Key Findings

• Increased Adverse Outcomes: The study indicates important adverse effects of extremely advanced maternal age on pregnancy outcomes, including higher rates of miscarriage, perinatal death, preterm birth (approximately 40%), low birth weight, and fetal growth restriction.
• Advanced Maternal Age Demographics: Women aged 45 years or older represented only 0.2% (99.8th percentile) of the study cohort, highlighting variations in fertility cessation age compared to some previous reports.
• Elevated Risk of Trisomy: The prevalence of trisomy or non-disjunction was notably high, reaching 9.1%.
• Autonomous Impact of Aging: Even when excluding cases with underlying diseases, adverse outcomes remained considerably elevated compared to the control group, underscoring the direct impact of aging on pregnancy outcomes.

Underlying Factors

While pre-existing medical conditions common in older women, such as chronic hypertension and pre-gestational diabetes, contribute to poor pregnancy outcomes, aging itself plays a significant role. The study suggests that aging itself can also be responsible for such poor outcomes, as seen in cases without any underlying diseases.

These adverse outcomes may stem from the body’s reduced ability to adapt to the physiological changes induced by pregnancy.

Uterine vasculature in women of advanced age had less capability to adapt to increased hemodynamic requirement.

De Weger et al.

Additionally, vascular issues can exacerbate these risks.

Women of advanced age had a high prevalence of sclerotic lesions in myometrial arteries, wich can certainly cause abnormal placentation, which can lead to several adverse pregnancy outcomes, such as preterm birth, miscarriage, or perinatal death, despite exclusion of cases elaborate with underlying medical diseases.

Hsieh et al.

Comparison with Previous Studies

Interestingly, the study found a higher magnitude of risk for most adverse outcomes compared to several previous studies. For instance, preterm birth rates in women of extremely advanced age were shown to have a relative risk ranging from 1.2 to 2.1 in earlier research, while this study recorded values exceeding 3.0.

Specifically, preterm birth, fetal growth restriction, and low birth weight were prevalent in approximately 40% of cases in this cohort, significantly higher than the 18.7% reported in a study by Laskov et al.

Increased Prevalence of pregnancy-Related Conditions

The study also confirmed that conditions like preeclampsia and gestational diabetes are significantly more prevalent in women of extremely advanced age, aligning with findings from numerous prior studies.

Recommendations

Given these findings, the study emphasizes the importance of preconception counseling and early prenatal care for women of advanced maternal age. A multidisciplinary approach is crucial to minimize the risk of adverse obstetric outcomes.

The study recommends that future research should report the percentile of age to facilitate better comparisons across different populations and studies.