INTRODUCTION: Mean maternal age continues to increase in the United States and more women are getting pregnant in their forties or older. We aimed to examine the risk of adverse obstetric outcomes in a diverse contemporary urban population of women of very advanced maternal age, defined as age 40 years or older at estimated date of delivery (EDD). METHODS: This retrospective cohort study examined patients presenting for delivery in an urban Midwest academic healthcare system from 2016 to 2017. Women 40 years of age or older at EDD (n=433) were compared with controls between age 25 to 30 years at EDD (n=755), in relation to risk of adverse obstetric outcomes. Chi-square and Fisher exact tests were used to evaluate categorical variables. RESULTS: Women 40 years or older were more likely to experience adverse obstetric outcomes, including an increased risk of gestational diabetes, gestational hypertension, amniotic fluid abnormalities, fetal growth restriction, PPROM, preterm labor and pre-delivery hospitalization (all P<.05). No difference in the identification of prenatal fetal anomalies was seen between the two groups. CONCLUSION: Very advanced maternal age (≥40 years at EDD) is associated with an increased risk of adverse obstetric complications. These data will help guide management and counseling of women contemplating or achieving pregnancy at more advanced maternal age.

INTRODUCTION: Little contemporary data are available on pregnancy delivery and neonatal outcomes in a diverse population of very advanced maternal age, defined as age 40 years or greater at estimated date of delivery (EDD). We examined the association of adverse delivery and neonatal outcomes in women at very advanced maternal age from 2016 to 2017. METHODS: This retrospective cohort study examined patients presenting for delivery in an urban academic healthcare system from 2016 to 2017. Women 40 years old or older at EDD (n=433) were compared with controls age 25-30 years (n=755). The primary outcome compared rates of cesarean delivery between the two groups. Differences in delivery and neonatal outcomes were also examined. Chi-square and Fisher exact tests were used for categorical variables; Wilcoxon rank-sum test was used for continuous variables. Logistic regression was used adjust for any demographics that were associated with age. RESULTS: Women age 40 or older were more likely to deliver via cesarean section than younger controls even after adjusting for demographic differences (42.7% vs 31.1%, adjusted P<.001). Secondary outcomes also identified significant associations between very advanced maternal age and an earlier gestational age at delivery (P<.001), as well as neonatal anomalies identified at birth, NICU admission and infant length of stay (all P<.05). CONCLUSION: Very advanced maternal age is associated with an increased risk of cesarean section, as well as an increased risk of additional delivery and neonatal complications. Prospective research is needed to determine whether these risks might be modifiable with changes in current obstetric management.

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