Maternal and Neonatal Outcomes Among Women of Advanced Maternal Age: A Retrospective Cohort Study at a Tertiary Hospital

Objectives This study aimed to characterise the sociodemographic profile of women aged ≥ 35 years (advanced maternal age [AMA]) delivering at Sultan Qaboos University Hospital and to compare obstetric and neonatal outcomes with mothers aged < 35 years over a one‐year period. Methods A retrospective cohort of 452 singleton deliveries from January to December 2023 was analysed. Participants were classified as AMA ( n = 226) and non‐AMA ( n = 226). Pregnancies with preexisting chronic hypertension or diabetes, systemic lupus erythematosus, in vitro fertilisation or multiple gestations were excluded. Data were retrieved from electronic medical records. Categorical variables were compared using chi‐squared or Fisher’s exact tests and continuous variables with t ‐tests. Statistical significance was defined as p < 0.05 (two‐tailed). Prespecified outcomes included antenatal complications (e.g., gestational diabetes), intrapartum events (mode of delivery, preterm birth), postpartum haemorrhage, foetal growth restriction and neonatal measures (birth weight, Apgar scores at 1 and 5 min). Results Compared with non‐AMA mothers, AMA was associated with higher rates of gestational diabetes (50.9% vs. 38.5%; p = 0.011), preterm birth (40.7% vs. 27.9%; p = 0.005), postpartum haemorrhage (8.4% vs. 2.7%; p = 0.012) and caesarean delivery ( p < 0.001). Foetal growth restriction occurred less often in AMA than in non‐AMA (5.8% vs. 9.3%; p = 0.211). Neonatal outcomes, including mean birth weight and Apgar scores, were broadly comparable between groups, with no statistically significant differences observed. Conclusion In this tertiary‐care cohort, AMA was associated with increased risks of gestational diabetes, preterm birth, postpartum haemorrhage and caesarean delivery, whereas neonatal outcomes did not differ materially by age group. These findings support vigilant antenatal surveillance, optimisation of modifiable risk factors and individualised intrapartum planning for AMA pregnancies. The results add region‐specific evidence from Oman and may inform counselling regarding risks and monitoring strategies for women planning pregnancy at AMA.