Pregnancy in advanced (≥ 40) and very advanced (≥ 45) reproductive age: Maternal and fetal risks

Aim of the study. The aim of our study is to evaluate the pregnancy complications, mode of delivery and neonatal outcome in women of advanced reproductive age (≥ 40 years) and very advanced reproductive age (≥ 45 years). Methods and materials. We selected 343 patients aged ≥ 40 years who subsequently gave birth at the Department of Obstetrics- Gynecology at the Policlinico Umberto I in Rome, between 2010 and 2011. We selected a control group of 527 patients aged between 25 and 35 who gave birth in the same period. After excluding twin pregnancies and intrauterine deaths, the study sample is made up of 312 patients, subdivided into two subgroups according to age: 40-44 years (group A: 274 patients) and age ≥ 45 years (group B: 38 patients), while the control group includes 510 patients. For each group we evaluated the pregnancy outcomes (chronic maternal diseases, gestational maternal diseases, obstetric complications), delivery (mode of delivery, gestational age at birth) and neonatal outcome (birth weight and Apgar). Obstetric history (parity and previous cesarean section), mode of onset of pregnancy (spontaneous or assisted reproductive technology) and duration of the hospital stay were reported. Results. We found in women over 40 compared to the control group a significant increase in the frequency of both chronic and gestational maternal diseases: diabetes mellitus (2.6% vs 0.4%), chronic hypertension (6.1% vs 2%), gestational diabetes (9% vs 2.5%), gestational hypertension (8.7% vs 2%); and of obstetric complications: oligohydramnios (7.4% vs 3.7%), intrauterine growth restricion-IUGR (6.7% vs 2.5 %); an increase of cesarean section (70.2% vs 48.2 %) and an increased risk of neonatal complications such as prematurity (20.8% vs 7.5%), low birth weight (17.3% vs 10.6%) and Apgar score less than 7 at the first minute (7.4% vs 1.6%) were evidenced in the study group. We found no significant differences in the frequency of preeclampsia, placental disorders (placenta previa, placental abruption), instrumental delivery. Considering only the group over 40, the comparison between group A (40-44 years) and group B (≥ 45 years) showed a significantly increased frequency of preeclampsia (1.5% vs 13.2%), gestational hypertension (5.8% vs 28.9%), cesarean section (67.2% vs 92.1%), low birth weight (15% vs 34.2%), prematurity (19.3% vs 31.6%) and Apgar score less than 7 at the first minute (5.8% vs 18.4%) in the patients ≥ 45 years. No significant differences emerged for maternal chronic diseases (hypertension, diabetes), for gestational diabetes, obstetric complications (oligohydramnios, IUGR, placental disorders) and instrumental delivery. Conclusions. The pregnancy in age ≥ 40 is associated with an increased risk for the majority of the maternal-fetal complications, but it is mostly over 45 years that the increase of frequency of gestational diseases involving the cardiovascular system becomes highly prevalent (gestational hypertension and preeclampsia); fetal complications such as low birth weight and prematurity are increased. © Copyright 2014, CIC Edizioni Internazionali, Roma.