1. Inonu University, Turgut Ozal Medical Centre
The effect of advanced maternal age on perinatal outcomes in nulliparous singleton pregnancies
Bekir Kahveci
Rauf Melekoglu
Ismail Cuneyt Evruke
Cihan Cetin
Good afternoon my name is Rauf Melekoglu I have been working as assistant professor in Inonu University School of Medicine Department of Obstetrics and Gynecology. Today I want to present our study titled ‘The effect of advanced maternal age on perinatal outcomes in nulliparous singleton pregnancies’.
Before starting my presentation I want to thank scientific committee to give us the oppurtunity to present our study.
Inonu University, Turgut Ozal Medical Centre

2. Advanced Maternal Age and Pregnancy Outcomes
Advanced maternal age is defined as being 35 years or older at delivery, very advanced maternal age is used to describe women older than 40 or 45 years.
Pregnancies at the advanced maternal age have been gradually rising in both developed and developing countries over the last decades.
Widespread use of family planning, deferring pregnancy for the industrial or academic career plan and advances in assisted reproductive techniques contribute this increment
Therefore, concerns about the adverse effect of advanced maternal age on perinatal outcomes have also increased steadily over the past years.

3. Advanced Maternal Age and Pregnancy Outcomes
The association between adverse perinatal outcomes and advanced maternal age has controversially discussed in several studies.
While several studies have noted an increased rate of adverse pregnancy outcomes in women older than 35 years, others have failed to find any association between advanced maternal age and adverse perinatal outcomes
The discordance in the studies could be attributed to the heterogeneity of the study population, differences in the definition of pregnancy outcomes and failure of adjustment for potential confounders

4. Advanced Maternal Age and Pregnancy Outcomes
Objective
To determine the impact of advanced maternal age on perinatal and neonatal outcomes of nulliparous singleton pregnants.
Material and Methods
471 pregnant aged 18-34
Demographic characteristics and perinatal outcomes
Admitted for the routine mid-trimester fetal ultrasound scan
A total of 957 singleton pregnancies
The records of patients admitted to the Department of Obstetrics and Gynecology, University of Cukurova School of Medicine, between January 1, 2011, and July 1, 2015, for the routine mid-trimester fetal ultrasound scan were retrospectively reviewed.
399 pregnant aged between 35-39
87 pregnant aged 40 or more

5. Advanced Maternal Age and Pregnancy Outcomes
Inclusion criteria
Maternal age between 18-45;
Singleton viable pregnancy;
Nulliparity;
Admission at weeks of gestation for mid-trimester fetal ultrasound scan;
Unremarkable obstetric history
Exclusion criteria
Any concomitant chronic disease (diabetes, hypertension, chronic renal disease);
Body mass index >35 kg/m2;
A history of IUI and IVF/ICSI);
A history of uterine surgery;
Any known Mullerian anomaly;
Multiple pregnancies;
Any fatal congenital anomalies or chromosomal abnormalities
Patients who met the following criteria were enrolled

6. Advanced Maternal Age and Pregnancy Outcomes
Results
Control Group AdvancedAge Very Advanced Age
(18≤ - ≤ 35) (35 - <40) (≥40)
n= n= n=87
Age ±4.2a ±1.4b ±2.0c
BMI ±4.1a ±5.8a ±4.6a
Consanguinity (5.5)a (4.7)a (3.4)a
CVS & AS (5.1)a (6.5)a (26.4)b
Education
P school (2.5) a (4.7) a (6.9)a
H school (17.2)a (19.1) a (19.6)a
Graduated (80.3) a (76.2)a (88.5)a
The demographic characteristics of the study population are presented in Table. There was a significant difference regarding age among the groups. The invasive prenatal diagnostic procedures were more performed in patients aged 40 or older. There was no significant difference in patient's body mass index, consanguinity between the spouse, and educational status between the groups.

7. Advanced Maternal Age and Pregnancy Outcomes
The frequency of pregnancy outcomes according to the maternal age group is described in this Table
Gestational diabetes, gestational hypertension, and cesarean delivery rates were more common in the very advanced maternal age group compared with the advanced maternal age and the younger age group. While the frequency of preeclampsia and small for gestational age were similar in patients aged years and 40 years or older, the risk of preeclampsia and SGA were significantly greater than patients aged younger than 35 years.
There was no significant difference regarding spontaneous preterm delivery before 34 weeks of gestation, prolonged rupture of membranes, ablatio placenta, placenta previa, large for gestational age and operative vaginal delivery rates between the groups

8. Advanced Maternal Age and Pregnancy Outcomes
The low birth weight, first and the fifth minute APGAR score of the neonates were found similar between the groups. The neonatal intensive care unit requirement was higher in the advanced and very advanced maternal age group compared with the younger age group, the neonatal morbidity rate was similar among the groups.

9. Advanced Maternal Age and Pregnancy Outcomes
Odds ratios for the risk of maternal and neonatal outcomes at advanced and very advanced maternal age groups compared with <35 years group are shown in the Table.
In the logistic regression analysis perinatal outcomes including gestational diabetes, gestational hypertension, spontaneous late preterm delivery between 34 and 37 weeks of gestation, SGA and cesarean delivery rate increased by maternal age, with the largest increase seen in gestational diabetes and cesarean delivery rate in ≥40 years group (OR 2.41; 95% CI 2.13– 3.76 and OR 2.67; 95%CI ).

10. Conclusion Advanced Maternal Age and Pregnancy Outcomes Thank you
This study demonstrated that advanced maternal age is a risk factor for gestational diabetes, gestational hypertension, pre-eclampsia, SGA, spontaneous late preterm delivery between 34 and 37 weeks of gestation and cesarean section.
The interpretation of these findings to the clinical practice might have significant implications on maternal and perinatal outcomes of advanced age pregnants.
The modification of follow-up protocols according to these increasing obstetric risk factors could improve pregnancy outcomes of this patient group.
Thank u for your attention
Thank you