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Licensed Unlicensed Requires Authentication Published online by De Gruyter May 13, 2022

The effect of advanced maternal age on perinatal outcomes in nulliparous pregnancies

Gülhan Elçi ORCID logo, Ayşegül Çakmak ORCID logo, Erkan Elçi ORCID logo and Sena Sayan ORCID logo



In the current study, we aimed to evaluate the effect of advanced maternal age on perinatal outcomes in nulliparous singleton pregnancy.


The perinatal outcome data of 11,366 patients who gave birth between 2015 and 2020 were evaluated retrospectively. Patients were subgrouped according to their age as control group (C) (20–29 years), late advanced maternal age group (30–34 years), advanced maternal age group (35–39 years), and very advanced maternal age group (≥40 years). Multinomial logistic regression analyses were performed to test the possible independent role of maternal age as a risk factor for adverse pregnancy outcomes.


Statistically significant difference was observed between the control group and the other groups in terms of preterm delivery, preeclampsia, gestational diabetes mellitus (GDM), small gestational age (SGA), large gestational age (LGA), premature rupture of membranes (PROM), high birth weight (HBW), and perinatal mortality rates (p<0.05). An increased risk of the need for neonatal intensive care unit (NICU) and perinatal mortality was observed in groups over 35 years old.


Age poses a risk in terms of preterm delivery, preeclampsia, LGA, GDM, and HBW in the groups over 30 years of maternal age. The rates of PROM, NICU, and perinatal mortality increase in addition to those perinatal results in the groups above 35 years of maternal age.

Corresponding author: Erkan Elçi, MD, Department of Obstetrics and Gynecology, University of Health Sciences Umraniye Training and Research Hospital, Istanbul, Turkey, Adem Yavuz, Str No 01, Elmalıkent, Umraniye, Postal zip Code: 34070, Istanbul, Turkey, Phone: +90 506 484 5469, E-mail:

  1. Research funding: None declared.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent was not required because of the retrospective nature of the study; the research involves no more than minimal risk to the subjects and the waiver will not adversely affect the rights and welfare of the subjects.

  5. Ethical approval: Ethics Committee approval was received from the local ethics committee (approval number: 11/02/2021-14).


1. Montan, S. Increased risk in the elderly parturient. Curr Opin Obstet Gynecol 2007;19:110–2. in Google Scholar

2. Bongaarts, J, Blanc, AK. Estimating the current mean age of mothers at the birth of their first child from household surveys. Popul Health Metrics 2015;13:1–6. in Google Scholar

3. Traisrisilp, K, Tongsong, T. Pregnancy outcomes of mothers with very advanced maternal age (40 years or more). J Med Assoc Thai 2015;98:117–22.Search in Google Scholar

4. Yogev, Y, Melamed, N, Bardin, R, Tenenbaum-Gavish, K, Ben-Shitrit, G, Ben-Haroush, A. Pregnancy outcome at extremely advanced maternal age. Am J Obstet Gynecol 2010;203:558. e1–7. in Google Scholar

5. Zipori, Y, Linder, R, Khatib, N, Weiner, Z, Barzilay, E. Advanced maternal age and perinatal outcome in twin pregnancies: a meta-analysis. J Matern Fetal Neonatal Med 2020;33:3193–9. in Google Scholar

6. Klemetti, R, Gissler, M, Sainio, S, Hemminki, E. At what age does the risk for adverse maternal and infant outcomes increase? Nationwide register-based study on first births in Finland in 2005–2014. Acta Obstet Gynecol Scand 2016;95:1368–75. in Google Scholar

7. Kanungo, J, James, A, McMillan, D, Lodha, A, Faucher, D, Lee, SK, et al.. Advanced maternal age and the outcomes of preterm neonates: a social paradox?. Obstet Gynecol 2011;118:872–7. in Google Scholar

8. Timofeev, J, Reddy, UM, Huang, C-C, Driggers, RW, Landy, HJ, Laughon, SK. Obstetric complications, neonatal morbidity, and indications for cesarean delivery by maternal age. Obstet Gynecol 2013;122:1184. in Google Scholar

9. Kenny, LC, Lavender, T, McNamee, R, O’Neill, SM, Mills, T, Khashan, AS. Advanced maternal age and adverse pregnancy outcome: evidence from a large contemporary cohort. PLoS One 2013;8:e56583. in Google Scholar

10. Cordina, M, Bhatti, S, Fernandez, M, Syngelaki, A, Nicolaides, KH, Kametas, NA. Association between maternal haemoglobin at 27–29 weeks gestation and intrauterine growth restriction. Pregnancy Hypertens 2015;5:339–45. in Google Scholar

11. Dulitzki, M, Soriano, D, Schiff, E, Chetrit, A, Mashiach, S, Seidman, DS. Effect of very advanced maternal age on pregnancy outcome and rate of cesarean delivery. Obstet Gynecol 1998;92:935–9. in Google Scholar

