Maternal and perinatal outcomes in adolescents and women with advanced maternal age
DOI:
https://doi.org/10.11606/s1518-8787.2025059006538Keywords:
Maternal Age, Pregnancy in Adolescence, Pregnancy Complications, Pregnancy Outcome, Infant, PrematureAbstract
OBJECTIVE: To analyze the association between age extremes and maternal and perinatal outcomes in births in the state of Rio de Janeiro, Brazil.
METHODS: Data from the Birth in Brazil II: National Survey on Abortion, Delivery, and Birth (2021–2023) were used. A total of 1,734 puerperae were included, with live or stillborn newborns, interviewed in the immediate postpartum period. Information was obtained from interviews, clinical records, and prenatal cards. Multiple logistic regression was carried out to evaluate associations between maternal age and outcomes, having women aged 20–34 years as reference.
RESULTS: Delivery in adolescents represented 10.1% of the participants, while women with advanced maternal age (AMA ≥ 35 years) corresponded to 18.0%. Adolescents were less likely to receive guidance as to reference maternity hospital (odds ratio — OR = 0.68) and to have a companion at all times (OR = 0.77), in addition to presenting lower prevalence of gestational diabetes (OR = 0.26). In turn, women with advanced maternal age were more often guided on reference maternity hospitals (OR = 1.46) and presented a higher risk of gestational hypertension (OR = 1.78), gestational diabetes (OR = 1.87), placental abruption (OR = 3.30), and severe maternal morbidity (OR = 1.84). In perinatal outcomes, adolescents had a higher risk of perinatal death (OR = 4.52) and spontaneous early-term delivery (OR = 1.47); however, there was a lower probability of early-term delivery by obstetric intervention (OR = 0.48). Newborns of women with advanced maternal age presented higher risk of 5-minute Apgar index < 7 (OR = 3.05) and lower chance of congenital syphilis (OR = 0.34).
CONCLUSIONS: Adolescents were provided worse care compared to adults, while women with advanced maternal age presented a higher frequency of age-related complications. These results highlight the need for special care, particularly considering the increase in deliveries in women with advanced age.
References
Brasil. Ministério da Saúde. Sistema de Informações sobre Nascidos Vivos (SINASC). Brasília: Ministério da Saúde; 2024.
Aoyama K, Pinto R, Ray JG, Hill AD, Scales DC, Lapinsky SE, et al. Association of maternal age with severe maternal morbidity and mortality in Canada. JAMA Netw Open. 2019;2(8):e199875. https://doi.org/10.1001/jamanetworkopen.2019.9875
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. https://doi.org/10.1186/s12884-020-2740-6
Attali E, Yogev Y. The impact of advanced maternal age on pregnancy outcome. Best Pract Res Clin Obstet Gynaecol. 2020;70:2-9. https://doi.org/10.1016/j.bpobgyn.2020.06.006
Nogueira da Gama SG, Martinelli KG, Soares Dias BA, Pereira-Esteves AP, do Carmo Leal M, Dos Santos-Neto ET. A population-based study of the relationship between advanced maternal age and premature/early-term birth in Brazil. Int J Gynaecol Obstet. 2022;159(1):173-81. https://doi.org/10.1002/ijgo.14057
Kenny LC, Lavender T, McNamee R, O'Neill SM, Mills T, Khashan AS. Advanced maternal age and adverse pregnancy outcome: evidence from a large contemporary cohort. PLoS One. 2013;8:e56583. https://doi.org/10.1371/journal.pone.0056583
Marvin-Doyle K, Soltani H. A comparison of neonatal outcomes between adolescent and adult mothers in developed countries: a systematic review and meta-analysis. Eur J Obstet Gynecol Reproduct Biol. 2020;6:100109. https://doi.org/10.1016/j.eurox.2020.100109
Zhang T, Wang H, Wang X, Yang Y, Zhang Y, Tang Z, et al. The adverse maternal and perinatal outcomes of adolescent pregnancy: a cross sectional study in Hebei, China. BMC Pregnancy Chilbirth. 2020;20:339. https://doi.org/10.1186/s12884-020-03022-7
Glick I, Kadish E, Rottenstreich M. Management of pregnancy in women of advanced maternal age: improving outcomes for mother and baby. Int J Womens Health. 2021;13:751-9. https://doi.org/10.2147/IJWH.S283216
Scipioni A, VanDeman H, Tanner JP, Salemi J, Duncan J. 1. Adverse obstetrical outcomes are increased in adolescent pregnancy. J Pediatr Adolesc Gynecol. 2024;37(2):306.
