Pregnancy Outcomes in Women of Advanced Maternal Age: a Retrospective Cohort Study from China

Abstract

This retrospective cohort study attempts to investigate pregnancy complications and adverse pregnancy outcomes in women of advanced maternal age (AMA). Data were extracted from electronic medical records system at West China Second University Hospital of Sichuan University from January 2013 to July 2016. The study cohort consisted 8 subgroups of women on 4 different age levels (20-29 years, 30-34 years, 35-39 years and ≥40 years) and 2 different parities (primiparity and multiparity). In the study period, 38811 women gave birth at our hospital, a randomized block was used to include 2800 women of singleton pregnancy >28 gestational weeks, with 350 patients in each subgroup. Maternal complications and fetal outcomes were collected and defined according to relevant guidelines. Confounding factors representing maternal demographic characteristics were identified from previous studies and analysed in multivariate analysis. There was an increasing trend for the risks of adverse pregnancy outcomes with increasing age, especially in AMA groups. Our study showed that AMA, primiparity, maternal overweight or obesity, lower educational level and residence in rural area increased pregnancy complications and adverse fetal outcomes. Increased professional care as well as public concern is warranted.

Figure 1

Study flow chart.

Figure 2

Risks of caesarean sections and gestational diabetes in primiparous women compared with multiparous women in different age levels (30–34 years, 35–39 years and ≥40 years). Note: Forest plot of odds ratios with 95% CIs in multivariate logistic regression analysis, after adjustment for gravidity, maternal baseline BMI, conceiving method, insurance, education, and residence. Multiparous women as the referent group. CS: caesarean section; GDM: gestational diabetes mellitus.