INTRODUCTION:
Advanced maternal age (AMA) and obesity have been shown to independently influence maternal and neonatal outcomes. We sought to determine if obese AMA women had greater risk for adverse outcomes compared to non-obese AMA women.
METHODS:
A retrospective cohort study of non-anomalous, singleton AMA (age 35+) pregnancies at Oregon Health & Science University from 2009–2014 to assess if obesity (pre-pregnancy BMI 30+) impacted outcomes above AMA status alone. Maternal outcomes included gestational diabetes (GDM), pre-eclampsia (PET), and cesarean section (CS). Neonatal outcomes included NICU admission, SGA/LGA, preterm birth, and hypoglycemia. Univariate analyses were used to determine significant differences between groups (P<.05), and multivariate logistic regression adjusting for biologically plausible confounders was utilized to determine strength of association.
RESULTS:
Of the 7,953 deliveries during the study period, 1,712 were to AMA women with 459 obese (27%) and 1,253 non-obese (73%). Obese AMA women were associated with significantly increased rates of GDM (aOR 3.04, 95% CI 2.23–4.40), PEC (aOR 1.64, 95% CI 1.09–2.47), and CS (aOR 1.42, 95% CI 1.12–1.85). Neonates born to obese AMA women were associated with significantly increased rates of LGA (aOR 2.66, 95% CI 1.86–3.80) and hypoglycemia (aOR 1.98, 95% CI 1.10–3.58). There was no significant association between obesity in AMA women and SGA, preterm birth, or NICU admission.
CONCLUSION:
In AMA pregnancies, obesity is associated with significantly increased rates of GDM, PEC, CS, LGA neonates, and neonatal hypoglycemia. These results suggest that AMA pregnancies complicated by maternal obesity may benefit from earlier intervention and counseling.
