Impact of advanced maternal age on obstetric and neonatal outcomes: an Indian cohort analysis
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20261264Keywords:
Advanced maternal age, India, Maternal outcomes, Perinatal outcomes, Preterm birthsAbstract
Background: To describe clinical profile, labour characteristics, maternal and neonatal outcomes of advanced maternal age pregnancies.
Methods: This retrospective observational study evaluated maternal, labour, and neonatal outcomes among women of advanced maternal age (AMA), with comparisons across normal maternal age, very advanced maternal age (VAMA), and extremely advanced maternal age (EAMA) groups. Demographic characteristics, mode of conception, comorbidities, labour profile, and neonatal outcomes were analysed.
Results: A total of 99,467 mothers delivered during the study period (January 2013 and December 2023), with majority belonging to normal age group (91.40%). AMA accounted for 6.77%, VAMA was 0.73%, EAMA was 0.07% and teenage pregnancy accounted for 1.03%. Proportion of AMA increased significantly over time, rising from 5.79% in 2013 to 14.83% in 2023. Most AMA pregnancies were singleton (94.45%), with a mean BMI of 28.05 ± 4.99 kg/m²; 1.23% were morbidly obese. Although spontaneous conception predominated (83.15%), assisted reproduction especially IVF (12.07%) was significantly more frequent. AMA mothers had a higher comorbidity burden, with multi-system disease in 39.33%. Caesarean delivery was common with 68.03%, with higher preterm birth rates (21.13%). Neonates showed more growth abnormalities (SGA 16.28%, LGA 12.55%) and higher NICU admissions (17.43%), live birth rates remained high (98.30%). Risk severity increased progressively in VAMA and EAMA groups.
Conclusions: AMA is associated with increased maternal comorbidity, caesarean delivery, preterm birth, and neonatal morbidity. These risks escalate further with increasing maternal age, underscoring the need for targeted antenatal surveillance, individualized risk stratification, multidisciplinary care, specialized intrapartum and neonatal care pathways.
References
American college of obstetricians and gynaecologists. Obstetric care consensus no. 11: pregnancy at age 35 years or older. Obstet Gynecol. 2022;140(3):348–66.
Banerjee A. Very advanced maternal age and pregnancy. In: Global Lib Women's Med. 2021;2:857.
Deng Q, Ji T, Chu G, Tan H. Pregnancy outcomes following assisted reproductive technology in advanced maternal age primiparous women: a retrospective cohort study. Int J Women Health. 2025;17:2443-9.
Correa-de-Araujo R, Yoon SSS. Clinical outcomes in high-risk pregnancies due to advanced maternal age. J Womens Health (Larchmt). 2021;30(2):160-7.
Singh Sardar S, Singh Sardar S. Socioeconomic and demographic factors affecting age at first birth among tribal women in india: an NFHS-5 analysis. J Rac Ethn Heal Dispar. 2025;7:1-2.
Singh M, Shekhar C, Gupta J. Transition in the ages at key reproductive events and its determinants in India: evidence from NFHS 1992-93 to 2019-21. BMC Women's Health. 2023;23(1):145.
Ravula PC, Aziz N, Surapaneni T, Kolar G, Vavilala S, Fernandez E. Clinical profile, risk factor stratification and outcomes of the fernandez birth cohort from india: a decade of experience. J Obstet Gynaecol India. 2025;75(5):422-9.
Yerubandi S, Ravula PC. Maternal risk factor stratification and outcomes of births at a tertiary perinatal referral centre network in India: an observational study. J Obstet Gynecol India. 2025;20:1-6.
Sparić R, Stojković M, Plešinac J, Pecorella G, Malvasi A, Tinelli A. Advanced maternal age (AMA) and pregnancy: a feasible but problematic event. Arch Gynecol Obstet. 2024;310(3):1365-76.
Ye X, Baker PN, Tong C. The updated understanding of advanced maternal age. Fundam Res. 2023;4(6):1719-28.
Mehari M, Maeruf H, Robles CC. Advanced maternal age pregnancy and its adverse obstetrical and perinatal outcomes in Ayder comprehensive specialized hospital, Northern Ethiopia, 2017: a comparative cross-sectional study. BMC Preg Child. 2020;20:60.
Asah-Opoku K, Mumuni K, Ntumy M, Boafor T, Ameme DK, Okere M, et al. Pregnancy outcomes of elderly primigravidae in a tertiary hospital in west Africa: a retrospective cohort study. Am J Trop Med Hyg. 2024;112(2):462-6.
Yaman FK, Ezveci H, Dogru S, Harmanci MS, Bahçeci P, Gezginç K. The impact of advanced maternal age on pregnancy complications and neonatal outcomes. J Clin Med. 2025;4(15):5387.
Cimadomo D, Fabozzi G, Vaiarelli A, Ubaldi N, Ubaldi FM, Rienzi L. Impact of maternal age on oocyte and embryo competence. Front Endocrinol (Lausanne). 2018;9:327.
Mendez-Vidal C, Fernández-Sánchez M, Domínguez-Moreno M, García-Díaz L, Dopazo J, Antiñolo G. Advanced maternal age and assisted reproductive technologies: outcomes, genomics, and real-world evidence. Front Reprod Heal. 2026;8:1787867.
Li Q, Wei X, Zeng W, Lin Y. Impact of IVF-ET on obstetrics and perinatal outcomes in advanced maternal age women. Placenta. 2025;167:55-62.
Frick AP. Advanced maternal age and adverse pregnancy outcomes. Best Pract Res Clin Obstet Gynaecol. 2021;70:92-100.
Yen IW, Kuo CH, Lin MW, Tai YY, Chen KY, Chen SC, et al. Advanced maternal age-related clustering of metabolic abnormalities is associated with risks of adverse pregnancy outcomes. J Formos Med Assoc. 2024;123(3):325-30.
Hochler H, Lipschuetz M, Suissa-Cohen Y, Weiss A, Sela HY, Yagel S, et al. The impact of advanced maternal age on pregnancy outcomes: a retrospective multicenter study. J Clin Med. 2023;12(17):5696.
Fuchs F, Monet B, Ducruet T, Chaillet N, Audibert F. Effect of maternal age on the risk of preterm birth: A large cohort study. PLoS One. 2018;13(1):191002.
Aradhya S, Tegunimataka A, Kravdal Ø, Martikainen P, Myrskylä M, Barclay K, Goisis A. Maternal age and the risk of low birthweight and pre-term delivery: a pan-Nordic comparison. Int J Epidemiol. 2023;52(1):156-64.
Pettersson ML, Bladh M, Nedstrand E, Svanberg AS, Lampic C, Sydsjö G. Maternal advanced age, single parenthood, and ART increase the risk of child morbidity up to five years of age. BMC Ped. 2022;22(1):39.
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