Impact of Different Maternal Age Subgroups on Pregnancy Adverse Outcomes in China: A Multicenter Cohort Study

To analyze the distribution pattern of maternal age and the impact of different maternal age subgroups on pregnancy adverse outcomes in China.

This is a multicenter retrospective cohort study from 2010 to 2017. Live-born singletons were included. The pregnancy and perinatal adverse outcomes were collected. The χ² test was used to compare the frequencies among categorical data, Student's t-test, or Kruskal-Wallis H-test for continuous variables. Each adverse outcome (p-value < 0.2 in univariate analysis) was entered into a multinomial multivariate logistic regression to compare maternal age subgroups (< 20 years, 21-24 years, 30-34 years, and ≥ 35 years) with the 25-29 years group, adjusting for parity.

There were 216,404 mothers with a mean age of 27.4 ± 4.9 years. The proportion of mothers of < 20 years, 21-24 years, 25-29 years, 30-34 years, and ≥ 35 years was 2.5%, 26.0%, 42.5%, 20.1%, and 9.0%, respectively. Mean gestational age at delivery and birthweight were inverted U-shaped associated with the maternal age. The incidence of preterm delivery was high in the maternal age < 20 years (11.4%) and ≥ 35 years (10.7%) categories. Compared with maternal age 25-29 years, age < 20 years and age 20-24 years were associated with preterm delivery, low birthweight infants, very low birthweight infants, Apgar score ≤ 5 at 5 min, and eclampsia. Maternal age ≥ 35 years and age 30-34 years were associated with the elevated risk of preterm delivery, macrosomia, low birthweight infants, very-low-birthweight infant delivery, gestational diabetes mellitus, gestational hypertension, pre-eclampsia, eclampsia, placenta previa, elective and emergency cesarean delivery. Maternal age ≥ 35 years was associated with a high risk of Apgar score ≤ 5 at 5 min. The overall incidence of cesarean delivery was 41.7% (56.7% in age ≥ 35 years).

This large cohort study demonstrated a significant impact of maternal age on pregnancy adverse outcomes in China, with the < 20 years, 20-24 years, 30-34 years, and ≥ 35 years age groups being associated with an enhanced risk compared with the 25-29 years age group. The high cesarean delivery rate was alarming.