New evidence on risks of advanced maternal age
A study undertaken in Finland identified that certain risk factors associated with pregnancy are more harmful when the expectant mother is over 35. According to an extensive, register-based study carried out at the University of Eastern Finland, the risks associated with being overweight, smoking, gestational diabetes and pre-eclampsia are higher in advanced maternal age than in younger expectant mothers. In this study, the author analysed data from 690 555 expectant mothers and their newborns by combining the data from three national-level registers from 1997–2008.
The outcome of childbirth in advanced maternal age was compared to younger mothers, i.e. those under 35. The study highlighted that it was not the age of the woman alone, which was a risk factor. It was only when older age was combined with other risk factors that women were at more risks of complications. These results have implications for clinical practice, as earlier recognition of the women at risk would make it possible to guide mothers to further treatment at an earlier stage and consequently, could help reduce the risks to the mother and baby.
Psychiatric illness in women requesting caesarean section
A recent study conducted in Sweden has shown that women who request a caesarean section (CS) have been found to have an increase in diagnosed psychiatric conditions. The prospective, population-based register study, compared the records of 64 834 primiparae women between 2002 and 2004. The psychiatric in- and outpatient care during the 5 years before first delivery in primiparae who delivered by CS on maternal request (n=1009) were compared with all other primiparae women (63 825) who had given birth during the same time period. The study found that psychiatric illness was significantly higher in women giving birth by CS on maternal request (P<0.001). The study also found that women giving birth by CS on maternal request were older, had increased rates and use of tobacco, lower educational age, higher body mass index, were more often married, unemployed, and parents were more often born outside of Scandinavia (P<0.05).
‘Too posh to push’ is the popular media myth which we are all too familiar with. As health professionals we are aware of the risks of a CS compared to a vaginal birth. This study highlights that women with a psychiatric illness are more likely to request a caesarean section. Current national UK guidance (National Institute for Health and Care Excellence, 2011) recognises the importance of exploring reasons for an elective CS with women. This study draws attention to the possibility that the woman may have experienced a previous psychiatric illness. This should be explored and discussed sensitively with women who request a CS. All women should then be offered evidenced-based information on the risks of caesarean section and the benefits of continuity of care/carer and support.
Targeted strategies needed to prevent obesity in women of child bearing age
A major European obesity project has concluded that strategies are needed to reduce the prevalence of obesity in women of childbearing age, due to the long lasting consequences of maternal obesity for mothers and their children. The Developmental ORIgins of healthy and unhealthy AgeiNg: the role of maternal obesity (DORIAN) consortium aimed to generate a better understanding of the basic mechanisms of early life development and ageing, with the aim of improving health and quality of life during the entire life course. In particular, the Consortium of DORIAN investigated and analysed the impacts of maternal obesity on the process of ageing and its effects on children throughout their lives. DORIAN was divided into various projects looking at specific questions related to this issue, with the consortium led by Dr Patricia Iozzo.
The research found that obese women eat a diet richer in saturated fats and poorer in micronutrients (vitamins, minerals) during pregnancy compared with lean women. Using a preclinical model, the investigators found that the placenta of mothers eating a high-fat diet offered weakened protection to the fetus against cortisol; and consequently, fetal growth is reduced and these offspring are more likely to suffer mood disorders in adulthood. Professor Holmes and Professor Reynolds say: ‘The two most important messages to pregnant women from these findings are that they should have a healthy diet and lifestyle during pregnancy, and if suffering from anxiety or depression they should seek treatment to help their symptoms.’ These findings highlight the need for clearer guidance to be given to pregnant mothers regarding diet and for those mothers who are anxious and obese ways to reduce stress should be discussed.