Advanced Age Pregnancy Research Articles

Pregnancy Outcome in Patients with Placenta Praevia with Delayed Child Bearing Age

This is a hospital-based cross sectional descriptive study was carried out during January 2015 to June 2015 in the Department of Obstetrics and Gynaecology of Rajshahi Medical College Hospital to determine pregnancy outcome in placenta praevia cases with delayed child bearing age. Total 8107 patients were admitted during the study period and among them 82 patients were diagnosed as placenta praevia. Patients were categorized into two groups as above 35 years & below 35 years and relationship between advanced maternal age and placenta praevia was seen. Socio-demographic condition, clinical condition, course of management, maternal and perinatal outcome were observed and recorded. Proportion of placenta praevia was 1.01% during the study time. Among 82 patients of placenta praevia, 25 were advanced maternal age group (30.49%). Prevalence of placenta praevia in advanced maternal age group in comparison to below 35 years among total admitted patient was seen 9.73% and 0.73% respectively. So, incidence is more in advanced maternal age group which is statistically significant (p<0.05). Most of the patients of placenta praevia came from middle class family 42(51.21%) and most women were multi gravida 75(91.5%). 42.68% patient had history of caesarean section and 47.56% patients had history of menstrual regulation (MR), abortion & dilatation, evacuation & curettage (DE & C). Major placenta praevia was more in advanced maternal age group (64%) which is statistically significant (<0.05) and mode of delivery was caesarean section 62(75.60%). Maternal and perinatal complications were more in advanced maternal age group. Maternal mortality rate 9(10.97%) and perinatal mortality rate 14(17.07%). Advanced maternal age has a relation with placenta praevia and associated with more adverse maternal and perinatal outcome. So, pregnancy in advanced age should be considered as a risk factor for developing placenta praevia.
 TAJ 2019; 32(2): 48-55

The effect of oxytocin on atrial and ventricular repolarization parameters of surface 12-lead electrocardiography(ECG)

Aim: We were aimed to demonstrate the effect of oxytocin on both ventricular and atria depolarization parameters. Material and Methods: We planned cross-sectional study. The Seventy- five patients, who were their last trimester and nulipar and admitted to hospital for spontaneous labor, were included to this study. A 12-lead ECG was recorded for each woman twice at 12 hour before oxytocin infusion at rest while in the supine position and shortly after from labor and upon cessation of oxytocin infusion. The Tp-e interval was defined as the interval between the peak and end of the T wave, measurements of the Tp-e interval were performed from precordial leads, and the Tp-e/QTc ratio and P wave dispersion, QTc was calculated from these measurements. In total, 280 pregnant women, of whom 98 were of advanced age and 182 were under 35 years of age were included in the study. The risk of arrhythmia was evaluated by calculating the electrocardiographic P-wave duration, QT interval, T peak-to-end interval, and the Tp-e/QT ratio.Go to:Results: There were statistically significant differences in the Tp–e interval and Tp-e/QTc ratio and other parameters before and after oxytocin infusion , the maximum QTc, minimum QTc, and QTc dispersion values, P wave dispersion and other parameters of repolarization were significantly higher after labor compared to the before labor. Although there were no differences in the Tp-e interval and Tp-e/QTc ratio between the groups, the maximum QTc, minimum QTc, and QTc dispersion values were significantly higher in advanced-age pregnancies compared to the control group. In addition, the P dispersion was greater in advanced-age pregnancies. In correlation analysis, the increased dispersion of QTc and P were positively correlated with maternal age. Multiple linear regression analysis showed that QTc dispersion was independently associated with maternal age. Go to: Conclusion: In conclusion, although study population was small and arrhythmic potential of oxytocin was evaluated with surface ECG. The repolarization parameters were increased in women with oxytocin infusion during their labor. To obtain these repolarization parameters are easy and usage of these parameters as a cardiac arrhythmic risk factor are logical.

