Advanced maternal age and adverse pregnancy outcomes: A cohort study.

OBJECTIVES: To assess the association between advanced maternal age and adverse perinatal outcomes in single pregnancies. MATERIALS AND METHODS: A cohort study was conducted using data from 27,455 singleton births attended at our hospital between 2007 and 2018. Three maternal age groups were established, and perinatal outcomes were compared between-groups (<35 years (n = 19,429; 70.7%), 35-40 years (n = 7189; 26.2%), and >40 years (n = 846; 3.1%). The data were compared using chi-square analysis and the results were adjusted using a logistic regression model. Decision trees were designed to examine the fetal mortality and caesarean section variables. We used the SPSS 23 statistical software program for the statistical analysis. RESULTS: The mean age of the women was 31.21 years. No differences were found associated with age for neonatal acidosis, an Apgar score <7 at 5 min after birth, threatened preterm labour, preterm rupture of membranes, or high-grade perineal tear. The analyses found statistically significant increases in the rates of hypertensive disorders, diabetes mellitus, induction of labour, and caesarean section, after 35 years of age. The risks of fetal death, neonatal admission, small for gestational age, placenta previa, instrument delivery, maternal ICU admission, and postpartum haemorrhage were greater after 40 years of age. CONCLUSIONS: The results of our study indicated that women >35 years of age had worse perinatal outcomes, compared with younger women. This finding was more evident in patients >40 years of age, which highlighted the greater risk of fetal death and serious maternal complications in this group.

[Health levels in San Andres Cholula]. / Niveles de salud en San Andres Cholula.

PIP: In matters of health and curing, the community of San Andres Cholula in Puebla, Mexico, demonstrates a syncretism similar to religious syncretism. Perspectives on illness and health consistent with the traditional medical practices of curanderos coexist with modern medical practices. Curanderos and physicians often treat the same patients. A curandero's powers are viewed as a special gift transmitted by God or the saints during a dream. The curandero effects a cure not only through knowledge of the medicinal plants, rites, and ceremonies, but by understanding the context of the patient. The Western medical concept of disease emphasizes a biological model and technological control, to the detriment of mental, behavioral, and social factors and determinants. The traditional medical concept stresses the relationship of the individual to the social and ecological environment. Improvements in life expectancy in the developing countries in recent years have been attributed to improved levels of living or to importation of vaccination programs, antibiotics, and similar technologies from the developed countries. The vital register of San Andres Cholula records many deaths whose cause cannot be easily interpreted according to the World Health Organization International Classification of Diseases. It is clear, however, that the root cause of many deaths is malnutrition. The proportion of deaths caused by infectious diseases has declined in Mexico since 1940, but Puebla is still included among the states with the highest incidence. There are great regional and rural-urban mortality differentials in Mexico. In the past 50 years, the infant mortality rate has declined from 250 to 40/1000 live births in San Andres Cholula, more as a result of vaccination campaigns than of improved levels of living. 89% of children have been vaccinated, but the population still lives in about the same state of material comfort as it has for generations except that most households have televisions. Less than 15% on the other hand have refrigerators, and many are poorly fed, clothed, and housed. A nutritional study found a very low consumption of animal protein, fruits, and vegetables in San Andres Cholula. 22% of households stated they had only 2 meals/day. Although respondents were asked only about what foods they ate and not what quantities, the low weights for age of infants and children indicated deficient nutritional status.^ieng