Research Article
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Pregnancy outcomes and risks in over 40; a retrospective analysis from Turkey’s highest birth rate region

Year 2025, Volume: 64 Issue: 2, 330 - 336, 10.06.2025

Elif Uçar , Melih Bestel

https://doi.org/10.19161/etd.1622248

Abstract

Aim: Pregnancies at advanced maternal age pose significant global health concerns, particularly in regions with high birth rates. This study evaluates the pregnancy outcomes, associated risks, and strategies to improve maternal and neonatal health among women aged 40 and above in Siverek, Şanlıurfa, Turkey—an area with the highest crude birth rate in the country.
Materials and Methods: The short-term pregnancy outcomes of 107 women aged 40 years and older, who delivered at a second level state hospital's obstetrics and gynecology clinic between 2020 and 2021, were retrospectively analyzed.
Results: The study revealed a high average gravida (6.4 ± 2.3) and parity (5.2 ± 2.2) among participants, reflecting the region's high fertility rates. Normal spontaneous vaginal delivery occurred in 69 (64.5%) cases, while 38 (35.5%) women underwent cesarean delivery, with prior cesarean section being the leading indication (31.6%). The mean gestational age was 38.7 ± 1.6 weeks, and the average birth weight was 3282 ± 488 grams. Neonatal outcomes were favorable, with mean Apgar scores of 7.7 ± 1.2 (at the first minute) and 8.8 ± 1.2 (at the fifth minute). However, 2 (1.9%) mothers required blood transfusions, and 5 (4.7%) neonates experienced asphyxia-related complications.
Conclusions: Pregnancies in women over 40 are associated with higher obstetric and neonatal risks, requiring meticulous monitoring and individualized care strategies. These findings emphasize the need for targeted interventions to enhance maternal and neonatal outcomes in regions with high fertility rates and limited healthcare resources.

Keywords

Multipar Pregnant Women Blood Transfusion Apgar Score Advanced Maternal Age

Ethical Statement

Ethics Committee Approval: This study was approved by the Ethics Committee of Istanbul Esenyurt University (protocol no: 05.03.2024 /2024-02 ).

Supporting Institution

Ethics Committee Approval: This study was approved by the Ethics Committee of Istanbul Esenyurt University (protocol no: 05.03.2024 /2024-02 ).

