Pregnancy at 40 and over: a case-control study in a developing country

This study was performed to determine the obstetric and neonatal outcome in women who become pregnant at and after 40 years of age compared to pregnancies below the age of 40. The study was performed at Colombo South Teaching Hospital in Sri Lanka and the study population included 150 women of 40 years and over at the time of delivery during the period from 1 September 2001 to 30 December 2002. A total of 8721 deliveries took place during this period and the control sample consisted of 150 women less than 40 years who delivered during the same period. Gestational diabetes mellitus and pregnancy-induced hypertension were more frequent in the older age pregnancies when compared to the controls (14.6% vs. 6.6% and 27.3% vs. 12%, respectively). There was no significant difference in the incidence of premature deliveries and birth weight among the two groups. Both emergency and elective caesarian sections were greater in the older age group women than in the controls (48.7% vs. 20% and 21.3% vs. 14.7%, respectively). When corrected for repeat sections and sections conducted specifically for advanced maternal age, the difference was less but still significant (42.7% vs. 32.7%). There was no significant difference in the 5-minute Apgar score and the incidence of congenital anomalies among the two groups.