Adverse fetal outcomes and associated factors among mothers of advanced age at a tertiary hospital, Southwestern Uganda: a cross-sectional study

Abstract

Background: Pregnancies among mothers of advanced age (≥35 years) are inherently associated with poor fetal outcomes. In this study, we determined the proportion of adverse fetal outcomes and identified associated factors among pregnant mothers of advanced age who delivered at Kabale Regional Referral Hospital (KRRH) in Southwestern Uganda. Methods: We conducted a cross-sectional study at KRRH’s Maternity Ward from March to August 2023. We enrolled post-delivery mothers aged ≥35 years. We collected data on socio-demographic, obstetric, and medical characteristics, as well as fetal outcomes, using interviewer-administered structured questionnaires. We defined an adverse fetal outcome as the occurrence of any of the following complications: early neonatal death, preterm birth, congenital anomalies, macrosomia, low APGAR score, or low birth weight, sustained by the fetus or neonate during pregnancy, delivery, or the immediate post-delivery period before discharge from the hospital. We performed multivariable logistic regression to identify factors associated with adverse fetal outcomes. Results: We enrolled 417 participants, of whom 206 (49.4%) were aged 35-37 years. The majority (n=273; 65.5%) were multiparous (parity ≥5). Adverse fetal outcomes occurred in 8.4% (n=36; 95% CI: 6.1-11.5%) of participants, with early neonatal death being the most common (3.6%), followed by low birth weight (2.4%), congenital anomalies (2.6%), macrosomia (1.4%), low APGAR score (1.4%), and preterm birth (1.2%). Prolonged labor (adjusted odds ratio [aOR]=3.71, 95% CI: 1.40-9.85) and a history of abortion (aOR=2.56, 95% CI: 1.17-5.60) were significantly associated with adverse fetal outcomes. Conclusion: Approximately 1 out of every 10 advanced-aged mothers surveyed experienced a poor fetal outcome, with mothers who had prolonged labor or history of abortions having increased odds of the poor fetal outcomes. Close monitoring during pregnancy and neonatal care preparedness among mothers of advanced age especially those with prolonged labour and history of abortion could mitigate risks of adverse fetal outcomes in this study population.