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Pregnancy and delivery outcomes among women aged 40 and older who also delivered prior to age 40: A paired sample study
Abstract Number: F3D-142
Abstract Type: Original Research
Background: Morbidities and poor outcomes among women of advanced maternal age (AMA) are well reported. However outcomes of women who delivered both before and after age 40 have not been previously reported.
Methods: We searched medical records (2003-2014) to identify women who delivered at least once <40 and at least once ≥40 years of age. The primary outcome was cesarean delivery (CD) rate comparing the first and last delivery identified for each woman; we retrieved maternal and obstetric outcomes for all pregnancies and deliveries. Pregnancy-related complications recorded were diabetes, hypertension, placenta previa, varicose veins, hospitalizations during pregnancy, bleeding during pregnancy, anemia/thrombocytopenia, intrauterine growth restriction and preterm contractions. Risk for venous thromboembolism (VTE) was defined as hypercoagulable conditions and/or varicose veins. Categorical variables in the paired groups were compared using McNemar’s test, and the p-value that presents the change over time (delivery <40 versus ≥40 versus years of age) is reported.
Results: Our cohort comprised 198 women and 645 individual births. Maternal age at first birth was mean(SD) 33.6(2.8) and last birth 41.3(1.5); parity was median(range) 2(0-9) and 4(1-14). The rate of CD was significantly higher in women ≥40, 10.6% versus 2.5% <40, p=0.002. This difference remained even after excluding all nulliparous births (11.1% ≥40 versus 2.2% <40, p=0.008). This rise in CD rate was affected by age but not by change in parity. More women ≥40 had co-morbidities (11.1% versus 0.5% <40, p<0.001) and more took medication during pregnancy (11.6% versus 2.5% <40, p=0.001). Pregnancy-related complications were reported more among women ≥40, 19.2% versus 9.6% <40, p=0.016. The frequency for VTE risk was 11.6% ≥40 versus 1% <40, p<0.001. Parity had a bigger effect on increased VTE risk than age (age-adjusted model, Odds Ratio=1.51, 95% CI 1.09-2.10, p=0.013). Second stage was shorter ≥40, 0.4±0.9 hours 95%CI (0.2-0.5), p< 0.001. For vaginal delivery, more women ≥40 did not receive neuraxial anesthesia even though they had used it in previous births, than women who labored without neuraxial anesthesia <40 and then received epidural ≥40 years (24.6% versus 4.9% respectively, p<0.001).
Conclusions: AMA women have higher CD frequency delivering age ≥40 years compared to their deliveries <40 years of age. AMA women ≥40 suffer more from comorbidities, use more medication, have greater VTE risk, but use epidural analgesia less frequently even after using in previous deliveries. The increased complications among women ≥40 who delivered at least once <40 must be recognized. Shorter second stage may impact epidural accessibility, although the desire to receive epidural was not known in our cohort.