Pregnancy outcome in nulliparous women 35 years and older

To compare pregnancy and delivery complications of first births in women 35 years and older with women 25-29 years old.

Maternal and newborn records for first births at three suburban hospitals from July 1, 1986 to June 30, 1990 were studied retrospectively.

The older women differed significantly in: 1) antepartum factors (type of insurance, marital status, prior pregnancy experience, weight gain, obesity, chronic and pregnancy-induced hypertension, gestational diabetes [without insulin], asthma, leiomyomas; and third-trimester bleeding), 2) intrapartum factors (anesthesia for vaginal delivery, gestational age at delivery, preterm labor, spontaneous labor, oxytocin use, malpresentation, cesarean births, and postpartum hemorrhage), and 3) neonatal outcomes (gestational age, birth weight, preterm births, abnormal karyotypes, neonatal intensive care unit admissions, low birth weight, and small for gestational age infants). Logistic regression determined that risk factors significantly predicting perinatal mortality were leiomyomas (odds ratio [OR] 2.6, 95% confidence interval [CI] 1.3-5.0), preterm birth (OR 4.9, 95% CI 3.1-7.7), and chorioamnionitis (OR 5.9, 95% CI 3.1-11.4), but not age.

Nulliparous women 35 years and older had higher rates of antepartum, intrapartum, and newborn complications than nulliparas between the ages of 25-29 years, but not an increased perinatal mortality rate. Despite the increased risk of complications, maternal and perinatal outcomes were good.