References

  • Saccone G, Gragnano E, Ilardi B, et al. Maternal and perinatal complications according to maternal age: A systematic review and meta-analysis. Int J Gynaecol Obstet. 2022;159(1):43-55 DOI: 10.1002/ijgo.14100
  • Smithson SD, Greene NH, Esakoff TF. Pregnancy outcomes in very advanced maternal age women. Am J Obstet Gynecol MFM. 2022;4(1):100491. DOI: 10.1016/j.ajogmf.2021.100491
  • Zhang M, Wang Y, Qi X. Effect of Very Advanced Maternal Age on Pregnant Women and Fetuses. J Coll Physicians Surg Pak. 2021;31(5):542-45. DOI: 10.29271/jcpsp.2021.05.542.
  • Correa-de-Araujo R, Yoon SSS. Clinical Outcomes in High-Risk Pregnancies Due to Advanced Maternal Age. J Womens Health (Larchmt). 2021;30(2):160-67. Doi: 10.1089/jwh.2020.8860.
  • Vollset SE, Goren E, Yuan CW, et al. Fertility, mortality, migration, and population scenarios for 195 countries and territories from 2017 to 2100: a forecasting analysis for the Global Burden of Disease Study. Lancet. 2020;396(10258):1285-306. Doi: 10.1016/S0140-6736(20)30677-2.
  • Keskin F, Çavlin A. Cohort fertility heterogeneity during the fertility decline period in Turkey. J Biosoc Sci. 2023;55(4):779-94. Doi: 10.1017/S0021932022000268.
  • Tuik.gov.tr [ https://data.tuik.gov.tr/Bulten/Index?p=Birth-Statistics-2022-49673&dil=2 ] Turkey: Turkish Statistical Institute. Birth Statistics 2022. [ Release date:15 May 2023 ; Number 49673] Available from : https://data.tuik.gov.tr
  • Yogev Y, Melamed N, Bardin R, Tenenbaum-Gavish K, Ben-Shitrit G, Ben-Haroush A. Pregnancy outcome at extremely advanced maternal age. Am J Obstet Gynecol. 2010 ;203(6):558.e1-7. Doi: 10.1016/j.ajog.2010.07.039.
  • Frick AP. Advanced maternal age and adverse pregnancy outcomes. Best Pract Res Clin Obstet Gynaecol. 2021;70:92-100. Doi: 10.1016/j.bpobgyn.2020.07.005.
  • Lu L, He L, Hu J, Li J. Association between very advanced maternal age women with gestational diabetes mellitus and the risks of adverse infant outcomes: a cohort study from the NVSS 2014-2019. BMC Pregnancy Childbirth. 2023;23(1):158. Doi: 10.1186/s12884-023-05449-0.
  • Deng L, Ning B, Yang H. Association between gestational diabetes mellitus and adverse obstetric outcomes among women with advanced maternal age: A retrospective cohort study. Medicine (Baltimore). 2022;101(40):e30588. Doi: 10.1097/MD.0000000000030588.
  • Montori MG, Martínez AA, Álvarez CL, Cuchí NA, Alcalá PM, Ruiz-Martinez S. Advanced maternal age and adverse pregnancy outcomes: A cohort study. Taiwan J Obstet Gynecol. 2021;60(1):119-24. Doi: 10.1016/j.tjog.2020.11.018.
  • Carr RC, McKinney DN, Cherry AL, Defranco EA. Maternal age-specific drivers of severe maternal morbidity. Am J Obstet Gynecol MFM. 2022;4(2):100529. Doi: 10.1016/j.ajogmf.2021.100529.
  • Zhou Y, Yin S, Sheng Q, et al. Association of maternal age with adverse pregnancy outcomes: A prospective multicenter cohort study in China. J Glob Health. 2023;1(13):04161. Doi: 10.7189/jogh.13.04161.
  • Ratiu D, Sauter F, Gilman E, et al. Impact of Advanced Maternal Age on Maternal and Neonatal Outcomes. In Vivo. 2023;37(4):1694-702. Doi: 10.21873/invivo.13256.
  • Maloney SI, Abresch C, Grimm B, Lyons K, Tibbits M. Factors associated with giving birth at advanced maternal age in the United States. Midwifery. 2021;98:102975. Doi: 10.1016/j.midw.2021.102975.
  • Osterman MJK, Hamilton BE, Martin JA, Driscoll AK, Valenzuela CP. Births: Final Data for 2021. Natl Vital Stat Rep. 2023;72(1):1-53.
  • Luby JL, England SK, Barch DM, et al. Social disadvantage during pregnancy: effects on gestational age and birthweight. J Perinatol. 2023;43(4):477-83. Doi: 10.1038/s41372-023-01643-2.
