engleski

Why 40 is not the new 20? Pregnancy and obstetrical outcomes in women of advanced maternal age.

Problem statement: There has been a notable shift to pregnancy at older maternal ages, which is generally agreed upon as age over 40 years. It is well recognized that women who delay childbearing are at increased risk of pregnancy complications. Our study aimed to compare the incidence of births to older women from 1 January 1995 to 31 December 1997 and from 1 January 2014 to 31 December 2016 and to evaluate the effects of advanced maternal age on pregnancy outcomes in Clinical Hospital Center Rijeka. Methods: Maternal and obstetrical data were collected from the Register of Clinical Hospital Center Rijeka. We compared the outcomes for women aged ≥40 years with those of three younger subgroups stratified by maternal age (<20 years ; 20-29 years (control group) ; 30-39 years). Statistical analyses were performed using Statistica 13.3.0. and MedCalc for Windows. In all analyses, P-values less than 0.05 were considered statistically significant. Results: Over the last two decades, the percentage of mothers aged ≥40 years has increased from 2.1% to 3.8% (Χ2=46.25 ; P<0.001). A similar change has taken place in the rates of first-time mothers over 40, showing an increase of 64.1% compared to the 1990s. Moreover, our data revealed a notable rise in the frequency of both autosomal (61.1%) and sex chromosomal aneuploidies (68.2%), as a woman ages. Besides, we found a statistically significant association between pregnancy losses (ectopic pregnancies and abortions) and advanced maternal age. This association might reflect a decline in oocyte quality and/or changes in uterine and hormonal function. Finally, women ≥40 years of age are more likely in the diagnosis of hypertensive disorders (OR=1.86 ; P=0.009), gestational diabetes mellitus (OR=3.81 ; P<0.001) and preterm birth (OR=2.09 ; P<0.001). Compared to the control group, both elective (OR=5.83 ; P<0.001) and emergency (OR=1.67 ; P<0.001) Caesarean section, as well as instrumental vaginal delivery (OR=3.19 ; P=0.002), occur more often in older women. However, their neonates do not show higher odds for Apgar ≤7 and/or perinatal mortality. Conclusion: In conclusion, the results of our retrospective analysis indicate a significant increase in delayed childbearing and propose advanced maternal age as a risk factor for pregnancy and obstetrical complications.

advanced maternal age ; aneuploidy ; obstetrical complication

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