Association between advanced maternal age and maternal and neonatal morbidity: A cross-sectional study on a Spanish population

Autoři: Ana Casteleiro aff001;  María Paz-Zulueta aff002;  Paula Parás-Bravo aff002;  Laura Ruiz-Azcona aff002;  Miguel Santibañez aff002
Působiště autorů: Hospital Universitario de Basurto, Bilbao, Spain aff001;  Department of Nursing, University of Cantabria, Cantabria, Spain aff002;  IDIVAL, GRIDES, Cantabria, Spain aff003;  IDIVAL, Grupo de Investigación en Enfermería, Cantabria, Spain aff004
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225074


Background and objective

Over recent decades, a progressive increase in the maternal age at childbirth has been observed in developed countries, posing a health risk for both women and infants. The aim of this study was to analyze the association between advanced maternal age (AMA) and maternal and neonatal morbidity.

Material and methods

A cross-sectional study of 3,315 births was conducted in the north of Spain in 2014. We compared childbirth between women aged 35 years or older, with a reference group of women aged between 24 and 27 years. AMA was categorized based on ordinal ranking into 35–38 years, 39–42 years, and >42 years to estimate a dose-response pattern (the older the age, the greater the risk). As an association measure, crude and adjusted Odds Ratios (OR) were estimated by non-conditional logistic regression and 95% Confidence Intervals (95%CI) were calculated.


Repeated abortions were more common among women of AMA in comparison to pregnant women aged 24–27 years (reference group): adjusted OR = 2.68; 95%CI (1.52–4.73). A higher prevalence of gestational diabetes was also observed among women of AMA, reaching statistical significance when restricted to first time mothers: adjusted OR = 8.55; 95%CI (1.12–65.43). In addition, the possibility of an instrumental delivery was multiplied by 1.6 and the possibility of a cesarean by 1.5 among women of AMA, with these results reaching statistical significance, and observing a dose-response pattern. Lastly, there were associations between preeclampsia, preterm birth (<37 weeks) and low birthweight, however without reaching statistical significance.


Our results support the association between AMA and suffering repeated abortions. Likewise, being of AMA was associated with a greater risk of suffering from gestational diabetes, especially among primiparous women, as well as being associated with both instrumental deliveries and cesareans among both primiparous and multiparous women.

Klíčová slova:

Birth – Cesarean section – Labor and delivery – Morbidity – Neonates – Preeclampsia


1. Hodes-Wertz B, Druckenmiller S, Smith M, Noyes N. What do reproductive-age women who undergo oocyte cryopreservation think about the process as a means to preserve fertility?. Fertil Steril. 2013;100(5):1343–13439. doi: 10.1016/j.fertnstert.2013.07.201 23953326

2. Schimmel MS, Bromiker R, Hammerman C, Chertman L, Ioscovich A, Granovsky-Grisaru S, Samueloff A, Elstein D. The effects of maternal age and parity on maternal and neonatal outcome. Arch Gynecol Obstet. 2015; 291:793–798. doi: 10.1007/s00404-014-3469-0 25227657

3. Sheen JJ, Wright JD, Goffman D, Kern-Goldberger AR, Booker W, Siddiq Z, D’Alton ME, Friedman AM. Maternal age and risk for adverse outcomes. Am J Obstet Gynecol. 2018; 219(4):390.e1–390.e15.

4. Joseph KS, Allen AC, Dodds L, Turner LA, Scott H, Liston R. The Perinatal Ef-fects of Delayed Childbearing. Obstetrics & Gynecology. 2005;105(6):1410–1418.

5. Kate FW, Jim GT. Advanced maternal age. Obstetrics, Gynaecology and Re-productive Medicine. 2016;26(12):354–357.

6. Martin JA, Hamilton BE, Ventura SJ, Osterman MJK, Wilson EC, Mathews TJ. Births: final data for 2016. Natl Vital Stat Rep. 2018;67(1):1–55 29775434

7. Instituto Nacional de Estadística. Estadísticas del Movimiento Natural de la Po-blación (Nacimientos, Defunciones y Matrimonios). Primer semestre de 2018. Datos provisionales. [accessed December 2018]

8. Astolfi P, Zonta LA (2002) Delayed maternity and risk at delivery. Paediatr Peri-nat Epidemiol. 2002;16(1):67–72.

9. Laopaiboon M, Lumbiganon P, Intarut N, Mori R, Ganchimeg T, Vogel JP, Sou-za JP, Gülmezoglu AM; WHO Multicountry Survey on Maternal Newborn Health Research Network. Advanced maternal age and pregnancy outcomes: a multicountry assessment. BJOG. 2014;121(1):49–56.

10. Osmundson SS, Gould JG, Butwick AJ, Yeaton-Massey A, El-Sayed Y. Labor outcome at extremely advanced maternal age. AJOG. 2016;214(3): 362.e1–362.e7.

11. Heras B, Gobernado J, MaOR P, Almaraz A. Maternal age as an obstetric risk factor. Perinatal outcomes in pregnant women of advanced age | [La edad materna como factor de riesgo obstétrico. Resultados perinatales en gestantes de edad avanzada]. Prog Obstet Ginecol. 2011;54(11):575–580.