Correlation between pregnancy-induced hypertension and age in pregnant women from Hebei province, 2016

Objective: To analyze the correlation between age and pregnancy-induced hypertension (PIH) in pregnant women from Hebei province in 2016. Methods: A retrospective analysis was conducted by using the clinical data of 64 909 pregnant women, delivering in 22 hospitals in Hebei in 2016. Descriptive statistics was used to describe the general data and pregnancy outcomes of pregnant women, and χ(2) test was used to compare the incidence of PIH in different age groups, and logistic regression analysis was used to analyze the risk factors for PIH. Results: The incidence of PIH was lowest in 20-29 year old women, and increased obviously in those aged<20 and>35 years (P<0.05), and the incidence was positively correlated with age. Logistic regression analysis showed that age, times of pregnancy, number of previous cesarean section and fetus number of current pregnancy were the risk factors for PIH (OR=1.293, 1.153, 1.307, 3.607), while times of deliver and times of prenatal examination were the protective factors (OR=0.655, 0.951). Conclusion: Advanced age pregnancy and young age pregnancy would significantly increase the incidence of PIH. Prenatal care should be strengthened for pregnant women at risk for PIH.

Reproducción en pacientes de más de 40 años: estudio multicéntrico de los resultados obstétricos de 2.578 partos

IntroductionAdvanced age reproduction has become a social reality associated to medical complications. Material and methodsData were collected from 2578 women, all over 40 years-old, who gave birth in 9 public hospitals in Spain between 2015 and 2016. Data from those pregnancies, as well as those from Spanish National Registry, were used to evaluate the pregnancy and the obstetrics outcomes. ResultsUp to 33.3% of the pregnancies analysed were from using assisted reproduction techniques, and according to the National Registry, 79.5% of them were obtained by egg donation. The incidence of positive aneuploidy screening was 7.8%, with a malformation rate of 5.07%. Gestational diabetes was also detected in 13.98%. Hypertensive events occurred in 5.37%, and 2.87% cases were diagnosed with intra-uterine foetal growth retardation. As regards the newborns, 18.9% weighed less than 2500 g, and 2.63% less than 1500 g. There were 15.5% preterm deliveries, with 12.32% between 32 and 37 weeks, 2.08% between 28 and 32 weeks, and 0.7% less than 28 weeks. The incidence of intra-uterine foetal death was 0.48%. A total of 33.09% caesarean sections were performed. An unfavourable Apgar Score (<7) was observed in 13.75% of the newborns, and maternal pospartum complications appeared in 7.86% of the cases. There were 5.59% twin pregnancies in the women in the study. ConclusionsThe analysis of these perinatal results confirms that advanced age pregnancy is a risk situation. There is a need of an adequate counselling before using assisted reproduction techniques, and specific obstetrics care follow-up seems unquestionable.

Pregnancy late in rodent life has detrimental effects on the heart.

During pregnancy, the heart undergoes significant and numerous changes, including hypertrophy, that are usually described as physiological and reversible. Two aspects of the cardiac response to pregnancy are relatively understudied: advanced maternal age and multiple pregnancies (multiparity). Repeated breeder (RB) mice that have undergone five to seven consecutive pregnancies were euthanized 21 days after the weaning of their last pups and compared with age-matched primiparous, one-time pregnant (O1P) mice. The ages of the older mouse groups were similar (12 ± 1 mo). Pregnancy at a later age resulted in reduced fertility (40%); resorption was 29%, maternal mortality was 10%, and mortality of the pups was 17%. Contractile function as indicated by percent fractional shortening was significantly decreased in O1P and RB groups compared with the old nonpregnant control (ONP) group. There was no pathological induction of the fetal program of gene expression, with the exception of β-myosin heavy chain mRNA, which was induced in O1P compared with ONP mice ( P < 0.05) but not in RB mice. MicroRNA-208a was significantly increased in O1P compared with ONP mice ( P < 0.05) but significantly decreased in RB compared with ONP mice ( P < 0.05). mRNA of genes regulating angiogenesis (i.e., vascular endothelial growth factor-A) were significantly downregulated, whereas proinflammatory genes [i.e., interleukin-6, chemokine (C-C motif) ligand 2, and Cd36] were significantly upregulated in O1P ( P < 0.05) but not in RB mice. Overall, our results suggest that rather than multiparity, pregnancy in advanced age is a much more stressful event in both pregnant dams and fetuses, as evidenced by increased mortality, lower fertility, downregulation of angiogenesis, upregulation of inflammation, and cardiac dysfunction. NEW & NOTEWORTHY Pregnancy in older mice significantly decreases cardiac function, although repeated breeder mice demonstrated increased wall hypertrophy and dilated chamber size compared with one-time pregnant mice. Interestingly, many of the molecular changes were altered in one-time pregnant mice but not in repeated breeder mice, which may contribute to adverse pregnancy outcomes in a first pregnancy at a later age.

