Obstet Gynecol Sci.  2019 Mar;62(2):93-102. 10.5468/ogs.2019.62.2.93.

Perinatal outcome of twin pregnancies according to maternal age

Affiliations
  • 1Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. drmaxmix.choi@samsung.com
  • 2Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.

Abstract


OBJECTIVE
To investigate the perinatal outcomes of twin pregnancies according to maternal age.
METHODS
This is a retrospective cohort study of twin pregnancies delivered ≥24 weeks' gestation at a tertiary academic hospital from 1995 to 2016. Subjects were categorized into 5 groups according to maternal age: < 25, 25-29, 30-34, 35-39, and ≥40 years. Maternal and neonatal outcomes of each maternal age group were analyzed using the Jonckheere-Terpstra test and the linear-by-linear association test.
RESULTS
A total of 1,936 twin pregnant women were included, of which 47 (2.4%), 470 (24.3%), 948 (49.0%), 417 (21.5%), and 54 (2.7%) women were aged < 25, 25-29, 30-34, 35-39, and ≥40 years, respectively. Higher maternal age was significantly associated with a higher rate of dichorionic twins and a higher risk of gestational diabetes and placenta previa. However, rates of preterm labor, preterm premature rupture of membranes, cervical incompetence, preterm delivery, preeclampsia, placenta abruption, and cesarean section were not associated with maternal age. Birth weight increased and the rate of admission to the neonatal intensive care unit (NICU) decreased with older maternal age, but other neonatal outcomes did not change with age. Maternal age was significantly associated with a lower rate of NICU admission after controlling for potential confounding factors in multivariable analysis.
CONCLUSION
Advanced maternal age in twin pregnancies was associated with increased risk of gestational diabetes, placenta previa, and higher birth weight but a lower rate of NICU admission. However, other outcomes were not significantly associated with maternal age.

Keyword

Maternal age; Twin pregnancy, Perinatal care

MeSH Terms

Birth Weight
Cesarean Section
Cohort Studies
Diabetes, Gestational
Female
Humans
Infant, Newborn
Intensive Care, Neonatal
Maternal Age*
Membranes
Obstetric Labor, Premature
Placenta
Placenta Previa
Pre-Eclampsia
Pregnancy
Pregnancy, Twin*
Pregnant Women
Retrospective Studies
Rupture
Twins*

Figure

  • Fig. 1 Numbers and rates of twin birth.

  • Fig. 2 Numbers and rates of twin births according to the maternal age.


