Archives of Gynecology and Obstetrics

, Volume 290, Issue 6, pp 1109–1114 | Cite as

Would it be too late? A retrospective case–control analysis to evaluate maternal–fetal outcomes in advanced maternal age

  • Leonarda Ciancimino
  • Antonio Simone LaganàEmail author
  • Benito Chiofalo
  • Roberta Granese
  • Roberta Grasso
  • Onofrio Triolo
Maternal-Fetal Medicine



To evaluate maternal–fetal outcomes in women of advanced maternal age (AMA; >35 years old) and women of physiological maternal age as controls (C; <35 years old).


Single-center, retrospective case–control analysis, from January 1 to December 31, 2013. For each group, we evaluated obstetric history, number of twin pregnancies, delivery mode, incidence of obstetric diseases and neonatal outcomes (5-min Apgar score, neonatal weight, meconium stained fluid rate, admission to the neonatal intensive care unit rate, and incidence of congenital malformations). Data are presented as n (%) and analyzed with χ 2 test and Fisher exact test (when required). A p value < 0.05 was considered statistically significant. Moreover, we calculated the odds ratio (OR), with confidence interval (CI) at 95 %.


We enrolled 1,347 pregnant women, 210 (15.6 %) in AMA and 1,137 (84.4 %) C. AMA patients showed a higher rate of previous (anamnestic) spontaneous abortion (SA; p = 0.001; OR = 2.10) and previous (anamnestic) voluntary pregnancy termination (p = 0.022; OR = 1.59), iterative cesarean section (p = 0.026; OR = 2.33), SA (p = 0.001; OR = 12.82), preterm delivery (p = 0.001; OR = 69.84), congenital malformations (p = 0.036; OR = 3.94). In C there was a greater number of nulliparous (p = 0.009; OR = 0.52) and vaginal deliveries (p = 0.025; OR = 0.41). There were not any statistically significant differences between the two groups for twin pregnancies (p = 0.862; OR = 0.97), first cesarean section (p = 0.145; OR = 0.95), other obstetric diseases and neonatal outcomes.


AMA could be considered an important risk factor only for SA and PTD and does not influence neonatal outcomes except for congenital malformations.


Advanced maternal age Maternal–fetal outcomes Pregnancy Delivery Obstetric diseases 



The authors are grateful to Sandy Maria Cartella for the language revision of the manuscript.

Conflict of interest

All authors have no proprietary, financial, professional or other personal interest of any nature in any product, service or company.