  • Mehari MA, Maeruf H, Robles CC, et al. Advanced maternal age pregnancy and its adverse obstetrical and perinatal outcomes in Ayder comprehensive specialized hospital, Northern Ethiopia, 2017: a comparative cross-sectional study. BMC Pregnancy Childbirth. 2020;20(1):60. Doi: 10.1186/s12884-020-2740-6.
  • Toker, S. Dünyada ve Türkiye’de Kadınlarda Cinsel Sağlık ve Üreme Sağlığı Sorunları: Güncel Veriler. ERÜ Sağlık Bilimleri Fakültesi Dergisi, 2023;10(2): 31-8.
  • Soysal G, Özcan C, Akın A. Dünyada ve Türkiye’de kadın, anne ve çocuk sağlığının güncel durumu. Sağlık ve Toplum 2022;32(1), 3-13.
  • Akarsu R, Şahiner L. (2020). Çok İleri Maternal Yaş Gebelik Sonuçlarının Değerlendirilmesi. ACU Sağlık Bil Derg 2020; 11(3):522-25 . https://doi.org/10.31067/0.2020.302
  • Gündüz S, Aslan Çetin B, Yalçın Bahat P, Atış Aydın A, Köroğlu N. Çok İleri Anne Yaşının Perinatal ve Neonatal Sonuçlara Etkisi. J Clin Obstet Gynecol. 2016;26(4):220-25. DOI: 10.5336/gynobstet.2016-53202
  • Abu-Heija AT, Jallad MF, Abukteish F. Maternal and perinatal outcome of pregnancies after the age of 45. J Obstet Gynaecol Res. 2000;26(1):27-30. Doi: 10.1111/j.1447-0756.2000.tb01196.x.
  • Shechter Y, Levy A, Wiznitzer A, Zlotnik A, Sheiner E. Obstetric complications in grand and great grand multiparous women. J Matern Fetal Neonatal Med. 2010;23(10):1211-7. Doi: 10.3109/14767051003615459.
  • Tezcan M, Kan Davaları, Sosyal Antropolojik Yaklaşım, Ankara Üniversitesi Eğitim Fakültesi Yayınları, 1981.
  • Ecker JL, Chen KT, Cohen AP, Riley LE, Lieberman ES. Increased risk of cesarean delivery with advancing maternal age: indications and associated factors in nulliparous women. Am J Obstet Gynecol. 2001;185(4):883-87. Doi: 10.1067/mob.2001.117364.
  • Hsieh TT, Liou JD, Hsu JJ, Lo LM, Chen SF, Hung TH. Advanced maternal age and adverse perinatal outcomes in an Asian population. Eur J Obstet Gynecol Reprod Biol. 2010;148(1):21-6. Doi: 10.1016/j.ejogrb.2009.08.022.
  • Wang Y, Tanbo T, Abyholm T, Henriksen T. The impact of advanced maternal age and parity on obstetric and perinatal outcomes in singleton gestations. Arch Gynecol Obstet 1. 2011;284(1):31-7. Doi: 10.1007/s00404-010-1587-x.
  • Cnattingius S, Forman MR, Berendes HW, Isotalo L. Delayed childbearing and risk of adverse perinatal outcome. A population-based study. JAMA. 1992;268(7):886-90.
  • Şekeroğlu M, Baksu A, İnce Z, Gültekin H, Göker N, Özsoy S. Adolesan ve ileri yaş gebeliklerde obstetrik sonuçlar. Şişli Etfal Hastanesi Tıp Bülteni, 2009; 43(1): 1-7
  • Kulhan M, Kulhan NG, Naykı Ü, Naykı C, Uluğ P, Ata N. Erzincan’daki ileri anne yaşı gebeliklerinin retrospektif analizi. Van Tıp Dergisi, 2017;24(4), 272-78.
  • Alsharif A, Almatary AM, Ahmed F, Badheeb M. Perinatal Birth Asphyxia Among Newborns at Jiblah Public Health Hospital in Ibb City, Yemen, During Six Years of Conflict and Its Predictive Factors: A Retrospective Cross-Sectional Study. Cureus 2024 Feb 12;16(2):e54100. doi: 10.7759/cureus.54100
  • Tyas BD, Lestari P, Akbar MIA. Maternal Perinatal Outcomes Related to Advanced Maternal Age in Preeclampsia Pregnant Women. J Family Reprod Health . 2019;13(4):191-200
  • Gündoğdu M. Perinatal Asfiksi Ve Hipoksik İskemik Ensefalopati Tanısıyla İzlenen Olguların Retrospektif İncelenmesi. Van,Yüzüncü Yıl Üniversitesi ,Tıp Fakültesi , Tıpta Uzmanlık Tezi. 2010.
  • Awoyesuku PA, John DH, Josiah AE, Sapira-Ordu L. Maternal, Obstetric, and Foetal Risk Factors for Perinatal Asphyxia: Prevalence and Outcome at a Tertiary Hospital in Port Harcourt, Nigeria. Nigerian Journal of Medicine 2022;31(3):285-92. DOI: 10.4103/NJM.NJM_197_21