Study on the dynamic variations and influencing factors of serum lipid levels during pregnancy and postpartum

Objective: To study the variations and influencing factors of serum triglycerides and cholesterol levels during pregnancy and postpartum. Methods: A retrospective study was performed among 5 020 healthy singleton (95.10%, 4 774/5 020) and twin (4.90%, 246/5 020) women who had delivery in Women's Hospital, Zhejiang University School of Medicine from January 2011 to December 2016. Serum triglycerides and cholesterol levels during pregnancy and postpartum of all the cases were collected. Both singleton and twin pregnant women were divided into advanced age and appropriate age groups, and then data of serum sample were assigned to 3 groups according to the gestation weeks, which were second trimester pregnancy (24-28 gestation weeks) , third trimester pregnancy (32-41 gestation weeks) and postpartum (within 72 hours after delivery) . The serum triglycerides and cholesterol levels in each groups were compared. Results: (1) Serum triglycerides and cholesterol levels during the second trimester pregnancy, third trimester pregnancy and postpartum were higher than levels of non-pregnancy in both singleton and twin groups (all P<0.05) . (2) Serum triglycerides and cholesterol levels in the third trimester pregnancy group were higher than those of second trimester pregnancy group in both advanced age and appropriate aged women regardless singleton or twin pregnancy (all P<0.05) . The 95%CI of serum lipid levels in each group during second and third trimester pregnancy were as follows: in appropriate aged singleton group, the triglycerides levels were 1.07-4.13 and 1.52-7.21 mmol/L, and the cholesterol levels were 2.77-12.11 and 4.44-9.36 mmol/L. In advanced aged singleton group, the triglycerides levels were 1.28-4.61 and 1.70-7.80 mmol/L, and the cholesterol levels were 4.35-8.40 and 4.46-9.35 mmol/L; in appropriate aged twin group, the triglycerides levels were 1.39-7.16 and 1.90-9.29 mmol/L, and the cholesterol levels were 4.99-12.16 and 4.52-10.07 mmol/L; in advanced aged twin group, the triglycerides levels were 1.61-5.32 and 1.94-9.29 mmol/L, and the cholesterol levels were 5.24-8.10 and 4.53-8.86 mmol/L. (3) Serum lipids levels rapidly decreased during postpartum compared to the third trimester pregnancy. The 95%CI of blood lipid levels in each group were as follows: in appropriate aged singleton group, the triglycerides level was 0.90-5.64 mmol/L and the cholesterol level was 4.70-8.52 mmol/L; in advanced aged singleton group, the triglycerides level was 0.87-5.43 mmol/L and the cholesterol level was 4.68-9.04 mmol/L; in appropriate aged twin group, the triglycerides level was 1.20-8.21 mmol/L and the cholesterol level was 4.66-8.45 mmol/L; in advanced aged twin group, the triglycerides level was 1.32-6.61 mmol/L, and the cholesterol level was 5.01-7.94 mmol/L. (4) Serum triglycerides and cholesterol levels in twin pregnant women were significantly higher than in singleton during the second trimester and third trimester pregnancy both in advanced age and appropriate age groups (all P<0.05) . During postpartum, there was no difference in serum lipid levels between the singleton and twin pregnant women in appropriate age group (triglycerides: P=0.982; cholesterol: P=0.759, respectively) . While the serum lipid levels in twin pregnant women were significantly higher than those of singleton women in advanced age group (triglycerides: P=0.000; cholesterol: P=0.000, respectively) . Conclusions: The standard of serum lipid levels of non-pregnant adults is not suitable for assessing that in pregnant women. Regardless of singleton or twin pregnancy, serum triglyceride and cholesterol levels during pregnancy elevate with the increasing gestational week and then rapidly decrease during postpartum. Age and twins are the influencing factors of the elevated physiological lipid levels during pregnancy.

