Investigating the prevalence of chronic diseases in pregnant mothers over 35 years of age and its effect on the pregnancy outcome from 2004 to 2009 in Shahrood city.

Dissertation for receiving a professional doctorate

Abstract

Introduction and purpose: One of the risk factors during pregnancy is the age of the mother. Nowadays, a large number of women get pregnant over the age of 35. Also, in women over 35 years of age, the possibility of pregnancy complications such as placental abruption, diabetes, macrosomia, and high blood pressure and fetal complications such as premature birth, intrauterine growth disorder, and low birth weight increases. This study was conducted in order to investigate chronic diseases in pregnant mothers over 35 years of age and its effect on pregnancy outcomes from 2004-2016 in Shahrood city.

Materials and methods: This descriptive-cross-sectional study was conducted on 151 pregnant women over 35 years of age who gave birth at Khatam Al-Anbia Hospital in Shahrood from 2004-2014. The data collection tool was a questionnaire containing questions such as mother's illness, pregnancy complications, baby's weight, birth Apgar and newborn complications. The samples were divided into two groups according to the presence or absence of maternal chronic disease (diabetes, high blood pressure, thyroid, epilepsy) from before pregnancy. The data was analyzed using SPSS software and descriptive statistics and chi-square and T tests at the P?0.05 level. Findings: Among the samples, 80.1% had cesarean delivery. 9.1% of mothers had a chronic disease before pregnancy. In the group with a chronic disease before pregnancy: the average age of mothers was 37.53 years, the average number of pregnancies was 3, and the rate of using assisted reproductive methods was 13.3%. In terms of pregnancy complications: 73.3% had no complications. The prevalence of preeclampsia was 13.3% and diabetes was 13.3%. Increased blood pressure during pregnancy, placental abruption, placenta previa, miscarriage and postpartum bleeding were not observed in this group. The average weight of newborns was 3199.3 and the rate of hospitalization of newborns in NICU was 33.5%. In the group of healthy mothers: the average age of mothers was 37.18 years, the average number of pregnancies was 3, and the rate of using assisted reproductive methods was 21.3%. In terms of pregnancy complications: 72.8% had no complications. Abortion rate was 1.5%, preeclampsia 1.5%, diabetes 13.2%, pregnancy hypertension 8.8%, postpartum hemorrhage 2.2%. Placental detachment and placenta previa were not seen in this group. The average weight of newborns was 3120.8 and the rate of hospitalization of newborns in NICU was 30.9%. 4 cases of intrauterine fetal death and 2 cases of fetal malformations were observed in this group.

Discussion and conclusion: According to the results of this study, there was no significant difference in terms of fetal complications in the group of mothers older than 35 years who had a previous underlying disease and the group without underlying disease. Also, there was no significant difference between the two groups in terms of increased blood pressure, preeclampsia, gestational diabetes and placenta previa. It seems that nulliparity affects pregnancy more than age.

Key words: pregnancy after 35 years, chronic diseases, fetal and maternal complications

Introduction

One ??of the factors influencing the occurrence of risk during pregnancy, maternal age is If pregnancy occurs in two ranges of reproductive age (less than 20 years and more than 35 years), the problems and consequences of pregnancy are aggravated. The consequences of pregnancy at the age of over 35 are not as favorable as at a young age. (1) Nowadays, a large number of women are pregnant at the age of over 35, the causes of which are education, marriage at an older age than in the past, more prevalence of infertility and progress in infertility treatments. In women over the age of 35, the possibility of chronic hypertension, pregnancy-induced hypertension, placenta previa, placental abruption, diabetes and macrosomia increases. (2) In a study, pregnancy at the age of 35 and older causes a 1.5-fold increase in pregnancy complications and a 6.2-1.6-fold increase in neonatal complications. (1) Behler et al. It is 0.6 per thousand, which is almost 4 times the age of 20-34 years old, and it seems that this risk is mainly due to pregnancy being associated with diseases that elderly mothers suffer from before pregnancy. (3) Also, fetal complications such as premature birth, low birth weight, and intrauterine growth disorder increase.(2)

On the other hand, in some studies, no significant difference in the rate of neonatal complications related to age has been seen. (2) In another study, it has been concluded that the overall outcome of a newborn is not affected in women aged 40 years or older, but the possibility of low birth weight and low Apgar score of 5 minutes is more. (1) In a study in 2000, there is also a significant difference in neonatal mortality, abnormalities Maternal and fetal weight did not exist with increasing maternal age. (3)

Given the above-mentioned materials and conflicting reports about the relationship between maternal age and fetal outcomes and the increase in elderly mothers, we decided to conduct a study to investigate the prevalence of chronic diseases in pregnant mothers over 35 years of age and its effect on the outcome of pregnancy in health-treatment centers of Shahrood city from 1984 to 1989

2 Statement of the problem:

With increasing age, chronic diseases may develop in women (such as: high blood pressure, diabetes or thyroid disorders, especially hypothyroidism), each of which may be life-threatening for women. But during pregnancy, they may be incompletely controlled. (4) Even some of these diseases may cause abortion or intrauterine death, so knowing these diseases and closely monitoring these pregnant mothers (over 35 years old) can improve the outcome of pregnancy. (5) In 2002, a site called "mild life mother" was established to determine ways to improve the pregnancy outcome in these mothers. (4)

1-2 hypotheses:

Chronic diseases are more common in pregnant mothers over 35 years old.

Chronic diseases during pregnancy affect the outcome of pregnancy.

1-3 main goals:

Knowledge of chronic diseases before couples decide to get pregnant, especially at ages > 35 (preconception counseling)

1-4 practical goals:

Careful monitoring and special care of people over 35 years old, to improve pregnancy outcome

1-5 special needs:

Treatment of chronic disorders of pregnant mothers during pregnancy to ensure the health of mother and baby

1-6 Information analysis method:

The present study is a descriptive and cross-sectional study that was conducted from 1384-1389 at Khatam Al-Anbia Hospital in Shahrood. All pregnant mothers who gave birth in Khatam Al-Anbiah Hospital in these years and were 35 years old or older were included in this study. Then, the information of questionnaires designed about the characteristics of mothers and babies was collected using the information available in their files.  In case of having a chronic disease, the type of disease, the duration of this disease and the treatments performed were recorded. Then, the outcome of pregnancy in pregnant people over 35 years old who had a chronic disease was compared with the outcome of pregnancy in people over 35 years old without underlying disease. Also, the complications caused during pregnancy such as: placental abruption, placenta previa, abortion, fetal distress, prolonged delivery, increased cesarean section, low birth weight, eclampsia, gestational diabetes and heart complications were investigated in these people. Then the data was analyzed by statistical software.

pregnancy out come since 1384 to 1389 in Shahroud