Pregnancy in women over forty

A retrospective review of the 289 women over the age of 40 years and delivering at the Turku University Central Hospital between 1986-1990 is presented. Forty-seven women were nulliparous and 242 multiparous. The proportion of women over 40 of all parturients during this time period was 2.1%. Infertility was treated in 12% of couples. There were three multifetal pregnancies, all spontaneous. 88% of the women had a first trimester amniocentesis or chorion villus biopsy for fetal chromosomal analysis. The most common pregnancy-related complications were prematurity (11%), gestational diabetes (8%), pre-eclampsia (7%) and infectious diseases (11%). The rate of Caesarean section was high, 26% (among the primipara 36%). The perinatal mortality rate was very low, 3.4 per thousand, and neonatal mortality rate 6.8 per thousand. The incidence of congenital anomalies was 2%, and most of these anomalies were cardiac. Large-for-date babies were overpresented in this population and primipara had a higher rate of small-for-gestational age babies than in the normal population. Although advanced maternal age alone does not carry major risks of abnormal pregnancy outcome, the higher frequency of complications among some subgroups may explain the high rate of Caesarean sections in this population.