Retrospective Cohort Study to Investigate Pregnancy Outcomes in a Population of Advanced Maternal Age Congolese Women of Kinshasa: A Study Protocol

Introduction: Pregnancies at advanced maternal age (AMA) are those occurring after the age of 35 years old. They carry a high risk of maternal-fetal morbidity and mortality, thus constituting a public health problem. Several African countries have reported an upward trend in both the age of childbirth and the frequency of women with AMA over the past 20 years. In the Democratic Republic of Congo (DRC), where maternal and neonatal morbidity and mortality remain very high, data on AMA pregnancies go back more than 20 years. Objective: We propose evaluating obstetrical outcomes among women in AMA in our setting and the associated factors. Methods: This retrospective cohort study will be conducted in two healthcare facilities (ESS) in Kinshasa. The study population will consist of all women who delivered a single fetus after 28 weeks of gestation between January 2012 and December 2022 (10 years) in the selected ESS. The data collected will be analyzed using R software version 4.2.0. Quantitative variables will be summarized as means with standard deviation or medians with interquartile range. Qualitative variables will be presented as proportions (%). Multivariate logistic regression will be used to determine the main maternal-fetal complications associated with AMA and predictors of obstetric outcomes. P Discussion: The high maternal and infant mortality rates in DRC are among the highest in the world. The context of maternal age has become a topic of growing interest due to its potential implications for the health of women and newborns, it is crucial to identify the risk factors associated with obstetric outcomes by identifying obstetrical outcomes associated with advanced maternal age in the DRC. Many Congolese women tend to start their maternity journey at a relatively young age. However, there is also an emerging trend towards delayed childbearing, particularly in urban areas and among women with access to education and family planning services. Conclusion: The results of this study will enable us to update the frequency of AMA pregnancies in our environment. The socio-demographic and clinical profile of these pregnancies will be determined. The main maternal-fetal complications associated with AMA in our setting and the associated factors will be identified.

Intrafollicular Soluble RAGE Benefits Embryo Development and Predicts Clinical Pregnancy in Infertile Patients of Advanced Maternal Age Undergoing In Vitro Fertilization

Soluble receptor for advanced glycation end products（s RAGE） can decoy the toxic AGEs and is considered to be a protective factor.This study aimed to evaluate the correlation between intrafollicular s RAGE levels and clinical outcomes in infertile women of young or advanced maternal age（AMA） undergoing in vitro fertilization（IVF）.A total of 62 young women and 62 AMA women who would undergo IVF were included in this prospective study.The intrafollicular s RAGE concentration was measured to determine its association with the number of retrieved oocytes,fertilized oocytes,high-quality embryos or achievement of clinical pregnancy in young and AMA women,respectively.Besides,correlations between sR AGE and age or follicle-stimulating hormone（FSH） were examined.We found that the intrafollicular s RAGE levels were higher in young patients than those in AMA patients,suggesting that the s RAGE levels were inversely correlated with age.In young patients,sR AGE showed no correlation with the number of retrieved oocytes,fertilized oocytes,high-quality embryos or achievement of clinical pregnancy.But it was found that AMA patients with more retrieved oocytes,fertilized oocytes and high-quality embryos demonstrated higher sR AGE levels,which were a prognostic factor for getting clinical pregnancy independent of age or FSH level.In conclusion,the s RAGE levels decrease with age.Elevated intrafollicular s RAGE levels indicate good follicular growth,fertilization and embryonic development,and successful clinical pregnancy in AMA women,while in young women,the role of s RAGE may not be so predominant.

Seizure frequency and obstetric complications at advanced maternal age:a preliminary observational study in women with epilepsy

Background:Seizure control during pregnancy and obstetric outcomes are of important concerns for women with epilepsy(WWE)and their families.Advanced maternal age(≥35 years)shows a growing trend in the society with changes of lifestyle,which also occurs in diseased populations.The advanced maternal age is an independent factor for some unsatisfying obstetric outcomes.In this study we explored the seizure control and obstetric complications associated with advanced maternal age in WWE.Methods:This study was based on the epilepsy pregnancy registry at West China Hospital.Patients with epilepsy in this registry who were aged 35 or older when starting pregnancy were included in this study.Their basic demographics and detailed information on epilepsy management and obstetric issues in all trimesters and during 1-year follow-up after birth were documented and reviewed.Data were processed by IBM SPSS version 22.0.The demographic characteristics,seizure frequency,treatment change,obstetric complications,and outcomes were analyzed and compared.Results:Fifteen patients were included in this study,with an average age of 36.32±2.39 years at pregnancy,and 73.33%of them were primiparas.The change of seizure frequency during pregnancy was not in a clear pattern,but there was an increased incidence of tonic-clonic seizures during the mid-and last trimesters.More than 20%of the patients had obstetric complications throughout the trimesters,including vaginal bleeding,hypothyroidism,and pre-eclampsia.The pre-eclampsia seemed extraordinarily complicated with other conditions.However,none of the complications were related with malformations or poor outcome of babies after 1-year follow-up.Conclusion:Advanced maternal age combined with WWE is associated with frequent common obstetric complications.Future controlled studies with large sample sizes are needed to explore the related risks in comparison with other WWE and non-epileptic populations.

中药坤泰胶囊提高高龄女性不孕妊娠率的研究

目的探讨中药坤泰胶囊对高龄女性不孕妊娠率的影响。方法选取2016年3月—2018年2月期间收治的130例高龄女性不孕患者为研究对象,随机分为对照组和治疗组,每组65例,对照组给予克罗米芬治疗,治疗组患者在对照组的基础上实施中药坤泰胶囊治疗,观察并比较两组患者的卵泡成熟时间、子宫内膜厚度及容受性、性激素水平、排卵、妊娠情况以及不良反应等指标。结果治疗组的卵泡成熟时间和子宫内膜厚度均优于对照组,差异具有统计学意义(P<0.05)。治疗前,两组患者的PI、RI差异无统计学意义(P>0.05);治疗后,治疗组的PI、RI均优于对照组,差异具有统计学意义(P<0.05)。治疗前,两组患者的T、E2、LH及FSH水平差异无统计学意义(P>0.05);治疗后,治疗组患者的T和LH水平均低于对照组,且E2和FSH水平均高于对照组,差异具有统计学意义(P<0.05)。治疗组患者的排卵率和妊娠率均高于对照组,差异具有统计学意义(P<0.05)。治疗组患者的总不良反应低于对照组,差异具有统计学意义(P<0.05)。结论针对高龄女性不孕患者实施中药坤泰胶囊治疗,可有效增加子宫内膜厚度,改善子宫内膜的容受性,促进卵泡成熟,能有效调节性激素水平,促进排卵,提高妊娠率,降低不良反应的发生,值得临床上推广使用。