Læknaneminn - 01.04.2005, Blaðsíða 70

Verkefni 4. árs læknanema
The association between advanced maternai
age and poor obstetric and neonatal outcome
in Australia 1991-2000
Eydís Konráðsdóttir', Alex Yueping Wang2, Sally Tracy3, Elizabeth
Sullivan2
'Læknadeild Háskóia Islands, 2AIHW Natíonal Perinatal Statistic Unit, 3University of
Technology Sydney.
Introduction: Women in most developed countries are
delaying childbirth. The median age of Australian mothers has
risen from 25.4 years in 1971 to 30.2 years in 2002. The aim of
this study was to determine whether advanced maternal age is
a risk factor for poor obstetric and neonatal outcomes.
Methods: Data from 2,547,352 confinements in Australia
between 1st January 1991 and 31 st December 2000 were
obtained from the AIHW National Perinatal Collection. The study
groups consisted of all primiparous, singleton women aged 35-
39 (n=64,835) and 40-44 years (n=9547) at delivery.
Primiparous, singleton women aged 25-29 years (n=350,087)
at delivery were used as a reference group. Outcome measures
were maternal characteristics, obstetric complications and
neonatal outcome. A new composite variable, combining birth
status, gestation, birth weight and Apgar, was constructed and
used in the final model. Uni- and multivariate logistic regression
were used for the analyses, whilst controlling for potential
confounding factors.
Results: Older primiparous women were more likely to be
single, live in major cities and be in the highest quintile for
socioeconomic advantage. Increasing maternal age was
associated with a progressive increase in most obstetric
interventions and poorer neonatal outcomes. This effect
persisted after adjustment of confounding factors. In the final
model increasing maternal age, adjusted odds ratio (AOR)
1:1.13 (1.11-1.15): 1.14 (1.09-1.20), elective caesarean section
(CS) AOR 1:1.41 (1.37-1.44), emergency CS AOR 1:1.36 (1.34-
1.39) and vaginal breech delivery AOR 1:4.26 (3.97-4.58) were
all associated with poorer neonatal outcome.
Conclusion: Maternal age is an independent risk factor for
higher rates of obstetric intervention and poorer neonatal
outcomes. Further investigation is needed to determine the
extent of the effect of advanced maternal age as breech
presentation, vaginal breech and operative deliveries seem to
have a stronger association with poor neonatal outcome.
Key words: Advanced maternal age, risk, obstetric
interventions, neonatal outcome.
Proinflammatory cytokines in dilated car-
diomyopathy and their relationship with
measures ofmyocardiai function
Helga Ásgeirsdóttir*, Erika Lindberg#, Yvonne Magnusson#, Kristjan
Karason#
'Faculty of Medicine, University of lceland, #Sahlgrenska University Hospital,
Göteborg
Introduction: Proinflammatory cytokines have been suggested
to play an important role in the pathophysiology of dilated
cardiomyopathy (DCM). However, the mechanism for their
increased expression and the site of their production is
unknown. The aim of this study was to investigate the
relationships between cytokines and measures of myocardial
function and to compare cytokine levels in the coronary sinus
with those in the peripheral circulation.
Methods: We included 42 patients with DCM, (mean age 50
years; 71% male) and 14 healthy controls. DCM patients
underwent echocardiography and right-sided heart
catheterisation and were classified according to the NYHA
functional classification system. Peripheral blood samples were
drawn from all study subjects and blood samples from the
coronary sinus were obtained from a subgroup of patients with
DCM (n=15). Plasma levels of tumour necrosis factor-a (TNF-a),
interleukin-6 (IL-6) and interleukin-10 (IL-10) were measured
with enzyme-linked immunosorbent assay kits.
Results: Patients with DCM had significantly higher serum
levels of TNF-a and IL-6 compared with normal controls
(p<0.01) and a trend towards higher IL-10 levels. Compared
with normal subjects, levels of IL-6 in DCM patients were
elevated in functional classes III and IV (p<0.05) with the highest
levels in class IV. IL-6 was also significantly higher in class IV
compared with class II (p<0.05). Cytokine levels were not
related to left ventricular ejection fraction, but IL6 and IL10 were
positively correlated with pulmonary capillary wedge pressure
(r=0.56 and 0.52, respectively, p<0.01). DCM patients who had
been stabilized on medical treatment had lower levels of IL-6
compared to those with recent disease onset (p<0.05). Levels
of TNF-a and IL-10 from the coronary sinus were similar to
corresponding levels from the peripheral circulation, whereas
coronary sinus IL-6 levels were lower than those observed in
peripheral blood samples (p<0.05).
Conclusions: Dilated cardiomyopathy is associated with
increased levels of proinflammatory cytokines. Compared with
TNF-a, the levels of IL-6 and IL-10 relate stronger to the degree
of left ventricular dysfunction and impairment of functional
capacity. Adequate heart failure treatment may reduce IL-6
levels. Our findings do not support that elevated levels of
circulating cytokines in DCM originate from the heart itself.
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LÆKNANEMINN
2005