AUTHOR=Nyongesa Paul , Ekhaguere Osayame A. , Marete Irene , Tenge Constance , Kemoi Milsort , Bann Carla M. , Bucher Sherri L. , Patel Archana B. , Hibberd Patricia L. , Naqvi Farnaz , Saleem Sarah , Goldenberg Robert L. , Goudar Shivaprasad S. , Derman Richard J. , Krebs Nancy F. , Garces Ana , Chomba Elwyn , Carlo Waldemar A. , Mwenechanya Musaku , Lokangaka Adrien , Tshefu Antoinette K. , Bauserman Melissa , Koso-Thomas Marion , Moore Janet L. , McClure Elizabeth M. , Liechty Edward A. , Esamai Fabian TITLE=Maternal age extremes and adverse pregnancy outcomes in low-resourced settings JOURNAL=Frontiers in Global Women's Health VOLUME=4 YEAR=2023 URL=https://www.frontiersin.org/journals/global-womens-health/articles/10.3389/fgwh.2023.1201037 DOI=10.3389/fgwh.2023.1201037 ISSN=2673-5059 ABSTRACT=Introduction

Adolescent (<20 years) and advanced maternal age (>35 years) pregnancies carry adverse risks and warrant a critical review in low- and middle-income countries where the burden of adverse pregnancy outcomes is highest.

Objective

To describe the prevalence and adverse pregnancy (maternal, perinatal, and neonatal) outcomes associated with extremes of maternal age across six countries.

Patients and methods

We performed a historical cohort analysis on prospectively collected data from a population-based cohort study conducted in the Democratic Republic of Congo, Guatemala, India, Kenya, Pakistan, and Zambia between 2010 and 2020. We included pregnant women and their neonates. We describe the prevalence and adverse pregnancy outcomes associated with pregnancies in these maternal age groups (<20, 20–24, 25–29, 30–35, and >35 years). Relative risks and 95% confidence intervals of each adverse pregnancy outcome comparing each maternal age group to the reference group of 20–24 years were obtained by fitting a Poisson model adjusting for site, maternal age, parity, multiple gestations, maternal education, antenatal care, and delivery location. Analysis by region was also performed.

Results

We analyzed 602,884 deliveries; 13% (78,584) were adolescents, and 5% (28,677) were advanced maternal age (AMA). The overall maternal mortality ratio (MMR) was 147 deaths per 100,000 live births and increased with advancing maternal age: 83 in the adolescent and 298 in the AMA group. The AMA groups had the highest MMR in all regions. Adolescent pregnancy was associated with an adjusted relative risk (aRR) of 1.07 (1.02–1.11) for perinatal mortality and 1.13 (1.06–1.19) for neonatal mortality. In contrast, AMA was associated with an aRR of 2.55 (1.81 to 3.59) for maternal mortality, 1.58 (1.49–1.67) for perinatal mortality, and 1.30 (1.20–1.41) for neonatal mortality, compared to pregnancy in women 20–24 years. This pattern was overall similar in all regions, even in the <18 and 18–19 age groups.

Conclusion

The maternal mortality ratio in the LMICs assessed is high and increased with advancing maternal age groups. While less prevalent, AMA was associated with a higher risk of adverse maternal mortality and, like adolescence, was associated with adverse perinatal mortality with little regional variation.