title: Pregnancy outcome at advanced maternal age in a group of African women in two teaching Hospitals in Yaounde, Cameroon.
abstract: BACKGROUND
  Women older than 40 years have been termed "advanced maternal age" and considered to be at risk of adverse pregnancy outcome. This study aimed to examine the obstetrical outcomes among primiparous and multiparous African advanced maternal age women.
  
  
  METHODS
  We conducted a retrospective cohort study study at two teaching hospitals at Yaounde, Cameroon. From the hospital records, obstetrical characteristics of 585 consecutive women aged 40 or above who delivered from January 2007 to December 2011 were compared with those of 1816 younger mothers aged 20 to 29 years as control cases. Associations between maternal age and selected obstetrical variables were assessed with the contigency X (2) test or two-tailed Fisher exact test.
  
  
  RESULTS
  Primiparous and multiparous advanced maternal age were more likely to undergo cesarean delivery than were their younger counterparts (38.5% vs 13.5%, RR=2.85, p<0.05 and 16.1% vs 9.1%, RR=1.76, p<0.05). Older primiparous women had similar perinatal outcomes than their younger counterparts. Older multiparous women had increased incidence of preeclampsia/eclampsia (2.4% vs 0.6%, RR=4, p<0.01); antepartum hemorrhage (1.8% vs 0.8%, RR=2.25, p<0.01); fetal distress (3.5% vs 1.3%, RR=2.69, p<0.01); fetal death (3.5% vs 1.6%, RR= 2.18, p<0.05); postpartum hemorrhage (2.4% vs 1.2%; RR=2, p<0.05); preterm delivery (12% vs 9.2%, RR=1.30, p<0.05); low birth weight (11% vs 7.7%, RR=1.42, p<0.05); admission to special care neonatalogy unit(14.1% vs 10.2%, RR=1.38, p<0.05); low Apgar scores at 1min and 5min; and perinatal mortality (3.5% vs 1.6, RR=2.18, p<0.05).
  
  
  CONCLUSIONS
  Advanced maternal age women are at higher risk to cesarean delivery. Increased risk of antepartum and intra partum complications among multiparous advanced maternal age women were associated to adverse perinatal outcome. Our results are in concordance with the view that increased risk of adverse perinatal outcome with advanced maternal age is indirectly related to age through the increased risk of obstetrical complications associated with age.
authors.affiliation: Department of Obstetrics and Gynecology, University of Yaounde, Yaounde, Cameroon.
authors.forename: Jean Dupont Kemfang
authors.initials: JD
authors.lastname: Ngowa
authors.forename: Anny-Nadege
authors.initials: AN
authors.lastname: Ngassam
authors.forename: Julius Sama
authors.initials: JS
authors.lastname: Dohbit
authors.forename: Celestine
authors.initials: C
authors.lastname: Nzedjom
authors.forename: Jean Marie
authors.initials: JM
authors.lastname: Kasia
mesh_terms: D000328:Adult; D000367:Age Factors; D002163:Cameroon; D015331:Cohort Studies; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D008423:Maternal Age; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: Advanced maternal age; perinatal outcome; pregancy outcome