Maternal and perinatal outcomes in women aged 50 years and older: A nationwide cross-sectional study

Aim

This study aimed to investigate maternal and perinatal outcomes in pregnancies among women aged50–54 and 55–59, to refine risk assessments and inform evidence-based counseling and perinatal management guidelines.

Methods

A nationwide registry maintained by the Japan Society of Obstetrics and Gynecology identified pregnancies between January 2013 and December 2022. Analyses included women aged 45–59 years with assisted reproductive technology pregnancies, excluding triplet or higher-order multiple gestations. Participants were categorized into three groups: 45–49, 50–54, and 55–59 years. Outcomes included cesarean section, instrumental delivery, preeclampsia, gestational diabetes mellitus, placenta previa, placenta accreta, placental abruption, postpartum hemorrhage, hysterectomy, maternal mortality, preterm birth, small for gestational age, low 5-min Apgar scores, and perinatal death. Logistic regression analyses estimated the impact of maternal age on these outcomes, adjusting for maternal baseline characteristics.

Results

A total of 4272 participants were included: 3877 in the 45–49 years, 350 in the 50–54 years, and 45 in the 55–59 years. Compared to the 45–49 years, women aged 50–54 had significantly higher risks of cesarean section, preeclampsia, gestational diabetes mellitus, placenta previa, placenta accreta, and preterm birth, while the instrumental delivery rate was lower. In particular, placenta previa increased significantly with advancing maternal age. However, the small sample size in the 55–59 years limited the ability to draw definitive conclusions.

Conclusion

Women aged 50–54 years experience significantly higher risks of adverse pregnancy outcomes compared to those aged 45–49 years. The small sample size in the 55–59-year age group limits the ability to draw definitive conclusions.