Maternal and Fetal Outcomes in Pregnancy in the Fifth Decade of Life and Beyond

ABSTRACT Objective The objective is to evaluate maternal and fetal outcomes at an extremely advanced maternal age (over age 50) in Calgary. The secondary objective is to determine if there is a role to protocolize complex care plans for patients at extremely advanced maternal ages. Method A retrospective chart review was conducted of all pregnancies ≥20 weeks gestation in patients over the age of 50 that delivered in Calgary between January 2007 and December 2021. Pregnancy data was collected, including maternal age, pre-existing medical conditions, mode and timing of delivery, neonatal outcomes, neonatal intensive care unit (NICU) and adult intensive care unit (ICU) admissions, postpartum complications, and maternal or neonatal death. Data was extracted for maternity patients as well as neonatal intensive care unit databases. Maternal and neonatal outcomes were assessed until discharge from hospital. Results All 23 pregnancies identified were achieved through assisted reproductive technologies. Comorbidities varied, but the most common comorbidities included hypertension and gestational diabetes. Cesarean delivery was the most common form of delivery. Three cases involved post-partum maternal ICU admission. Neonatal outcomes included gestational ages of 22–39 weeks and birth weights of 486–3593g, with 8 confirmed NICU admissions. The most common neonatal complications were jaundice and small for gestational age. Conclusions Extremely advanced maternal age patients are more likely to have pre-existing comorbidities and develop comorbidities during pregnancy. The potential for adverse maternal and fetal outcomes is greater for these pregnancies; however, the complications are diverse and developing a universal complex care plan is difficult.