Pregnancy at 40 years Old and Above: Obstetrical, Fetal, and Neonatal Outcomes. Is Age an Independent Risk Factor for Those Complications?

Abstract

Objectives: Maternal age has been increasing for several decades with many of these late pregnancies between 40 and 45 years old. The main objective of this study is to assess whether maternal age is an independent factor of obstetric, fetal, and neonatal complications. Patients and methods: A monocentric, French study "exposed-unexposed" was conducted during 11 years in a maternity level IIB. Maternal and perinatal outcomes were studied using univariates and multivariate analysis. We compared women aged 40 and above in a 1:1 ratio with women of 25-35 years old. Results: One thousand nine hundred eighty-two women were 40 or older (mean age: 41.9) on the day of their delivery and compared to other 1,982 women who were aged between 25 and 35 years old (mean age: 30.7) Preeclampsia, gestational diabetes, were significantly higher in the study group (4.6 vs. 1.5% and 14.5 vs. 6.9%, respectively, p < 0.001). We found also a significant difference for gestational hypertension (3.1 vs. 1.1% p < 0.001), preterm birth (10.4 vs. 6.5% p < 0.001), cesarean (16.6 vs. 5.4% for scheduled cesarean, and 50.4 vs. 13.9% for emergency cesarean, p < 0.001) and fetal death in utero (2.1 vs. 0.5% in the study group, p < 0.001). These results were also significantly different in multivariate analysis. Conclusion: A pregnancy after 40 years old is worth considering today as far as the risk factors are controlled and understand by the patient and the obstetrician. However, they have a significantly higher risks of cesarean, preterm delivery, pre-eclampsia, gestational diabetes, and fetal death in utero (FDIU). It is therefore the responsibility of the obstetrician to inform correctly these women in a detailed way, to reassure them and to adapt the monitoring of their pregnancy accordingly.

Neonatal Morbidity and Mortality in Advanced Aged Mothers—Maternal Age Is Not an Independent Risk Factor for Infants Born Very Preterm

“…Many studies have analyzed the impact of aging on obstetric and perinatal outcome among women with AMA/vAMA (19,21,27,47,48). Yet, data about AMA and outcome of VPT neonates remains sparse (24)(25)(26)28) and contradictory, as some studies report favorable outcomes for VPT infants born to AMA/vAMA mothers (49) and others less favorable outcomes (17). The large amount of heterogeneity among most studies and the neonatal outcomes that were investigated suggest that those results must be interpreted with caution (15,50).…”

“…Several studies have explored advanced and very advanced maternal age (AMA/vAMA), in association with pregnancyrelated morbidities (15) and mode of obstetric interventions (15)(16)(17)(18)(19)(20) and large cohort studies have analyzed data of term newborns (21). However, studies of the outcomes of very preterm infants born to mothers of AMA/vAMA remain sparse (22)(23)(24)(25)(26)(27)(28). An important aim of combined obstetric and neonatal care is to reduce morbidities and improve neonatal outcome by addressing risk factors (20,29).…”

Diagnosing Arterial Stiffness in Pregnancy and Its Implications in the Cardio-Renal-Metabolic Chain

“…Another critical aspect that is becoming obvious is related to the increasing maternal age, and the fact that the cut-off value of 35 y will probably be modified towards higher ages. In the latest INSEE report from France, it was stated that approximately 5% of women who give birth are at least 40 y old, hence the idea of pushing the limit for advanced maternal age to 43–45 y old [ 211 ].…”

Ocrelizumab during pregnancy and lactation: Rationale and design of the MINORE and SOPRANINO studies in women with MS and their infants

“…Other eligibility criteria are designed to select the population of interest while excluding women at high risk for adverse pregnancy and infant outcomes, which could interfere with data interpretation or study compliance. Women must be 18-40 years, inclusive, at screening, since advanced maternal age is associated with higher rates of maternal and foetal complications (Bouzaglou et al 2020). Women with a history of adverse obstetric or gynaecological conditions (e.g., preterm birth, spontaneous abortion after the first trimester, stillbirth, pre-eclampsia/eclampsia, etc.)…”