A Study on Feto-Maternal Outcome Among Elderly Pregnant Women During the Intrapartum and Postpartum Period in a Tertiary Care Center

Abstract

Introduction: The rising incidence of pregnancies among older women, typically defined as those aged 35 and above, has raised concerns regarding both maternal and fetal health outcomes. Advanced maternal age is linked to various pregnancy complications, such as a higher risk of chromosomal abnormalities, gestational hypertension, preterm birth, and other adverse outcomes. This prospective cohort study aimed to investigate maternal and fetal outcomes in this population of elderly pregnant women, shedding light on the risks and complications they face during pregnancy. The study also explored the prevalence of pregnancy-related issues in older women and how these conditions affected both maternal and fetal health. Materials and methods: This prospective cohort study was conducted over two years at a tertiary care hospital, with ethics approval and written informed consent obtained. It included pregnant women aged ≥35 attending the antenatal clinic and delivering at the hospital. Women with major pre-existing medical conditions (e.g., severe respiratory or cardiac disease, uncontrolled diabetes or hypertension) were excluded. Data were collected through patient interviews and medical record reviews, covering maternal factors (age, parity, socioeconomic status, religion, obstetric history, and comorbidities) and pregnancy complications (e.g., gestational diabetes, preeclampsia, anemia, cardiac issues, and antepartum hemorrhage). Fetal outcomes, such as gestational age, birth weight, Apgar score, congenital anomalies, and mode of delivery, were documented. Participants were followed from the antenatal period through delivery and postpartum discharge.

Results: Out of 23,777 total recruited participants, 311 were elderly mothers (1.3%). The mean age was 36.2±1.7 years, with most women (89.6%) aged 35-40. The majority were Muslim (89.6%) and from a Class IV socioeconomic background (50%). Delayed childbirth was often due to unknown causes (45.3%) or a preference for male children (35.8%). Delayed childbirth in the study was primarily attributed to unknown causes (45.3%) and a preference for male children (35.8%). The "unknown causes" category likely reflects delayed marriage, career, or education pursuits, infertility issues, or broader societal shifts. In contrast, the preference for male children highlights a cultural influence, where sons are providers of financial and social security. This can lead couples to postpone childbirth or continue trying for a male child, thereby increasing maternal age. Most were multigravida (84.9%), with 58.5% having cesarean sections. Common complications included anemia (24.5%), PIH (9.4%), and preterm labor (21.7%). Most births were live (98.1%), with 32.7% requiring NICU admission due to low birth weight or prematurity, and 17.6% neonatal deaths were recorded.

Conclusion: Elderly pregnancies carry a greater risk for both maternal and fetal complications, including gestational hypertension, preeclampsia, gestational diabetes, low birth weight, preterm labor, and an increased likelihood of cesarean delivery. However, with proper prenatal care, regular monitoring, and timely interventions, many of these risks can be effectively managed to enhance both maternal and fetal health. This study emphasizes the need for personalized care for older pregnant women, advocating for early detection, prevention measures, and a collaborative approach to ensure safe pregnancies in this growing population.

Keywords: advanced age; antenatal complications; elderly pregnancy; feto-maternal outcome; pregnancy complications.