Advanced Maternal Age and Perinatal and Obstetrical Outcomes – A Population-Based Study [37C

Abstract

INTRODUCTION: Our objectives are to update the existing literature on the association between advanced maternal age (AMA) and adverse obstetrical and perinatal outcomes and to determine the effect of parity on this association. METHODS: A retrospective cohort study was conducted using the Alberta Perinatal Health Program database including all singleton births without congenital or chromosomal anomalies at greater than 20 weeks gestation from 1998-2013. Maternal age was categorized as less than 20, 20-24, 25-30, 31-34, 35-40, and greater than 40 years. Outcomes were grouped by obstetrical and perinatal. Multinomial logistic regression models were constructed controlling for various confounders. RESULTS: 105,067 of 690,471 total births (15.2%) were in women 35 years or greater. Compared with those 20-24, women 35-40 have increased risk of various adverse obstetrical outcomes including pre-existing hypertension or diabetes (aOR 3.40 95%CI 3.09-3.74), gestational diabetes (aOR 5.01 95%CI 4.69-5.36), preeclampsia (aOR 1.28 95%CI 1.14-1.43). Controlling for additional relevant obstetrical complications, they have increased risk of adverse perinatal outcomes including preterm birth (aOR 1.33 95%CI 1.26-1.39), low birth weight (LBW) (aOR 1.29 95%CI 1.21-1.38), and low Apgar score at 5 minutes (aOR 1.17 95%CI 1.08-1.26). Women under 20 and over 40 also have increased risk of perinatal mortality (aOR 1.35 and 1.36 95%CI 1.12-1.64 and 1.01-1.82). Compared to multiparas, primiparas have greater risk of adverse outcomes including preeclampsia, preterm birth, LBW, low Apgar score at 5 minutes and NICU admission (P<.05). CONCLUSION: AMA is independently associated with various pregnancy complications while primiparas have greater risk of these complications.