title: Pregnancy beyond the age of 40 - the influence of parity on perinatal outcome.
abstract: OBJECTIVE
  The aim of the study was to compare the pregnancy course and neonatal outcome in women at least 40 years old during conception.
  
  
  METHODS
  Data were collected on the basis of medical records of patients who gave birth between 2009-2014 at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw. Women enrolled were at least 40 years old at the moment of conception and delivered after 22 completed weeks of gestation - they were also assigned into 2 groups: primiparas and multiparas. Demographic features, pregnancy and delivery complications, mode of delivery and neonatal outcome were analyzed and compared.
  
  
  RESULTS
  9760 women delivered at the Department during the study period, among them 193 met the inclusion criteria for the study: 40 primiparas (average age 40.9 ± 1.14) and 153 multiparas (average age 41.3 ± 1.35). No relation between parity and preterm delivery was observed (5% primiparas vs 11.1% multiparas; p>0.05). However, gestational age at delivery was associated with the number of pregnancies - the higher the pregnancy number, the lower the gestational age (p=0.009; R=-0.188). Primiparity was associated with an increased rate of oligohydramnios (RR=4.78; 95% CI 1.15-20.63) and pregnancy induced hypertension (RR=2.34; 95% CI 0.93-5.58). Primiparas had a significantly greater risk of operative delivery (RR=1.83; 95% CI 1.42-2.12) and unsuccessful labor inductions (RR=3.60; 95% CI 1.04-5.29). They were more often diagnosed with fibroids (RR=3.04; 95%CI 1.15-7.81). No relations between parity and birth weight, fetal abnormalities or Apgar score were observed.
  
  
  CONCLUSIONS
  Delayed childbearing of a first child seems to increase the risk of perinatal complications, which is important for counseling purposes.
authors.affiliation: Students' Research Group at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Wielgos
authors.affiliation: 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland.
authors.forename: Iwona
authors.initials: I
authors.lastname: Szymusik
authors.affiliation: Students' Research Group at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland.
authors.forename: Pawel
authors.initials: P
authors.lastname: Bartnik
authors.affiliation: Students' Research Group at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland.
authors.forename: Joanna
authors.initials: J
authors.lastname: Kacperczyk
authors.affiliation: 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Kosinska-Kaczynska
authors.affiliation: 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Poland.
authors.forename: Bronislawa
authors.initials: B
authors.lastname: Pietrzak
mesh_terms: D000328:Adult; D000367:Age Factors; D005260:Female; D020073:Gravidity / Q000502:physiology*; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology*; D007744:Obstetric Labor Complications / Q000453:epidemiology*; D016104:Oligohydramnios / Q000453:epidemiology*; D010298:Parity / Q000502:physiology*; D011044:Poland / Q000453:epidemiology; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*