Impact of Advanced Maternal and Paternal Age on Perinatal Outcome

Abstract

Objectives: Through recent decades, there is an increase in mean maternal age at childbirth in most high-resourced countries. Women are delaying their pregnancy to later ages. In literature, advanced maternal age has been associated with several adverse maternal and perinatal outcomes. Our goal was to investigate whether there is an association between advanced maternal age and adverse perinatal outcomes in Slovak population. Material and Methods: We performed a retrospective population-based cohort study of pregnancies managed in years 2008- 2012 at the Department of Obstetrics and Gynecology, Jessenius Faculty of Medicine (Martin, Slovakia). Perinatal data of primiparous women aged 35 years or more (n = 288, studied group), giving birth to a singleton child, were compared to data of primiparous women aged 20-29 years old (n = 2002, control group). The odds ratio (OR) and 95% confidence intervals (95%CIs), obtained from unconditional logistic regression, were used to set the association between advanced maternal age and perinatal outcomes, using MedCalc(registered trademark) 10.2.0 (Mariakerke, Belgium), p=0.05. Results: We have reviewed perinatal data from patient register related to obstetric (mode of delivery, preterm labor, gestational diabetes, preeclampsia) and neonatal outcome (birth weight, birth length, Apgar score, admission at NICU). We did not find significant difference in neonatal outcome, particularly Apgar score (8,9(plus or minus)1,1 vs. 9,0(plus or minus)1,1), gestation week (39,3(plus or minus)2,7 vs. 39,6(plus or minus)2,3), neonatal length (50,7(plus or minus)3,4 vs. 50,6(plus or minus)4,1), neonatal weight (3207,8(plus or minus)664,8g vs 3264,7(plus or minus)605,4g), respectively. However we found an unsignificant increased risk for very low birth weight (<1500 gram) of OR=1.54 (95%CI 0.8-3.1), preterm (OR=1.23, 95%CI 0.8-1.9), and very preterm birth (<32 g.w.) of 1.4 risk (95%CI 0.7-2.8) was revealed in women aged 35-years and more. Furthermore, these pregnancies were more frequently terminated by operative delivery, giving a significant risk of caesarean section (CS) of OR=2.6 (95%CI 2.0-3.4, p<0.0001). The frequency of CS was 55.9% in studied group compared to 32.6% in controls. In studied group we have found a significant higher prevalence of pregnancy associated pathologies, particularly gestational diabetes (OR=7.4, 95%CI 4.3-12.5, p<0.0001), gestational hypertension and preeclampsia (OR=3.7, 95%CI 3.7-8.4, p<0.0001). Conclusion: Advanced maternal age at delivery does not influence neonatal outcome, however an impact on obstetric outcome is apparent, particularly higher rate of operative deliveries and pregnancy associated pathologies.