Pregnancy Outcome in Women Aged 40 Years and Above: A Cross Sectional Study

The primary objective was to evaluate maternal and neonatal outcomes in pregnant women aged 40 years or older, compared to those aged 35-39 and 20-34 years. The secondary objective was to assess caesarean section rates and indications in the same age groups.

This retrospective case-control study was conducted at the Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, from January 2014 to July 2020.After taking ethical clearance, pregnant women who delivered after 24 weeks of gestation from January 2014 to July 2020 were recruited in this study and divided into three groups: 40 years and above (group A), 35-39 years (group B), and controls aged 20-34 years (group C). Multiple pregnancies were excluded. 43 pregnant women aged 40 years & above and 99 pregnant women aged 35-39 years who delivered during the study period were included in groups A and B respectively, while 100 control cases were randomly allocated to group C. Their case records were analysed Statistical analyses included t-tests/ANOVA for continuous variables and Chisquare/Fisher's exact tests for categorical data, with p < 0.05 considered statistically significant.

Infertility was highest in women aged ≥ 40 years (30.23%, p < 0.05), and ART conception rates were elevated in women aged 35-39 years as compared to other two groups (16.27%). Gestational diabetes mellitus (GDM) was significantly more common in women aged ≥ 40 years (44.18%, p < 0.001), while preeclampsia, though more frequent in women aged 35-39, was not statistically significant across groups. Intrahepatic cholestasis of pregnancy was most prevalent in Group B (17.17%, p < 0.05). There were no significant differences in anemia rates or fetal growth restriction (FGR) among groups, though FGR was highest in women aged ≥ 40 years. Preterm birth rates also did not differ significantly. NICU admissions were highest in Group B (18.18%) but were not statistically significant. Vaginal delivery rates were highest in Group C (41%), with significantly lower rates in Group A (16.27%, p < 0.05). Group A had no instrumental deliveries, while Groups B and C had similar rates (3.30% and 3%, p = 0.514). Elective caesarean sections were significantly more common in women aged 35-39 (68.18%) than in those ≥ 40 years (51.16%) or aged 20-34 years (33.33%, p < 0.05).

Maternal age significantly influences obstetric outcomes, with higher risks of GDM, infertility, and lower vaginal delivery rates in older women. These findings highlight the need for age-specific management to improve maternal and neonatal outcomes.