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Reference

1. Carolan M. The graying of the obstetric population: implications for the older mother. J Obstet Gynecol Neonatal Nurs. 2003; 32:19–27.
Article
2. Yogev Y, Melamed N, Bardin R, Tenenbaum-Gavish K, Ben-Shitrit G, Ben-Haroush A. Pregnancy outcome at extremely advanced maternal age. Am J Obstet Gynecol. 2010; 203:558.e1–558.e7.
Article
3. Joyce A, Martin JA, Hamilton BE, Osterman MJK, Driscoll AK, Drake P. Births: final data for 2016. Natl Vital Stat Rep. 2018; 67:1–55.
4. Sohn K. Parents are rapidly getting older in South Korea. Hum Fertil (Camb). 2017; 20:212–216.
Article
5. Korean Statistical Information Service. Birth data for 2016, Korea. Daejeon: Korean Statistical Information Service;2017.
6. Black M, Bhattacharya S. Epidemiology of multiple pregnancy and the effect of assisted conception. Semin Fetal Neonatal Med. 2010; 15:306–312.
Article
7. Templeton A. The multiple gestation epidemic: the role of the assisted reproductive technologies. Am J Obstet Gynecol. 2004; 190:894–898.
Article
8. Hoffman MC, Jeffers S, Carter J, Duthely L, Cotter A, González-Quintero VH. Pregnancy at or beyond age 40 years is associated with an increased risk of fetal death and other adverse outcomes. Am J Obstet Gynecol. 2007; 196:e11–e13.
Article
9. Huang L, Sauve R, Birkett N, Fergusson D, van Walraven C. Maternal age and risk of stillbirth: a systematic review. CMAJ. 2008; 178:165–172.
Article
10. McLennan AS, Gyamfi-Bannerman C, Ananth CV, Wright JD, Siddiq Z, D'Alton ME, et al. The role of maternal age in twin pregnancy outcomes. Am J Obstet Gynecol. 2017; 217:80.e1–80.e8.
Article
11. Lisonkova S, Joseph KS, Bell R, Glinianaia SV. Effect of advanced maternal age on perinatal outcomes in twins: the impact of chorionicity. Ann Epidemiol. 2013; 23:428–434.
12. Gluck O, Mizrachi Y, Bar J, Barda G. The impact of advanced maternal age on the outcome of twin pregnancies. Arch Gynecol Obstet. 2018; 297:891–895.
Article
13. de Vries LS, Eken P, Dubowitz LM. The spectrum of leukomalacia using cranial ultrasound. Behav Brain Res. 1992; 49:1–6.
Article
14. Retinopathy of prematurity: guidelines for screening and treatment. The report of a joint working party of The Royal College of Ophthalmologists and the British Association of Perinatal Medicine. Early Hum Dev. 1996; 46:239–258.
15. Lee JS, Polin RA. Treatment and prevention of necrotizing enterocolitis. Semin Neonatol. 2003; 8:449–459.
Article
16. Kenny LC, Lavender T, McNamee R, O'Neill SM, Mills T, Khashan AS. Advanced maternal age and adverse pregnancy outcome: evidence from a large contemporary cohort. PLoS One. 2013; 8:e56583.
Article
17. Prapas N, Kalogiannidis I, Prapas I, Xiromeritis P, Karagiannidis A, Makedos G. Twin gestation in older women: antepartum, intrapartum complications, and perinatal outcomes. Arch Gynecol Obstet. 2006; 273:293–297.
Article
18. Fox NS, Rebarber A, Dunham SM, Saltzman DH. Outcomes of multiple gestations with advanced maternal age. J Matern Fetal Neonatal Med. 2009; 22:593–596.
Article
19. Helle S. Why twin pregnancies are more successful at advanced than young maternal age? A potential role of ‘terminal reproductive investment’. Hum Reprod. 2008; 23:2387–2389.
Article
20. Yu HY, Lau T, Sahota DS, Ting Y, Leung T. Perinatal outcome of monochorionic twin pregnancies. Zhonghua Fu Chan Ke Za Zhi. 2013; 48:405–410.
21. Al Riyami N, Al-Rusheidi A, Al-Khabori M. Perinatal outcome of monochorionic in comparison to dichorionic twin pregnancies. Oman Med J. 2013; 28:173–177.
Article
22. Zhang J, Meikle S, Grainger DA, Trumble A. Multifetal pregnancy in older women and perinatal outcomes. Fertil Steril. 2002; 78:562–568.
Article
23. Ananth CV, Demissie K, Smulian JC, Vintzileos AM. Placenta previa in singleton and twin births in the United States, 1989 through 1998: a comparison of risk factor profiles and associated conditions. Am J Obstet Gynecol. 2003; 188:275–281.
Article
24. Cleary-Goldman J, Malone FD, Vidaver J, Ball RH, Nyberg DA, Comstock CH, et al. Impact of maternal age on obstetric outcome. Obstet Gynecol. 2005; 105:983–990.
Article
25. Johnston R, Fong A, Lovell S, Sobolewski PS, Rad S, Turner A. Demographic and obstetric outcomes of pregnancies conceived by assisted reproductive technology (ART) compared to non-ART pregnancies. JBRA Assist Reprod. 2015; 19:16–20.
Article
26. Strong TH Jr, Brar HS. Placenta previa in twin gestations. J Reprod Med. 1989; 34:415–416.
27. Crawford BS, Davis J, Harrigill K. Uterine artery atherosclerotic disease: histologic features and clinical correlation. Obstet Gynecol. 1997; 90:210–215.
Article
28. Naeye RL. Maternal age, obstetric complications, and the outcome of pregnancy. Obstet Gynecol. 1983; 61:210–216.
29. Jackson RA, Gibson KA, Wu YW, Croughan MS. Perinatal outcomes in singletons following in vitro fertilization: a meta-analysis. Obstet Gynecol. 2004; 103:551–563.
Article
30. Romundstad LB, Romundstad PR, Sunde A, von Düring V, Skjaerven R, Vatten LJ. Increased risk of placenta previa in pregnancies following IVF/ICSI; a comparison of ART and non-ART pregnancies in the same mother. Hum Reprod. 2006; 21:2353–2358.
Article
31. Paulson RJ, Boostanfar R, Saadat P, Mor E, Tourgeman DE, Slater CC, et al. Pregnancy in the sixth decade of life: obstetric outcomes in women of advanced reproductive age. JAMA. 2002; 288:2320–2323.
Article
32. Bianco A, Stone J, Lynch L, Lapinski R, Berkowitz G, Berkowitz RL. Pregnancy outcome at age 40 and older. Obstet Gynecol. 1996; 87:917–922.
Article
33. Zhu C, Wang M, Niu G, Yang J, Wang Z. Obstetric outcomes of twin pregnancies at advanced maternal age: a retrospective study. Taiwan J Obstet Gynecol. 2018; 57:64–67.
Article
34. Delbaere I, Verstraelen H, Goetgeluk S, Martens G, Derom C, De Bacquer D, et al. Perinatal outcome of twin pregnancies in women of advanced age. Hum Reprod. 2008; 23:2145–2150.
Article
35. Blickstein I, Keith LG. Aging, twinning, and perinatal outcomes. Fertil Steril. 2003; 79:661.
Article
36. Strobino DM, Ensminger ME, Kim YJ, Nanda J. Mechanisms for maternal age differences in birth weight. Am J Epidemiol. 1995; 142:504–514.
Article
37. Lee KS, Ferguson RM, Corpuz M, Gartner LM. Maternal age and incidence of low birth weight at term: a population study. Am J Obstet Gynecol. 1988; 158:84–89.
Article
38. Hack KE, Derks JB, Elias SG, Franx A, Roos EJ, Voerman SK, et al. Increased perinatal mortality and morbidity in monochorionic versus dichorionic twin pregnancies: clinical implications of a large Dutch cohort study. BJOG. 2008; 115:58–67.
Article
39. Hook EB, Cross PK, Schreinemachers DM. Chromosomal abnormality rates at amniocentesis and in live-born infants. JAMA. 1983; 249:2034–2038.
Article
40. Meyers C, Adam R, Dungan J, Prenger V. Aneuploidy in twin gestations: when is maternal age advanced? Obstet Gynecol. 1997; 89:248–251.
Article
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