Adverse Obstetric Outcomes at Advanced Maternal Age in Arba Minch Zuria, and Gacho Baba District, Southern Ethiopia: A Prospective Cohort Study
Authors: Mersha Abera , Ayele Gistane , Worku Tilahun , Zerdo Zerihun , Shibiru Shitaye , Bante Agegnehu , Chonka Tamiru 
Published: May 2020

Abstract
Background: Advanced maternal age significantly increased the risk of adverse obstetric outcomes. So, adequate and updated information on the status of advanced maternal age and their effect on obstetric outcomes is vital for effective policy and program formulation in Ethiopia. Pockets of studies conducted, but most are retrospective and record reviews. Thus, studies that show the status of advanced maternal age and their effect on obstetric outcomes is very limited in Ethiopia. As such, this study fills those gaps in our set up.Methods: A community-based prospective cohort study was conducted among 709 study participants from October 15, 2018, to September 30, 2019. A pretested interviewer-administered structured Open Data Kit survey tool was used to collect the data. The downloaded data from the Open Data Kit aggregate was exported to SPSS version 25 for analysis. Log-linear regression was used to compare obstetric outcomes among women aged 20–34 years and ≥ 35 years. The model was adjusted for educational and occupational status, party, wealth index, body mass index, household food insecurity, habits, distance to health care institution, and sex of the neonate, antenatal care, postnatal care, and place of delivery. The model fitness was tested by the log-likelihood ratio.Results: In this study, 209(29.5%) of the women were aged ≥ 35 years, and 500(70.5%) aged 20–34 years. Women aged ≥ 35 years were at increased risk of miscarriage (β = 0.29, 95%CI: 0.02, 0.56), and hypertensive disorder (β = 0.07, 95%CI: 0.004, 0.13).Conclusions: Advanced maternal age was independently associated with miscarriage and hypertensive disorder after controlling for possible cofounders. As such, different intervention programs should be designed to create awareness and to provide counseling services for women with advanced age or delayed childbearing.Plain English summaryWomen who bear a child at the age of ≥35 years old are stated as advanced maternal age. At this age, the risk of different obstetric complications is increased. This study was aimed to assess the effect of advanced maternal age on obstetric outcomes in the study settings.A prospective follow-up study was conducted among pregnant women during the study period. The women were followed from the time pregnancy was confirmed up to the immediate postpartum period. Seven hundred forty-four women were interviewed in the baseline and 24 participants became lost to follow-ups during the follow-up period, and 11 excluded from the analysis because of incomplete information.Of the study participants, 209 of the women were beard children at the age of ≥35 years (advanced maternal age), and 500 were age group from 20-34 years old.This study found that advanced maternal age increased risk of miscarriage (termination of pregnancy before fetal viability) and hypertensive disorder during pregnancy, the intrapartum and immediate postpartum period after controlled for possible confounders.In brief, this study showed that a significant number of women became pregnant during advanced maternal age. Therefore, different strategies should be designed for the women who planned to bear child, and information should be provided for women who are advanced age or delayed childbearing to alert them.