40 yaş üstü kadınlarda gebelik sonuçları ve riskler; Türkiye'nin en yüksek doğum oranına sahip bölgesinin retrospektif analizi

Year 2025, Volume: 64 Issue: 2, 330 - 336, 10.06.2025

Elif Uçar , Melih Bestel

https://doi.org/10.19161/etd.1622248

Abstract

Amaç: İleri anne yaşı gebelikleri, özellikle yüksek doğum oranlarının görüldüğü bölgelerde önemli küresel sağlık sorunları oluşturmaktadır. Bu çalışma, Türkiye'nin en yüksek kaba doğum oranına sahip Siverek, Şanlıurfa'da 40 yaş ve üzeri kadınlar arasında gebelik sonuçlarını, ilgili riskleri ve anne ve yenidoğan sağlığını iyileştirmek için potansiyel stratejileri değerlendirmektedir.
Materyal ve Yöntemler: 2020-2021 yılları arasında kırsal bir devlet hastanesinin kadın doğum kliniğinde doğum yapan 40 yaş ve üzeri 107 kadının kısa dönem gebelik sonuçları retrospektif olarak analiz edilmiştir.
Bulgular: Çalışma, katılımcılar arasında yüksek ortalama gravida (6,4 ± 2,3) ve parite (5,2 ± 2,2) oranlarını ortaya koyarak bölgedeki yüksek doğurganlık oranlarını yansıtmıştır. Olguların 69'unda (%64,5) normal spontan vajinal doğum gerçekleşirken, 38'inde (%35,5) sezaryen doğum yapılmış, sezaryen endikasyonlarının başında önceki sezaryen öyküsü (%31,6) gelmiştir. Ortalama gebelik süresi 38,7 ± 1,6 hafta, ortalama doğum ağırlığı ise 3282 ± 488 gram olarak tespit edilmiştir. Yenidoğan sonuçları genellikle olumlu olup, ortalama Apgar skorları 1. dakikada 7,7 ± 1,2 ve 5. dakikada 8,8 ± 1,2 olarak kaydedilmiştir. Ancak 2 anne (%1,9) kan transfüzyonuna ihtiyaç duymuş ve 5 yenidoğan (%4,7) asfiksiye bağlı komplikasyonlar yaşamıştır.
Sonuç: 40 yaş üstü kadınlarda gebelikler, daha yüksek obstetrik ve neonatal risklerle ilişkilidir ve dikkatli izlem ile bireyselleştirilmiş bakım stratejileri gerektirir. Bu bulgular, yüksek doğurganlık oranlarına ve sınırlı sağlık hizmeti kaynaklarına sahip bölgelerde anne ve yenidoğan sonuçlarını iyileştirmek için hedefe yönelik müdahalelerin önemini vurgulamaktadır.