Assessment of increased risk of arrhythmia in advanced age pregnancies.

Background and Objective:Cardiovascular deaths usually occur in older pregnancies and arrhythmia is the third most common cause. Our study aimed to determine whether the risk of arrhythmia increases in pregnancy with advanced age.Methods:In total, 280 pregnant women, of whom 98 were of advanced age and 182 were under 35 years of age were included in the study. The risk of arrhythmia was evaluated by calculating the electrocardiographic P-wave duration, QT interval, T peak-to-end interval, and the Tp-e/QT ratio.Results:Although there were no differences in the Tp-e interval and Tp-e/QTc ratio between the groups, the maximum QTc, minimum QTc, and QTc dispersion values were significantly higher in advanced-age pregnancies compared to the control group. In addition, the P dispersion was greater in advanced-age pregnancies. In correlation analysis, the increased dispersion of QTc and P were positively correlated with maternal age. Multiple linear regression analysis showed that QTc dispersion was independently associated with maternal age.Conclusion:Repolarization parameters increase in advanced-age pregnancies even though they remain in the normal range, which should lead to an investigation of whether this is a pathological condition.

Is there A Relationship between route of delivery, perinatal characteristics, and neonatal outcome in preterm birth?

Preterm birth is one of the most challenging problems in obstetric care and it is closely related to perinatal mortality and morbidity. The aim of the current study was to document our experience with preterm births and to analyze the association between perinatal variables and clinical outcomes. In this retrospective study, data were derived from the medical records of 785 singleton preterm births delivered in the obstetrics and gynecology department of our institution. Variables under investigation were maternal and gestational ages, fetal gender, route of delivery (vaginal vs. cesarean section [C/S]), causes of preterm birth, birth weight, placental weight, umbilical cord length, and Apgar scores at the 1st and 5th min. Pregnant women with advanced age (≥35 years) were more likely to undergo C/S (P < 0.001). Apgar score at the 1st and 5th min was influenced significantly by gestational age (P < 0.001), newborn birth weight (P < 0.001), placental weight (P < 0.001), and umbilical cord length (P < 0.001). Infants delivered due to antepartum fetal distress indication had remarkably lower Apgar scores at the 1st min and the birth weight seemed to be positively correlated with Apgar scores at both 1st (P < 0.001) and 5th min (P < 0.001). Apgar scores both at the 1st and 5th min were positively correlated with placental weight (R: 0.239 and 0.231, respectively, and P < 0.001 for both) and length of umbilical cord (R:0.228 and 0.211, respectively, and P < 0.001 for both). Advanced age pregnancies have higher C/S rates, but Apgar scores are significantly correlated with infant characteristics. Umbilical cord length and placental weight might be the new add-on predictors of postpartum well-being in premature infants.

Association of Maternal Serum 25-hydroxyvitamin D Concentrations in Second Trimester with Delivery Mode in A Chinese Population

Objective: To determine the maternal serum 25-hydroxyvitamin D [25(OH)D] concentrations in a Chinese population and investigate its associations with subsequent delivery mode by studying 1924 unrelated pregnant women.Methods: The serum 25(OH)D concentrations was measured by euzymelinked immunosorbent assay (ELISA). Simultaneously, maternal information and subsequent delivery mode were collected. Logistic regression analysis was performed to assess the associations between 25(OH)D concentrations and caesarean section.Results: The median (IQR) serum concentration of 25(OH)D for the total subjects was 43.4 (35.2-56.9) nmol/L. Among them, 1225 (63.7%) women were in the status of 25(OH)D deficiency (< 50.0 nmol/L). The 25(OH)D concentrations showed significant variation by body mass index (BMI), parity and season of sampling. Women with caesarean section was older, and with higher BMI and rate of abnormal pregnancy history, suggesting advanced age, obesity and abnormal pregnancy history may be the risk factors for the subsequent caesarean section. Compared with 25(OH)D from 50.0 to 74.9 nmol/L, women with low 25(OH)D concentrations (< 50.0 nmol/L) was not significantly associated with caesarean section. Only in the subgroup of the women without abnormal pregnancy history, higher 25(OH)D (> 75.0 nmol/L) concentrations could significantly decrease the risk of caesarean section.Conclusion: Vitamin D deficiency is a quite serious problem in Chinese pregnant women. There is no evidence that the maternal serum 25(OH)D concentrations is associated with increased risk of caesarean section.

