Preeclampsia Mediates the Association between Advanced Maternal Age and Adverse Pregnancy Outcomes: A Structural Equation Modeling Approach

Background: advanced maternal age (ama) is considered a risk factor associated with preeclampsia and adverse pregnancy outcomes. we aimed to assess the mediating role of preeclampsia between ama and adverse pregnancy outcomes. methods: a sample of 14646 pregnant women from the tertiary hospital of hubei province, china, during the years 2011-2017 were included in this study. pregnant women were divided into 4 groups according to their age at delivery. mediated effect of preeclampsia with relation to ama and adverse pregnancy outcomes was measured using structural equation modeling. results: women in the highest age group were significantly associated with preterm delivery [rr 1.37 (95% ci 1.24 - 1.49)] and low birth weight [rr 1.28 (95% ci 1.11 - 1.45)] compared with women in the lowest age group. the indirect effect (mediated effect) of ama on preterm delivery and low birth weight mediated by preeclampsia was [β 0.053 (95% ci: 0.047, 0.060)], and [β 0.045 (95% ci: 0.038, 0.052)], respectively. the estimated mediation proportion of the effect of ama due to mediated effect of preeclampsia was (35.5%) for preterm delivery and (23.5%) for low birth weight. conclusion: preeclampsia partially mediates the association between ama and adverse pregnancy outcomes.