Keywords

Multipar Gebe Kan Transfüzyonu Apgar Skoru İleri Anne Yaşı

References

  • Saccone G, Gragnano E, Ilardi B, et al. Maternal and perinatal complications according to maternal age: A systematic review and meta-analysis. Int J Gynaecol Obstet. 2022;159(1):43-55 DOI: 10.1002/ijgo.14100
  • Smithson SD, Greene NH, Esakoff TF. Pregnancy outcomes in very advanced maternal age women. Am J Obstet Gynecol MFM. 2022;4(1):100491. DOI: 10.1016/j.ajogmf.2021.100491
  • Zhang M, Wang Y, Qi X. Effect of Very Advanced Maternal Age on Pregnant Women and Fetuses. J Coll Physicians Surg Pak. 2021;31(5):542-45. DOI: 10.29271/jcpsp.2021.05.542.
  • Correa-de-Araujo R, Yoon SSS. Clinical Outcomes in High-Risk Pregnancies Due to Advanced Maternal Age. J Womens Health (Larchmt). 2021;30(2):160-67. Doi: 10.1089/jwh.2020.8860.
  • Vollset SE, Goren E, Yuan CW, et al. Fertility, mortality, migration, and population scenarios for 195 countries and territories from 2017 to 2100: a forecasting analysis for the Global Burden of Disease Study. Lancet. 2020;396(10258):1285-306. Doi: 10.1016/S0140-6736(20)30677-2.
  • Keskin F, Çavlin A. Cohort fertility heterogeneity during the fertility decline period in Turkey. J Biosoc Sci. 2023;55(4):779-94. Doi: 10.1017/S0021932022000268.
  • Tuik.gov.tr [ https://data.tuik.gov.tr/Bulten/Index?p=Birth-Statistics-2022-49673&dil=2 ] Turkey: Turkish Statistical Institute. Birth Statistics 2022. [ Release date:15 May 2023 ; Number 49673] Available from : https://data.tuik.gov.tr
  • Yogev Y, Melamed N, Bardin R, Tenenbaum-Gavish K, Ben-Shitrit G, Ben-Haroush A. Pregnancy outcome at extremely advanced maternal age. Am J Obstet Gynecol. 2010 ;203(6):558.e1-7. Doi: 10.1016/j.ajog.2010.07.039.
  • Frick AP. Advanced maternal age and adverse pregnancy outcomes. Best Pract Res Clin Obstet Gynaecol. 2021;70:92-100. Doi: 10.1016/j.bpobgyn.2020.07.005.
  • Lu L, He L, Hu J, Li J. Association between very advanced maternal age women with gestational diabetes mellitus and the risks of adverse infant outcomes: a cohort study from the NVSS 2014-2019. BMC Pregnancy Childbirth. 2023;23(1):158. Doi: 10.1186/s12884-023-05449-0.
  • Deng L, Ning B, Yang H. Association between gestational diabetes mellitus and adverse obstetric outcomes among women with advanced maternal age: A retrospective cohort study. Medicine (Baltimore). 2022;101(40):e30588. Doi: 10.1097/MD.0000000000030588.
  • Montori MG, Martínez AA, Álvarez CL, Cuchí NA, Alcalá PM, Ruiz-Martinez S. Advanced maternal age and adverse pregnancy outcomes: A cohort study. Taiwan J Obstet Gynecol. 2021;60(1):119-24. Doi: 10.1016/j.tjog.2020.11.018.
  • Carr RC, McKinney DN, Cherry AL, Defranco EA. Maternal age-specific drivers of severe maternal morbidity. Am J Obstet Gynecol MFM. 2022;4(2):100529. Doi: 10.1016/j.ajogmf.2021.100529.
  • Zhou Y, Yin S, Sheng Q, et al. Association of maternal age with adverse pregnancy outcomes: A prospective multicenter cohort study in China. J Glob Health. 2023;1(13):04161. Doi: 10.7189/jogh.13.04161.
  • Ratiu D, Sauter F, Gilman E, et al. Impact of Advanced Maternal Age on Maternal and Neonatal Outcomes. In Vivo. 2023;37(4):1694-702. Doi: 10.21873/invivo.13256.
  • Maloney SI, Abresch C, Grimm B, Lyons K, Tibbits M. Factors associated with giving birth at advanced maternal age in the United States. Midwifery. 2021;98:102975. Doi: 10.1016/j.midw.2021.102975.
  • Osterman MJK, Hamilton BE, Martin JA, Driscoll AK, Valenzuela CP. Births: Final Data for 2021. Natl Vital Stat Rep. 2023;72(1):1-53.
  • Luby JL, England SK, Barch DM, et al. Social disadvantage during pregnancy: effects on gestational age and birthweight. J Perinatol. 2023;43(4):477-83. Doi: 10.1038/s41372-023-01643-2.
  • Mehari MA, Maeruf H, Robles CC, et al. Advanced maternal age pregnancy and its adverse obstetrical and perinatal outcomes in Ayder comprehensive specialized hospital, Northern Ethiopia, 2017: a comparative cross-sectional study. BMC Pregnancy Childbirth. 2020;20(1):60. Doi: 10.1186/s12884-020-2740-6.
