PREGNANCY OUTCOMES AMONG WOMEN OF ADVANCED MATERNAL AGE WHO DELIVER IN MULAGO HOSPITAL

Abstract

Introduction Advanced maternal age has been traditionally defined as 35years and above. Advanced maternal age represents a significant and growing fraction of pregnant women in Africa. The women become pregnant at advanced age due to concept of large family size, desire for specific sex and sometimes due to lack of knowledge of availability of effective contraception. Advanced maternal age is associated with increased incidence of preeclampsia/eclampsia, antepartum hemorrhage, diabetes mellitus, postpartum hemorrhage ,preterm delivery, maternal mortality, admission to special care neonatology unit, low birth weight low Apgar scores at 1min and 5min, fetal distress and fetal death perinatal mortality. Currently there paucity of literature in Uganda on pregnancy outcome among women of advanced maternal age and no guidelines exist regarding preconception, antenatal and postnatal management of the group. Objective: To determine the association between advanced maternal age and adverse pregnancy outcomes among women who deliver in Mulago Kawempe hospital. Methods: Comparative cross sectional study was conducted in the postnatal ward and high dependency unit Mulago Kawempe hospital. 392 women were enrolled. A ratio of 1:2 (≥35years: 18-34 years) recruited by consecutive and systematic sampling respectively. Pregnancy outcome was recorded using a pretested interviewer questionnaire within 24hours of delivery. Analysis: Categorical data was presented as proportions or percentages and a Chi square test was used to compare categorical data. Continuous data was presented as means with their standard deviations or medians and interquartile range. Continuous data was compared using student T test. Bivariate analysis was carried out. All factors with a P value of 0.2 or less were included in a multivariate model to determine factors that are independently associated with adverse maternal and fetal outcome. Factors with a P value of 0.05 considered significant. RESULTS Data from 392 pregnancies was studied of which 255(65.1%) were those below between 18-34years and 137(34.9%) were those considered to be of advanced maternal age (≥35years). 70.4% of the respondents were married, 29.6% were not married. The overall xi socio-economic status; 74.0% were of middle status, 22.2% were poor and 3.8% had a high socio-economic status Advanced maternal age was associated with increased odds of getting pre-eclampsia 23.4% OR 5.3(95%CI 2.58-11.1) versus 5.5% in those below 34years. Women of AMA were more likely to get APH 5.1% OR 4.55 (95%CI1.27-16.67) versus 1.2% for women between 18-34years. The odds of getting PPH if a woman is of AMA were 5times (12.4%) versus 2.8% in the younger women. Women of AMA were more likely to have C/S 43.8% OR 3.46 (95%CI 2.11-5.62) versus 18.4% in younger ones. Women of AMA were more likely to have preterm labor 14.6% OR 6.06(95%CI2.37-17.4) versus 2.8% in the younger women. The risk of SGA, macrosomia, chromosomal abnormalities, NICU admission and fresh still birth were increased in women of AMA. The factors which were independently associated with adverse pregnancy outcomes included maternal age, marital status and antenatal care attendance. CONCLUSION: Women of advanced maternal age were thrice more likely to have at least one adverse maternal outcome like pre-clampsia, PHH, Cesarean section and preterm labour adverse maternal outcome compared to younger women. Women of AMA were 2 times more likely to have at least one adverse perinatal outcome like macrosomia, SGA and admission to NICU compared to the younger women.