Physical activity and sedentary behavior among older adults with non-communicable diseases

Abstract

Issue Invasive prenatal tests for trisomy have a 0.5-1% risk of pregnancy loss. Prenatal screening for trisomy 21, 18 and 13 identifies pregnant women needing invasive tests. NIPTs are more sensitive and specific than all other trisomy screening tests. Their price not allowing insurance coverage as a first line test, different screening strategies are being studied internationally. Description of the problem In 2015, the Swiss authorities decided for economic reasons to limit the reimbursement of NIPTs to women with elevated trisomy risk (> 1:1000) based on the first trimester contingent test (FTCT). This strategy inevitably misses some cases in low risk pregnancies. Women can undergo an NIPT outside this limitation at their own expense. In 2016 data from laboratories where collected and experts in fetomaternal medicine (FMM) consulted in order to review the 2015 decision. Results The annual NIPT number rose from 7'044 before coverage to 12'988 (15.5% of pregnancies) after. No information on pre-test risk being available in 7'483, it is assumed that most of these were paid by the women themselves. 4'763 NIPT were done due to a risk score of 1/1000, 430 with a risk score of < 1/1000, 217 in twin pregnancies and 95 after abnormal echography. Results were inconclusive in 3.0%. 0.28% were lost for follow up. Test performance was in line with published trials. The number of invasive tests decreased. In 2017 FMM experts published a statement about situations where the FTCT is not reliable for determining trisomy risk (e.g. after infertility treatments; twins). Lessons Switzerland is among the first countries with social insurance coverage for NIPTs. The reason for a two-step screening is economical. Routine data and expert advice were used to review the pragmatic reimbursement decision taken in 2015. This review resulted in only minor adaptations of reimbursement rules. Once NIPT prices will fall substantially, coverage as a first line test will become an option. Key messages: Prenatal trisomy screening evolves rapidly in terms of technology, costs, and indications. The coverage decision taken early in order to reduce harm was reassessed once real wold data were available. Analysis of routine laboratory data supported the coverage decision made in 2015. The expert opinion from FMM specialists allowed to further refine the screening strategy. Background Advanced maternal age has been found to increase the risk of obstetric interventions and pregnancy complications are also known to be more common among women of advanced maternal age. However, it is not known if the association between maternal age and obstetric interventions also exists for women with and without pregnancy complications. Methods The study was restricted to all singleton births to nulliparous women delivering in Iceland during 1997-2015 identified from the Icelandic Medical Birth Registry. Logistic regression models were used to calculate odds ratios and 95% confidence intervals for the risk of caesarean section (pre-labour and intrapartum), labour induction and instrumental delivery according to maternal age group, adjusted for maternal characteristics and birth year. This was done for women without pregnancy complications and for women with a hypertension or a diabetes diagnosis during pregnancy. Results The risk of labour induction and pre-labour and intrapartum caesarean section increased with increasing age for women without pregnancy complications and was 3.2 (95% CI 2.2-4.6), 8.1 (3.7-15.9) and 2.3 (1.6-3.3), respectively, for women aged 40+ years compared with 20-29 years. The risk of instrumental delivery was slightly increased for women without pregnancy complications aged 30-39 years 1.3 (1.2-1.4), compared with 20-29 years, but not for women aged 40+. Similar trends were seen for women with hypertension and diabetes. Conclusions Older nulliparous women, both who do and do not experience pregnancy complications, are more likely to have obstetric interventions. This indicates obstetricians are more likely to intervene for older pregnant women based solely on their age, which could be due to increased risk of perinatal death among older mothers. However, these results suggest that obstetric protocols may have to be revised to minimize interventions performed based on age alone and without medical indication. Key messages: The results from this study show that the risk of obstetric interventions increases with increasing maternal age, both for women who do and do not experience pregnancy complications. The results suggest that obstetricians are more likely to perform obstetric interventions for older pregnant women based solely on their age and without medical indication. 4.A. Public health interventions (life-style interventions) and prevention of NCDs Physical activity and sedentary behavior among older adults with non-communicable diseases Background Non-communicable diseases (NCD) are the leading causes of death worldwide with disproportionate burden in low-and middle-income countries (LMIC). Increasing physical activity (PA) and decreasing sedentary behaviour (SB) have the potential to mitigate symptoms and reduce the risk of developing other conditions. We explored the extent to which people from six LMIC, aged 50, with and without