Pregnancy in advanced age and the risk of stroke in postmenopausal women: analysis of Women’s Health Initiative Study

The incidence of pregnancy in advanced age among women is increasing because of the availability of assisted reproduction, although the long-term health consequences are not known. The purpose of this study was to determine the effect of pregnancy in advanced age on the occurrence of cardiovascular events in a large cohort of postmenopausal women. We analyzed the data for 72,221 women aged 50-79 years who were enrolled in the observational arm of the Women's Health Initiative study. We determined the effect of pregnancy in advanced age (last pregnancy at age ≥40 year) on the risk of ischemic stroke, hemorrhagic stroke, myocardial infarction, and cardiovascular death over a mean period (±standard deviation) of 12±1 years using Cox Proportional Hazards analysis after adjusting for potential confounders. A total of 3306 of the 72,221 participants (4.6%) reported pregnancy in advanced age. Compared with pregnancy in normal age, the rates of ischemic stroke (3.8% vs 2.4%), hemorrhagic stroke (1.0% vs 0.5%), and cardiovascular death (3.9% vs 2.3%) were significantly higher among women with pregnancy in advanced age. In multivariate analysis, women with pregnancy in advanced age were 50% more likely to experience a hemorrhagic stroke (hazard ratio, 1.5; 95% confidence interval, 1.0-2.1) after adjustment for age, race/ethnicity, congestive heart failure, systolic blood pressure, atrial fibrillation, alcohol use, and cigarette smoking. There was no significant difference in the risk of ischemic stroke, myocardial infarction, and cardiovascular death among women with pregnancy in advanced age after adjustment for potential confounders. Women with pregnancy at an advanced age have a higher risk for hemorrhagic stroke in the postmenopausal period.

Prevalence and risk factors related to preterm birth in Brazil.

BackgroundThe rate of preterm birth has been increasing worldwide, including in Brazil. This constitutes a significant public health challenge because of the higher levels of morbidity and mortality and long-term health effects associated with preterm birth. This study describes and quantifies factors affecting spontaneous and provider-initiated preterm birth in Brazil.MethodsData are from the 2011–2012 “Birth in Brazil” study, which used a national population-based sample of 23,940 women. We analyzed the variables following a three-level hierarchical methodology. For each level, we performed non-conditional multiple logistic regression for both spontaneous and provider-initiated preterm birth.ResultsThe rate of preterm birth was 11.5 %, (95 % confidence 10.3 % to 12.9 %) 60.7 % spontaneous - with spontaneous onset of labor or premature preterm rupture of membranes - and 39.3 % provider-initiated, with more than 90 % of the last group being pre-labor cesarean deliveries. Socio-demographic factors associated with spontaneous preterm birth were adolescent pregnancy, low total years of schooling, and inadequate prenatal care. Other risk factors were previous preterm birth (OR 3.74; 95 % CI 2.92–4.79), multiple pregnancy (OR 16.42; 95 % CI 10.56–25.53), abruptio placentae (OR 2.38; 95 % CI 1.27–4.47) and infections (OR 4.89; 95 % CI 1.72–13.88). In contrast, provider-initiated preterm birth was associated with private childbirth healthcare (OR 1.47; 95 % CI 1.09–1.97), advanced-age pregnancy (OR 1.27; 95 % CI 1.01–1.59), two or more prior cesarean deliveries (OR 1.64; 95 % CI 1.19–2.26), multiple pregnancy (OR 20.29; 95 % CI 12.58–32.72) and any maternal or fetal pathology (OR 6.84; 95 % CI 5.56–8.42).ConclusionThe high proportion of provider-initiated preterm birth and its association with prior cesarean deliveries and all of the studied maternal/fetal pathologies suggest that a reduction of this type of prematurity may be possible. The association of spontaneous preterm birth with socially-disadvantaged groups reaffirms that the reduction of social and health inequalities should continue to be a national priority.

