The effect of parity on obstetric and perinatal outcomes in pregnancies at the age of 40 and above: a retrospective study

AimTo examine the characteristics of pregnancies at a very advanced age and the effect of parity on adverse obstetric outcomes.MethodsWe retrospectively reviewed the records of women who gave birth at the Obstetrics and Gynecology Department of Okmeydanı Training and Research Hospital between January 2012 and December 2019. Overall, 22 448 of women were younger than 40 and 593 were aged 40 and older. Women aged 40 and older were divided into the primiparous (52 or 8.77%) and multiparous group (541 or 91.23%).ResultsSignificantly more women aged 40 and older had a cesarean section. The most common indications for a secondary cesarean delivery in both age groups were a previous cesarean procedure or uterine operation. The most frequent indication for primary cesarean section in both groups was fetal distress. Cesarean section rates due to non-progressive labor, fetal distress, and preeclampsia were significantly more frequent in primiparous women compared with multiparous women aged 40 and older. In primiparous women, fetal birth weight was lower and preeclampsia/gestational hypertension frequency were higher.ConclusionSince primiparity was a risk factor for lower fetal birth weight and preeclampsia/gestational hypertension in the age group of 40 years and above, more attention should be paid to the follow-up and treatment of these patients.

Due to social and economic problems, career priority, and prolonged education, an increasing number of women choose to give birth at an advanced age. Their choice is facilitated by the availability and efficacy of contraceptive methods and assisted reproductive technology (ART) (1). Still, the rate of nulliparity at advanced age increases, while the parity rate decreases (2).The International Federation of Gynecology and Obstetrics (FIGO) uses the term “advanced maternal age” for pregnancies at the age of 35 and over, and the term “very advanced maternal age” for pregnancies at the age 40 and over. In these pregnancies, chronic diseases and medical problems are more common and these women constitute a high-risk patient group (3).Most studies have shown that the advanced maternal age increases the risk of hypertension, gestational diabetes mellitus, postpartum hemorrhage, premature birth, cesarean procedure, intrauterine growth retardation, and perinatal mortality (4,5). However, studies comparing the outcomes in primiparous and multiparous women pregnant at an advanced maternal age are scarce, and the evidence for some of the outcomes is conflicting. Therefore, the aim of our study is to examine the characteristics of pregnancies at a very advanced maternal age and to assess the effect of parity on negative obstetric outcomes.