Analysis of the influence of advanced maternal age on gestational and fetal outcomes

Abstract Objective: Advanced maternal age has become more common due to factors such as increased academic preparation for women, labor market participation, delayed family planning, and advances in reproductive medicine. This phenomenon raises questions about the risks and gestational outcomes associated with advanced maternal age (AMA). This study aims to explore the gestational and perinatal outcomes in pregnant women with AMA (> 35 years), comparing them with those of women aged 20 to 34 years. Methods: The research was conducted as an observational and retrospective analysis, examining data from 2012 to 2022 from the Hospital Production System (SIH/SUS) available on the DATAsus platform, covering all regions of Brazil. Variables analyzed included gestational duration, type of pregnancy (single or multiple), mode of delivery, Robson group, APGAR score at five minutes, birth weight, and occurrence of congenital anomalies. Results: Pregnant women with AMA showed statistically significant differences in the higher percentage of cesarean sections (63.3% AMA vs 58% non-AMA, p<0.05), higher percentage of low birth weight newborns (12.5% AMA vs 6.7% non-AMA, p<0.05), lower APGAR scores at the fifth minute (OR = 1.08, p<0.001) and a higher prevalence of any congenital anomalies (1.23% AMA vs 0.77% non-AMA, OR =OR = 1.34, p < 0.001). In addition, this group had a higher incidence of premature births (12.99% AMA vs 8.78% non-AMA) and multiple pregnancies (1.39% AMA vs 0.83% non-AMA). Furthermore, in the Robson classification, there was a predominance of older mothers in Group 5 (previous cesarean section) and in the groups with nulliparity. Conclusion: Pregnant women with AMA face higher gestational and perinatal risks, such as preterm births and an increased need for cesarean sections. These findings underscore the importance of public policies and personalized management strategies to improve maternal and neonatal outcomes for older pregnant women.