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Delivery by 38 weeks lowers risk of stillbirth in older pregnant women

12 Sep 2017

Delivery by 38 weeks appears to reduce the risk of stillbirth in pregnant women at least 44 years of age, according to a study.

To determine the gestational age at which the risk of foetal or neonatal death associated with delaying delivery by 1 week exceeded the risk of neonatal death associated with immediate delivery, researchers examined a total of 11,957,690 live births, 8,779 stillbirths and 8,664 neonatal deaths that occurred in the United States between 2010 and 2013. Only singleton, nonanomalous pregnancies without hypertensive disease or diabetes were included.

A generalized linear model was used to compare the rate of death associated with immediate delivery to those of expectant management, with the women grouped into six age categories.

Immediate delivery was associated with lower relative risk of neonatal death by 39 weeks across all age groups, with the exception of ≥44 years age group. The odds ratios (ORs) for death were 1.0 (95 percent CI, 0.32 to 3.10) in the <25 years age group, 0.67 (0.19 to 2.37) in the 25 to 29 years age group, 0.80 (0.21 to 2.98) in the 30 to 34 years age group, 0.67 (0.19 to 2.36) in the 35 to 39 years age group, and 0.45 (0.16 to 1.31) in the 40 to 44 years age group.

Among women aged ≥44 years and older, immediate delivery was associated with a lower relative risk of neonatal death by 38 weeks (OR, 0.35; 0.14 to 0.90).

Advanced maternal age carries a greater risk complications such as foetal congenital anomalies, maternal hypertensive disorders, gestational diabetes and pregestational diabetes. These conditions are associated with heightened stillbirth risk. [BJOG 2012;119:276–282; Am J Obstet Gynecol 2007;196:433–444]

Researchers noted that the current finding that delivery by 38 weeks gestational age may reduce the risk of stillbirth in women ≥44 years of age is important given the limited future fertility of mothers in this age group.

“Induction of labour among women 44 years or older at the time of delivery, might be useful in reducing stillbirth. However, it needs to be weighed against compromising maternal outcomes, neonatal morbidity, patient preference and healthcare costs,” researchers said.

“Quantifying and counselling women of advanced maternal age on their risk of stillbirth is important and requires a nuanced approach... Further research regarding the mechanism behind unexplained foetal death in women of advanced maternal age will help determine the most effective forms of prevention,” they added.

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Most Read Articles
27 Nov 2017
Transdermal oestradiol added to progesterone reduces menopause-related depression, researchers reported at the annual meeting of The North American Menopause Society in Philadelphia, US.
5 days ago
Intravenous (IV) iron is less toxic and more effective compared to oral iron, making it a potential frontline therapy for neonatal iron deficiency anaemia, suggests a recent study.
Tracy TC Kwan, BSc (Nursing), MPH; Hextan YS Ngan, MBBS, FHKAM (O&G), MD (HK), FRCOG, 01 Aug 2013

Human papillomavirus (HPV) infection is a prevalent disease worldwide. Consequences of HPV infection vary, depending on the infected individuals and the HPV genotype involved. Life-threatening consequences are not uncommon, and cervical cancer is a clear demonstration of the virus’s potency. While the incidence of cervical cancer is heavily concentrated on developing countries,1 the impact of HPV-related diseases on developed countries has not ceased. In the United States alone, HPV infections are the most common sexually transmitted disease with an estimated 5 million new cases being diagnosed in 2000 among young adults, incurring nearly US$3 billion in terms of direct medical costs.2 A multinational study involving 18,498 women showed that cervical HPV prevalence varied greatly geographically, ranging from the low of 1.6% in North Vietnam to the high of 27% in Nigeria. In general, HPV prevalence peaked among young, sexually active women and declined with age. In selected countries, however, a second peak was noted in women older than 55 years.3 The high prevalence of HPV-related diseases incurs a heavy burden on the healthcare systems of developed and developing countries alike, which renders HPV research and prevention a global public health imperative. On an individual level, the afflictions caused by HPV-related diseases go beyond that of physical suffering to affecting the psychological well-being of the infected. This is the focus of our paper.

27 Nov 2017
Chronic hepatitis B virus (HBV) infection is a global problem. Chronic HBV infection is probably the most common maternal infection encountered in Hong Kong, China, and Southeast Asia. In Hong Kong, which is one of the endemic areas, immunisation against HBV was first provided in 1983 to infants born to mothers who were screened positive for hepatitis B surface antigen (HBsAg). Immunisation became widespread since November 1988, but HBsAg-positive mothers are still encountered frequently.1