A retrospective study of 21,442 Singaporean women who gave birth at the National University Hospital, Singapore, between January 1986 and November 1991 is used to assess the effects of increasing age on obstetric performance. The results show that reproduction after the age of 35 years in Singapore is associated with a higher incidence of antenatal complications such as hypertension and diabetes and a higher rate of obstetric intervention. However, given the current level of obstetric and neonatal care in Singapore, these adverse features do not prejudice the obstetric and neonatal outcomes.
PIP: Physicians compared data on 2410 women, 35 years old and older, with 19,032 women younger than 35 years old, all of whom delivered at the National University Hospital in Singapore between January, 1986, and November, 1991, to examine the effects of advanced maternal age on pregnancy outcome. Older women were more likely to suffer from pregnancy-induced hypertension and diabetes mellitus than the younger women (odds ratio [OR] = 2.32 and 2.92 for primiparity; OR = 2.17 and 2.22 for multiparity, respectively; p .05 for all but diabetes among primiparae). Breech delivery occurred more frequently among the older mothers than younger, but it was significant only for primiparae (OR = 1.46; p .05). Intervention during delivery was more common among older mothers than younger mothers and among primiparae than multiparae. On the other hand, perinatal outcomes of neonatal death and stillbirths were essentially the same for primiparae and multiparae (OR = 0.76 and 0.78; respectively). When the researchers controlled for race and parity, the odds of pregnancy-induced hypertension and diabetes increased for every 5-year increase in age (OR = 1.46 and 1.81, respectively). The same was true for induced labor (OR = 1.22), elective cesarean section (OR = 1.96), and instrumental delivery (OR = 1.48). The odds did not increase, however, for premature birth and low birth weight. Since Singapore has quality obstetric and neonatal care facilities, and the older mothers tend to be of a higher socioeconomic class than younger mothers, the increased risk of pregnancy complications does not adversely affect obstetric outcome.