Complications and Outcome of Pregnancy in Extremes of Reproductive Age Groups: Experience at Tertiary Care Center

Background: Pregnant women of extremes of reproductive age group at both ends ( 35 years age) comprise high risk groups. Pregnant women up to 35 years get many complications like diabetes, spontaneous abortion, hypertensive disorders, autosomal trisomies, increased newborn and maternal morbidity and mortality and cesarean sections. Pregnancies of 35 year age group and to compare both the groups. Methods: This retrospective study was done at department of obstetrics and gynaecology, Chatrapati Shahuji Maharaj Medical Uni- versity, Lucknow, from January 2010 to December 2010. Data were collected from institutional logbook and various complications and outcome were studied. Statistical analyses were carried out by using the statistical package for SPSS-15. Results: Present study showed that the definite increased risk of preeclampsia, eclampsia, obstetric cholestasis, twin gestation, anemia, preterm labor, premature rupture of membranes, intrauterine fetal growth restriction, and intrauterine fetal death in ado- lescent pregnancies and increased risk of eclampsia, diabetes, and cesarean sections in advanced age pregnancies. Conclusions: Both adolescent and advanced age groups are high risk pregnancy groups so for best reproductive outcome, preg- nancies at these ages should be very carefully supervised with both good maternal and fetal surveillance to achieve best maternal and fetal results.

Is primiparity a risk factor for advanced maternal age pregnancies?

Objective: Currently, more women are delaying childbearing until their 40s.This study compared the pregnancy and maternal features, pregnancy and foetal outcomes between multiparous and primiparous patients. We compared the same factors between assisted reproductive technology (ART) and non-ART primiparous patients because of the high proportion of ART used in the primiparous patients.Methods: The study retrospectively examined 1680 patients, 35 years of age and older, between March 2008 and February 2015.Results: Comparing the features of these two groups, there was an increased incidence of employment and the use of ART in primiparous patients, while birthweight tended to be higher in the multiparous group. There were no significant differences in pregnancy complications other than hypertension disorders, such as pre-eclampsia and HELLP syndrome, which were significantly more frequent in primiparous patients. The rates of foetal growth retardation and perinatal death were significantly higher in primiparous women. Comparison of the data between ART and non-ART primiparous patients indicated that the ART group had a higher initial body mass index and a lower smoking rate. No significant differences in pregnancy complications or foetal outcome were observed between these two groups.Conclusion: Primiparity is associated with increased pregnancy and foetal complications in advanced age pregnancies. However, the use of ART in this age group does not seem to be an additional risk factor.

Perinatal Outcomes in Advanced Age Pregnancies

Objective: The aim of this study is to evaluate the impact of advanced maternal age on pregnancy outcomes Methods: A retrospective analysis of 951 birth registry records of Zeynep Kamil Hospital, were analyzed between Janu­ary 2003 and December 2007. Study group was made up of women ≥40 years old and control group was made up of women younger than 40 years. Results: Mean maternal age was 41.48 years in the study group and 26.41 years in the control group. Mean gesta­tional age at the time of delivery is 37.73 weeks in study group and 38.10 weeks in the control group. There was no statistical difference in terms of preterm delivery, multiple pregnancy, fetal anomaly, IUGR, superimpose preeclampsia oligohidramnios, presentation anomaly and placenta previa rates between the study and control groups. Incidence of preeclampsia (p=0.041), Chronic hypertension (p=0.001), GDM (p= 0.003),is found to be higher in study group. Cesar­ean birth rate is higher (p<0.05) and hospitalization time is longer in study group (p=0.001). 1st minute and 5th minute APGAR scores of the study group (6.99±2, 8.27±2) was lower than the 1st minute and 5th Minutes APGAR scores of the control group (7.38±1.6, 8.58±1.7). Neonatal intensive care unit administration rate is seen also higher in study group (p<0.01). Conclusion: Advanced maternal age was related to increased pregnancy complications and poor perinatal outcome. Preeclampsia, GDM, chronic hypertension is seen more common in advanced age pregnancies. Neonatal intensive care administration is higher and APGAR scores are lower; cesarean delivery was performed more common, and hospitaliza­tion time was longer in advanced age pregnancies.

