[Pregnancy outcome in women over the age of 35]

To assess pregnancy outcome in women aged > or =35, followed prospectively, and the relation between maternal age and the incidence of abortions after 12 gw (spontaneous and medical), preterm delivery, mode of delivery and congenital anomalies.

495 women from the Fetal Medicine Clinic of the State University Hospital "Maichin Dom" in Sofia were enrolled in the study between 02/2012 and 02/2014 with gestational age > or =12 completed weeks. The patients were devided in 3 groups according to age-- < or =34, between 35 and 39 and > or = 40 years of age. Pregnancy outcome was veirified from hospital records and phone intenrviews with the patients themselves. Data were processed with SPSS 13.0 statistical package. Descriptive and comparative analysis was performed after grouping according to one or more characteristics; p values <0.05 were considered as evidence of statistical significance for tested effects.

131/495 (26.5%) of the patients were < or =34 years of age, 254/495 (51.3%) were between 35 and 39 and 110/495 (22.2%) were > or =40 years of age. Maternal age > or =35 was associated with statistically significant increase of the total late abortion rate (spontaneous and medical abortions)--from 6.9% for those < or =34 yars of age to 11.3%--for the ones between 35-39 and 11.4%--for the ones > or =40 years. There was also statistically significant increase in the incidence of late medical abortions in the group > or =40 years of age (p=0.011). It was 2/124 (1.6%) for the group aged < or =34, 7/230 (3%)--in the group aged 35-39 and 9/100 (9.0%)--in the group > or =40 years of age. The difference in late spontaneous abortions rate was not statistically significant among the groups. There was statistically significant increase in the incidence of preterm deliveries (spontaneous and induced)--14/131 (10.7%) in the group aged < or =34, 52/208 (25.0%)--in the group between 35-39 and 20/93 (21.5%)--in the group > or =40 years of age (p=0.013). There was also a significant increase in Cesarean section rate with age--from 44/131 (33.6%) in the group < or =34, to 139/254 (54.7%)--in the group between 35-39, and 69/110 (62.7%)--in the group > or =40 years (p=0.0001). There is a tendency for increased operative vaginal delivery rate with age; however the difference is not statistically significant, probably due to the small number of cases (p=O. 113). There was also statistically significant increase in the proportion of newborns with congenital anomalies in women > or =40 years of age (p=0.005)--from 1/131 (0.8%) in patients < or =34, to 2/254 (1.0%) for those between 35 and 39, and 6/110 (5.5%)--for those > or =40 years. Part of the congenital anomalies was prenatally diagnosed chromosomal defects without termination of pregnancy

Maternal age > or =35 years is associated with statistically significant increase in late medical abortions, preterm delivery and Cesarean section rate and congenital fetal anomalies.