  1. 1.
    Carolan M, Frankowska D (2011) Advanced maternal age and adverse perinatal outcome: a review of the evidence. Midwifery 27:793–801PubMedCrossRefGoogle Scholar
  2. 2.
    Chan BC, Lao TT (2008) Effect of parity and advanced maternal age on obstetric outcome. Int J Gynaecol Obstet 102:237–241PubMedCrossRefGoogle Scholar
  3. 3.
    Jacobsson B, Ladfors L, Milsom I (2004) Advanced maternal age and adverse perinatal outcome. Obstet Gynecol 104:727–733PubMedCrossRefGoogle Scholar
  4. 4.
    Joseph KS, Allen AC, Dodds L, Turner LA, Scott H, Liston R (2005) The perinatal effects of delayed childbearing. Obstet Gynecol 105:1410–1418PubMedCrossRefGoogle Scholar
  5. 5.
    Aliyu MH, Salihu HM, Wilson RE, Alio AP, Kirby RS (2008) The risk of intrapartum stillbirth among smokers of advanced maternal age. Arch Gynecol Obstet 278:39–45PubMedCrossRefGoogle Scholar
  6. 6.
    Delbaere I, Verstraelen H, Goetgeluk S, Martens G, De Backer G, Temmerman M (2007) Pregnancy outcome in primiparae of advanced maternal age. Eur J Obstet Gynecol Reprod Biol 135:41–46PubMedCrossRefGoogle Scholar
  7. 7.
    Hoffman MC, Jeffers S, Carter J, Duthely L, Cotter A, González-Quintero VH (2007) Pregnancy at or beyond age 40 years is associated with an increased risk of fetal death and other adverse outcomes. Am J Obstet Gynecol 196:e11–e13PubMedCrossRefGoogle Scholar
  8. 8.
    Nybo Andersen AM, Wohlfahrt J, Christens P, Olsen J, Melbye M (2000) Maternal age and fetal loss: population based register linkage study. BMJ 320:1708–1712PubMedCrossRefGoogle Scholar
  9. 9.
    Kuliev A, Cieslak J, Verlinsky Y (2005) Frequency and distribution of chromosome abnormalities in human oocytes. Cytogenet Genome Res 111:193–198PubMedCrossRefGoogle Scholar
  10. 10.
    Pellestor F, Anahory T, Hamamah S (2005) Effect of maternal age on the frequency of cytogenetic abnormalities in human oocytes. Cytogenet Genome Res 111:206–212PubMedCrossRefGoogle Scholar
  11. 11.
    Hunt PA, Hassold TJ (2008) Human female meiosis: what makes a good egg go bad? Trends Genet 24:86–93PubMedCrossRefGoogle Scholar
  12. 12.
    Janssens S, Wallace KL, Chang AM (2008) Prepartum and intrapartum caesarean section rates at Mater Mothers’ Hospital Brisbane 1997–2005. Aust N Z J Obstet Gynaecol 48:564–569PubMedCrossRefGoogle Scholar
  13. 13.
    Bell JS, Campbell DM, Graham WJ, Penney GC, Ryan M, Hall MH (2001) Can obstetric complications explain the high levels of obstetric interventions and maternity service use among older women? A retrospective analysis of routinely collected data. BJOG 108:910–918PubMedGoogle Scholar
  14. 14.
    Rosenthal AN, Paterson-Brown S (1998) Is there an incremental rise in the risk of obstetric intervention with increasing maternal age? Br J Obstet Gynaecol 105:1064–1069PubMedCrossRefGoogle Scholar
  15. 15.
    Khoshnood B, Bouvier-Colle MH, Leridon H, Blondel B (2008) Impact of advanced maternal age on fecundity and women’s and children’s health. J Gynecol Obstet Biol Reprod (Paris) 37:733–747CrossRefGoogle Scholar
  16. 16.
    Tough SC, Newburn-Cook C, Johnston DW, Svenson LW, Rose S, Belik J (2002) Delayed childbearing and its impact on population rate changes in lower birth weight, multiple birth, and preterm delivery. Pediatrics 109:399–403PubMedCrossRefGoogle Scholar
  17. 17.
    United Nations Economic Commission for Europe (2005) Trends in Europe and North America: the statistical yearbook of the Economic Commission for Europe 2005. The Commission, GenevaGoogle Scholar
  18. 18.
    Johnson JA, Tough S, Society of Obstetricians and Gynaecologists of Canada (2012) Delayed child-bearing. J Obstet Gynaecol Can 34:80–93PubMedGoogle Scholar
  19. 19.
    Carolan M (2004) First time mothers over 35 years: challenges for care? Birth Issues 13:91–97Google Scholar
  20. 20.
    Heffner LJ (2004) Advanced maternal age: how old is too old? N Engl J Med 351:1927–1929PubMedCrossRefGoogle Scholar
  21. 21.
    Hourvitz A, Machtinger R, Maman E, Baum M, Dor J, Levron J (2009) Assisted reproduction in women over 40 years of age: how old is too old? Reprod Biomed Online 19:599–603PubMedCrossRefGoogle Scholar
  22. 22.
    von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, STROBE Initiative (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 370:1453–1457CrossRefGoogle Scholar
  23. 23.
    Giri A, Srivastav VR, Suwal A, Tuladhar AS (2013) Advanced maternal age and obstetric outcome. Nepal Med Coll J 15:87–90PubMedGoogle Scholar
  24. 24.
    Benzies KM (2008) Advanced maternal age: are decisions about the timing of child-bearing a failure to understand the risks? CMAJ 178:183–184PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Di Mario S, Say L, Lincetto O (2007) Risk factors for stillbirth in developing countries: a systematic review of the literature. Sex Transm Dis 34:S11–S21PubMedCrossRefGoogle Scholar
  26. 26.
    Stojnic J, Radunovic N, Jeremic K, Kotlica BK, Mitrovic M, Tulic I (2013) Perinatal outcome of singleton pregnancies following in vitro fertilization. Clin Exp Obstet Gynecol 40:277–283PubMedGoogle Scholar
  27. 27.
    Pinborg A, Wennerholm UB, Romundstad LB, Loft A, Aittomaki K, Söderström-Anttila V, Nygren KG, Hazekamp J, Bergh C (2013) Why do singletons conceived after assisted reproduction technology have adverse perinatal outcome? Systematic review and meta-analysis. Hum Reprod Update 19:87–104PubMedCrossRefGoogle Scholar
  28. 28.
    Hook EB (1981) Rates of chromosome abnormalities at different maternal ages. Obstet Gynecol 58:282–285PubMedGoogle Scholar
  29. 29.
    Caserta D, Bordi G, Stegagno M, Filippini F, Podagrosi M, Roselli D, Moscarini M (2014) Maternal and perinatal outcomes in spontaneous versus assisted conception twin pregnancies. Eur J Obstet Gynecol Reprod Biol 174:64–69PubMedCrossRefGoogle Scholar
  30. 30.
    Klemetti R, Gissler M, Sainio S, Hemminki E (2014) Associations of maternal age with maternity care use and birth outcomes in primiparous women: a comparison of results in 1991 and 2008 in Finland. BJOG 121:356–362PubMedCrossRefGoogle Scholar
  31. 31.
    Houlihan CM, Knuppel RA (1994) Meconium-stained amniotic fluid. Current controversies. J Reprod Med 39:888–898PubMedGoogle Scholar
  32. 32.
    Battin M, Bevan C, Knight D (2007) Neonatal intensive care utilisation by infants born to mothers older than 40 years of age: a 10-year review. N Z Med J 120:U2859PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Leonarda Ciancimino
    • 1
  • Antonio Simone Laganà
    • 1
    Email author
  • Benito Chiofalo
    • 1
  • Roberta Granese
    • 1
  • Roberta Grasso
    • 1
  • Onofrio Triolo
    • 1
  1. 1.Department of Pediatric, Gynecological, Microbiological and Biomedical SciencesA.O.U. “G. Martino”, University of MessinaMessinaItaly

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