Todhunter L, Hogan-Roy M, Pressman EK. Complications of pregnancy in adolescents. Semin Reprod Med. 2022;40(1-02):98-106. https://doi.org/10.1055/s-0041-1734020
Carr RC, McKinney DN, Cherry AL, Defranco EA. Maternal age-specific drivers of severe maternal morbidity. Am J Obstet Gynecol. 2022;4(2):100529. https://doi.org/10.1016/j.ajogmf.2021.100529
Bittencourt SDA, Vilela MEA, Marques MCO, Santos AM, Silva CKRT, Domingues RMSM, et al. Atenção ao parto e nascimento em Maternidades da Rede Cegonha/Brasil: avaliação do grau de implantação das ações. Ciênc Saúde Coletiva. 2021;26(3):801-21. https://doi.org/10.1590/1413-81232021263.08102020
Leal MC, Esteves-Pereira AP, Bittencourt AS, Domingues RMSM, Theme-Filha MM, Leite TH, et al. Protocolo Nascer no Brasil II: Pesquisa Nacional sobre Aborto, Parto e Nascimento. Cad Saúde Pública. 2024;40(4):e00036223. https://doi.org/10.1590/0102-311XPT036223
Leal MC, Gama SGN. Nascer no Brasil. Cad Saúde Pública. 2014;30(Supl. 1):S5. https://doi.org/10.1590/0102-311XED01S114
D’Orsi E, Brüggemann OM, Diniz CSG, Aguiar JM, Gusman CR, Torres JA, et al. Desigualdades sociais e satisfação das mulheres com o atendimento ao parto no Brasil: estudo nacional de base hospitalar. Cad Saúde Pública. 2014;30(Supl. 1):S154-S168. https://doi.org/10.1590/0102-311X00087813
Brasil. Assistência em Planejamento Familiar: Manual Técnico. 4ª ed. Brasília: Ministério da Saúde; 2002.
Brasil. Portaria nº 1.537, de 15 de junho de 2010 [Internet]. Ministério da Saúde; 2010 [acessado em 7 jul. 2024]. Disponível em: http://portal.mec.gov.br/index.php?option=com_docman&view=download&alias=8601-portaria-1537-15-junho-2010-pse-programa-saude-escola-pdf&Itemid=30192
Lisonkova S, Potts J, Muraca GM, Razaz N, Sabr Y, Chan WS, et al. Maternal age and severe maternal morbidity: A population-based retrospective cohort study. PLos One. 2017;14(5):e1002307. https://doi.org/10.1371/journal.pmed.1002307
Kenny LC, Lavender T, McNamee R, O'Neill SM, Mills T, Khashan AS. Advanced maternal age and adverse pregnancy outcome: evidence from a large contemporary cohort. PLoS One. 2013;8(2):e56583. https://doi.org/10.1371/journal.pone.0056583
Domingues RMSM, Viellas EF, Dias MAB, Torres JA, Theme-Filha MM, Gama SGN, et al. Adequação da assistência pré-natal segundo as características maternas no Brasil. Pan Am J Public Health. 2015;37(3):140-7.
World Health Organization. Companion of choice during labour and childbirth for improved quality of care [Internet]. Genebra: World Health Organization; 2020 [acessado em 7 jul. 2024]. Disponível em: https://www.who.int/publications/i/item/WHO-SRH-20.13
Brasil. Lei nº 14.737, de 27 de novembro de 2023 [Internet]. Brasília; 2023 [acessado em 7 jul. 2024]. Disponível em: https://www.planalto.gov.br/ccivil_03/_ato2023-2026/2023/lei/l14737.htm
Diniz CSG, D’Orsi E, Domingues RMSM, Torres JA, Dias MAB, Schnek CA, et al. Implementação da presença de acompanhantes durante a internação para o parto: dados da pesquisa nacional Nascer no Brasil. Cad Saúde Pública. 2014;30(Sup. 1):S140-S153. https://doi.org/10.1590/0102-311X00127013
Martinelli KG, Garcia EM, Santos-Neto ET, Gama SGN. Advanced maternal age and its association with placenta previa and placental abruption: a meta-analysis. Cad Saúde Pública. 2018;34(2):e00206116. https://doi.org/10.1590/0102-311X00206116
Almeida AHV, Gama SGN, Costa COM, Carmo CN, Pacheco VE, Martinelli KG, et al. Prematuridade e gravidez na adolescência no Brasil, 2011-2012. Cad Saúde Pública. 20202;36(12):00145919. https://doi.org/10.1590/0102-311X00145919
Delnord M, Zeitlin J. Epidemiology of late preterm and early term births - An international perspective. Semin Fetal Neonatal Med. 2019;24(1):3-10. https://doi.org/10.1016/j.siny.2018.09.001
Oshiro BT, Henry E, Wilson J, Branch DW, Varner MW. Decreasing elective deliveries before 39 weeks of gestation in an integrated health care system. Obstet Gynecol. 2009;113(4):804-11. https://doi.org/10.1097/AOG.0b013e31819b5c8c
Conselho Federal de Medicina. Resolução CFM nº 2.284, de 22 de outubro de 2020 [Internet]. Brasília: Conselho Federal de Medicina; 2020 [acessado em 7 jul. 2024]. Disponível em: https://www.in.gov.br/en/web/dou/-/resolucao-cfm-n-2.284-de-22-de-outubro-de-2020-321640891
Vandekerckhove M, Guignard M, Civadier MS, Benachi A, Bouyer J. Impact of maternal age on obstetric and neonatal morbidity: a retrospective cohort study. BMC Pregnancy Childbirth. 2021;21:732. https://doi.org/10.1186/s12884-021-04177-7
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Copyright (c) 2025 Silvana Granado Nogueira da Gama, Arthur Orlando Corrêa Schilithz, Maria do Carmo Leal, Talita Teresa do Carmo, Mariza Miranda Theme Filha, Denise Cavalcante de Barros, Glauce Cristine Ferreira Soares, Katrini Guidolini Martinelli
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