Pregnancy Outcome at Advanced Maternal Age (≥35 Years): A Prospective Cohort Study

Background: Advanced maternal age (AMA), which is defined as becoming pregnant at the age of 35 or older, is becoming more common due to people getting married later in life, pursuing higher education and advances in reproductive technologies. AMA has been associated with heightened risks of maternal and perinatal complications, though findings remain inconsistent across populations.Aim: This study aimed to evaluate the maternal and neonatal outcomes associated with advanced maternal age among pregnant women in Basrah, Iraq.Method: A prospective cohort study was conducted from December 2011 to September 2012, involving 531 pregnant women in their second trimester attending antenatal clinics in four primary health care centers in Basrah. Women aged ≥35 years (n=180) comprised the study group, while those aged 20–29 years (n=351) served as controls. Data were collected through structured interviews and follow-up through the postnatal period. Statistical analysis included chi-square tests, logistic regression, and relative risk calculations.Results: AMA was significantly and independently associated with gestational hypertension (RR=9.86), preeclampsia (RR=5.33), gestational diabetes (RR=15.2), cesarean delivery (RR=1.96 elective; 1.69 emergency), postpartum fever (RR=2.9), postpartum hemorrhage (RR=1.96), low birth weight (RR=2.59), macrosomia (RR=5.44), and NICU admission (RR=2.91). No significant association was found with antepartum hemorrhage, preterm birth, or ICU admission. All births were live, with only one neonatal death recorded.Conclusion: Advanced maternal age significantly increases the risk of several maternal and neonatal complications. However, with appropriate antenatal care, pregnancy at AMA can still result in favorable outcomes, as perinatal mortality was rare.