Abstract
BackgroundIn Australia, approximately 0.1% of births occur to women 45 years or older and this rate has been increasing in recent years. There are however, few population based studies examining perinatal outcomes among this age group. The aim of this study was to determine the maternal and perinatal outcomes of pregnancies in women aged 45 years or older compared to women aged 30–34 years.MethodsData on births at 20 or more weeks’ gestation were obtained from the Victorian Perinatal Data Collection for the years 2005 and 2006. We examined selected maternal and perinatal outcomes for women of very advanced maternal age (VAMA) aged 45 years or older (n = 217) and compared them to women aged 30–34 years (n = 48,909). Data were summarised using numbers and percentages. Categorical data were analysed by Chi-square tests and Fisher’s exact test. Comparisons are presented using unadjusted odds ratios, 95 percent confidence intervals (CIs) and p-values.ResultsWomen aged 45 years and older had higher odds of gestational diabetes (OR 2.05; 95% CI 1.3–3.3); antepartum haemorrhage (OR 1.89; 95% CI 1.01–3.5), and placenta praevia (OR 4.88; 95% CI 2.4–9.5). The older age-group also had higher odds of preterm birth between 32–36 weeks (OR 2.61; 95% CI 1.8–3.8); low birth-weight (<2,500 gr) (OR 2.22; 95% CI 1.5–3.3) and small for gestational age (OR 1.53; 95% CI 1.0–2.3). Stratified analysis revealed that VAMA was most strongly associated with caesarean section in primiparous women (OR 8.24; 95% CI 4.5, 15.4) and those using ART (OR 5.75; 95% CI 2.5, 13.3), but the relationship persisted regardless of parity, ART use and plurality. Low birthweight was associated with VAMA only in first births (OR 3.90; 95% CI 2.3, 6.6), while preterm birth was more common in older women for both first (OR 3.13; 95% CI 1.8, 5.3) and subsequent (OR 2.08; 95% CI 1.2, 3.5) births, and for those having singleton births (OR 2.11; 95% CI 1.3, 3.4), and those who did not use ART (OR 2.10; 95% CI 1.3, 3.4). Preterm birth was very common in multiple births and following ART use, regardless of maternal age.ConclusionsThis study demonstrates that women aged 45 years and older, in Victoria, Australia, have higher rates of pregnancy and perinatal complications, compared to women aged 30–34 years.
Highlights
In Australia, approximately 0.1% of births occur to women 45 years or older and this rate has been increasing in recent years
The evidence is limited, pregnancy after 45 years has been associated with an increased risk of adverse maternal and perinatal outcomes, such as hypertensive disorders, gestational diabetes, caesarean birth, [6,9,10,11], placenta praevia [11], postpartum haemorrhage [10], low birth-weight (LBW)[11], preterm birth [11], and stillbirth [12,13]
This is in contrast to previously, when very advanced maternal age was more often associated with high parity and low socio economic status [9,10,17,18], and may have represented the final birth for women, who for social or cultural reasons, continued to childbear until menopause [9,19]
Summary
In Australia, approximately 0.1% of births occur to women 45 years or older and this rate has been increasing in recent years. Pregnant women aged 45 years or older are more likely to be of low parity and higher socio economic circumstance [6,15], and a sizeable percentage may use ART to conceive [4,8,16] This is in contrast to previously, when very advanced maternal age was more often associated with high parity and low socio economic status [9,10,17,18], and may have represented the final birth for women, who for social or cultural reasons, continued to childbear until menopause [9,19]. These changing social circumstances may impact positively on pregnancy outcomes, as higher socio economic circumstance is associated with more favourable pregnancy outcomes and fewer stillbirths [17,20,21]
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