# Fetomaternal Outcome Among Antenatal Attendees With Advanced Maternal Age: A Cohort Study

## TL;DR

This study finds that women over 40 who are pregnant face higher risks of complications like preterm birth and gestational diabetes, suggesting the need for closer monitoring.

## Contribution

The study provides new regional data from Oman on the impact of advanced maternal age on pregnancy outcomes.

## Key findings

- Women aged ≥40 had significantly higher rates of gestational diabetes, hypertensive disorders, and preterm deliveries.
- AMA was an independent predictor of adverse outcomes like cesarean delivery, miscarriage, and NICU admissions.
- Spontaneous vaginal deliveries were less common among AMA women compared to younger controls.

## Abstract

Background

Advanced maternal age (AMA) has become increasingly prevalent as women postpone childbearing due to social, cultural, and economic reasons. Previous studies have linked AMA to a higher risk of adverse maternal and fetal outcomes, but regional data from Oman remain limited.

Objective

This study aimed to evaluate the association between AMA and pregnancy outcomes in women attending antenatal visits at Musannah Polyclinic and AR-Rustaq General Hospital.

Methodology

This observational comparative cohort study was conducted at Musannah Polyclinic, Sultanate of Oman, over 12 months beginning in July 2024. A total of 646 pregnant women were enrolled, comprising 323 women aged ≥40 years (AMA group) and 323 women <35 years (control group). Participants were recruited using non-probability convenience sampling. Data collection included demographic variables, maternal comorbidities, pregnancy complications, and fetal outcomes. Laboratory and imaging assessments were performed according to Ministry of Health protocols. Statistical analysis was conducted using SPSS version 26, with t-tests and chi-square tests applied for group comparisons, and logistic regression performed to identify independent predictors of adverse outcomes.

Results

The mean age in the AMA group was 42.8 ± 2.1 years versus 28.6 ± 3.5 years in controls (p < 0.001). AMA women had significantly lower spontaneous vaginal delivery rates (52/323; 16.1% vs. 149/323; 46.1%, p < 0.001) and higher preterm delivery rates (14/323; 4.3% vs. 5/323; 1.5%, p = 0.03). Gestational diabetes was significantly higher in AMA women (156/323; 48.3% vs. 47/323; 14.6%, p < 0.001), as were hypertensive disorders (38/323; 11.8% vs. 9/323; 2.8%, p < 0.001) and thyroid disorders (38/323; 11.8% vs. 11/323; 3.4%, p < 0.001). Fetal complications were also increased, including miscarriage (17/323; 5.3% vs. 4/323; 1.2%, p = 0.004) and NICU admissions (11/323; 3.4% vs. 3/323; 0.9%, p = 0.04). Logistic regression confirmed AMA as an independent predictor of gestational diabetes, hypertensive disorders, cesarean delivery, miscarriage, NICU admission, and thyroid disorders.

Conclusion

AMA is strongly associated with adverse maternal and fetal outcomes, underscoring the need for targeted antenatal monitoring, early screening, and specialized counseling in this high-risk group.