Background: The incidence of pregnancies at older age is on an increase internationally but there is disturbing body of evidence which implicates adverse perinatal outcomes in mothers at advanced age.
Patients and Methods: The study was conducted as an ambispective cohort study at a tertiary care Medical College Hospital over a period of 4and a half years from December 2013 to May 2018 to evaluate the outcomes associated with the risk.
Results: Obesity, higher socio-economic status, higher literacy and assisted conception appeared to be the statistically well associated with conception at advanced age. A statistically significant association was observed between the fetuses of older mothers developing foetal growth restriction (aRR-1.67, CI -1.37 – 1.98; P<0.001) and malpresentation (aRR-2.97, CI-2.43-3.55; P-<0.001). A significantly higher operative interference in terms of instrumental deliveries (P-0.003) and Caesarean section (P<0.001) was observed in mothers at advanced age. A 1.43 and 2.13 times higher risk of intrapartum foetal distress (P-0.002) and intrauterine death (<0.001) was also noted in these mothers. A significant difference in the birth weights was also noted with 2.86±0.81 kg vs 3.27±0.69 kg being noted in older and younger mothers respectively (P<0.001). Macrosomia and birth asphyxia did not have significant variation between the cohorts but APGAR scores at 1st and 5th minute varied significantly with neonates of older mothers at a 1.41 and 2.08 times higher risk of lower APGAR scores respectively. A relative risk of 1.82 (CI-1.38-2.37) in terms of perinatal mortality was observed in mothers with pregnancy at advanced age.
Conclusions: It is essential that women be in informed about the occurrence of such perinatal events at advanced age so that they can take informed decisions in best interest of the foetus and neonate.