12. Balayla, J, Azoulay, L, Assayag, J, Benjamin, A, Abenhaim, HA. Effect of maternal age on the risk of stillbirth: a population-based cohort study on 37 million births in the United States. Am J Perinatol 2011;28:643–50. in Google Scholar

13. Rademaker, D, Hukkelhoven, CW, van Pampus, MG. Adverse maternal and perinatal pregnancy outcomes related to very advanced maternal age in primigravida and multigravida in The Netherlands: a population‐based cohort. Acta Obstet Gynecol Scand 2021;100:941–8. in Google Scholar

14. Nieto, MC, Barrabes, EM, Martínez, SG, Prat, MG, Zantop, BS. Impact of aging on obstetric outcomes: defining advanced maternal age in Barcelona. BMC Pregnancy Childbirth 2019;19:342. in Google Scholar

15. Robinson, HP. Sonar measurement of fetal crown-rump length as means of assessing maturity in first trimester of pregnancy. Br Med J 1973;4:28–31. in Google Scholar

16. Tranquilli, AL, Dekker, G, Magee, L, Roberts, J, Sibai, BM, Steyn, W, et al.. The classification, diagnosis and management of the hypertensive disorders of pregnancy: a revised statement from the ISSHP. Pregnancy Hypertens 2014;4:97–104. in Google Scholar

17. Group, NDD. Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes 1979;28:1039–57. in Google Scholar

18. Londero, AP, Rossetti, E, Pittini, C, Cagnacci, A, Driul, L. Maternal age and the risk of adverse pregnancy outcomes: a retrospective cohort study. BMC Pregnancy Childbirth 2019;19:1–10. in Google Scholar

19. World Health Organization. Pregnancy, childbirth, postpartum and newborn care: a guide for essential practice(PCPNC)- Advise on routine and follow-up visits C17 [Online], 3rd ed. Available from: [Accessed 18 Oct 2021].Search in Google Scholar

20. World Health Organization. Global Health Observatory data. Indicator Metadata Registry List – Maternal Deaths [Online]. Available from: [Accessed 16 Oct 2021].Search in Google Scholar

21. Tough, SC, Newburn-Cook, C, Johnston, DW, Svenson, LW, Rose, S, Belik, J. Delayed childbearing and its impact on population rate changes in lower birth weight, multiple birth, and preterm delivery. Pediatrics 2002;109:399–403. in Google Scholar

22. Jacobsson, B, Ladfors, L, Milsom, I. Advanced maternal age and adverse perinatal outcome. Obstet Gynecol 2004;104:727–33. in Google Scholar

23. Delpisheh, A, Brabin, L, Attia, E, Brabin, BJ. Pregnancy late in life: a hospital-based study of birth outcomes. J Womens Health 2008;17:965–70. in Google Scholar

24. Londero, AP, Rossetti, E, Pittini, C, Cagnacci, A, Driul, L. Maternal age and the risk of adverse pregnancy outcomes: a retrospective cohort study. BMC Pregnancy Childbirth 2019;19:261. in Google Scholar

25. Waldenström, U, Cnattingius, S, Vixner, L, Norman, M. Advanced maternal age increases the risk of very preterm birth, irrespective of parity: a population-based register study. BJOG 2017;124:1235–44. in Google Scholar

26. Marozio, L, Picardo, E, Filippini, C, Mainolfi, E, Berchialla, P, Cavallo, F, et al.. Maternal age over 40 years and pregnancy outcome: a hospital-based survey. J Matern Fetal Neonatal Med 2019;32:1602–8. in Google Scholar

27. Başer, E, Seçkin, KD, Erkılınç, S, Karslı, MF, Yeral, IM, Kaymak, O, et al.. The impact of parity on perinatal outcomes in pregnancies complicated by advanced maternal age. J Turk Ger Gynecol Assoc 2013;14:205. in Google Scholar

28. Diejomaoh, MF, Al-Shamali, IA, Al-Kandari, F, Al-Qenae, M, Mohd, AT. The reproductive performance of women at 40 years and over. Eur J Obstet Gynecol Reprod Biol 2006;126:33–8. in Google Scholar

29. Khalil, A, Syngelaki, A, Maiz, N, Zinevich, Y, Nicolaides, KH. Maternal age and adverse pregnancy outcome: a cohort study. Ultrasound Obstet Gynecol 2013;42:634–43. in Google Scholar

30. Arya, S, Mulla, ZD, Plavsic, SK. Outcomes of women delivering at very advanced maternal age. J Womens Health 2018;27:1378–84. in Google Scholar

31. Kahveci, B, Melekoglu, R, Evruke, IC, Cetin, C. The effect of advanced maternal age on perinatal outcomes in nulliparous singleton pregnancies. BMC Pregnancy Childbirth 2018;18:343. in Google Scholar

