title: Pregnancy and Birth Outcomes Among Primiparae at Very Advanced Maternal Age: At What Price?
abstract: OBJECTIVE
  In light of the potential physical and emotional costs to both woman and child, this study was conducted to assess pregnancy complications and birth outcomes in primiparae at very advanced maternal age (VAMA, aged ≥45) compared to younger primiparae.
  
  
  METHODS
  Retrospective cohort study comparing 222 VAMA primiparae and a reference group of 222 primiparae aged 30-35, delivering at Sheba Medical Center from 2008 through 2013.
  
  
  RESULTS
  VAMA primiparae were more likely than younger primiparae to be single, to have chronic health conditions, and higher rates of gestational diabetes mellitus (GDM), gestational-hypertension (GHTN) and preeclampsia-eclampsia. VAMA primiparae conceived mostly by oocyte donation. They were more likely to be hospitalized during pregnancy, to deliver preterm and by cesarean birth. Infants of VAMA primiparae were at greater risk for low birthweight and Neonatal Intensive Care Unit admission. There were no differences in outcomes between VAMA primiparae with or without preexisting chronic conditions, or between those aged 45-49 and ≥50. In multivariable analysis VAMA was an independent risk factor for GDM, GHTN and preeclamsia-eclampsia, with adjusted odds ratio of 2.38 (95 % CI 1.32, 4.29), 5.80 (95 % CI 2.66, 12.64) and 2.45 (95 % CI 1.03, 5.85); respectively. The effect of age disappeared in multiple pregnancies.
  
  
  CONCLUSIONS
  Primiparity at VAMA holds a significant risk for adverse pregnancy and birth outcomes. The absence of chronic medical conditions or the use of a young oocyte donor does not improve these outcomes. Multiple pregnancies hold additional risk and may diminish the effect of age. Primiparity at an earlier age should be encouraged.
authors.affiliation: Sackler Faculty of Medicine, School of Public Health, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Alon
authors.initials: A
authors.lastname: Ben-David
authors.affiliation: Women and Children's Research Unit, Gertner Institute for Epidemiology and Health Policy Research, Chaim Sheba Medical Center, 52621, Tel Hashomer, Ramat Gan, Israel. saraleeg@gertner.health.gov.il.
authors.forename: Saralee
authors.initials: S
authors.lastname: Glasser
authors.affiliation: The Joseph Buchman Gynecology and Maternity Center, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
authors.forename: Eyal
authors.initials: E
authors.lastname: Schiff
authors.affiliation: The Joseph Buchman Gynecology and Maternity Center, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
authors.forename: Aliza Segev
authors.initials: AS
authors.lastname: Zahav
authors.affiliation: Women and Children's Research Unit, Gertner Institute for Epidemiology and Health Policy Research, Chaim Sheba Medical Center, 52621, Tel Hashomer, Ramat Gan, Israel.
authors.forename: Valentina
authors.initials: V
authors.lastname: Boyko
authors.affiliation: Sackler Faculty of Medicine, School of Public Health, Tel Aviv University, Tel Aviv, Israel.|Women and Children's Research Unit, Gertner Institute for Epidemiology and Health Policy Research, Chaim Sheba Medical Center, 52621, Tel Hashomer, Ramat Gan, Israel.
authors.forename: Liat
authors.initials: L
authors.lastname: Lerner-Geva
mesh_terms: D002585:Cesarean Section / Q000706:statistics & numerical data; D000013:Congenital Abnormalities / Q000453:epidemiology; D016640:Diabetes, Gestational / Q000453:epidemiology; D005260:Female; D006801:Humans; D046110:Hypertension, Pregnancy-Induced / Q000453:epidemiology; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008423:Maternal Age; D008875:Middle Aged; D015999:Multivariate Analysis; D010298:Parity; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011256:Pregnancy Outcome / Q000453:epidemiology*; D047928:Premature Birth / Q000453:epidemiology; D012189:Retrospective Studies; D050497:Stillbirth / Q000453:epidemiology
keywords: Birth outcome; Pregnancy complications; Primiparity; Very advanced maternal age