PROJECTED OBSTETRIC RISKS IN AN AGING MATERNAL POPULATION IN TAIWAN: A BAYESIAN AGE-PERIOD-COHORT ANALYSIS
Author(s)
Hui-Min Chuang, PharmD1, Lin-Chieh Meng, MS2, Hsi-Yu Lai, MS2, Fei-Yuan Sharon Hsiao, PhD2.
1National Taiwan University, Taipei City, Taiwan, 2National Taiwan University, Taipei, Taiwan.
1National Taiwan University, Taipei City, Taiwan, 2National Taiwan University, Taipei, Taiwan.
OBJECTIVES: With demographic shifts toward delayed childbearing, maternal and neonatal adverse outcome profiles may alter, potentially challenging current healthcare strategies and resource allocation. Therefore, we aimed to provide the first comprehensive Bayesian projections of pregnancy outcomes through 2050 to inform urgent healthcare system adaptation.
METHODS: We analyzed all singleton pregnancies in Taiwan using linked data from National Health Insurance and Birth Certificate Application databases from 2004 to 2021. Maternal baseline characteristics were described and stratified by maternal age. Temporal trends and age-stratified prevalence were assessed for maternal (gestational hypertension, gestational diabetes mellitus, mortality, sepsis, and postpartum hemorrhage) and neonatal (stillbirth, preterm birth, low birth weight, small for gestational age, and large for gestational age) outcomes. Bayesian Age-Period-Cohort (BAPC) models were applied to disentangle age, period, and cohort effects, facilitating projections of both prevalence and absolute burden based on official national fertility estimates through 2050.
RESULTS: From 2004 to 2021, total pregnancies in Taiwan declined by 25.3%, while the proportion of pregnancies aged ≥35 years tripled (12.0% to 35.0%). Notably, pregnancies aged ≥35 years exhibited a nearly 6-fold higher mean Obstetric Comorbidity Index (OCI) score than younger pregnancies. During this period, gestational hypertension (GHTN) prevalence rose from 0.4% to 2.1% and gestational diabetes (GDM) from 2.0% to 9.3%. By 2050, GHTN and GDM are projected to reach 26.4% (95% credible interval [CrI], 5.2%-67.4%) and 60.9% (95% CrI, 28.9%-85.0%), respectively. Preterm birth and low birth weight are projected to increase modestly to 11.2% and 11.9%. BAPC modeling indicates these trends are associated not only with advancing maternal age but also with cohort patterns, reflecting evolving risk profiles shaped by shifting healthcare and behavioral practices.
CONCLUSIONS: Obstetric risk is shifting due to demographic and generational transitions, requiring prenatal care systems to adopt more proactive and routine management approaches.
METHODS: We analyzed all singleton pregnancies in Taiwan using linked data from National Health Insurance and Birth Certificate Application databases from 2004 to 2021. Maternal baseline characteristics were described and stratified by maternal age. Temporal trends and age-stratified prevalence were assessed for maternal (gestational hypertension, gestational diabetes mellitus, mortality, sepsis, and postpartum hemorrhage) and neonatal (stillbirth, preterm birth, low birth weight, small for gestational age, and large for gestational age) outcomes. Bayesian Age-Period-Cohort (BAPC) models were applied to disentangle age, period, and cohort effects, facilitating projections of both prevalence and absolute burden based on official national fertility estimates through 2050.
RESULTS: From 2004 to 2021, total pregnancies in Taiwan declined by 25.3%, while the proportion of pregnancies aged ≥35 years tripled (12.0% to 35.0%). Notably, pregnancies aged ≥35 years exhibited a nearly 6-fold higher mean Obstetric Comorbidity Index (OCI) score than younger pregnancies. During this period, gestational hypertension (GHTN) prevalence rose from 0.4% to 2.1% and gestational diabetes (GDM) from 2.0% to 9.3%. By 2050, GHTN and GDM are projected to reach 26.4% (95% credible interval [CrI], 5.2%-67.4%) and 60.9% (95% CrI, 28.9%-85.0%), respectively. Preterm birth and low birth weight are projected to increase modestly to 11.2% and 11.9%. BAPC modeling indicates these trends are associated not only with advancing maternal age but also with cohort patterns, reflecting evolving risk profiles shaped by shifting healthcare and behavioral practices.
CONCLUSIONS: Obstetric risk is shifting due to demographic and generational transitions, requiring prenatal care systems to adopt more proactive and routine management approaches.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EPH247
Topic
Epidemiology & Public Health
Disease
Reproductive & Sexual Health