What question did this study set out to answer?

This study aims to quantify maternal and neonatal complications in women aged ≥ 35 years delivering in tertiary hospitals in Dhaka, Bangladesh.

April 25, 2026Open Access

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

Key Points

This study aims to quantify maternal and neonatal complications in women aged ≥ 35 years delivering in tertiary hospitals in Dhaka, Bangladesh.
Conducted an analytical cross-sectional study at two tertiary referral hospitals.
Enrolled 384 consecutive eligible women aged ≥ 35 years at discharge.
Examined associations using Pearson's χ² tests and adjusted odds ratios (AORs) with 95% confidence intervals via Firth penalized logistic regression.
Maternal adverse outcomes occurred in 97.7% of women; most common were preeclampsia (27.3%) and premature rupture of membranes (26.0%).
Neonatal adverse outcomes occurred in 80.5% of births, with prematurity affecting 72.9% and low birthweight in 52.3%.
Very-low birthweight significantly more frequent in mothers ≥ 40 years (51.9% vs. 7.6%, p < 0.001).

Abstract

ABSTRACT 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 χ ² 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.

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