European Journal of Cardiovascular Medicine

The child bearing age is 15-44 years in Indian women. It is important because it constitutes 22.2 percent of total population. Along with that it is also a vulnerable and high risk group in view maternal morbidity and mortality¹.Maternal age has always been an important factor for conception and pregnancy. Delayed child bearing, for different reasons, appears to be well established. Women who find themselves at upper end of reproductive age confront a short “window” for childbearing. However in recent years, most nations have seen a decrease in number of young women giving birth, which has been driven by increased educational attainment ,family planning methods and behavioral changes^2,3.As per a  study conducted in India ,Women over the age of 40 had a 2.4 times higher chance of miscarriage than women aged less than 35 year^4.Studies have reported a higher incidence of preterm birth, intrauterine growth restriction, fetal malformation, and neonatal deaths among children born to older mothers^5,6. Further, women having a pregnancy at older ages are at higher risk of pregnancy complications, including maternal mortality and severe morbidities⁷.Assisted reproductive technique has been proved as an opportunity for pregnancy even at advanced maternal age, however, outcome may vary in patients conceived via ART and patients who conceived spontaneously.⁸In this study efforts are made to evaluate maternal and perinatal outcome in elderly gravida patients.

This is a retrospective observational study including 500 patients over a period of 1 year i.e., 2021-2022.

All participants were divided into 2 groups:

Cases: Patients who aged 35 or above at the time of study. The number of patients is 250.

Controls: Patients between age >18 years and <35 years at the time of study.The number of patients are 250.

Inclusion Criteria: 1) Patients who aged 35 or above and married at the time of study.The number of patients are 250.

2) Patients between age >18 years and <35 years and married at the time of study.The number of patients are 250.

Exclusion Criteria:1) Married women who have underwent permanent sterilization.

2) Patients with major systemic disorders.

Patients are admitted from routine OPD as well as on emergency basis and history regarding age, parity, period of gestation, menstrual history, surgical history, history of any complication in present as well as past history is noted followed by routine investigations as CBC, Blood group and Rh typing, thyroid profile and random and fasting blood sugar levels. Patients are also screened for HIV, HBV, HCV and VDRL. Urine routine and microscopy is also done.

Blood pressure and weight of patients are also taken. Also the mode of delivery and Neonatal NICU Admissions are also noted.

Table 1: Tabulation for parity among cases and controls:

In this study, a total of 170 primigravida patients are included. Out of 170, 70 patients are elderly primigravidae i.e., 28% cases are elderly primigravida and 100 i.e., 40% patients are primigravidae of <18 but >35 years.

In multigravida group, 180 patients i.e., 72% patients from case group and 150 patients i.e., 60% patients belonged to multigravida patients between the age >18 years &<35 years.

Table 2: Pre-existing medical conditions:

Above table signifies the preexisting medical conditions among the case and control group patients. Out of 250 cases,20 patients i.e.,8% patients had preexisting hypertension while 4 patients from control population had preexisting HTN.The incidence of thyroid disorders, obesity and diabetes mellitus is found to be 32%,10% and 4.8% respectively in cases group while 12%,2.4% and 1.2% in control group respectively.

Table 3: Gestational age at the time of admission:

On the basis of gestational age, 13.6% elderly gravida patients reported or admitted at less than or at 20 weeks of gestation while 26.4% elderly gravida patient admitted at 20-28 weeks of gestation.24.4% elderly gravida patients admitted at 28-34 weeks of gestation and 14.4 % elderly gravida patients admitted between 34 weeks to term period of gestation.21.2% elderly gravida patients admitted in post term period of gestation. The period of gestation for non elderly gravida patients admission at 20 or less weeks,20-28 weeks,28-34 weeks,34 weeks-term and post term are 10%,15.2%,18%,39.6% & 17.2% respectively .

