The effect of advanced maternal age on perinatal outcomes in nulliparous singleton pregnancies

Abstract

BackgroundPregnancy at advanced maternal age has become more common in both developed and developing countries over the last decades. The association between adverse perinatal outcomes and advanced maternal age has been a matter of controversy in several studies. The objective of this study is to investigate the impact of advanced maternal age on perinatal and neonatal outcomes of nulliparous singleton pregnancies.MethodsRecords of patients admitted to the Department of Obstetrics and Gynecology, University of Cukurova School of Medicine, between January 2011 and July 2015 for routine mid-trimester fetal ultrasonography were retrospectively reviewed. The control (age: 18–34 years), advanced maternal age (35–39 years), and very advanced maternal age (> 40 years) groups included 471, 399, and 87 women, respectively.ResultsGestational diabetes, gestational hypertension, and cesarean delivery rates were more common in the very advanced maternal age group, with compared with the advanced maternal age and the younger age group. There were no significant differences in regarding rates of spontaneous preterm delivery before 34 weeks of gestation, prolonged rupture of membranes, large for gestational age infants, and operative vaginal delivery rates between the groups. Also, there were no significant differences regarding in APGAR scores, the rate of low birth weight infants, and neonatal morbidity rates between the groups. However, admission to the neonatal intensive care unit requirement was more common in the two advanced maternal age groups compared with the control group.ConclusionAdvanced maternal age is a risk factor for gestational diabetes mellitus, gestational hypertension, preeclampsia, small for gestational age infants, spontaneous late preterm delivery, and cesarean section, with significant potential clinical implications.

Risk factors and pregnancy outcome in women aged over 40 years at Korle‐Bu Teaching Hospital in Accra, Ghana

“…13 In two recent studies that, like ours, defined AMA as being over 40 years, AMA was associated with gestational diabetes and cesarean delivery but the rate of preterm birth and stillbirth were not increased, as in our study. 14,15 In another large multi-country survey by Laopaiboon et al, 16 involving over 350 health facilities in 29 countries across the world, AMA was associated with composite adverse maternal and perinatal outcome. In the present study, however, AMA was not associated with increased adverse perinatal outcomes such as preterm birth, stillbirth, or NICU admission.…”

Impact of Advanced Maternal Age on Physiologic Adaptations to Pregnancy in Vervet Monkeys

“…AMA in humans is an established risk factor for the development of an array of pregnancy-induced pathologies 6, 8, 26, 38, 39 . While the relationship between maternal age and the incidence of pregnancy-related pathologies exists, pre-clinical models with similar reproductive physiology to that of humans are severely lacking.…”

“…These findings indicate that the vervet monkey recapitulates some, but not all aspects of altered BP regulation during pregnancy in older mothers. Gaillard et al indicated that a woman’s maternal age per se was not consistently correlated with gestational hypertension, and that maternal body mass index might influence alterations in BP regulation during pregnancy 38 . In fact, maternal obesity has been shown to interact with maternal age to promote a variety of other pregnancy-induced pathologies 38 .…”

“…Gaillard et al indicated that a woman’s maternal age per se was not consistently correlated with gestational hypertension, and that maternal body mass index might influence alterations in BP regulation during pregnancy 38 . In fact, maternal obesity has been shown to interact with maternal age to promote a variety of other pregnancy-induced pathologies 38 . We observed no association between maternal body weight and maternal age (Figure 4), which may explain differences observed between our study in vervet monkeys and human studies in the regulation of third trimester systolic BP.…”

“…This concept is known as the developmental origin of disease 72 . A commonality between maternal stress and AMA is they are both risk factors for the development of intrauterine growth restriction in humans and small gestational age infants 6, 8, 38, 39, 73, 74 . Our ultrasound data of fetal biparietal diameter revealed no association between maternal age and head size.…”