Globally, women and children are among the most vulnerable in terms of unfavorable influences in the environment including insufficient nutrition, inadequate health care and poor education. In addition, pregnancy brings those factors as high risk for women. Worldwide, it is estimated that more than 50 million women suffer  from poor reproductive health and serious pregnancy related complications (Tesfay et al., 2015).

Mothers age 35 and above at estimated date of delivery is known to be old maternal age (Yogev et al., 2010). Older age is risk factor for decreasing fertility and increasing  miscarriage.  For   women   who   succeed   in conception at higher age, the risk of complication during pregnancy and delivery is high (Almhfooth et al., 2013). Older pregnant mothers have an increased risk of pregnancy, labour complications and adverse fetal outcome. Medical complications like hypertensive disorders, gestational diabetes and preterm birth and labour related complications like induction of labour, prolonged labour and hemorrhage are the most common ones. This aged group mothers mostly delivered with caesarean section and their children will have a higher risk of congenital anomalies and will face fetal and neonatal mortality (Tromp et al., 2010). Even if the issue is essential and its effect is bad to the mother and fetus, studies on this area lack adequate data. Therefore this study aimed to compare pregnancy outcomes between advanced maternal age and younger age and identify predicting factors among women delivering at public health facilities of Shashemene Town.

 

Study setting and Study period

Shashemene town is situated in West Arsi Zone in Oromia Regional State, Ethiopia (“CSA-Ethiopia”, 2012). The city lies on the trans-African highway 4 of Cairo-Cape town, about 150 miles (240 km) from Addis Ababa. Based on the 2007 population Census, the population size of Shashemene were 102,062 of which 51,477(50.4%) are males and 50,585 (49.6%) are females. According to the Central Statistical Agency of 2005, females 35.2% (16,288.5) were in reproductive age group (15 to 49), the total fertility rate was 4.2. The population expected for 2013 using the census data in 2007, was 129,084, of which 65,091 were men and 63,993 were women.

Study design and population

A comparative cross sectional study was conducted on pregnancy outcomes among women aged 20 to 34 years and 35⁺ delivering at public health facilities in Shashemene town. All pregnant mothers who gave birth at public health facilities of Shashemene town, Ethiopia, from March to April, 2016 were taken as source population and selected mothers who gave birth during the study period at public health facilities of Shashemene town, Ethiopia taken as study population. All mothers 20 years and above who gave birth at public health facilities of Shashemene town, Ethiopia during data collection period were included and women who were seriously ill and unable to respond were not included in the study.

Ethical consideration

Ethical clearance was obtained from the Institutional Review Board (IRB) of Jimma University College of Health Sciences to shashemene town health facility authorities. Permission letters were obtained from Shashemene Referral Hospital and Melkaoda Hospital Administration, after the objectives of the study were explained, consent was obtained from head of maternal and child health unit. Written and verbal consent were taken from selected participant to validate willingness to participate in the study before the interview. Privacy and confidentiality were ensured by using coding.

Sampling technique

A comparative cross sectional study was conducted among women aged 20 to 34 years and 35⁺ delivering at public health facilities in the town.

Data collection tools

Data were collected using pretested and structured questionnaire and through chart review. Questionnaire contained socio demographic, obstetrics, medical history and other characteristics.

Data analysis and quality control

Collected data were entered into Epi data version 3.1 and exported to SPSS version 20.0 for analysis. After cleaning data for inconsistencies and missing value in SPSS, binary logistic regressions with p value < 0.25 were transferred to multivariable logistic regression. Variables with p value < 0.05 were considered as significant variable. Training for data collectors, pretest and supervision were undertaken to control data quality.

 

Socio demographic characteristics of the respondent

Three hundred and six study participants participated with a response rate of 100%. The mean age of women (20 to 34) was 24.39 (SD ± 3.865). Regarding residence in the age group 20 to 34, 88 (50.3%) were living in urban. Married women between age 20 to 34 was 151. Those mothers who can read and write were 49(32.02) and 31(20.2) in both age group, respectively. Oromo was the dominant ethnicity is the study area with 110 (71.89%) and 102 (66.69%). Majority of participants in both age group were housewives in their occupation 116 (48.7%), 112(79.7%) and their Income ranged from 1801 to 3000 48.3 (31.37%) (Table 1).

