Delivery outcomes for nulliparous women at the extremes of maternal age – a cohort study

Authors

  • DA Vaughan,

    1. Coombe Women and Infants University Hospital, Dublin, Ireland
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  • BJ Cleary,

    1. Coombe Women and Infants University Hospital, Dublin, Ireland
    2. School of Pharmacy, Royal College of Surgeons in Ireland, Dublin, Ireland
    3. Academic Department of Obstetrics and Gynaecology, Trinity College, University of Dublin, Dublin, Ireland
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  • DJ Murphy

    Corresponding author
    1. Coombe Women and Infants University Hospital, Dublin, Ireland
    2. Academic Department of Obstetrics and Gynaecology, Trinity College, University of Dublin, Dublin, Ireland
    • Correspondence: Prof DJ Murphy, Academic Department of Obstetrics and Gynaecology, Trinity College, University of Dublin, Coombe Women & Infants University Hospital, Cork Street, Dublin 8, Ireland. Email deirdre.j.murphy@tcd.ie

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Abstract

Objective

To examine the associations between extremes of maternal age (≤17 years or ≥40 years) and delivery outcomes.

Design

Retrospective cohort study.

Setting

Urban maternity hospital in Ireland.

Population

A total of 36 916 nulliparous women with singleton pregnancies who delivered between 2000 and 2011.

Methods

The study population was subdivided into five maternal age groups based on age at first booking visit: ≤17 years, 18–19 years, 20–34 years, 35–39 years and women aged ≥40 years. Logistic regression analyses were performed to examine the associations between extremes of maternal age and delivery outcomes, adjusting for potential confounding factors.

Main outcome measures

Preterm birth, admission to the neonatal unit, congenital anomaly, caesarean section.

Results

Compared with maternal age 20–34 years, age ≤17 years was a risk factor for preterm birth (adjusted odds ratio [adjOR] 1.83, 95% confidence interval [95% CI] 1.33–2.52). Babies born to mothers ≥40 years were more likely to require admission to the neonatal unit (adjOR 1.35, 95% CI 1.06–1.72) and to have a congenital anomaly (adjOR 1.71, 95% CI 1.07–2.76). The overall caesarean section rate in nulliparous women was 23.9% with marked differences at the extremes of maternal age; 10.7% at age ≤17 years (adjOR 0.46, 95% CI 0.34–0.62) and 54.4% at age ≥40 years (adjOR 3.24, 95% CI 2.67–3.94).

Conclusions

Extremes of maternal age need to be recognised as risk factors for adverse delivery outcomes. Low caesarean section rates in younger women suggest that a reduction in overall caesarean section rates may be possible.

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