Risk for Cesarean Delivery by Severity of Hypertension in Women of Advanced Maternal Age [A151

Abstract

INTRODUCTION: Advanced maternal age (AMA) is associated with increased risk for hypertensive disorders of pregnancies (HDP) as well as cesarean delivery (CD). We sought to determine if severity of HDP increases CD risk among AMA women. METHODS: Cohort study of women with HDP, delivering at a single institution from 2013 to 2018. Participants were divided into four groups: chronic hypertension (CHTN), gestational hypertension (GHTN), preeclampsia (PE) without severe features, and PE with severe features. The CD rate was compared between AMA and non-AMA women, stratified by HDP group. Differences were evaluated by chi-square test or t test, and logistic regression was utilized to adjust for confounders, with significance at P<.05. This study was institutional review board‒approved. RESULTS: We identified 1,625 women with HDP, of whom 450 (28%) were AMA. CD rate was highest in PE with severe features compared to all other groups (P<.001). In AMA women, the CD rate also varied significantly by HDP, with the highest CD rate in PE with severe features compared to all other groups (P=.008). AMA was associated with increased odds of CD (OR, 1.6; 95% CI, 1.3–2.0; P<.001), and this association remained significant after adjustment for race-ethnicity, BMI, gestational age, parity, diabetes, and prior preeclampsia (aOR, 1.7; 95% CI, 1.0–2.7; P=.03). CONCLUSION: CD rates vary by severity of HDP and are significantly higher among AMA women with HDP compared to non-AMA women. This data may impact delivery counseling for AMA women, especially those with PE with severe features.