O-267: Older maternal age and pregnancy risks

Abstract

To evaluate the risks of pregnancy complications and adverse outcomes with increasing maternal age. Population-based, historical cohort study. The study population included 8,079,996 live births of singletons of ≥20 weeks among women ages 30-54 years from the 1995-2000 Birth Cohort Linked Birth/Infant Death Data Set. Nine outcomes were modeled by maternal age, by age and race (white vs black), and by age and parity (nulliparas vs multiparas) using Mantel-Haenzel adjusted odds ratio (AOR) and 95% confidence intervals (CI). The outcomes included diabetes (pregestational or gestational), chronic hypertension (pregestational or before 20 weeks gestation), pregnancy hypertension, tocolysis, premature rupture of membranes (PROM), excessive bleeding at delivery, cesarean delivery, early preterm birth (<32 weeks), and infant mortality. The risks for all nine outcomes paralleled increasing maternal age, as shown below. The highest risk among the oldest women, overall and within parity and racial groups, was for chronic hypertension (AORs of 3.70-4.89), followed by diabetes (AORs of 2.19-3.12). By parity, the next highest risks (AORs of 2.0 or greater) were for cesarean delivery, excessive bleeding, and early preterm birth among nulliparas, and pregnancy hypertension among multiparas. By race, the next highest risks were for excessive bleeding, cesarean delivery, and infant death among white women, and cesarean delivery among black women. The risks were consistently higher for black vs white women within each age group, although the difference decreased with advancing age for PROM, early preterm birth, and infant mortality, as shown below.Tabled 1Tabled 1 Increasing maternal age is associated with significantly elevated risks for pregnancy complications and adverse outcomes, which vary by parity and racial group. Women undergoing infertility treatment should be counseled regarding the increased risks associated with pregnancy at older ages.