  • Toker, S. Dünyada ve Türkiye’de Kadınlarda Cinsel Sağlık ve Üreme Sağlığı Sorunları: Güncel Veriler. ERÜ Sağlık Bilimleri Fakültesi Dergisi, 2023;10(2): 31-8.
  • Soysal G, Özcan C, Akın A. Dünyada ve Türkiye’de kadın, anne ve çocuk sağlığının güncel durumu. Sağlık ve Toplum 2022;32(1), 3-13.
  • Akarsu R, Şahiner L. (2020). Çok İleri Maternal Yaş Gebelik Sonuçlarının Değerlendirilmesi. ACU Sağlık Bil Derg 2020; 11(3):522-25 . https://doi.org/10.31067/0.2020.302
  • Gündüz S, Aslan Çetin B, Yalçın Bahat P, Atış Aydın A, Köroğlu N. Çok İleri Anne Yaşının Perinatal ve Neonatal Sonuçlara Etkisi. J Clin Obstet Gynecol. 2016;26(4):220-25. DOI: 10.5336/gynobstet.2016-53202
  • Abu-Heija AT, Jallad MF, Abukteish F. Maternal and perinatal outcome of pregnancies after the age of 45. J Obstet Gynaecol Res. 2000;26(1):27-30. Doi: 10.1111/j.1447-0756.2000.tb01196.x.
  • Shechter Y, Levy A, Wiznitzer A, Zlotnik A, Sheiner E. Obstetric complications in grand and great grand multiparous women. J Matern Fetal Neonatal Med. 2010;23(10):1211-7. Doi: 10.3109/14767051003615459.
  • Tezcan M, Kan Davaları, Sosyal Antropolojik Yaklaşım, Ankara Üniversitesi Eğitim Fakültesi Yayınları, 1981.
  • Ecker JL, Chen KT, Cohen AP, Riley LE, Lieberman ES. Increased risk of cesarean delivery with advancing maternal age: indications and associated factors in nulliparous women. Am J Obstet Gynecol. 2001;185(4):883-87. Doi: 10.1067/mob.2001.117364.
  • Hsieh TT, Liou JD, Hsu JJ, Lo LM, Chen SF, Hung TH. Advanced maternal age and adverse perinatal outcomes in an Asian population. Eur J Obstet Gynecol Reprod Biol. 2010;148(1):21-6. Doi: 10.1016/j.ejogrb.2009.08.022.
  • Wang Y, Tanbo T, Abyholm T, Henriksen T. The impact of advanced maternal age and parity on obstetric and perinatal outcomes in singleton gestations. Arch Gynecol Obstet 1. 2011;284(1):31-7. Doi: 10.1007/s00404-010-1587-x.
  • Cnattingius S, Forman MR, Berendes HW, Isotalo L. Delayed childbearing and risk of adverse perinatal outcome. A population-based study. JAMA. 1992;268(7):886-90.
  • Şekeroğlu M, Baksu A, İnce Z, Gültekin H, Göker N, Özsoy S. Adolesan ve ileri yaş gebeliklerde obstetrik sonuçlar. Şişli Etfal Hastanesi Tıp Bülteni, 2009; 43(1): 1-7
  • Kulhan M, Kulhan NG, Naykı Ü, Naykı C, Uluğ P, Ata N. Erzincan’daki ileri anne yaşı gebeliklerinin retrospektif analizi. Van Tıp Dergisi, 2017;24(4), 272-78.
  • Alsharif A, Almatary AM, Ahmed F, Badheeb M. Perinatal Birth Asphyxia Among Newborns at Jiblah Public Health Hospital in Ibb City, Yemen, During Six Years of Conflict and Its Predictive Factors: A Retrospective Cross-Sectional Study. Cureus 2024 Feb 12;16(2):e54100. doi: 10.7759/cureus.54100
  • Tyas BD, Lestari P, Akbar MIA. Maternal Perinatal Outcomes Related to Advanced Maternal Age in Preeclampsia Pregnant Women. J Family Reprod Health . 2019;13(4):191-200
  • Gündoğdu M. Perinatal Asfiksi Ve Hipoksik İskemik Ensefalopati Tanısıyla İzlenen Olguların Retrospektif İncelenmesi. Van,Yüzüncü Yıl Üniversitesi ,Tıp Fakültesi , Tıpta Uzmanlık Tezi. 2010.
  • Awoyesuku PA, John DH, Josiah AE, Sapira-Ordu L. Maternal, Obstetric, and Foetal Risk Factors for Perinatal Asphyxia: Prevalence and Outcome at a Tertiary Hospital in Port Harcourt, Nigeria. Nigerian Journal of Medicine 2022;31(3):285-92. DOI: 10.4103/NJM.NJM_197_21
There are 36 citations in total.

Details

Primary Language English
Subjects Obstetrics and Gynaecology
Journal Section Research Articles
Authors

Elif Uçar 0000-0001-5302-4688

Melih Bestel 0000-0001-6677-2087

Publication Date June 10, 2025
Submission Date January 17, 2025
Acceptance Date March 10, 2025
Published in Issue Year 2025Volume: 64 Issue: 2

Cite

Vancouver Uçar E, Bestel M. Pregnancy outcomes and risks in over 40; a retrospective analysis from Turkey’s highest birth rate region. EJM. 2025;64(2):330-6.
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