1. Antenatal Complications
Advanced Maternal Age and the Correlation to Cesarean Birth Rates
Dr. Linda Graf CNM, WHNP-C, DNP, Hope Campbell MSN, RN
DePaul University, Chicago, IL 60604
Background
Conclusions
There is a correlation between advanced maternal age and a higher rate of cesarean delivery.
It is not certain what the exact reason for the higher rate of cesarean sections is.
Risk factors were identified that could contribute to the higher rate of cesareans
Mean age of first time mothers is increasing1
Fertility enhancing therapy allows for more women to push pregnancy to later in life2
Increasing rate of delayed pregnancy could contribute to the increased rate of cesarean section deliveries in women of advanced maternal age (35 years and older)3
Cesarean deliveries come with risk and complications such as blood loss, infection and blood clots
Nursing Implications
Patient educations regarding individual health status
Research to define clearer evidence based guidelines regarding fetal status and labor arrest
Informed decision making regarding delivery methods
Family planning and education on the risks of postponing pregnancy to later years of life
Purpose
To determine whether there is a direct correlation between rising maternal age and an increase in primary cesarean deliveries
To determine if those cesarean sections are due to medical necessity
References
Research Questions
Mathews TJ, Hamilton BE. Mean age of mothers is on the rise: United States, 2000–2014. NCHS data brief, no 232. Hyattsville, MD: National Center for Health Statistics
Martin, J. A., Hamilton, B. E., Ph, D., Osterman, M. J. K., Curtin, S. C., & Mathews, T. J. (2015). National Vital Statistics Reports Births: Final Data for 2013, 64(1).
American College of Obstetricians and Gynecologist. (2015). F AQ Having a baby after age 35. Retrieved from
Bayrampour, H., Heaman, M., Duncan, K. A., & Tough, S. (2012). Comparison of Perception of Pregnancy Risk of Nulliparous Women of Advanced Maternal Age and Younger Age. Journal of Midwifery & Women’s Health. 445–454. doi: /j x
Nilesh, M., & Raju, A. (2015). Study of the Risk Factors for Cesarean Delivery in Induced Labors at Term. The Journal of Obstetrics and Gynecology of India, 65(August), 236–240.
Neill, M. O., Mills, T., Kenny, L. C., Lavender, T., Mcnamee, R., & Khashan, A. S. (2013). Advanced Maternal Age and Adverse Pregnancy Outcome : Evidence from a Large Contemporary Cohort, 8(2), 1–9.
Herstad, L., Klungsøyr, K., Skjærven, R., Tanbo, T., Forsén, L., & Åbyholm, T. (2016). Elective cesarean section or not? Maternal age and risk of adverse outcomes at term : a population-based registry study of low- risk primiparous women. BMC Pregnancy and Childbirth, 1–11. doi: /s
Grotegut, C. A., Chisholm, C. A., Johnson, L. N. C., Brown, H. L., Heine, R. P., & James, A. H. (2014). Medical and Obstetric Complications among Pregnant Women Aged 45 and Older, 9(4).
Haslinger, C., Stoiber, B., Capanna, F., Schäffer, M., Zimmermann, R., & Schäffer, L. (2016). Postponed pregnancies and risks of very advanced maternal age.
10. Walker, K. F., Bugg, G. J., Macpherson, M., McCormick, C., Grace, N., Wildsmith, C., Thornton, J. G. (2016). Randomized Trial of Labor Induction in Women 35 Years of Age or Older. New England Journal of Medicine, 374(9), 813–822.
11. MacMahon, B., & Pugh, T. G. (1970). Epidemiologic principles and methods. Boston: Little, Brown.
Is the lower rate of cesarean section deliveries in women aged 25 – 35 due to lower medical necessity?
Is the higher rate of cesarean section deliveries in women aged due to higher medical necessity?
Have there been any interventions targeting mothers with advanced age to reduce the number of cesarean deliveries?
What other factors besides medical necessity contribute to higher cesarean birth rates in patients of advanced maternal age?
Results
Comorbidities
Antenatal Complications
Comorbidities are a disease or disorder that co-occurs with pregnancy such as hypertension, obesity and diabetes mellitus
One study found a correlation between a BMI  30 kg/m2 and cesarean delivery5
A second study demonstrated that a BMI  30 kg/m2 did not influence adverse outcomes in women of advanced maternal age (AMA)6
Antenatal complications are complications that arise during pregnancy such as gestational diabetes, pre-eclampsia, pregnancy associated hypertension, and placental abruption
Increased odds of antenatal complications in women of advanced maternal age leads to a higher rate of cesarean deliveries8
Advanced maternal age was associated with higher rates of complications such as preterm birth (26.4% vs 13.8%), preeclampsia (9.9% vs 2.4%), gestational hypertension (1.1% vs 0.6% and gestational diabetes (8.8% vs 3.5%) 9
Inducing labor because of antenatal complications does not have any significant effect on the rate of cesarean section in women of AMA10
Materials and Methods
Perception of Risk
Databases searched included CINAHL Complete, PubMed and ProQuest Nursing
Search terms: Maternal age, cesarean birth and advanced maternal age
Theory used was The Web of Causation Model by MacMahon and Pugh (1970) which guided the framework of the literature review11
A patient’s and their providers perception of risk may contribute to a higher rate of cesarean deliveries in women of AMA7
Women of AMA had a higher perception of pregnancy risk than younger women (20 – 29 years ) 7
Risk perception may not reflect an individual risk situation4