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Effect of older maternal age on birth outcomes in twin pregnancies: a population-based study

Journal of Perinatology volume 31, pages 85–91 (2011)Cite this article

Subjects

Abstract

Objective:

We compared perinatal mortality, preterm birth (<37, <33 and <28 weeks), small for gestational age (SGA), Apgar score (<4), mechanical ventilation (⩾1 days) and prolonged neonatal intensive care unit (NICU) hospitalization (⩾13 days) between twins of 25 to 34 and >35-year-old women. Further, we examined whether older maternal age effects were modified by parity or otherwise affected by chorionicity.

Study Design:

We carried out a population-based retrospective cohort study including all twin births in British Columbia (BC), Canada, from 1999 to 2003. The BC perinatal database registry was used to obtain clinical, behavioral and demographic data. Adjusted odds ratios (OR) with 95% confidence intervals (CI) were calculated using generalized estimating equation models.

Result:

Overall, twins of older women were more likely to be born preterm (<37 weeks), but not very or extremely preterm (<33 weeks). These twins were not at increased risk of perinatal death, mechanical ventilation or were not SGA compared with twins of younger women. Twins of older primiparous women did not have an elevated risk of NICU hospitalization; twins born to older multiparous women had higher risk (OR=1.8; 95% CI: 1.2 to 2.6). Analyses restricted to opposite-sex (dichorionic) twins showed that perinatal death, mechanical ventilation and very preterm birth occur less likely among older women (OR=0.2 (95% CI: 0.0 to 0.8), OR=0.3 (95% CI: 0.1 to 0.7) and OR=0.4 (95% CI: 0.2 to 0.7), respectively). Further, the risk of late preterm birth was increased and NICU hospitalization was reduced among opposite-sex twins born to older compared with younger primiparous women (OR=1.9 (95% CI: 1.3 to 2.8) and OR=0.2 (95% CI: 0.1 to 0.5), respectively).

Conclusion:

Twins of older mothers did not have an elevated risk for most adverse birth outcomes, except for late preterm birth. Risks of neonatal care admission may be elevated among older multiparous women.

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Acknowledgements

Sarka Lisonkova was supported by the Western Regional Training Centre for Health Services Research, the Michael Smith Foundation for Health Research and the Canadian Institutes for Health Research through a graduate and senior graduate scholarship. We thank the BC Perinatal Health Program for access to the data.

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Authors and Affiliations

  1. Department of Obstetrics and Gynaecology, Children's and Women's Health Centre, University of British Columbia, Vancouver, BC, Canada

    S Lisonkova & L Dahlgren

  2. School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada

    S B Sheps & P A Janssen

  3. Division of Neonatology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada

    S K Lee

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  1. S Lisonkova
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  2. S B Sheps
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  5. L Dahlgren
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Corresponding author

Correspondence to S Lisonkova.

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Appendix

Appendix

Table A1

Table a1 Mother and newborn characteristics by maternal age (twin births, British Columbia (2001 to 2003))
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Lisonkova, S., Sheps, S., Janssen, P. et al. Effect of older maternal age on birth outcomes in twin pregnancies: a population-based study. J Perinatol 31, 85–91 (2011). https://doi.org/10.1038/jp.2010.114

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