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Geburtshilfe Frauenheilkd 2015; 75(08): 827-832
DOI: 10.1055/s-0035-1546109
Original Article
GebFra Science
Georg Thieme Verlag KG Stuttgart · New York

Pregnancy and Obstetrical Outcomes in Women Over 40 Years of Age

Schwangerschaft und Geburt bei Frauen über 40 Jahre
A. Dietl
1   Department of Obstetrics and Gynecology, University of Freiburg i. Br., Freiburg i. Br.
,
S. Cupisti
2   Department of Obstetrics and Gynecology, University of Erlangen, Erlangen
,
M. W. Beckmann
2   Department of Obstetrics and Gynecology, University of Erlangen, Erlangen
,
M. Schwab
3   Department of Obstetrics and Gynecology, University of Würzburg, Würzburg
,
U. Zollner
3   Department of Obstetrics and Gynecology, University of Würzburg, Würzburg
› Author Affiliations
Further Information

Publication History

received 07 December 2014
revised 28 April 2015

accepted 29 April 2015

Publication Date:
31 August 2015 (online)

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Abstract

Introduction: Delayed childbearing is increasing, and advanced maternal age has been associated with an increased risk of obstetrical complications. The purpose of this study was to evaluate pregnancy outcomes in women with advanced maternal age (≥ 40 years). Methods: Maternal and obstetrical data were collected from the Department of Obstetrics and Gynecology of the University of Wuerzburg for the period from 2006 to 2011. In this retrospective analysis we compared the outcomes for women aged ≥ 40 years (n = 405) with those of three younger subgroups (I: < 30 y; II: 30–34 y; III: 35–39 y). Results: Pregnant women older than 40 years had more chronic diseases such as hypertension, needed medical treatment more frequently and had a higher thrombosis risk. Pregnancy-induced diseases such as gestational diabetes, preeclampsia and pregnancy-associated hypertension occurred more often in women ≥ 40 years of age. Compared to mothers who were younger than 30 years, primiparous women ≥ 40 years had a more than four times higher overall cesarean section rate and four times higher elective cesarean section rate. Furthermore, they required longer hospital stays, both after cesarean section and after vaginal delivery. The preterm birth rate (≤ 32 weeks of gestation) was similar across the different age groups. Conclusions: The outcomes of pregnancy and childbirth and for newborns born to women ≥ 40 years did not vary significantly from those of younger women if the following conditions were met: a) pre-existing chronic diseases were treated medically and dietetically; b) pregnancy-induced morbidity was monitored regularly and controlled medically; c) women attended regular prenatal check-ups; d) a healthy lifestyle was adhered to during pregnancy, and e) delivery occurred in a perinatal center.

Zusammenfassung

Einleitung: Der Trend zur späten Mutterschaft steigt und im Zuge dessen wird fortgeschrittenes mütterliches Alter mit steigendem Risiko für geburtshilfliche Komplikationen verbunden. Ziel dieser Arbeit war es, den Schwangerschaftsausgang bei Frauen im fortgeschrittenen mütterlichen Alter (≥ 40 Jahre) zu untersuchen. Material und Methoden: Mütterliche und geburtshilfliche Daten zwischen 2006 und 2011 der Geburtshilflichen und Gynäkologischen Abteilung der Universitätsfrauenklinik Würzburg wurden analysiert. In einer retrospektiven Untersuchung wurde die Altersgruppe ≥ 40 Jahre (n = 405) mit 3 anderen Subgruppen (I: < 30 Jahre; II: 30–34 Jahre; III: 35–39 Jahre) verglichen. Ergebnisse: Schwangere Frauen älter als 40 Jahre litten häufiger an chronischen Erkrankungen wie Hypertonie, hatten häufiger behandlungsbedürftige Allgemeinerkrankungen und hatten ein höheres Thromboserisiko. Schwangerschaftsinduzierte Erkrankungen wie Gestationsdiabetes, Präeklampsie und schwangerschaftsinduzierte Hypertonie kamen häufiger bei Frauen ≥ 40 Jahre vor. Erstgebärende ≥ 40 Jahre hatten ein mehr als 4-mal höheres Risiko per Sectio und ein 4-mal höheres Risiko per elektiver Sectio zu entbinden als Frauen < 30 Jahre. Des Weiteren blieben diese Frauen sowohl nach Sectio- als auch nach Spontanentbindung länger im Krankenhaus. Die Frühgeburtenrate (≤ 32. SSW) verteilte sich gleichmäßig auf die verschiedenen Altersgruppen. Diskussion: Das Outcome der Schwangerschaft, Geburt und des Neugeborenen einer Frau ≥ 40 Jahre unterscheidet sich nicht signifikant von dem einer jüngeren Schwangeren, wenn folgende Voraussetzungen erfüllt sind: a) vorbestehende chronische Erkrankungen sind medikamentös und/oder diätetisch eingestellt, b) schwangerschaftsinduzierte Erkrankungen werden regelmäßig überwacht oder medikamentös eingestellt, c) die Schwangerschaftsvorsorge wird regelmäßig wahrgenommen, d) ein gesunder Lebensstil wird auch während der Schwangerschaft beibehalten, und e) die Entbindung erfolgt in einem Perinatalzentrum.

Key words

pregnancy - advanced maternal age - gestational diabetes - hypertension - cesarean section

Schlüsselwörter

Gestationsdiabetes - Schwangerschaft - Reproduktionsmedizin - Geburt - Plazenta - Präeklampsie
 
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