Nulliparity at advanced maternal age and long‐term morbidity in offspring: A population‐based cohort study

OBJECTIVE: Birth rates among women aged 30 and above have climbed to record highs, influenced by evolving social and economic dynamics, including focus on professional advancement, prolonged education, and increased access to fertility treatments. This study aimed to assess whether nulliparity at advanced maternal age (AMA) is associated with increased long-term morbidity in offspring. METHODS: A population-based retrospective cohort study was conducted at a single tertiary medical center between 1991 and 2021. The cohort included all nulliparous women aged ≥30 who delivered a live singleton. Participants were stratified into three age groups: 30-35, 36-40, and >40. Offspring were followed until 18 years of age for long-term morbidity, defined as hospitalizations or outpatient diagnoses of cardiovascular, respiratory, endocrine, neurologic, gastrointestinal, or infectious conditions. Kaplan-Meier survival analyses and Cox proportional hazards models were used to evaluate cumulative incidence and adjusted hazard ratios for each morbidity category. RESULTS: The study included 4951 women: 3729 (75.3%) aged 30-35, 946 (19.1%) aged 36-40, and 276 (5.6%) aged >40. Increasing maternal age was associated with higher rates of hypertensive disorders, gestational diabetes, preterm birth, and cesarean delivery (P < 0.001). However, no significant differences were observed in the cumulative incidence of long-term morbidity among offspring across age groups. In a Cox model, adjusting for fertility treatment, ethnicity, cesarean delivery, gestational age, gestational diabetes, and hypertensive disorders, AMA was not independently associated with long-term morbidity in any category. CONCLUSION: Although AMA is associated with adverse pregnancy outcomes, nulliparity at AMA is not associated with long-term morbidity in offspring.