title: Pregnancy outcomes for nulliparous women of advanced maternal age in South Australia, 1998-2008.
abstract: BACKGROUND
  Child bearing in the later reproductive years has become increasingly common in Australia with potential implications for clinical practice.
  
  
  OBJECTIVE
  To examine pregnancy outcomes for nulliparous women of advanced maternal age with singleton pregnancies.
  
  
  METHODS
  A retrospective population-based cohort study was conducted to compare the pregnancy outcomes for women aged 35-39 years and ≥40 years with women aged 25-29 years, analysing 34 695 records from the South Australian Perinatal Database between 1998 and 2008.
  
  
  RESULTS
  Pre-existing hypertension [relative risks (RR) 1.98 and 2.94 for women aged 35-39 years and ≥40 years, respectively], placenta praevia (RR 2.88 and 3.68), suspected intrauterine growth restriction (RR 1.33 and 1.77) and gestational diabetes (RR 1.97 and 2.53) increased with age. Women of advanced maternal age were more likely to have not laboured prior to birth (RR 2.19 and 3.28), be induced (RR 1.12 and 1.27) and have a breech presentation (RR 1.57 and 1.60). The likelihood of fetal distress increased with advancing maternal age (RR 1.15 and 1.24). Regression analyses revealed women of advanced maternal age were significantly more likely to have small for gestational age infants [adjusted odds ratios (AOR) 1.26 and 1.50], preterm birth (AOR 1.26 and 1.43), elective caesarean [relative risk ratios (RRR) 2.55 and 4.52], emergency caesarean (RRR 1.59 and 2.21) and experience a perinatal death (RRR 1.94 and 2.18).
  
  
  CONCLUSIONS
  The likelihood of pre-existing medical conditions, obstetric complications, adverse labour and birth outcomes and complications increased with advancing maternal age. Advanced maternal age was also independently associated with selected adverse pregnancy and infant outcomes.
authors.affiliation: Office of Public Health, Department for Health and Ageing, 11 Hindmarsh Square, Adelaide, SA 5000, Australia. isobel.ludford@health.sa.gov.au
authors.forename: Isobel
authors.initials: I
authors.lastname: Ludford
authors.forename: Wendy
authors.initials: W
authors.lastname: Scheil
authors.forename: Graeme
authors.initials: G
authors.lastname: Tucker
authors.forename: Rosalie
authors.initials: R
authors.lastname: Grivell
mesh_terms: D000328:Adult; D001946:Breech Presentation / Q000453:epidemiology; D002585:Cesarean Section / Q000706:statistics & numerical data; D016640:Diabetes, Gestational / Q000453:epidemiology; D005260:Female; D005316:Fetal Distress / Q000453:epidemiology; D005317:Fetal Growth Retardation / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D008423:Maternal Age; D010298:Parity; D054238:Perinatal Mortality; D010923:Placenta Previa / Q000453:epidemiology; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D047928:Premature Birth / Q000453:epidemiology; D012189:Retrospective Studies; D013021:South Australia / Q000453:epidemiology