Adverse Maternal and Neonatal Outcomes Among Women of Advanced Maternal Age in a Tertiary-Care Setting in Bangladesh: A Cross-Sectional Study.

BACKGROUND AND AIMS: Pregnancy at advanced maternal age is increasing globally, yet risks related to hypertensive disorders, prematurity, and impaired fetal growth remain substantial, particularly in tertiary-care settings. This study aimed to quantify maternal and neonatal complications among women aged ≥ 35 years delivering in tertiary hospitals in Dhaka, Bangladesh, and to examine factors associated with adverse maternal and neonatal outcomes.

METHODS

We conducted an analytical cross-sectional study at discharge in two tertiary referral hospitals. Consecutive eligible women aged ≥ 35 years were enrolled (N = 384). Primary outcomes were binary composites of any maternal adverse outcome and any neonatal adverse outcome. Associations were examined using Pearson's χ² tests, and adjusted odds ratios (AORs) with 95% confidence intervals were estimated using Firth penalized logistic regression to address sparse data.

RESULTS

Maternal adverse outcomes occurred in 97.7% of women, most commonly preeclampsia (27.3%), premature rupture of membranes (26.0%), and oligohydramnios (23.2%). Neonatal adverse outcomes affected 80.5% of births, dominated by prematurity (72.9%), preterm delivery (74.0%), and low birthweight (52.3%). Very-low birthweight was markedly more frequent among infants of mothers aged ≥ 40 years than 35-39 years (51.9% vs. 7.6%; p < 0.001). In adjusted analyses, no factors remained independently associated with maternal adverse outcomes. For neonatal outcomes, normal birthweight was strongly protective compared with very-low birthweight (AOR 0.03, 95% CI 0.01-0.35), while grand multiparity was associated with lower odds compared with primiparity (AOR 0.04, 95% CI 0.00-0.86).

CONCLUSION

In this tertiary referral context, maternal complications were nearly universal, while neonatal risk was strongly structured by birthweight. These findings support age-attuned antenatal surveillance and preparedness for small-baby care among women of advanced maternal age.