Impact of advanced maternal age on obstetric and neonatal outcomes: an Indian cohort analysis

Abstract

Background: To describe clinical profile, labour characteristics, maternal and neonatal outcomes of advanced maternal age pregnancies. Methods: This retrospective observational study evaluated maternal, labour, and neonatal outcomes among women of advanced maternal age (AMA), with comparisons across normal maternal age, very advanced maternal age (VAMA), and extremely advanced maternal age (EAMA) groups. Demographic characteristics, mode of conception, comorbidities, labour profile, and neonatal outcomes were analysed. Results: A total of 99,467 mothers delivered during the study period (January 2013 and December 2023), with majority belonging to normal age group (91.40%). AMA accounted for 6.77%, VAMA was 0.73%, EAMA was 0.07% and teenage pregnancy accounted for 1.03%. Proportion of AMA increased significantly over time, rising from 5.79% in 2013 to 14.83% in 2023. Most AMA pregnancies were singleton (94.45%), with a mean BMI of 28.05 ± 4.99 kg/m²; 1.23% were morbidly obese. Although spontaneous conception predominated (83.15%), assisted reproduction especially IVF (12.07%) was significantly more frequent. AMA mothers had a higher comorbidity burden, with multi-system disease in 39.33%. Caesarean delivery was common with 68.03%, with higher preterm birth rates (21.13%). Neonates showed more growth abnormalities (SGA 16.28%, LGA 12.55%) and higher NICU admissions (17.43%), live birth rates remained high (98.30%). Risk severity increased progressively in VAMA and EAMA groups. Conclusions: AMA is associated with increased maternal comorbidity, caesarean delivery, preterm birth, and neonatal morbidity. These risks escalate further with increasing maternal age, underscoring the need for targeted antenatal surveillance, individualized risk stratification, multidisciplinary care, specialized intrapartum and neonatal care pathways