[Perinatal outcomes of newborn infants of mothers over 40 years old. A case-control study]. / Esiti perinatali di neonati da madre ultraquarantenne. Uno studio caso-controllo.

The changing life patterns for women in current society are accompanied by a postponement of pregnancy in advanced reproductive age. The aim of our study was to compare perinatal outcome among 314 newborns from women > or = 40 years old with 6.683 controls from mothers 20-29-year-old who delivered at our Division between 1983 and 1993. For each analyzed variable (birth weight, gestational age, congenital malformations, still-births, neonatal mortality and morbidity) the odds ratio (OR) and 95% confidence intervals (95% CI) were calculated for the group of women > or = 40 years old. The incidence of nulliparas in the older age group was 13.5%. The cesarean section rate was higher in the mature mothers than in their younger controls (52.1% vs 34.7%). The more frequent prenatal genetic management in women past the age of 35 years may be the reason for the reduced overall frequency of still-births and malformations in the group > or = 40 years. Preterm delivery was observed more frequently in the older mothers compared with controls (18.5% vs 11.7%). The frequency of LBW and VLBW was higher, but not significant, in the cases than in the controls. Newborns from older mothers had a significant increase of macrosomia (8% vs 4.8%) and a twice increase of mortality (3.2% vs 1.6%) and morbidity (20.4% vs 11.4%). These data suggest to improve the perinatal care of women > or = 40 years old.