The Influence of Maternal Age on Pregnancy Outcome in Nulliparous Women with Twin Gestation

ABSTRACT

We sought to determine if outcomes of nulliparous twin pregnancies differ based on maternal age. Nulliparous women with current twin pregnancies were identified from a database of women enrolled for outpatient nursing surveillance. Data were stratified into four groups by maternal age: less than 20, 20 to 34, 35 to 39, and greater than or equal to 40 years. Maternal and neonatal outcomes for women less than 20, 35 to 39, and 40 or more were compared with 20- to 34-year-old controls using Kruskal-Wallis, Mann-Whitney, and Pearson chi-square analyses. We analyzed 2144 nulliparous twin pregnancies. Patients ≥35 years (34 to 39, 78.5% or ≥40, 85.9%) were more likely to have cesarean deliveries compared with controls 20 to 34 years old (71.2%). Women aged 35 to 39 were less likely to deliver at <37 weeks, and women in the ≥40 group were less likely to deliver at <35 weeks due to spontaneous preterm labor compared with the controls. Neonates born to women aged 35 to 39 had a greater gestational age at delivery and larger average birth weight than controls. Maternal and neonatal outcomes were not adversely influenced by advanced maternal age in nulliparous women carrying twin gestations.

Twin pregnancy - advanced maternal age - pregnancy outcomes

REFERENCES

• 1 Cleary-Goldman J, Malone F D, Vidaver J FASTER Consortium et al. Impact of maternal age on obstetric outcome.  Obstet Gynecol. 2005;  105 (5 Pt 1) 983-990
• 2 Delbaere I, Verstraelen H, Goetgeluk S, Martens G, De Backer G, Temmerman M. Pregnancy outcome in primiparae of advanced maternal age.  Eur J Obstet Gynecol Reprod Biol. 2007;  135 41-46
• 3 Gilbert W M, Nesbitt T S, Danielsen B. Childbearing beyond age 40: pregnancy outcome in 24,032 cases.  Obstet Gynecol. 1999;  93 9-14
• 4 Hansen J P. Older maternal age and pregnancy outcome: a review of the literature.  Obstet Gynecol Surv. 1986;  41 726-742
• 5 Joseph K S, Allen A C, Dodds L, Turner L A, Scott H, Liston R. The perinatal effects of delayed childbearing.  Obstet Gynecol. 2005;  105 1410-1418
• 6 Seoud M A, Nassar A H, Usta I M, Melhem Z, Kazma A, Khalil A M. Impact of advanced maternal age on pregnancy outcome.  Am J Perinatol. 2002;  19 1-8
• 7 van Katwijk C, Peeters L L. Clinical aspects of pregnancy after the age of 35 years: a review of the literature.  Hum Reprod Update. 1998;  4 185-194
• 8 Jacobsson B, Ladfors L, Milsom I. Advanced maternal age and adverse perinatal outcome.  Obstet Gynecol. 2004;  104 727-733
• 9 Martin J A, Hamilton B E, Sutton P D Centers for Disease Control and Prevention National Center for Health Statistics National Vital Statistics System et al. Births: final data for 2005.  Natl Vital Stat Rep. 2007;  56 1-103
• 10 Oleszczuk J J, Keith D M, Keith L G, Rayburn W F. Projections of population-based twinning rates through the year 2100.  J Reprod Med. 1999;  44 913-921
• 11 Blondel B, Kaminski M. Trends in the occurrence, determinants, and consequences of multiple births.  Semin Perinatol. 2002;  26 239-249
• 12 Blickstein I, Goldman R D, Mazkereth R. Maternal age and birth weight characteristics of twins born to nulliparous mothers: a population study.  Twin Res. 2001;  4 1-3
• 13 Zhang J, Meikle S, Grainger D A, Trumble A. Multifetal pregnancy in older women and perinatal outcomes.  Fertil Steril. 2002;  78 562-568
• 14 Branum A M, Schoendorf K C. The influence of maternal age on very preterm birth of twins: differential effects by parity.  Paediatr Perinat Epidemiol. 2005;  19 399-404
• 15 Delbaere I, Verstraelen H, Goetgeluk S et al.. Perinatal outcome of twin pregnancies in women of advanced age.  Hum Reprod. 2008;  23 2145-2150
• 16 Fox N S, Rebarber A, Dunham S M, Saltzman D H. Outcomes of multiple gestations with advanced maternal age.  J Matern Fetal Neonatal Med. 2009;  22 593-596
• 17 Prapas N, Kalogiannidis I, Prapas I, Xiromeritis P, Karagiannidis A, Makedos G. Twin gestation in older women: antepartum, intrapartum complications, and perinatal outcomes.  Arch Gynecol Obstet. 2006;  273 293-297
• 18 Blickstein I, Goldman R D, Mazkereth R. Incidence and birth weight characteristics of twins born to mothers aged 40 years or more compared with 35-39 years old mothers: a population study.  J Perinat Med. 2001;  29 128-132
• 19 Suzuki S. Obstetric outcomes in nulliparous women aged 35 and over with dichorionic twin pregnancy.  Arch Gynecol Obstet. 2007;  276 573-575