Pregnancy in Women Aged 35 Years and Above: A Prospective Observational Study

Abstract

Pregnancy is affected by maternal age from conception till delivery. Various studies have been conducted globally to study this effect; few in developing countries. Maternal age is increasing in developing countries as well, so we have conducted this study. Method This was a prospective observational study consisting of 1,263 women booked at Jehangir hospital during a period of 2 years, fulfilling inclusion criteria and consenting for the study. They were divided into two groups; women aged 35 years and above and women less than 35 years of age. Pregnancy outcomes were studied in terms of antepartum, intrapartum and postpartum complications. Neonatal outcomes were studied in terms of birth weight and NICU admissions. Data was analyzed statistically using statistical package for social sciences version 17, by applying Chi square test and Fisher exact test. A p value below 0.05 was considered significant. Results Women aged 35 years and above constituted 9.63 % of the total study population. Most were multigravidae. Rate of assisted conception was significantly higher among women aged 35 years and above; early pregnancy loss was also high in this group. Pre-eclampsia and abruption were significantly higher among them. Neonatal outcomes were comparable. Conclusion Women with advanced maternal age are at higher risk of complications from conception till delivery and should be provided close supervision for better pregnancy outcome.

Effects of advanced maternal age on pregnancy outcome

“…The incidence of Post-partum hemorrhage is higher advance maternal age because atonicity as a result of multiparity and poor myometrial function. 13,23 In present study incidence of ante partum hemorrhage was 6.25% which is comparable to study conducted by Giri…”

“…Study done by Anuya A et al, 26% and Meenakashi et al,23.9% which are not comparable present study. In present studies 20 (6.94%) new born babies admitted to NICU which is lesser than studies conducted by Priyadatt D. Patel who reported 15.66% of NICU admission 7,11,13,20.…”

A comparative prospective study of maternofetal outcome in advanced and younger maternal age group in higher socioeconomic strata

“…Study by Pawde A, et al also concluded that rate of assisted conception was significantly higher among women aged 35 years and above. 5 Our study shows that pregnancy induced hypertension was slightly in higher proportion in advanced maternal age than younger maternal age (20% and 7.5% respectively) but this variation in proportions was not statistically significant as evidenced by other studies as well. 7 But many authors like Naqvi MM et al, Amarin VN et al and Ziadeh SM et al reported significantly higher proportion of pregnancy induced hypertension in elderly primigravida than non-elderly.…”

“…2 Becoming pregnant after the age of 35 years can present a challenge because of the maternal risk factors associated with it, such as-subfertility, miscarriages, pre-eclampsia, gestational diabetes mellitus, anemia, intrauterine growth restriction, antepartum hemorrhage, higher incidence of instrumental deliveries, cesarean section, post-partum hemorrhage and fetal risk factors such as; malpresentation, multiple pregnancy, prematurity, increased NICU admissions due to increased perinatatal morbidity and mortality. [3][4][5] To summarize advance maternal age of a pregnant women is a high risk factor and such patients need to be handled by a trained person from the very early stage of pregnancy.…”

Advanced maternal age and its association with placenta praevia and placental abruption: a meta-analysis

“…Studies have shown an association between AMA and gestational complications, such as gestational diabetes, gestational hypertension, C-section, preeclampsia, premature rupture of membranes, and chromosomal fetal anomalies 9,10,11,12,13,14 . However, the evidence is inconclusive regarding the association of AMA with placenta praevia (PP) and placental abruption (PA), with some studies indicating a positive association 12,14,15,16 and others showing no statistically significant association 13,17,18,19,20,21,22,23,24,25 .…”