Advanced maternal age and pregnancy outcomes: a multicountry assessment

Authors

  • M Laopaiboon,

    1. Faculty of Public Health, Department of Biostatistics & Demography, Khon Kaen University, Khon Kaen, Thailand
    Search for more papers by this author
  • P Lumbiganon,

    Corresponding author
    1. Faculty of Medicine, Department of Obstetrics & Gynaecology, Khon Kaen University, Khon Kaen, Thailand
    • Correspondence: Prof. P Lumbiganon, Faculty of Medicine, Department of Obstetrics & Gynaecology, Khon Kaen University, Khon Kaen, Thailand. Email pisake@kku.ac.th

    Search for more papers by this author
  • N Intarut,

    1. Faculty of Public Health, Department of Biostatistics & Demography, Khon Kaen University, Khon Kaen, Thailand
    Search for more papers by this author
  • R Mori,

    1. Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
    Search for more papers by this author
  • T Ganchimeg,

    1. Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
    Search for more papers by this author
  • JP Vogel,

    1. Faculty of Medicine, Dentistry and Health Sciences, School of Population Health, University of Western Australia, Crawley, Australia
    2. Department of Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
    Search for more papers by this author
  • JP Souza,

    1. Department of Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
    Search for more papers by this author
  • AM Gülmezoglu,

    1. Department of Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
    Search for more papers by this author
  • on behalf of the WHO Multicountry Survey on Maternal Newborn Health Research Network


Abstract

Objective

To assess the association between advanced maternal age (AMA) and adverse pregnancy outcomes.

Design

Secondary analysis of the facility-based, cross-sectional data of the WHO Multicountry Survey on Maternal and Newborn Health.

Settings

A total of 359 health facilities in 29 countries in Africa, Asia, Latin America, and the Middle East.

Sample

A total of 308 149 singleton pregnant women admitted to the participating health facilities.

Methods

We estimated the prevalence of pregnant women with advanced age (35 years or older). We calculated adjusted odds ratios of individual severe maternal and perinatal outcomes in these women, compared with women aged 20–34 years, using a multilevel, multivariate logistic regression model, accounting for clustering effects within countries and health facilities. The confounding factors included facility and individual characteristics, as well as country (classified by maternal mortality ratio level).

Main outcome measures

Severe maternal adverse outcomes, including maternal near miss (MNM), maternal death (MD), and severe maternal outcome (SMO), and perinatal outcomes, including preterm birth (<37 weeks of gestation), stillbirths, early neonatal mortality, perinatal mortality, low birthweight (<2500 g), and neonatal intensive care unit (NICU) admission.

Results

The prevalence of pregnant women with AMA was 12.3% (37 787/308 149). Advanced maternal age significantly increased the risk of maternal adverse outcomes, including MNM, MD, and SMO, as well as the risk of stillbirths and perinatal mortalities.

Conclusions

Advanced maternal age predisposes women to adverse pregnancy outcomes. The findings of this study would facilitate antenatal counselling and management of women in this age category.

Ancillary