Obstetric and Neonatal Outcomes for Women ≥ 45 years of Age: A Cohort Study

Abstract

Objective To evaluate outcomes in women ≥ 45 years of age in comparison to a group of women aged 40 to 44 years.

Materials and Methods A cohort study was conducted including women ≥ 45 years who delivered at > 24 weeks gestation during the period (1989–2011). Women aged 40 to 44 years formed the comparison group. The maternal demographics, mode of conception, maternal complications, timing and mode of delivery, neonatal features and postpartum complications were included as outcomes. Statistical analyses were performed using the t-test and Chi-square test.

Results There were 67,278 deliveries; 140 occurred in women ≥ 45 years of age, (2.1/1,000). Compared with the 40 to 44 year age group (n = 139), women ≥ 45 years had higher body mass index (26.7 ± 4.7 vs. 24.6 ± 7.1, p = 0.01), and were more likely to have a previous pregnancy loss at < 24 weeks gestation (57.9 vs. 44.6%, p = 0.03). There was no difference in the incidence of maternal complications, preterm delivery, birthweight, Apgar scores or admission to neonatal intensive care. The presence of pre-existing maternal hypertension was associated with a poor outcome. Women ≥ 45 years were more likely to be delivered by cesarean section (45 vs. 30.2%, p = 0.01).

Conclusion Women aged ≥ 45 years have comparable outcomes to those aged 40 to 44 years, albeit the presence of pre-existing maternal disease is higher and associated with a poor outcome.

Keywords

advanced maternal age - perinatal outcome - pregnancy complications

• References

• 1 Yogev Y, Melamed N, Bardin R, Tenenbaum-Gavish K, Ben-Shitrit G, Ben-Haroush A. Pregnancy outcome at extremely advanced maternal age. Am J Obstet Gynecol 2010; 203 (6) 558.e1-558.e7
• 2 Hammarberg K, Clarke VE. Reasons for delaying childbearing—a survey of women aged over 35 years seeking assisted reproductive technology. Aust Fam Physician 2005; 34 (3) 187-188, 206
• 3 Laskov I, Birnbaum R, Maslovitz S, Kupferminc M, Lessing J, Many A. Outcome of singleton pregnancy in women ≥ 45 years old: a retrospective cohort study. J Matern Fetal Neonatal Med 2012; 25 (11) 2190-2193
• 4 Kenny LC, Lavender T, McNamee R, O'Neill SM, Mills T, Khashan AS. Advanced maternal age and adverse pregnancy outcome: evidence from a large contemporary cohort. PLoS ONE 2013; 8 (2) e56583
• 5 Salem Yaniv S, Levy A, Wiznitzer A, Holcberg G, Mazor M, Sheiner E. A significant linear association exists between advanced maternal age and adverse perinatal outcome. Arch Gynecol Obstet 2011; 283 (4) 755-759
• 6 Abu-Heija AT, Jallad MF, Abukteish F. Maternal and perinatal outcome of pregnancies after the age of 45. J Obstet Gynaecol Res 2000; 26 (1) 27-30
• 7 Waltman LA, Eckel-Passow JE, Sharma RG, Van Dyke DL. Advanced maternal age in polyploidy with concurrent aneuploidy. Am J Med Genet A 2013; 161A (5) 1200-1202
• 8 van Katwijk C, Peeters LLH. Clinical aspects of pregnancy after the age of 35 years: a review of the literature. Hum Reprod Update 1998; 4 (2) 185-194
• 9 Callaway LK, Lust K, McIntyre HD. Pregnancy outcomes in women of very advanced maternal age. Aust N Z J Obstet Gynaecol 2005; 45 (1) 12-16
• 10 Kale A, Kuyumcuoğlu U, Güzel A. Is pregnancy over 45 with very high parity related with adverse maternal and fetal outcomes?. Clin Exp Obstet Gynecol 2009; 36 (2) 120-122