Abstract
Objectives: Maternal age has been increasing for several decades with many of these late pregnancies between 40 and 45 years old. The main objective of this study is to assess whether maternal age is an independent factor of obstetric, fetal, and neonatal complications.Patients and methods: A monocentric, French study “exposed-unexposed” was conducted during 11 years in a maternity level IIB. Maternal and perinatal outcomes were studied using univariates and multivariate analysis. We compared women aged 40 and above in a 1:1 ratio with women of 25–35 years old.Results: One thousand nine hundred eighty-two women were 40 or older (mean age: 41.9) on the day of their delivery and compared to other 1,982 women who were aged between 25 and 35 years old (mean age: 30.7) Preeclampsia, gestational diabetes, were significantly higher in the study group (4.6 vs. 1.5% and 14.5 vs. 6.9%, respectively, p < 0.001). We found also a significant difference for gestational hypertension (3.1 vs. 1.1% p < 0.001), preterm birth (10.4 vs. 6.5% p < 0.001), cesarean (16.6 vs. 5.4% for scheduled cesarean, and 50.4 vs. 13.9% for emergency cesarean, p < 0.001) and fetal death in utero (2.1 vs. 0.5% in the study group, p < 0.001). These results were also significantly different in multivariate analysis.Conclusion: A pregnancy after 40 years old is worth considering today as far as the risk factors are controlled and understand by the patient and the obstetrician. However, they have a significantly higher risks of cesarean, preterm delivery, pre-eclampsia, gestational diabetes, and fetal death in utero (FDIU). It is therefore the responsibility of the obstetrician to inform correctly these women in a detailed way, to reassure them and to adapt the monitoring of their pregnancy accordingly.
Highlights
Late pregnancies have been a sensitive subject in society and in the medical field since a couple years
The secondary objectives are to determine whether there is an association between some complications and the conception mode associated with the type of pregnancy
There was a significant difference between the two groups for the access to assisted procreation (ART), Body mass index (BMI), and type of pregnancy (p < 0.001) (Table 1)
Summary
Late pregnancies have been a sensitive subject in society and in the medical field since a couple years. A pregnancy was considered “late” if it was obtained after 35 years, today the threshold has shifted to 40 years or even 43 or 45 years according to the scientific literature [3, 5,6,7]. This is explained by a societal evolution marked by a constantly increasing level of studies by women who have more responsibilities at work and delay their project of childbearing giving their first priority to their professional career [1]. The increasing development of medically assisted procreation (ART), with access to oocyte donation in European countries, has recently been re-established [6, 8, 9]
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