# Maternal and perinatal outcomes in adolescents and women with advanced maternal age

## TL;DR

This study examines how maternal age affects pregnancy outcomes in Brazil, finding that adolescents and older mothers face distinct risks and care challenges.

## Contribution

The study provides empirical evidence on maternal and perinatal outcomes associated with adolescent and advanced maternal age in Brazil.

## Key findings

- Adolescents had higher perinatal death risk and lower gestational diabetes prevalence compared to adult women.
- Women with advanced maternal age faced higher risks of gestational hypertension, diabetes, and severe maternal morbidity.
- Newborns of older mothers had higher Apgar scores <7 but lower congenital syphilis rates.

## Abstract

To analyze the association between age extremes and maternal and perinatal outcomes in births in the state of Rio de Janeiro, Brazil.

Data from the Birth in Brazil II: National Survey on Abortion, Delivery, and Birth (2021–2023) were used. A total of 1,734 postpartum women were included, with live or stillborn newborns, interviewed in the immediate postpartum period. Information was obtained from interviews, clinical records, and prenatal cards. Multiple logistic regression was carried out to evaluate associations between maternal age and outcomes, having women aged 20–34 years as reference.

Delivery in adolescents represented 10.1% of the participants, while women with advanced maternal age (AMA ≥ 35 years) corresponded to 18.0%. Adolescents were less likely to receive guidance as to reference maternity hospital (odds ratio — OR = 0.68) and to have a companion at all times (OR = 0.77), in addition to presenting lower prevalence of gestational diabetes (OR = 0.26). In turn, women with advanced maternal age were more often guided on reference maternity hospitals (OR = 1.46) and presented a higher risk of gestational hypertension (OR = 1.78), gestational diabetes (OR = 1.87), placental abruption (OR = 3.30), and severe maternal morbidity (OR = 1.84). In perinatal outcomes, adolescents had a higher risk of perinatal death (OR = 4.52) and spontaneous early-term delivery (OR = 1.47); however, there was a lower probability of early-term delivery by obstetric intervention (OR = 0.48). Newborns of women with advanced maternal age presented higher risk of 5-minute Apgar index < 7 (OR = 3.05) and lower chance of congenital syphilis (OR = 0.34).

Adolescents were provided worse care compared to adults, while women with advanced maternal age presented a higher frequency of age-related complications. These results highlight the need for special care, particularly considering the increase in deliveries in women with advanced age.

Analisar a associação entre extremos etários e desfechos maternos e perinatais em nascimentos ocorridos no estado do Rio de Janeiro, Brasil.

Este estudo utilizou dados do projeto Nascer no Brasil II: Pesquisa Nacional Sobre Aborto, Parto e Nascimento (2021–2023). Foram incluídas 1.734 puérperas com recém-nascidos vivos ou natimortos, entrevistadas no pós-parto imediato. Informações foram obtidas por meio de entrevistas, prontuários clínicos e cartões de pré-natal. A análise empregou regressão logística múltipla para avaliar associações entre idade materna e desfechos, tendo como referência mulheres de 20–34 anos.

Parto em adolescentes representou 10,1% das participantes, enquanto mulheres com idade materna avançada (IMA ≥ 35 anos) corresponderam a 18,0%. As adolescentes tiveram menor probabilidade de receber orientação para maternidade de referência (odds ratio — OR = 0,68) e de contar com acompanhante constante (OR = 0,77) e apresentaram menor prevalência de diabetes gestacional (OR = 0,26). Já mulheres com idade materna avançada foram mais frequentemente orientadas para maternidades de referência (OR = 1,46) e apresentaram maior risco de síndromes hipertensivas (OR = 1,78), diabetes gestacional (OR = 1,87), descolamento prematuro de placenta (OR = 3,30) e morbidade materna grave (OR = 1,84). Nos desfechos perinatais, adolescentes tiveram maior risco de óbito perinatal (OR = 4,52) e parto espontâneo a termo precoce (OR = 1,47), contudo menor probabilidade de termo precoce por intervenção obstétrica (OR = 0,48). Recém-nascidos de mulheres com idade materna avançada apresentaram maior risco de Apgar < 7 no quinto minuto (OR = 3,05) e menor chance de sífilis congênita (OR = 0,34).

Adolescentes receberam pior assistência em relação às adultas, enquanto as mulheres com idade materna avançada apresentam maior frequência de complicações relacionadas à idade. Esses resultados destacam a necessidade de atenção diferenciada, especialmente diante do aumento de partos em mulheres com idade avançada.