Pregnancy Outcomes in Very Advanced Maternal Age Pregnancies: the Impact of Assisted Reproductive Technologies

Abstract

Objective

To determine if there are differences in adverse pregnancy outcomes in very Advanced Maternal Age (vAMA) women who conceived with assisted reproductive technologies (ART) compared to spontaneous conceptions.

Design

Retrospective cohort study

Setting

Academic tertiary-care medical center

Patients

472 women ≥ 45 years old who delivered at one institution

Interventions

Mode of conception

Main Outcome Measures

Maternal and neonatal outcomes

Results

For singleton pregnancies, vAMA women who conceived with ART were significantly older (47.0±2.3 vs. 45.6±0.1), more likely to be Caucasian (88.1% vs. 75.6%) and less parous (0.4±0.9 vs. 1.2±1.8) than vAMA women who conceived spontaneously. They were at significantly increased risk for cesarean delivery (CD) (75.1% vs. 49.7%) and were more likely to undergo elective primary CD without labor (25.4% vs. 9.4%). Risk of retained placenta was also significantly higher (2.7% vs. 0%). Rates of other maternal complications and neonatal outcomes were similar. Subgroup analysis of ART singleton pregnancies did not demonstrate differences in women using autologous oocytes versus donor oocytes.

Conclusions

vAMA women who conceive following ART are more likely to be Caucasian, older, primiparous and are more likely to proceed with an elective CD compared to vAMA who conceive spontaneously. The increased risk of retained placenta in women who conceive with ART may indicate an underlying risk for placentation defects.

Capsule

Very AMA (vAMA) women utilizing ART are more likely to be primiparous, undergo elective cesarean delivery and at increased risk of retained placenta. Oocyte source does not affect outcomes.