The association of maternal age with birthweight and gestational age: a cross-cohort comparison

Abstract

Background: We examined the associations of maternal age with low birthweight (LBW) and preterm birth in four cohorts from a middle- and a high-income country, where the patterning of maternal age by socio-economic position (SEP) is likely to differ.

Methods: Population-based birth cohort studies were carried out in the city of Pelotas, Brazil in 1982, 1993, and 2004, and in Avon, UK in 1991 [Avon Longitudinal Study of Parents and Children (ALSPAC)]. Adjustment for multiple indicators of SEP were applied.

Results: Low SEP was associated with younger age at childbearing in all cohorts, but the magnitudes of these associations were stronger in ALSPAC. Inverse associations of SEP with LBW and preterm birth were observed in all cohorts. U-shaped associations were observed between maternal age and odds of LBW in all cohorts. After adjustment for SEP, increased odds of LBW for young mothers (<20 years) attenuated to the null but remained or increased for older mothers (≥ 35 years). Very young (<16 years) maternal age was also associated with both outcomes even after full SEP adjustment. SEP adjusted odds ratio of having a LBW infant in women <16 years and ≥ 35 years, compared with 25-29 years, were 1.48 [95% confidence interval (CI) 1.00, 2.20] and 1.66 [95% CI 1.36, 2.02], respectively. The corresponding results for preterm birth were 1.80 [95% CI 1.23, 2.64)] and 1.38 [95% CI 1.15, 1.67], respectively.

Conclusion: Confounding by SEP explains much of the excess risk of LBW and preterm among babies born to teenage mothers as a whole, but not for mothers aged <16 or ≥ 35 years. Given that the proportion of women becoming pregnant at <16 years is smaller than for those ≥ 35 years, the population burden is greater for older age.

Keywords: low birthweight infant; maternal age; pregnancy in adolescence; preterm birth; socio-economic factors.

Figure 1

Combined unadjusted and adjusted odds ratio (OR) of low birthweight (LBW) by maternal age (including the three Pelotas cohorts and ALSPAC). P-values for interaction between associations of age and study with LBW were 0.8 for the unadjusted analyses and 0.9 for the adjusted analyses (i.e. suggesting that associations of age with LBW were similar in all four studies).

Figure 2

Combined unadjusted and adjusted odds ratio (OR) of preterm birth by maternal age (including the three Pelotas cohorts and ALSPAC). Unadjusted and adjusted P-values for interaction between maternal age and study were 0.5 and 0.7, respectively.