Impact of Maternal Age on Obstetric and Neonatal Outcome in Primiparous Women

Abstract

Background: Pregnancy at extremes of age can be very challenging. The reflex of a woman to pregnancy is influenced by various factors through which woman's age at pregnancy time can be known as the single most important factor that has undeniable effect on pregnancy process and labour. Both adolescent and elderly pregnancy are considered to be high risk as they have unique outcomes. Objective: To assess the effect of maternal age on obstetric and neonatal outcome. Methods: This prospective observational study was conducted on 250 primiparous women who attended at Department of Obstetrics & Gynaecology, 300 Bed Hospital, Narayanganj, Bangladesh from March 2019-February 2020. A detailed history regarding maternal age, period of gestation, development of any signs and symptoms of various comorbidities is taken and antenatal examination is done. Routine antenatal investigations were done and all the cases were followed till delivery. Development of various maternal co-morbidities, mode of delivery and neonatal outcome was assessed. Results: Majority of our study population were in 20-34 years age group (72.0%), teenagers constituted 19.2%, advanced maternal age constituted 8.8%.The number of pre- term births in gestational age between 28 to 36 weeks were similar in teenage mothers (12.5%) and elderly primi (13.6%) where as in normal age group it was only 3.8%. Post term pregnancy where comparatively higher in elderly primi (18.8%) than teenagers (10.4%) Association of gestational age with maternal age is statistically significant (P <0.05). In our study 11% patients had Gestational Hypertension. Association of Hypertension in pregnancy with maternal age is statistically significant (p <0.05). In our study, GDM was present in 7.6%; in teenage mothers 2.1% and in elderly mothers 28.5%. In teenage 12.5% and in elderly mothers it is 31.8%. Association of Hypothyroid and maternal age is statistically significant (p<0.05). In our study anemia was seen in 4.1% of teenagers, 4.5% advanced maternal age, 3.3% in age group 20 to 34 years. In our study, 47.9% of teenage mothers delivered vaginally and 52.1% of them delivered by cesarean section. In age group 20 to 34 years, vaginal delivery was 50.2% and caesarean delivery was 49.7%. Whereas in elderly primis the rate of cesarean delivery was 71.4% and vaginal delivery was 28.5%. Association of mode of delivery with maternal age is statistically significant (p<0.05). In our study teenagers, term babies were 78.7%, pre-term babies were 12.7%, IUGR babies were 6.3% and IUD 2.1%. In advanced maternal age; term babies were 68.1%, pre- term were 13.6%, IUGR were 13.6% and IUD were 4.5%. Association of outcome of baby is statistically significant (p<0.05). In our study the babies which got admitted in NICU were 33.7% in teenage mothers and in elderly is 13.3%. Association of NICU admission among teenage and advanced maternal age is statistically significant. (p<0.05). Conclusion: Teenage pregnancy is an essential public health issue as it is associated with poor maternal and fetal outcome. Teenage and Elderly pregnancy are associated increased maternal and perinatal mortality and morbidity early detection of risk factors and prevention is necessary to reduce the morbidity.