KWDI Korean Women’s Development Institute

As the rates of adverse pregnancy outcomes, such as preterm birth and low birth weight, among advanced maternal age have increased steadily, its quality has also become an important issue in the developed countries, including Korea. However, although, from a prevention perspective, prenatal policies are more important than postnatal policies to improve the quality of pregnancy outcomes, Korean government has more focused on the latter than on the former.

To find out a comprehensive approach to prenatal care interventions to improve pregnancy outcomes for advanced maternal age at higher risk of preterm and low birth weight, this study was to 1) review the current national policies for supporting pregnancy and childbirth by dividing into two periods, prenatal and postnatal, 2) examine the association between adverse pregnancy outcomes and maternal age and its difference in parental socioeconomic status (SES), 3) investigate the effect of adverse pregnancy outcomes on infant mortality according to maternal age and parental SES, 4) evaluate the associations of multiple social medical behaviors and experiences in advanced maternal age during pre-pregnancy and pregnancy with preterm and low birth weight, 5) parse out the current obstetric emergency medical service of Korea and its problems, and 6) ask ten professionals about necessity and feasibility of prenatal interventions for improving the quality of pregnancy outcomes.

Some of the key findings in the study are as follows: First, when we divided the current national policies for supporting pregnancy and childbirth into prenatal period and postnatal period, Korea has a large number of postnatal policies compared to prenatal policies. Indeed, prenatal policy programmes are mostly limited to a medical examination and treatment, iron supplements and leave, which have known as critical contributors for improving pregnancy outcomes. However, there is not any prenatal policy programmes for advanced maternal age at a great risk for having preterm birth and low birth weight. Furthermore, unlike Australia, Germany, England and Sweden, Korea have not dealt with consultants and treatment of mental disorders, relationships with husband and parents or parent-in-law, home visiting service, risk assesment and nutrition service during pregnancy as important prenatal programmes in social medical perspectives. Second, the rates of preterm, low birth weight, small for gestational age (SGA), large for gestational age (LGA), intrauterine growth retardation (IUGR) have increased steadily as pregnant women's age advances. Of interest is that the rates of these adverse pregnancy outcomes have continually elevated in old pregnant women over 30, even in young pregnant women under 30. Particularly, the gap of adverse pregnancy outcomes between old and young pregnant women has become narrow in recent years. However, its gap has considerably grown according to paternal and maternal educational level, even adjusting for maternal age, birth order, multiple birth and occupational status. Third, infant mortality rate has decreased in recent years. Nonetheless, infant mortality is still significantly associated with adverse pregnancy outcomes. However, as presented in the second main results of this study, the statistical association between infant mortality and adverse pregnancy outcomes has weaken when considering parental SES, especially parental educational attainment, even after adjusting for maternal age, birth order and multiple birth. Indeed, the parental education - infant mortality gradient has widen steadily. The above second and third findings were analyzed with using the Current Population Survey of National Statistical Office. Forth, we asked for what general mothers who gave a birth in the last three years and in their 30s and early 40s did and/or experienced during the recent pre-pregnancy and pregnancy periods. As a consequence, Those who took iron supplements and prenatal check-up or treatments regularly, and experienced negative life events (i.e., the death of a husband, divorce/separation, and the death of a close relative), high risky situations against pregnancy, smoking behavior and excessive weight gain during pre-pregnancy and pregnancy periods are more likely to have an elevated risk of delivering preterm and/or low birth weight than their counterparts, after adjusting for maternal age, parental SES (education, family income and occupational status), diseases negatively affecting pregnancy and childbirth, and previous experience of adverse pregnancy outcomes. Fifth, we analyzed the medical data of obstetrics and gynecology in a university hospital located in the metropolitan area. As the number of maternity clinics or hospitals in non-metropolitan areas has driven out of business in nowadays, prompt and adequate/efficient medical interventions for mothers with premature babies are lacking in these regions. Therefore, those who delivered prematurely but did not receive immediate care and treatments are often transferred to the neighborhood, even to the metropolitan area. This phenomenon more appeared in older mothers than in young mothers. In particular, most of the transferred patients died of delayed emergency interventions and inter-hospital transfer. Lastly, we also asked ten professionals, such as professors, public officials and researchers, about necessity and feasibility of prenatal programmes for improving the quality of pregnancy outcomes. Most of them very strongly or strongly agreed with both things. Also, three quarters of professionals pointed out that a priority support for pregnant women over 35 during the prenatal period is very important and should be needed for health equity.

From the findings of this study, we found that maternal age is still an important risk factor for adverse pregnancy outcomes. However, social medical behaviors and experiences during pre-pregnancy and pregnancy could reduce maternal age's impact and even improve the quality of pregnancy outcomes. Therefore, Korean government should not only pay attention to prenatal policies but develop practical prenatal programmes, including mental well-being. Particularly, priority prenatal support should be applied to advanced mater age in the lowest social group.