Perinatal outcomes of pregnancy in the fifth decade and beyond\u2013 a comparison of very advanced maternal age groups

Anat Schwartz,Swati Agrawal,Ariel Many,Tomer Avnon,Michal Rosenberg Friedman,Yariv Yogev,Shiri Shinar,Udi Shapira

doi:10.1038/s41598-020-58583-6

Abstract

To study the effect of very advanced maternal age on perinatal outcomes. A retrospective cohort study of women aged 45 years and above, who delivered ≥22 weeks of gestation in a single tertiary center between 1/ 2011 and 12/ 2018. Maternal and neonatal outcomes were compared between women ≥50 years and women of 45–49 years at delivery. Of 83,661 parturients, 593 (0.7%) were 45–49 years old and 64 (0.07%) were ≥50 years old. Obstetrical characteristics were comparable, though the rate of chronic hypertension and preeclampsia with severe features were greater in women ≥50 years (6.2% vs 1.4%, p = 0.04, 15.6% vs 7.0%, p = 0.01, 95% CI 0.19–0.86, respectively). Elective cesarean deliveries were independently associated with advanced maternal age ≥50 (OR 2.63 95% CI 1.21–5.69). Neonatal outcomes were comparable for singletons, but rates of ventilatory support and composite severe neonatal outcomes were higher in twin pregnancies of women ≥50 years (42.8% vs 13.5%, p = 0.01, and 21.4% vs 4.0%, p = 0.03, respectively). Healthy women ≥50 have higher elective cesarean rates, despite similar maternal and neonatal characteristics.

Highlights

Tremendous advances in artificial reproductive technologies (ART) and egg donation in the last [2,3] decades enable perimenopausal, and even postmenopausal women aged 50 years and above to conceive and deliver
While there were no differences in rates of gestational hypertension or preeclampsia without severe features, preeclampsia with severe features was more prevalent in the study group than in the control group (15.6% vs 7.0%, respectively, p = 0.01)
They were at an increased risk for preeclampsia with severe features, a risk that was likely attributed to higher rates of chronic hypertension compared to their younger counterparts

Summary

Introduction

Tremendous advances in artificial reproductive technologies (ART) and egg donation in the last [2,3] decades enable perimenopausal, and even postmenopausal women aged 50 years and above to conceive and deliver. While it has been established that pregnancy outcomes in women above 45 are generally poorer than those of women in their third or fourth decade of life[10,11,12], there is scarce data regarding the difference between pregnancy outcomes in the sixth and seventh decades of life and those in the fifth decade of life[1,7,9,10,13] Studies investigating this difference have generally regarded women above 45 as one group[1,6]. Age at delivery (yrs) Primiparity Previous CSa IVF pregnancy Multiple gestation Pre-gestational BMI (kg/m2) Weight gain in pregnancy (kg) Pre-gestational diabetes Chronic hypertension Aspirin use in pregnancy

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