Effect of Maternal Age and Parity on the Risk of Uteroplacental Bleeding Disorders in Pregnancy

OBJECTIVE: To examine the risk of placental abruption, placenta previa, and uterine bleeding of unknown etiology in relation to advanced maternal age and parity in a large, population-based study. METHODS: Data for this study were derived from the Nova Scotia Atlee perinatal provincial data base, Canada, an ongoing project on human reproduction. Women who delivered between 1980 and 1993 (n = 123,941) in the province of Nova Scotia were included in the study, with the exception of pregnancies resulting in multiple births (n = 2859) and those missing data on maternal age or parity (n = 14). Multivariable logistic regression models based on the method of generalized estimating equations were used to generate odds ratios after adjustment for multiple confounders. RESULTS: The frequency of abruption was increased slightly among younger women (relative risk RR 1.3, 95% confidence interval CI 1.0-1.7), compared with women ages 25-29 years, but there was no increase with advancing maternal age. In contrast, the risk of placenta previa increased dramatically with advancing maternal age, with women older than 40 years having a nearly ninefold greater risk than women under the age of 20, after adjustment for potential confounders, including parity. Uterine bleeding of unknown etiology was not associated with advanced maternal age, except for a slight increase among women over 40 (RR 1.3, 95% CI 1.0-1.6). The risk of placenta previa and placental abruption was increased with higher parity among younger women only, but uterine bleeding of unknown etiology was more weakly associated with higher parity. In addition, an analysis of the joint effects of age and parity on placental abruption indicated a strong parity effect for women under 30 years, whereas the risk of placenta previa increased with increasing parity up to age 35 years. Uterine bleeding of unknown etiology also indicated a parity effect that was restricted to women under 25 years. CONCLUSION: Multiparity is associated with the risk of placenta previa and, to a lesser extent, placental abruption, but not with other uterine bleeding. Increasing maternal age is associated independently with the risk of placenta previa, but not with either of the other two conditions. Finally, the increased risks of uteroplacental bleeding disorders with advanced parity among the younger women (ie, 20-25 years, parity 3+) may reflect effects of close pregnancy spacing, or confounding by unmeasured factors that characterize women who have many pregnancies at a relatively young age. Overall, the findings suggest that the three uteroplacental bleeding disorders do not share a common etiology in relation to maternal age and parity, and that placenta previa is linked to aging of the uterus and the effects of repeated pregnancies.