Advanced maternal age: perinatal outcome when controlling for physician selection

Our purpose was to determine whether differences in maternal outcome because of maternal age could be controlled by the elimination of bias in physician selection.

We performed a case-control study that compared pregnancy outcomes of 164 patients delivered at our institution at > or = 40 years old with outcomes in a control group consisting of the next two deliveries by the same attending physician of women with ages 20 to 29 years. Retrospective analysis of the antepartum and intrapartum records was done to compare clinical outcome.

We observed a significant increased incidence of nulliparous cesarean delivery (p = 0.046), elevated results of glucose screens with a 50 gm load (p = 0.00002), and hypertension throughout pregnancy in the older patients in spite of controlling for physician selection. The older patient group was more likely to have used assisted reproductive techniques (p = 0.000005) and had higher baseline weights (p = 0.001) and maximum pregnancy weights (p = 0.042). However, the neonatal outcome was similar in both groups. Despite controlling for physician selection, we demonstrated increased rates of abdominal delivery, glucose intolerance, and hypertension in older patients. Fetal and neonatal outcomes were similar in both groups.

Women > or = 40 years old tend to have an increased incidence of a few pregnancy-related complications, even when controlling for physician selection.