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Pregnancy and Birth Outcomes Among Primiparae at Very Advanced Maternal Age: At What Price?

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Abstract

Objectives In light of the potential physical and emotional costs to both woman and child, this study was conducted to assess pregnancy complications and birth outcomes in primiparae at very advanced maternal age (VAMA, aged ≥45) compared to younger primiparae. Methods Retrospective cohort study comparing 222 VAMA primiparae and a reference group of 222 primiparae aged 30–35, delivering at Sheba Medical Center from 2008 through 2013.Results VAMA primiparae were more likely than younger primiparae to be single, to have chronic health conditions, and higher rates of gestational diabetes mellitus (GDM), gestational-hypertension (GHTN) and preeclampsia-eclampsia. VAMA primiparae conceived mostly by oocyte donation. They were more likely to be hospitalized during pregnancy, to deliver preterm and by cesarean birth. Infants of VAMA primiparae were at greater risk for low birthweight and Neonatal Intensive Care Unit admission. There were no differences in outcomes between VAMA primiparae with or without preexisting chronic conditions, or between those aged 45–49 and ≥50. In multivariable analysis VAMA was an independent risk factor for GDM, GHTN and preeclamsia-eclampsia, with adjusted odds ratio of 2.38 (95 % CI 1.32, 4.29), 5.80 (95 % CI 2.66, 12.64) and 2.45 (95 % CI 1.03, 5.85); respectively. The effect of age disappeared in multiple pregnancies. Conclusions Primiparity at VAMA holds a significant risk for adverse pregnancy and birth outcomes. The absence of chronic medical conditions or the use of a young oocyte donor does not improve these outcomes. Multiple pregnancies hold additional risk and may diminish the effect of age. Primiparity at an earlier age should be encouraged.

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Acknowledgments

The authors wish to express their appreciation to Dana Fructer, MSc (Women & Children’s Research Unit, Gertner Institute) for her advice and assistance on the statistical analysis of the data, and to Daphna Pollack, MPH (Computer and Informatics Unit, Gertner Institute) for the SAS database programming assistance. No compensation was provided to either Ms. Fructer or Ms. Pollack for their assistance on this research.

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There has been no significant financial support for this work that could have influenced its outcome.

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Authors and Affiliations

  1. Sackler Faculty of Medicine, School of Public Health, Tel Aviv University, Tel Aviv, Israel

    Alon Ben-David & Liat Lerner-Geva

  2. Women and Children’s Research Unit, Gertner Institute for Epidemiology and Health Policy Research, Chaim Sheba Medical Center, 52621, Tel Hashomer, Ramat Gan, Israel

    Saralee Glasser, Valentina Boyko & Liat Lerner-Geva

  3. The Joseph Buchman Gynecology and Maternity Center, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel

    Eyal Schiff & Aliza Segev Zahav

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  1. Alon Ben-David
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  2. Saralee Glasser
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Correspondence to Saralee Glasser.

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Ben-David, A., Glasser, S., Schiff, E. et al. Pregnancy and Birth Outcomes Among Primiparae at Very Advanced Maternal Age: At What Price?. Matern Child Health J 20, 833–842 (2016). https://doi.org/10.1007/s10995-015-1914-8

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  • DOI: https://doi.org/10.1007/s10995-015-1914-8

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