Pregnancy in Advanced Age Increases the Risk of Hemorrhagic Stroke in Post-Menopausal Women. Analysis of Women's Health Initiative Study (P6.005)

Pregnancy in Advanced Age Increases the Risk of Hemorrhagic Stroke in Post-Menopausal Women. Analysis of Women's Health Initiative Study (P6.005)

A Retrospective Study on Advanced Maternal Age and Assisted Reproductive Techniques, Medico-Legal Advice, “Food for Thought”

Pregnancy in advanced reproductive age is nowadays part of the social and welfare scenario. The effects and assessment of the risks and complications in women over the age of 43 must still be more specifically defined. The aim of this study is to compare the outcomes between spontaneous pregnancies with those induced by assisted reproductive technology (ART) in women ≥ 43 years. This retrospective observational study enrolled 114 women with an age of ≥ 43 divided as follows: 74 with spontaneous pregnancies and 40 with ART-induced pregnancy. For statistical analysis, a t-test was used to compare the parameters analyzed for quantitative variables and χ2 was used for qualitative variables. A p-value ≤ 0.05 was considered statistically significant. Statistical Analysis was performed using the program SPSS 16.0 for Windows. The statistically significant differences between IVF and spontaneous pregnancy groups were respectively: gestational hypertension (30% vs 6.8%), preeclampsia (17.5% vs 2.7%), preterm delivery (47.5% vs 13.5%), IUGR (17.5% vs 4.1%), caesarian section (95% vs 70.3%), length of recovery (8.6±7.2 vs 5.9±3) and mean birth weight (2641± 695 g vs 3207±496 g). Women in advanced reproductive age (≥ 43 years) who undergo assisted fertilization procedures are at a higher risk of complications compared to women of the same age with spontaneous pregnancies.

Abstract WMP50: Pregnancy in Advanced Age Increases the Risk of Hemorrhagic Stroke in Post-menopausal Women. Analysis of Women's Health Initiative Study

Background: The incidence of pregnancy in advanced age among women is increasing due to availability of assisted reproduction although the complication rates associated with pregnancy are higher. The long-term health consequences in women with pregnancy in advanced age is not known. We determine the effect of pregnancy in advanced age on occurrence of cardiovascular events in a large cohort of post-menopausal women. Methods: We analyzed the data for 72,221 women aged 50-79 years who were enrolled in the observational arm of the Women's Health Initiative Study. We determined the effect of pregnancy in advanced age (last pregnancy at age≥40 year) on risk of ischemic stroke, hemorrhagic stroke, myocardial infarction, and cardiovascular death over a mean period (± standard deviation [SD]) of 12±1 years using Cox Proportional Hazards analysis after adjusting for potential confounders. Results: A total of 3306 (4.6%) of the 72,221 participants reported pregnancy in advanced age. Compared with pregnancy in normal age, the rate of ischemic stroke (2.4% versus 3.8%, p&lt;0.0001), hemorrhagic stroke (0.5% versus 1.0%, p&lt;0.0001), myocardial infarction (2.5% versus 3.0%, p&lt;0.0001), and cardiovascular death (2.3% versus 3.9%, p&lt;0.0001) was significantly higher among women with pregnancy in advanced age. In multivariate analysis, women with pregnancy in advanced age were 60% more likely to experience a hemorrhagic stroke (Hazards ratio [HR] 1.6, 95% confidence interval [CI] 1.1-2.4) after adjusting for age, race/ethnicity, congestive heart failure, systolic blood pressure, atrial fibrillation, alcohol use and cigarette smoking. There was no significant difference in the risk of ischemic stroke, myocardial infarction, and cardiovascular death among women with pregnancy in advanced age after adjusting for potential confounders. Conclusions: Women with pregnancy in advanced age have a higher risk for hemorrhagic stroke in post-menopausal period.