12. Alshami HA, Kadasne AR, Khalfan M, Iqbal SZ, Mirghani HM. Pregnancy out-come in late maternal age in a high-income developing country. Arch Gynecol Obstet. 2011; 284(5):1113–1116. doi: 10.1007/s00404-010-1821-6 21188401

13. Bayrampour H, Heaman M. Advanced maternal age and the risk of cesarean birth: a systematic review. Birth. 2010;37(3):219–226. doi: 10.1111/j.1523-536X.2010.00409.x 20887538

14. Carolan M, Frankowska D. Advanced maternal age and adverse perinatal out-come: a review of the evidence. Midwifery. 2011;27(6):793–801. doi: 10.1016/j.midw.2010.07.006 20888095

15. Goisis A, Remes H, Barclay K, Martikainen P, Myrskylä M. Advanced Maternal Age and the Risk of Low Birth Weight and Preterm Delivery: a Within-Family Analysis Using Finnish Population Registers. Am J Epidemiol. 2017;186(11):1219–1226. doi: 10.1093/aje/kwx177 29206985

16. Kalayci H, Ozdemir H, Alkas D, Cok T, Tarim E. Is primiparity a risk factor for advanced maternal age pregnancies? J Matern Fetal Neonatal Med. 2017;30(11):1283–1287. doi: 10.1080/14767058.2016.1211633 27406982

17. Koo YJ, Ryu HM, Yang JH, Lim JH, Lee JE, Kim MY, Chung JH. Pregnancy outcomes according to increasing maternal age. Taiwanese Journal of Obste-trics & Gynecology. 2012;51(1): 60–65

18. Kahveci B, Melekoglu R, Evruke IC, Cetin C. The effect of advanced maternal age on perinatal outcomes in nulliparous singleton pregnancies. BMC Pregnancy Childbirth. 2018;18(1):343. doi: 10.1186/s12884-018-1984-x 30134873

19. França AA, Sass A, Marcon SS, Pelloso SM. Outcomes in late-age pregnan-cies. Rev Esc Enferm USP. 2012;46(1):15–21. doi: 10.1590/s0080-62342012000100002 22441260

20. Almeida NK, Almeida RM, Pedreira CE. Adverse perinatal outcomes for advanced maternal age: a cross-sectional study of Brazilian births. J Pediatr (Rio J). 2015;91:493–498.

21. Carolan M. Maternal age >45 years and maternal and perinatal outcomes: A re-view of the evidence. Midwifery. 2013;29:479–489. doi: 10.1016/j.midw.2012.04.001 23159159

22. Leader J, Bajwa A, Lanes A, Hua X, Rennicks White R, Rybak N, Walker M. The Effect of Very Advanced Maternal Age on Maternal and Neonatal Outco-mes: A Systematic Review. J Obstet Gynaecol Can. 2018;40(9):1208–1218. doi: 10.1016/j.jogc.2017.10.027 29681506

23. Hinkle Stefanie N., Albert Paul S., Mendola Pauline, Sjaarda Lindsey A., Boghossian Nansi S., Yeung Edwina, et al. Differences in risk factors for incident and recurrent small-forgestational-age birthweight: a hospital-based cohort study. BJOG. 2014; 121(9):1080–1089. doi: 10.1111/1471-0528.12628 24702952

24. Blankenship SA, Woolfolk CL, Raghuraman N, Stout MJ, Macones GA, Cahill AG. First stage of labor progression in women with large-for-gestational age infants. Am J Obstet Gynecol. 2019 Jun 22.

25. Carrascosa Lezcano A, Ferrández Longás A, Yeste Fernández D, García-Dihinx Villanova J, Romo Montejo A, et al. Spanish cross-sectional growth study 2008. Part I: weight and height values in newborns of 26–42 weeks of gestational age. An Pediatr (Barc). 2008;68(6):544–51.

26. Paz-Zulueta M, Llorca J, Sarabia-Lavín R, Bolumar F, Rioja L, Delgado A, San-tibáñez M. The role of prenatal care and social risk factors in the relationship between immigrant status and neonatal morbidity: a retrospective cohort study. PLoS One. 2015;10(3):e0120765. doi: 10.1371/journal.pone.0120765 25816369

27. Garrido-Gimenez C, Alijotas-Reig J. Recurrent miscarriage: causes, evaluation and management. Postgrad Med J. 2015;91(1073):151–162. doi: 10.1136/postgradmedj-2014-132672 25681385

28. Khalil A, Syngelaki A, Maiz N, Zinevich Y, Nicolaides KH. Maternal age and adverse pregnancy outcome: a cohort study. Ultrasound Obstet Gynecol. 2013;42(6):634–643. doi: 10.1002/uog.12494 23630102

29. Mack LR, Tomich PG. Gestational Diabetes: Diagnosis, Classification, and Clinical Care. Obstet Gynecol Clin North Am. 2017;44(2):207–217. doi: 10.1016/j.ogc.2017.02.002 28499531

30. Bartsch E, Medcalf KE, Park AL, Ray JG, High Risk of Pre-eclampsia Identification Group. Clinical risk factors for pre-eclampsia determined in early pregnancy: systematic review and meta-analysis of large cohort studies. BMJ. 2016;353:i1753. doi: 10.1136/bmj.i1753 27094586

31. Statistics National Institute. Bulletin of demographic synthesis Cantabria, 2015. [Accessed Jan 2018].

Článek vyšel v časopise


2019 Číslo 11