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O Impacto da Idade Materna Avançada sobre os Resultados da Gravidez Translated title: Impact of Advanced Maternal Age on the Outcome of Pregnancy

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      Abstract

      Objetivo: identificar o efeito da idade sobre os resultados maternos e perinatais das gestações ocorridas em mulheres com 40 anos ou mais. Métodos: comparamos 494 gestantes com mais de 40 anos, com 988 gestantes com idade entre 20 e 29 anos, pareando-as por paridade. Após controlar possíveis variáveis confundidoras pela análise multivariada, a idade materna avançada manteve associação com a maior prevalência de hipertensão arterial, apresentação anômala, parto por cesária, hemorragia puerperal, índice de Apgar baixo, morte perinatal, natimortalidade e sofrimento fetal intraparto. Resultados: a idade materna avançada esteve isoladamente associada à hipertensão arterial, apresentação anômala, diagnóstico de sofrimento fetal intraparto, parto por cesária e hemorragia puerperal. Com relação aos resultados neonatais, a idade materna avançada estava associada independentemente apenas ao baixo índice de Apgar, morte perinatal e óbito fetal. Conclusões: esses achados mostram a necessidade de assistência obstétrica adequada com atenção especial a esses fatores para procurar melhorar os resultados maternos e perinatais das gestantes com idade avançada.

      Translated abstract

      Most authors agree on the negative impact of pregnancy in women with advanced maternal age on maternal and perinatal outcome. However, it is not usual to evaluate if some considered risk factors are only confounders because they are present in women over forty years. In order to identify the isolated effect of age on maternal and perinatal outcome of pregnancies in women over forty, 494 pregnancies from this age group were compared to 988 pregnancies among women aged 20 to 29 years, matched by parity. After controlling possible confounding variables through multivariate analysis, advanced maternal age maintained its association with a higher prevalence of hypertension, malpresentation, cesarean section, postpartum hemorrhage, low Apgar score, perinatal death, late fetal death and intrapartum fetal distress. These findings show the need for adequate obstetrical care with special attention to those factors in order to improve maternal and perinatal outcome of pregnancies in women with advanced age.

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      Most cited references 19

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      Older maternal age and pregnancy outcome: a review of the literature.

       Peter Hansen (1986)
      We are in the early phase of a period when the increased numbers of women born during the 1947 to 1965 baby boom are entering their later child-bearing years. They are also part of a generation of women who are increasingly delaying childbirth until their 30s. These two factors will likely increase the proportion of total births accounted for by this 35- to 49-year age group by 72 per cent, from 5.9 per cent in 1982 to 8.6 per cent by the turn of the century. There are important and specific risks related to pregnancies for older women as compared to younger women. It is likely that a woman's ability to conceive declines steadily to where it has been estimated that 34 to 46 per cent of women age 35 and older are unable to become pregnant. Hypertension, preeclampsia, and diabetes mellitus are not only more common but seem to carry an even greater risk for older women, resulting more frequently in fetal demise. Although there are conflicting findings, older women seem to have more babies weighing under 2,500 gm and more over 4,000 gm. It appears that there are more problems with abnormal labor patterns and a definite higher incidence of cesarean section. The literature seems to support the finding of high incidences of late pregnancy bleeding from placenta previa and abruptio placenta. Many of those factors contribute to a several-fold increase in maternal mortality for older compared to younger pregnant women. The fetus, likewise, is at greater risk. There appears to be a greater risk for spontaneous abortion, although the magnitude of the risk is unclear because of the potential confounding from gravidity, birth order, and reduced fecundity. The stillbirth rate seems to double by the late 30s and increases to 3- to 4-fold by the mid-40s. The neonatal mortality rate seems to have a mild association with maternal age. Chromosome abnormalities, especially trisomies 13, 18, and 21, and sex chromosome aneuploidies, increase exponentially with maternal age starting in the 30s, reaching levels of 1.4 per cent at age 35, 1.9 per cent at 40, and 8.9 per cent at 45, according to amniocentesis data. Some of those contribute to the higher stillbirth rate resulting in a slightly smaller incidence of chromosome abnormalities in newborns. Overall, the literature supports the finding that women and their offspring experience significant increased problems as maternal age progresses through the mid-30s and beyond.(ABSTRACT TRUNCATED AT 400 WORDS)
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        Pregnancy Outcome in Nulliparous Women 35 Years and Older

         M Prysak (1995)
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          Delivery at 40 years of age and over

           E Caspi,  Y. Lifshitz (1979)
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            Author and article information

            Affiliations
            [1 ] Universidade Estadual de Campinas Brazil
            Contributors
            Role: ND
            Role: ND
            Role: ND
            Role: ND
            Journal
            rbgo
            Revista Brasileira de Ginecologia e Obstetrícia
            Rev. Bras. Ginecol. Obstet.
            Federação Brasileira das Sociedades de Ginecologia e Obstetrícia (Rio de Janeiro )
            1806-9339
            August 1998
            : 20
            : 7
            : 389-394
            S0100-72031998000700004 10.1590/S0100-72031998000700004

            http://creativecommons.org/licenses/by/4.0/

            Product
            Product Information: SciELO Brazil
            Categories
            OBSTETRICS & GYNECOLOGY

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