Adverse pregnancy outcomes of advanced maternal age pregnant women in Sri Lanka

Introduction: Pregnant women above 35 years are in advanced maternal age (AMA) and those above 40 years in very advanced maternal age (VAMA). These pregnancies have become common in both low- and high-income countries, including Sri Lanka, showing a rising trend with possible adverse outcomes. Objectives: To describe the adverse pregnancy outcomes and associated factors of women in AMA in Sri Lanka Methods: A hospital-based cross-sectional study was conducted among 216 postpartum women aged 35 years and above at their booking visit and delivered by any mode, at Colombo North Teaching Hospital, selected by consecutive sampling method during 2020-2021, using a pretested interviewer-administered questionnaire. Maternal ages above years 35 and above years 40 were categorized as ‘advanced’ and ‘very advanced’ maternal age, respectively. Pregnancy outcomes were assessed under the mode of delivery, maternal outcomes, and new-born outcomes. The significance of adverse pregnancy outcomes and associated factors in VAMA was evaluated with multivariate analysis with p-value of 0. 05. Results: Response rate was 100%. The mean age of primiparous and multiparous women, who participated was 37.8 (SD=2.4) and 24.5% were >40 years. Nearly 40% of the participants had pre-existing chronic non-communicable diseases and of that, 23.6% were diabetes mellitus. The majority were planned pregnancies (77.8%) and 52.8.1% had antenatal complications. More than half (57.4%) had undergone caesarean section. Adverse new-born (37%) and maternal (8.3%) outcomes were reported. By multivariate analysis, Age over 40 years (adjusted odds ratio (aOR)=6.2; 95% CI: 2.9, 21.6; p=0.003), non-Sinhalese (aOR=4.0; 95% CI: 2.0, 16.2; p=0.036), lower segment caesarean section (LSCS) in previous pregnancy (aOR=12.5; 95% CI: 5.3, 29.6; p=0.000), antenatal complications (aOR=7.6; 95% CI: 1.8, 32.3; p=0.006), period of gestation (POG) at delivery (aOR=5.0; 95% CI: 1.9, 13.3; p=0.001) and educated above G.C.E. Ordinary Level (aOR=6.3; 95% CI: 2.3, 36.5; p=0.031) were significantly associated with adverse pregnancy outcomes in AMA. Conclusions & Recommendations: VAMA pregnancies are common in the study population. A high prevalence of non-communicable diseases was observed among the AMA population. The experience of adverse pregnancy outcomes is substantial being pregnant after 40 years. Effective strategies should be implemented to promote well-planned pregnancies in early reproductive ages of women and among AMA women.