[Maternal age as a risk factor in triplet pregnancy]

Abstract

Upon the diagnosis of triplet conception, pregnant women should be counseled about the risk of triplet pregnancy and the chances of survival of triplet newborns. This information can help women with triplet gestations to make well-informed decisions whether to continue their pregnancy or to undergo multifetal pregnancy reduction.

Aim: To assess the maternal age as a risk factor in a large representative sample of the Hungarian triplet population with evaluation of maternal complications and perinatal results.

Methods: In a retrospective cohort study we analyzed 114 triplet pregnancies which ended in delivery from July 1st, 1990 until June 30th, 2006.

Results: In the study population there were 15 patients aged 35 years or more at delivery (13.2%) and 99 women were younger than 35 years (86.8%). The rate of maternal complications was similar in the two groups, and there was no significant difference in gestational age at delivery (33.0 +/- 2.9 vs. 32.2 +/- 3.3 weeks), very early (< 28 weeks) premature deliveries (6.7% vs. 9.1%) and early (< 32 weeks) premature deliveries (32.9% vs. 43.4%), respectively, although all of these variables were more favorable over 35 years of age. The mean birth weight of live born infants (1796 +/- 492 vs. 1664 +/- 506 g, p = 0.064 g) was higher, the prevalence of very-very-low-birth-weight (< 1000 g) infants (6.8% vs. 10.7%) and very-low-birth-weight (< 1500 g) infants (34.1% vs. 38.6%) was lower in the groups of older patients. The 1- and 5-minute Apgar scores of newborns in the > 35-year group were significantly larger (8.4 +/- 0.5 vs. 8.0 +/- 1.0, p = 0.016 and 9.5 +/- 0.7 vs. 9.2 +/- 0.8, p = 0.006, respectively). There was no difference in perinatal results or puerperal complications between the groups. The incidence of sepsis/pneumonia and need for ventilation/oxygen therapy was lower among the infants of the patients over 35 years (6.9% vs. 28.6%, p = 0,011 and 31.0% vs. 58.2%, p = 0,011, respectively). The rate of other neonatal complications was similar in the two groups.

Conclusions: Although the incidence of some maternal complications during pregnancy and in the puerperal period is higher at older age, the favorable perinatal results and neonatal morbidity rates make older maternal age a risk reducing (protective) factor in triplet pregnancies.