32. Radoń-Pokracka, M, Adrianowicz, B, Płonka, M, Danił, P, Nowak, M, Huras, H. Evaluation of pregnancy outcomes at advanced maternal age. Open Access Maced J Med Sci 2019;7:1951. in Google Scholar

33. Schimmel, MS, Bromiker, R, Hammerman, C, Chertman, L, Ioscovich, A, Granovsky-Grisaru, S, et al.. The effects of maternal age and parity on maternal and neonatal outcome. Arch Gynecol Obstet 2015;291:793–8. in Google Scholar

34. Duckitt, K, Harrington, D. Risk factors for pre-eclampsia at antenatal booking: systematic review of controlled studies. BMJ 2005;330:565. in Google Scholar

35. Lamminpää, R, Vehviläinen-Julkunen, K, Gissler, M, Heinonen, S. Preeclampsia complicated by advanced maternal age: a registry-based study on primiparous women in Finland 1997–2008. BMC Pregnancy Childbirth 2012;12:47.10.1186/1471-2393-12-47Search in Google Scholar

36. Bergholt, T, Skjeldestad, FE, Pyykönen, A, Rasmussen, SC, Tapper, AM, Bjarnadóttir, RI, et al.. Maternal age and risk of cesarean section in women with induced labor at term – a Nordic register-based study. Acta Obstet Gynecol Scand 2020;99:283–9. in Google Scholar

37. Quach, D, Ten Eikelder, M, Jozwiak, M, Davies-Tuck, M, Bloemenkamp, K, Mol, B, et al.. Maternal and fetal characteristics for predicting risk of Cesarean section following induction of labor: pooled analysis of PROBAAT trials. Ultrasound Obstet Gynecol 2022;59:83–92. in Google Scholar

38. Bayrampour, H, Heaman, M. Advanced maternal age and the risk of cesarean birth: a systematic review. Birth 2010;37:219–26. in Google Scholar

39. Montoya-Williams, D, Lemas, DJ, Spiryda, L, Patel, K, Neu, J, Carson, TL. What are optimal cesarean section rates in the US and how do we get there? A review of evidence-based recommendations and interventions. J Womens Health 2017;26:1285–91. in Google Scholar

40. Demographic T. Health Survey. Hacettepe University Institute of population studies. 2018. TR Ankara: Ministry of Development, health and TUBITAK. Available from: [Accessed 16 Oct 2021].Search in Google Scholar

41. Favilli, A, Pericoli, S, Acanfora, MM, Bini, V, Di Renzo, GC, Gerli, S. Pregnancy outcome in women aged 40 years or more. J Matern Fetal Neonatal Med 2012;25:1260–3. in Google Scholar

42. Grotegut, CA, Chisholm, CA, Johnson, LN, Brown, HL, Heine, RP, James, AH. Medical and obstetric complications among pregnant women aged 45 and older. PLoS One 2014;9:e96237. in Google Scholar

43. Kim, S-Y, Park, J-Y, Bak, S-E, Jang, Y-R, Wie, J-H, Ko, H-S, et al.. Effect of maternal age on emergency cesarean section. J Matern Fetal Neonatal Med 2020;33:3969–76. in Google Scholar

44. Janoudi, G, Kelly, S, Yasseen, A, Hamam, H, Moretti, F, Walker, M. Factors associated with increased rates of caesarean section in women of advanced maternal age. J Obstet Gynaecol Can 2015;37:517–26. in Google Scholar

45. Mylonas, I, Friese, K. Indications for and risks of elective cesarean section. Dtsch Arztebl Int 2015;112:489. in Google Scholar

46. Igboanugo, S, Chen, A, Mielke, JG. Maternal risk factors for birth asphyxia in low-resource communities. A systematic review of the literature. J Obstet Gynaecol 2020;40:1039–55. in Google Scholar

47. Lee, Y-j, Kim, M-N, Kim, Y-M, Sung, J-H, Choi, S-J, Oh, S-Y, et al.. Perinatal outcome of twin pregnancies according to maternal age. Obstet Gynecol Sci 2019;62:93–102. in Google Scholar

48. Mutz-Dehbalaie, I, Scheier, M, Jerabek-Klestil, S, Brantner, C, Windbichler, GH, Leitner, H, et al.. Perinatal mortality and advanced maternal age. Gynecol Obstet Invest 2014;77:50–7. in Google Scholar

49. McLaren, E. Live Births in England and Wales by Characteristics of Mother: The age and living arrangements of mothers based on birth registration data Office for National Statistics; 2014. Available from: [Accessed 16 Oct 2021].Search in Google Scholar

50. Aoyama, K, Pinto, R, Ray, JG, Hill, AD, Scales, DC, Lapinsky, SE, et al.. Association of maternal age with severe maternal morbidity and mortality in Canada. JAMA Netw Open 2019;2:e199875–e. in Google Scholar

Received: 2021-06-17
Accepted: 2022-04-01
Published Online: 2022-05-13

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