Pregnancies in Elderly Mothers over 40 years: What to Expect from the Rising New Age High‑Risk Cohort?

Sunil E. Tambvekar¹ · Shilpa Adki² · Nozer K. Sheriar³

Dr. Sunil E. Tambvekar is an Assistant Professor, Department of Obstetrics and Gynecology, Nowrosjee Wadia Maternity Hospital, Seth G. S. Medical College, Mumbai, India; Dr. Shilpa Adki is an Ex Consultant, IVF Specialist and Gynecologist, Indira IVF Centre, Allahabad and Asansol, India; Dr. Nozer K. Sheriar is a Consultant Obstetrician and Gynecologist, Holy Family Hospital, Hinduja Hospital, Breach Candy Hospital, Mumbai, India.

Sunil E. Tambvekar s.tambvekar@hotmail.com

1 Nowrosjee Wadia Maternity Hospital, Seth G. S. Medical College, Parel, Mumbai, Maharashtra 400706,

2 India Indira IVF Centre, Allahabad, Uttar Pradesh, India

3 Holy Family Hospital, Hinduja Hospital, Breach Candy Hospital, Mumbai, Maharashtra, India

Introduction Elderly women are believed to experience many risks associated with pregnancy. Literature fails to provide a clear consensus on the age group in which there is a rise in risk and pathophysiology contributing. ‘Pregnancies over forty’ are increasing in society, owing to changing lifestyles and sensibilities of youth and the advent of assisted reproductive techniques. In India, studies on elderly pregnant women above 40 years of age are lacking. The aim of this study is to assess these pregnancies, their course, obstetric and perinatal outcomes in women delivering above 40 years.

Methods The study group (Group A) comprised of pregnancies in 50 women at age ≥ 40 years on the date of delivery. The control group (Group B) had 50 women who delivered subsequent to the study group and age < 40. Various parameters and outcomes including parity, gestational age, number of gestations, co-existing medical illnesses, the incidence of hypertensive diseases of pregnancy (HDP), gestational diabetes mellitus (GDM), pre-term labor, mode of delivery, birth weight and obstetric and neonatal outcomes were compared. Chi-square test and independent T test were used for statistical analysis.

Results While a good number of patients conceived spontaneously and with basic infertility management, i.e., 84% in the elderly gravid group (Group A) and 96% in the control group (Group B), the number of patients who required ART in Group A were statistically significant (Group A 16% and Group B 4%). Incidence of pre-existing medical diseases like hypertension, diabetes mellitus, thyroid dysfunction, other auto-immune diseases and chronic diseases were noted to be high (26%) in Group A (statistically significant difference). Incidence of HDP, GDM and fetal growth restriction were high in Group A. Tendency to have the presence of fibroid uterus was high in patients in Group A, i.e., 24%, compared to only 8% in the control group; difference was statistically significant. Proportion of pre-term deliveries were high in Group A. Cesarean section rate was high in Group A, though it was not statistically significant. Other perinatal observations and neonatal outcomes were comparable in both groups; differences were not statistically significant.

Conclusion The study reveals an association of a high-risk course of pregnancies in women above the age of 40 years. Proportions of IVF pregnancies are higher in elderly women. Interestingly, the proportion of women in elderly group who conceived spontaneously and with basic infertility management including IUI was 84% in the present study. Medical comorbidities and incidence of fibroids were high in elderly women. Obstetric and neonatal outcomes of these pregnancies when managed efficiently are favorable.

Keywords : Advanced maternal age · Pregnancy above 40 years of age · High-risk pregnancy

With changing social norms, late marriages and modern sensibilities of the youth, a large number of women over 40 years of age are presenting to obstetric OPD. Advancing age in women affects pregnancy from conception to delivery; these women are believed to experience many risks associated with pregnancy and its outcomes. ‘Increased incidence of infertility’ and the advent of ‘assisted reproductive techniques’ are factors contributing to pregnancies in those over forty.

The believed risks and morbidities complicating pregnancies are hypertension, diabetes mellitus (DM), obesity complicating pregnancy, uterine leiomyoma, previous cesarean section, hypertensive diseases of pregnancy (HDP), gestational diabetes mellitus (GDM), fetal growth restriction (FGR), operative delivery, high cesarean section rate and neonatal morbidity [1, 2]. Neonates are affected due to prematurity, low birth weight, FGR and fetal distress, which also increase the rates of NICU admissions [3–5]. Type II diabetes and hypertension show an incremental increase with advancing maternal age and therefore act as mediating variables on the pathway between age and pregnancy outcome [6]. In this manner, it remains unclear if advanced maternal age in itself contributes to poor pregnancy outcomes rather than age-related comorbidity? Literature fails to provide a clear consensus on the age group in which there is a rise of risk. In India, studies on women giving birth over the age of 40 years are lacking. Aim of this study is to assess these pregnancies, their course, obstetric and perinatal outcomes in women with age more than 40 years.

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