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Background <p>This study aims to investigate differences in pregnancy outcomes and potential risk factors between women of advanced maternal age (AMA, 35–39 years) and those of very advanced maternal age (vAMA, 40 years and older).</p> Methods <p>This retrospective cohort study included women (age ≥ 35) who were single pregnancy and delivered at a tertiary comprehensive hospital in China between 2014 and 2020 at a major urban Chinese medical center. Patient medical records were reviewed, and relevant clinical data were collected and organized into a structured data spreadsheet for analysis. Categorical variables were compared using chi-square analyses, while continuous variables were compared using either the Student t-test or Wilcoxon tests, depending on the data distribution. Logistic regression was employed to identify and evaluate risk factors.</p> Results <p>This study encompassed 19,560 pregnant, and divided into two groups: the AMA group with 16,131 patients and the vAMA group with 3,429 patients. A lower rate of gravidity and parity were observed in the vAMA group (<i>P</i> &lt; 0.001). Preexisting hypertension, diabetes, and assisted reproductive technologies (ART) were more prevalent. The AMA group exhibited an increased rate of spontaneous deliveries, and precipitated labor (<i>P</i> &lt; 0.001), while the vAMA group had a higher rate of cesarean delivery (CD) (<i>P</i> &lt; 0.001). Additionally, the vAMA group had a significantly shorter gestational age at delivery (<i>P</i> &lt; 0.001). Differences in birth outcomes between the AMA and vAMA groups were primarily observed in very preterm births (28–34 weeks) (<i>P</i> = 0.004) and low birth weight (LBW, 1,500-2,500&#xa0;g) (<i>P</i> &lt; 0.001). Incidences of gestational hypertension, pre-eclampsia, gestational diabetes, placenta previa, and adherent placenta were all significantly higher in the vAMA group (<i>P</i> &lt; 0.001). Logistic regression analysis identified that gestational hypertension and placenta previa are risk factors for adverse birth outcomes in AMA women, while gestational hypertension and adherent placenta are in vAMA women.</p> Conclusions <p>Our study suggests that vAMA women have an increased risk of developing gestational hypertension, gestational diabetes, CD, placenta previa, and adherent placenta compared to women of AMA. Gestational hypertension, placenta previa, and adherent placenta were identified as the most important risks for preterm birth and LBW in AMA and vAMA women. Subgroup analysis of birth outcomes suggests that gestational diabetes is a risk factor for LBW and moderate preterm birth in AMA women. These results provide valuable data for prenatal counseling of patients with advanced maternal age.</p>

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Effect of advanced maternal age on the risk of adverse birth outcomes: a retrospective cohort study

  • 期刊论文

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  • 发表日期：

    2025年12月15日

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  • Zhaodong Liu,
  • Jianping Tang,
  • Jingwen Li,
  • Yulong Zhang,
  • Jianying Yan

摘要

Background

This study aims to investigate differences in pregnancy outcomes and potential risk factors between women of advanced maternal age (AMA, 35–39 years) and those of very advanced maternal age (vAMA, 40 years and older).

Methods

This retrospective cohort study included women (age ≥ 35) who were single pregnancy and delivered at a tertiary comprehensive hospital in China between 2014 and 2020 at a major urban Chinese medical center. Patient medical records were reviewed, and relevant clinical data were collected and organized into a structured data spreadsheet for analysis. Categorical variables were compared using chi-square analyses, while continuous variables were compared using either the Student t-test or Wilcoxon tests, depending on the data distribution. Logistic regression was employed to identify and evaluate risk factors.

Results

This study encompassed 19,560 pregnant, and divided into two groups: the AMA group with 16,131 patients and the vAMA group with 3,429 patients. A lower rate of gravidity and parity were observed in the vAMA group (P < 0.001). Preexisting hypertension, diabetes, and assisted reproductive technologies (ART) were more prevalent. The AMA group exhibited an increased rate of spontaneous deliveries, and precipitated labor (P < 0.001), while the vAMA group had a higher rate of cesarean delivery (CD) (P < 0.001). Additionally, the vAMA group had a significantly shorter gestational age at delivery (P < 0.001). Differences in birth outcomes between the AMA and vAMA groups were primarily observed in very preterm births (28–34 weeks) (P = 0.004) and low birth weight (LBW, 1,500-2,500 g) (P < 0.001). Incidences of gestational hypertension, pre-eclampsia, gestational diabetes, placenta previa, and adherent placenta were all significantly higher in the vAMA group (P < 0.001). Logistic regression analysis identified that gestational hypertension and placenta previa are risk factors for adverse birth outcomes in AMA women, while gestational hypertension and adherent placenta are in vAMA women.

Conclusions

Our study suggests that vAMA women have an increased risk of developing gestational hypertension, gestational diabetes, CD, placenta previa, and adherent placenta compared to women of AMA. Gestational hypertension, placenta previa, and adherent placenta were identified as the most important risks for preterm birth and LBW in AMA and vAMA women. Subgroup analysis of birth outcomes suggests that gestational diabetes is a risk factor for LBW and moderate preterm birth in AMA women. These results provide valuable data for prenatal counseling of patients with advanced maternal age.