The Obstetric outcomes associated with advanced maternal age at the University Teaching Hospitals Women and Newborn Hospital in Lusaka, Zambia

Abstract

Introduction: Pregnant women aged 35 years and above have traditionally been termed as of advanced maternal age. These women are considered to have a higher incidence of obstetric complications than younger ones

Objectives: To investigate socio-demographic characteristics and obstetric outcomes in women of advanced age who delivered at the Women and Newborn Hospital, in Lusaka, Zambia.

Methods: This was a cross-sectional study in which a total of 226 postnatal women, both of advanced (35 years and above) and optimal age (20 - 34 years), that met the eligibility criteria were recruited. Systematic random sampling was used to recruit study participants and data was collected using a structured questionnaire, review of patient's hospital records, and the labour ward delivery registers. Statistical analysis was performed using a statistical package for social sciences (SPSS) version 26 software.

Results: The prevalence of advanced maternal age was 14.1%. The mean ages were 38years (range 35 - 46 years) and 28 years in advanced and optimal maternal age groups respectively. Socio­ demographic characteristics that were found to be significantly associated with advanced maternal age included; education (P=0.036), occupation (P= 0.015), the cultural belief of large families (P=0.003), and contraception use (P= 0.001). There were more married women among advanced age women 105 (92.9%) than among optimal age women 99 (87.2%), however, there was no significant difference between the two groups (P=0.262). Divorce (P=0.689), income (P=0.701), and history of subfertility P=0.291) were also not found to be different between the two groups. With regards to maternal outcomes, advanced maternal age was significantly associated with severe pre­ eclampsia (AOR 2.131; 95% CI 1.190 - 3.816; P=0.011), postpartum haemorrhage (AOR 1.400; 95% CI 0.187 - 0.855; P=0.018), caesarean deliveries (AOR 1.395; 95% CI 1.115 - 4.719; P=0.028) and antepartum haemorrhage (AOR 2.425; 95% CI 1.029 - 5.714; P=0.043). On foetal outcomes, advanced maternal age was significantly associated with NICU admissions (AOR 3.075; 95% CI 1.298 - 7.287; P=0.011). However, there was no association with APGAR score at 5 minutes (P=0.174), birth weight (P=l.000), gestation age at birth (P=0.676), and PROM (P=0.557)

Conclusion: Generally, women of advanced maternal age were associated with more adverse obstetric outcomes than women of optimal childbearing age. Hence, there is a need to sensitise these women and their spouses on the risk of advanced maternal age on obstetric outcomes and the need for not postponing conception until the late 3rd decade of life.