Demand of pregnancy in advanced age: A challenge to fertility specialists

The couples of advanced age nowadays are requesting for the promotion of fertility for the first time quite more than what it was before. This is because of career making of men and women, increased divorce, and re-marriage. Physicians dealing with infertility problems are facing a lot of challenges in this regard. The diminished fecundity in advanced age is a routine happening. That is because of diminished ovarian reserve and there may be more aneuploidy in the oocytes or problem with the male gametes, so far as the genetic constitution, fertilizability, and motility are concerned. Research is going on all over the world in this regard, and the present way out is egg donation for elderly women with poor ovarian reserve. Though in a certain percentage of cases, in elderly women, natural conception is possible with or without ovulation induction, in males, usually fertility remain for long, even up to the advanced age, and reproductive assistance in the form of intracytoplasmic sperm injection is required with very poor sperm quality.

Comparison of infants of adolescent and advanced age mothers in spontaneous vaginal deliveries occured between 2003 and 2013

Introduction: This study aims to compare obstetric results of pregnancies in adolescents and advanced age mothers, which is a significant Mother-Child health problem in developing countries. Methods: This retrospective study included mothers and infants, over a 10-year period, with babies born at full-term by spontaneous vaginal birth to adolescent mothers who were 18 years and younger, and to mothers who were 40 years and older. Both groups were investigated for abnormalities, gender, height, weight, head circumference and birth weight of newborns. Results: Over the 10-year period from 1 March 2003 to 31 March 2013, there were a total of 29981 normal spontaneous vaginal deliveries. 818 pregnant women aged 18 years and younger(2.73%) and 972 pregnant women aged 40 years and older(3.23%) were determined. When the abnormalities and stillbirth rates of newborns are examined, there was no statistically significant difference identified between the two groups. There was statistically significant difference found between height-birth weight-head circumference of infants of advanced age mothers and adolescent mothers. In both groups when the SGA( 4000 g) infants are compared, SGA infants were observed to be significantly higher for adolescent mothers, while LGA infants were found to be significantly higher for advanced age mothers. When the correlation between mothers age and birth weight was investigated, it was observed that infants of advanced age mothers were heavier, while infants born to adolescent mothers had lower birth weights. Conclusion: This study showed that adolescent and advanced age pregnancies form high risk groups. In both groups to improve pregnancy results, social support, education and regular monitoring should be provided.

Perinatal outcomes and risk factors in adolescent and advanced age pregnancies: Comparison with normal reproductive age women

The objective of the study was to analyse and compare demographic characteristics and clinical outcomes of pregnancies in adolescent, advanced age and normal reproductive age women. All completed pregnancies in a 6-month period, registered by the family practitioners in Denizli province, were included into the study. A face-to-face questionnaire was used to gather information. Participants were asked for demographic information, pregnancy outcome and obstetric history, obstetric and neonatal problems. Overall 5,882 pregnancies in different age groups: 296 (5%) adolescent (< 20-years-old); 4,957 (84.3%) normal reproductive age (20–35-years-old) and 629 (10.7%) advanced age (> 35-years-old ) (group III), were included into the study. Adolescent women had a lower educational status (p < 0.01), and family played a major role in decision of marriage (p < 0.01). Birth weight of the baby was lower in adolescents (p < 0.01). While adolescents tended to deliver vaginally (OR = 1.9, p < 0.01), elderly women were more prone to operative delivery (OR = 1.2, p < 0.05). Risk of caesarean section rate was higher in elderly nulliparous women (OR = 2.2, p 0.01). The number of spontaneous and induced abortions were increased with age (p < 0.01). Antenatal problems were seen least frequently in normal reproductive age women. Both antenatal (OR = 1.7, p < 0.01) and neonatal problems (OR = 1.5, p < 0.05), were significantly higher in advanced age pregnancy. It was concluded that with sufficient antenatal care, adolescent pregnancy is not associated with an increase in adverse pregnancy outcome, except low birth weights. Advanced maternal age is more likely to be associated with increased obstetric, maternal and neonatal complications.