Study of effect 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. There is a need for individualization of the antenatal surveillance programmes and obstetric care based on different age group in order to improve the outcomes. India, with its growing population needs to address this issue with all possible measures. Aims & Objectives: Aim is to assess the effect of maternal age on obstetric and neonatal outcome. Objective is 1) To assess the maternal outcome in terms of development of various co-morbidities like Gestational Hypertension, Pre-eclampsia, Eclampsia, Gestational diabetes, Oligohydraminos and Polyhydraminos, Anemia, Post-partum haemorrhage, Placenta previa, Abruptio placenta, etc., and to assess the mode of delivery. 2) To assess the neonatal outcome in terms of birth weight, maturity, Apgar score and NICU admissi This prospective observational study was conducted on 500 primiparous women who attended the antenatal clinic at Department of Obstetrics & Gynaecology, ESIC-MC & PGIMSR Hospital, Rajajinagar, Bengaluru from January 2018-June 2019. A detailed history regarding maternal age, period of gestation, development of any signs and symptoms of various co-morbidities 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 (72.2%), teenagers constituted 19.2%, advanced maternal age constituted 8.6%. · Teenagers had 12.5% of preterm labour, 20-34 years of age group had 3.9% and elderly had 13.9% of preterm labour and is statistically significant (p<0.05). · 12.5% of teenage mothers had pregnancy induced hypertension, 20-34 years of age group had 13.3% and older mothers had 39.4% of pregnancy induced hypertension. Eclampsia was seen only in teenagers (2.1%) and is statistically significant (p<0.05). · Gestational diabetes was highest among older mothers (25.7%) compared to 20-34 years age group (7.8%) and younger mothers (2.1%) and is statistically significant (p<0.05). · Vaginal delivery among teenagers was 47.9%, 20-34 years age group was 50.1% and older mothers was 30.2% which is statistically significant (p<0.05). · LSCS was 52.1% in teenagers, most common indication being fetal distress (32.3%) followed by malpresentation (6.2%) and CPD (1%). Among older mothers, LSCS was (69.8%), most common indication being fetal distress (53.5%), followed by CPD (14%) and malpresentation (4.7%). This was statistically significant (p<0.05). · Among NICU admissions, adolescents constituted 31.7%, 20 to 34 years age group constituted 53.3%, older age group 15%. NICU admissions among different age group is statistically significant (p<0.05). Conclusion: 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