The outcome of pregnancy in elderly primigravidas

OBJECTIVE: To investigate the effect of advancing age of 35 years and more (elderly primigravida) on the outcome of pregnancy in nulliparous women and to compare the type of complications observed in this group of women to those in the age of 20-34 years.

METHODS: This was a retrospective analysis of 2517 primigravidas delivered at King Fahd Hospital of the University, Al-Khobar, Kingdom of Saudi Arabia between 1996-2000. All were consecutive patients. The data were collected from the records of the labor room and the medical records were screened for maternal age, antenatal complications, gestational age, birth-weight of the neonate, sex of the neonate and the Apgar score.

RESULTS: Three-hundred and sixty-two nulliparous were below the age of 19 years; hence, excluded from the study group. Between age of 20-34 years (Group A) there were 1950 patients with the mean age of 24.79 years (range 20-34) and in women over the age of 35 years (Group B) there were 205 patients with the mean age of 38.72 years (range 35-48 years). Group B had significantly less number of normal deliveries 59.9 compared to group A 81% with p value of <0.001. Diabetes mellitus was common in group B as compared to group A and was statistically significant at p value <0.001. The gestational age in group B was 36.06 weeks and in group A it was 38.84 weeks (p value was markedly significant at <0.001). Women in group B had more deliveries by cesarean section (CS) 23.8% as in group A 12.6%, a significant p value <0.001. The Apgar score at 1 and 5 minutes was significant at p value <0.001 and <0.004. The birth-weight in group B was less compared to group A, p value of <0.002.

CONCLUSION: Childbearing in elderly primigravidas does have higher rates of complications due to diseases such as diabetes mellitus and preeclamptic toxemia. They are liable to have more deliveries by CS than by other methods, in spite of lower gestational age and birth weight. The overall outcome however does not appear grim, as was once believed. This study suggests that women in the age group of >35 years should be informed of their pregnancy expectations and outcomes.