Advanced Maternal Age at the First Pregnancy and Obstetric Performance

ABSTRACT

Maternal Age of 35 years or more at first pregnancy and childbirth is considered advanced reproductive age and a high pregnancy risk associated with increased adverse maternal and perinatal outcomes. The industrialized and developing countries are replete with supporting scientific literatures but only a few data on nulliparous women in our setting hence our interest to appraise the correlates of advanced maternal age at first childbirth and obstetric performance in Nigerian women. The objectives were to determine the influence of advanced maternal age at first pregnancy on the obstetric and perinatal outcomes. To compare the obstetric performance of women advanced in maternal age at first delivery with their younger counterparts and to determine the trend of identifiable adverse outcomes with increasing maternal age at first delivery. This was a retrospective comparative study of 1684 nulliparous women that had their childbirth between 2009 and 2013 at a mission Hospital. Those aged 35 years and above were the study subjects while those aged 20 - 34 years the control. Relevant database was raised from the case files. The prevalence of elderly nullipara in this study was 1.6%. They were statistically significant different in primary level of education (OR = 4.1, P = 0.02), prenatal care lack (OR = 2.6, P = 0.02), caesarean section (OR = 2.5, P = 0.0006), incidental myomectomy (OR = 19.1, P < 0.0001), prolonged pregnancy (OR = 0.6, P = 0.04) and episiotomy at vaginal delivery (OR = 0.5, P = 0.01). They were also insignificantly worse in ante partum hemorrhage (APH), induction of labor, perineal tear, HIV infection, postpartum hemorrhage (PPH), preterm birth, Low birth weight (LBW), Intrauterine growth restriction (IUGR), stillbirth ,neonatal birth asphyxia and Perinatal mortality. Caesarean section rate, caesarean myomectomy, APH, induction of labor, stillbirth rate, LBW and Perinatal mortality each maintained a statistical significant linear tendency (P < 0.05) with maternal age. First pregnancy at advanced maternal age is fraught with increased maternal morbidity, perinatal morbidity and mortality. We proffer early education, marriage or and childbearing, quality prenatal care and skilled attendance at delivery for safe motherhood.