Advanced Maternal Age and Obstetric Performance *

BackgroundWomen older than 35 years have traditionally been termed as of “advanced maternal age”, and considered to have higher incidence of obstetric complications and adverse pregnancy outcomes than younger pregnant women. The available scientific data suggests that risks begin to accelerate after the age of 35 years and increase more rapidly after the age of 40 years. Majority of these studies are from western countries and literature on obstetric performance of Indian women of 35 years age and above is sparse.ObjectiveThe study was aimed to assess if there was an age related incremental rise in obstetric complications and adverse outcome in women aged 35 years and above, as compared to their younger counterparts.Material and MethodsThis is a retrospective study based on the maternity records of 2560 deliveries under a single obstetrician at a private tertiary referral hospital - Indraprastha Apollo Hospitals, New Delhi. A total of 173 deliveries in mothers aged 35 year or above were identified. An equal number of women in the age group 34 years or less were randomly selected as the control group. The total numbers of patients (346) were subdivided into following four groups - group A- Women 40 years age and above (35), group B - women between 37 and 39 years age (58), group C- women of 35 and 36 years age (80) and group D Control group- women less than 34 years age (173). The antenatal complications, gestation age at delivery, mode of delivery, pregnancy outcome, birth weight of baby and Apgar Score were studies. A comparative analysis was made among above groups.ResultsThe incidence of deliveries in women of 35 years or above age was noted to be 7% of all deliveries (2560) during the study period. The women 40 years and above age group constituted 1.4% of total number of deliveries. The mean age of women in control group (173patients) was 29.2 years. As the maternity unit where study was undertaken, is the part of multispeciality tertiary referral hospital, even the control group had a high number of women with fetal growth restriction (38.7%), preterm premature rupture of membranes (11%), hypertension (13.3%), diabetes mellitus (8.7%) and other medical disorders leading to a high incidence of operative deliveries (60.7%) and births of preterm < 34 weeks gestation (13.3%) and low birth weight babies (22%). However when these figures were compared with the study group A, B and C, except for a trend towards higher incidence of IUGR (45.7%) and caesarean delivery rates (74.3%) in women aged 40 or above, no significant differences were observed in any of the parameters studied.ConclusionThe women aged 35 years and above have obstetric complications, similar to the high risk pregnancy group in younger women and increased rates of operative deliveries. However with careful monitoring, timely intervention and tertiary level maternal and neonatal care, these women can expect a favourable obstetric outcome.