BACKGROUND AND PURPOSE:

• Saccone et al. (International Journal of Gynecology and Obstetrics, 2022) evaluated the risk levels for maternal and perinatal complications at ≥40, ≥45, >50 years vs younger controls

METHODS:

• Systematic review and meta-analysis
• Study inclusion criteria
  • Studies that reported pregnancy outcome in pregnant women 40, 45 and 50 years or older vs younger controls
  • Exclusions: Case reports | Case series
• Study design
  • Meta-analysis was performed using the random effects model 
  • Heterogeneity was measured
  • Subgroup analyses were performed in women >45 years and >50 years
• Primary outcome
  • Incidence of stillbirth
• Secondary outcomes
  • Perinatal mortality | IUGR | Neonatal death | NICU admission | Preeclampsia | Preterm birth | Cesarean delivery | Maternal mortality

RESULTS:

• 27 studies | 31,090,631 pregnancies
  • Overall quality of included studies: moderate to high
  • Retrospective cohort studies: 77.8%
• Compared to women <40 years, women ≥40 years were at increased risk for the following
  • Perinatal mortality
  • IUGR
  • Neonatal death
  • Admission to NICU
  • Preeclampsia
  • Preterm delivery
  • Cesarean delivery
• Older women also had an increased risk of
  • Stillbirth, which increased with increasing maternal age (vs <40 years)
    • Women ≥40 years: RR 2.16 (95% CI, 1.86 to 2.51)
    • Women ≥45 years: RR 2.32 (95% CI, 1.17 to 3.16)
    • Women >50 years: RR 3.72 (95% CI, 1.42 to 9,83)
  • Maternal mortality increased with increasing maternal age (vs <40 years)
    • Women ≥40 years: RR 3.18 (95% CI, 1.68 to 5.98)
    • Women ≥45 years: RR 11.60 (95% CI, 3.27 to 41.11)
    • Women >50 years: RR 42.76 (95% CI, 12.36 to 147.92)
• The risk of stillbirth and cesarean delivery was significantly higher in women
  • >45 years compared to those aged 40 to 45 years
  • >50 years compared to those aged 45 to 50 years
• The risk of maternal mortality was higher in women >50 years compared to those aged 40 to 45 years
  • RR 60.40 (95% CI, 13.28 to 274.74)

CONCLUSION:

• Risk of several pregnancy complications increase with advanced maternal age, particularly
  • Stillbirth
  • Cesarean
  • Maternal mortality
• A major limitation of this study includes the inclusion of retrospective non-randomized studies
• The authors state

Our meta-analysis showed that the higher maternal age the higher risk of adverse pregnancy outcomes

These data should be used when women with advanced maternal age are counselled regarding their risk in pregnancy

Learn More – Primary Sources:

Maternal and perinatal complications according to maternal age: a systematic review and meta-analysis

Related ObG Topics:

Maternal Age: What is the Impact on Stillbirth and Other Adverse Pregnancy Outcomes?

Maternal Age 45 and Over – What is the Impact on Maternal and Newborn Health?

Advanced Maternal Age and Associated Severe Maternal Morbidity

Is Advanced Paternal Age Associated with Increased Chance of Spontaneous Abortion?