Advanced maternal age at first delivery as a risk factor for long-term cardiovascular disease

An increased numbers of women initiate motherhood at an advanced age. Advanced maternal age (AMA) at first delivery poses unique clinical challenges; however, limited literature exists regarding potential long-term implications. We investigated the association between AMA at first delivery on maternal long-term cardiovascular disease (CVD).

A population-based retrospective cohort study included all primiparous women at a tertiary medical center (1991-2021). Participants were stratified by age (< 30, 30-34, 35-40, and > 40 years). Kaplan-Meier analysis estimated cumulative incidence rates of morbidity, and a Cox regression model investigated the association between AMA and long-term maternal CVD while adjusting for confounding variables.

The study included 47,046 primiparous women; 43,426 (92.3%) were <30 years, 2,807 (6.0%) were aged 30-34 years, 658 (1.4%) were aged 35-40 years, and 155 (0.3%) were > 40 years. Kaplan-Meier survival analysis revealed a significant increase in the cumulative incidence of CVD associated with AMA, particularly among aged > 40 years (Log Rank: p < 0.001). Specifically, hypertension, ischemic heart disease, central vascular events and peripheral vascular disease were significantly more frequent in older age groups. Cox regression analysis indicated that AMA was independently associated with an increased risk of long-term CVD after adjusting for confounders [aHR = 1.81 (95% CI, 1.41-2.68); p < 0.001)].

AMA at first delivery associated with increased long-term risk of cardiovascular morbidity. These results suggest the importance of tailored monitoring and preventive strategies for women of AMA at first delivery to potentially mitigate future cardiovascular risks.