Maternal and perinatal outcomes in adolescents and women with advanced maternal age

To analyze the association between age extremes and maternal and perinatal outcomes in births in the state of Rio de Janeiro, Brazil.

Data from the Birth in Brazil II: National Survey on Abortion, Delivery, and Birth (2021-2023) were used. A total of 1,734 postpartum women were included, with live or stillborn newborns, interviewed in the immediate postpartum period. Information was obtained from interviews, clinical records, and prenatal cards. Multiple logistic regression was carried out to evaluate associations between maternal age and outcomes, having women aged 20-34 years as reference.

Delivery in adolescents represented 10.1% of the participants, while women with advanced maternal age (AMA ≥ 35 years) corresponded to 18.0%. Adolescents were less likely to receive guidance as to reference maternity hospital (odds ratio - OR = 0.68) and to have a companion at all times (OR = 0.77), in addition to presenting lower prevalence of gestational diabetes (OR = 0.26). In turn, women with advanced maternal age were more often guided on reference maternity hospitals (OR = 1.46) and presented a higher risk of gestational hypertension (OR = 1.78), gestational diabetes (OR = 1.87), placental abruption (OR = 3.30), and severe maternal morbidity (OR = 1.84). In perinatal outcomes, adolescents had a higher risk of perinatal death (OR = 4.52) and spontaneous early-term delivery (OR = 1.47); however, there was a lower probability of early-term delivery by obstetric intervention (OR = 0.48). Newborns of women with advanced maternal age presented higher risk of 5-minute Apgar index < 7 (OR = 3.05) and lower chance of congenital syphilis (OR = 0.34).

Adolescents were provided worse care compared to adults, while women with advanced maternal age presented a higher frequency of age-related complications. These results highlight the need for special care, particularly considering the increase in deliveries in women with advanced age.