Table 4: Comparison of associated co-morbidities between cases and controls:

Along the spectrum of hypertensive disorders of pregnancy, the percentage of gestational hypertension, preeclampsia, eclampsia and chronic hypertension is found to be 19%,48%,8% & 12% in case group followed by 8%,34%,6% &5% in control group respectively.

The incidence of diabetes, GDM is 18% & 12% in cases followed by 5% & 4% in control population respectively.

The incidence of preterm labor was 35% in cases while the controls have an incidence of 9% of preterm labor.in case of post datism it is found to be 20% &15% respectively.

The incidence of abruption placenta is 4% higher in cases in comparison to controls but the incidence of placenta previa was found to be same in both groups approximately.

The incidence of primary infertility is also higher in elderly gravida patients than controls. Therefore, conception via ovulation induction or ART are also found to be higher in elderly gravida patients, thus leading to higher incidence of multiple gestation in elderly gravida patients in comparison to non elderly gravida patients.

Table 5:. Mode of onset of labor:

As per above data, the incidence of spontaneous onset of labor is found higher in controls than the case group but the percentage of induction of labor and LSCS is found higher in elderly gravida patients.

Table 6: Perinatal outcome:

The incidence of growth restricted fetus and prematurity are found significantly higher in elderly gravida patients in comparison to non elderly gravida patients. The incidence of still birth is 25% in elderly gravida patients while 12% in control population.

In this study, 500 patients are included. These patients are divided into 2 groups of cases and controls. 250 patients are elderly gravida who are assigned  to cases category while 250 patients of age group 18-<35 years are assigned to control group and are studied on the basis of parity, preexisting medical conditions, period of gestation at time of admission, comorbidities, mode of onset of labor and perinatal prognosis.

As per a study done by Dixit PV et al (2017)⁹, the incidence of preexisting disorders were found to be 10% for thyroid disorders, 3.33% for preexisting HTN and 6.67% for preexisting diabetes mellitus while in this study this incidences are found to be 32%,8% & 4.8% respectively. Also, the incidence of preexisting obesity is found to be 10% in elderly gravida patients.

In a study conducted by Basa A et al (2021)¹⁰, some women had developed more than one maternal complication. 42 % had preeclampsia, 28 % of them had gestational diabetes, 20 % were IUGR, 24 % were antepartum haemorrhage, 18 % had multiple pregnancies, 17 % were observed with postpartum haemorrhage, 16 % had anaemia, another 10 % with preterm labour, 12 % had malpresentations. In this study, the incidence of GHTN is found to be 20%, pre-eclampsia is 48%, eclampsia developed in 8% of cases and chronic HTN is seen in 12% of elderly gravida patients. The incidence of diabetes and GDM are found to be 18% & 12%.The incidence of preterm labour found to be 35% and that of post datism is found to be 20%.The incidence of primary infertility was is also found to be on higher side I.e., 52% and thereby higher incidence of multiple pregnancies in elderly gravida patients in this study.

As per a study done by Rajput N et al (2018)¹¹, Incidence of abortions 28(9.72%), preterm delivery 18(6.25%), oligohydramnios 18(6.25%), APH 18(6.25%) and PROM 17(5.90%), low birth weight baby 30(13.19%), NICU admission 20 (6.94%), IUGR 11(3.81%) while in this study  the percentage of growth restricted fetus are significantly high followed by preterm deliveries, stillbirths and meconium aspiration syndromes.

As the pregnancy with advancing age can be a cause for high risk there can be certain factors which needs to be considered for prevention of complications as proper preconceptional counselling regarding decrease in fertility and potential risk of fetal congenital and chromosomal anomalies should be explained. Therapeutic dose of folic acid along with screening of various congenital anomalies should be explained to patient. After conception, patient can be considered for low dose aspirin for prevention of hypertensive disorders of pregnancy. Also presence of pre-existing medical conditions should be taken in consideration and should be taken care of Patient should be counselled for delivery at higher or highest referral points, so that potential maternal as well as fetal complications should be managed with utmost care. Very small steps can give best possible results in elderly gravida patients.

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