MLBW (OR = 1.4); very preterm birth (OR = 1.2); and SGA infants (OR = 1.4). Among women aged 35 to 39 years, the adjusted OR was significantly higher for VLBW (OR = 1.9); MLBW (OR = 1.7); very preterm birth (OR = 1.7); moderately preterm birth (OR = 1.2); and SGA infants (OR = 1.7). Among women 40 years old and older, the adjusted OR was significantly higher for VLBW (OR = 1.8); MLBW (OR = 2.0); very preterm birth (OR = 1.9); moderately preterm birth (OR = 1.5); and SGA infants (OR = 1.4). Delayed childbearing is associated with an increased risk of poor pregnancy outcomes after adjustment for maternal complications and other risk factors.
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              Decision-making for termination of pregnancies with fetal anomalies: analysis of 53,000 pregnancies.

              To evaluate the degree to which prenatal knowledge of fetal anomalies and sociodemographic characteristics determined outcome of 53,000 pregnancies. Pregnancies were consecutively evaluated at a university hospital between 1984 and 1997. The severity of anomalies was graded by using an ordinal scale, in which 0 was no anomalies, 1 was no impact on quality of life, 2 was little impact but possibly requiring medical therapy, 3 was serious impact on quality of life even with optimal medical therapy, and 4 was incompatible with life. The abortion rates for grades 1 and 3 anomalies increased from 0.9% to 72.5%, and 0.9% to 37.1% for central nervous system and non-central nervous system anomalies, respectively (P <.001). Multiple logistic regression showed that mothers without a high school education were more likely than those who completed high school to abort a normal pregnancy (odds ratio [OR] 1.62, 95% confidence interval [CI] 1.07, 2.45). In the 452 pregnancies in which there was one grade 3 anomaly, logistic regression also showed that the abortion rate decreased by 6% per year as maternal age decreased (OR 0.94, 95% CI 0.91, 0.97). The severity of anomalies directly correlates with abortion rates, but at similar degrees of severity, central nervous system anomalies are more likely to lead to abortion. Maternal level of education inversely correlates with likelihood of termination of a normal pregnancy, whereas maternal age directly correlates with pregnancy termination when serious anomalies are present. Serious congenital anomalies may disproportionately affect children from families with the youngest mothers because these mothers are likely to continue these pregnancies.
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                Author and article information

                Journal
                rchog
                Revista chilena de obstetricia y ginecología
                Rev. chil. obstet. ginecol.
                Sociedad Chilena de Obstetricia y Ginecología (Santiago, , Chile )
                0048-766X
                0717-7526
                2002
                : 67
                : 2
                : 139-142
                Affiliations
                [02] orgnamePontificia Universidad Católica de Chile orgdiv1Departamento de Salud Pública
                [01] orgnamePontificia Universidad Católica de Chile orgdiv1Departamento de Obstetricia y Ginecología
                Article
                S0717-75262002000200011 S0717-7526(02)06700211
                10.4067/S0717-75262002000200011
                4ea795de-eae0-4929-ac5e-2028723dd6cf

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : June 2002
                : June 2002
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 19, Pages: 4
                Product

                SciELO Chile

                Categories
                Trabajos Originales

                late fetal mortality,Older maternal age,Edad materna avanzada,maternal mortality,mortalidad perinatal,mortalidad materna,infant mortality,neonatal mortality,chilean vital statistics

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