 

 

Obstetric characteristics of participants

Majority of normal reproductive age group participants are multigravida which accounts for 92(41.3) and 131(58.7) in advance reproductive age group. Moreover, multiparas were 86(41.1%) and 123(58.9%). Those mothers with 1 to 3 antenatal visits were 89(50.9%) and 86(49.1%), respectively. Mothers who took iron/folic acid during antenatal care visit were 98(44.1%) and 124(55.9%). For mothers in both age group, their current mode of delivery of SVD was 112(73.2%) and 106(26.8). Current labour with no complication in advanced age group was 129(84.3%) (Table 2).

 

 

Medical related complications of the respondents

Advanced reproductive age  group  mothers  who  do  not report medical illness before pregnancy was 136(88.88). Whereas in both age group from those who reported previous medical illness 22(14.37) and 17(11.11) anemia is commonly mentioned one 17(11.11) and 6(3.92) respectively (Table 3).

 

 

Frequency of maternal adverse pregnancy outcomes of the respondent

While comparing the prevalence of adverse maternal pregnancy outcomes among women aged 20 to 34 and 35⁺, the risks were high among advanced maternal age (Table 4).

 

 

Frequency of fetal adverse pregnancy outcomes of the respondent

Adverse pregnancy outcome at normal reproductive age group was 45(29.41%) and in advanced age group it was 62(40.5%). Adverse fetal outcomes were more at advanced maternal age in comparison with normal reproductive age group except  still  birth  which  was  the same frequency among the two age group (Table 5). In binary multiple logistic regression age, education, ethnicity, occupation, outcome of last delivery, previous caesarian section and antenatal follow up showed association with p value < 0.2, these variables transferred to multivariate logistic regression then age, antenatal follow up, previous caesarian section and mode of current labour showed significant association with p value < 0.05 (Table 6).

 

 

 

 

 

 

 

 

The prevalence of postpartum hemorrhage in advanced maternal age was higher when compared to their younger counter parts. This study was supported by the study done in Israel (Tesfay et al., 2015). Also according to Laopaiboon et al. (2014), the prevalence of caesarian [DAV1] delivery was 6 times higher among advanced maternal age when compared to younger mother. Study done in Nigeria supports this result; advanced age has higher incidence of cesarean delivery than their counterparts (Bako et al., 2013). These two findings can be based on the reason that advanced age women are more likely to be grand multi-para and this may lead them to face postpartum hemorrhage due to uterine atony. Obstructed labour, prolonged labour, mal presentation and related fetal complications which is more common in advanced maternal age may lead them to caesarean section than their counter part.

Adverse fetal outcome like low birth weight, preterm birth, Apgar score 5 min < 7, congenital anomaly, admission to neonatal intensive care unit (NICU) and fetal death are highly related with advanced age group. This result is similar with a study conducted in Turkey which ruled out that advanced maternal age were significantly associated with fetal complication and Apgar score 5 min < 7 (Lamminpää, 2015). Similarly, study conducted in Flemish found that advanced maternal age were associated with very preterm and low birth weight (Delbaere et al., 2007).

Advanced maternal age (35⁺) was 2 times risky of wide range of adverse pregnancy out come when compared to mothers in normal reproductive age group (20 to 34). The result is in line with a case control study conducted in Iran, which revealed that advanced maternal age of 40 and above were more complicated by maternal and neonatal complication (Khalil et al., 2013). A retrospective study done in Spain supports this result (Jahromi and Husseini, 2008). In this study antenatal care follow up was significantly associated with adverse pregnancy outcome. Studies done in Gondar University Hospital, Northwest Ethiopia rule out that lack of ANC follow up were associated with adverse pregnancy outcome like still birth (Adane et al., 2014).

A prospective study done at University Hospital UZ Brussels proved that lack of antenatal follow up was associated with adverse pregnancy outcome like preterm (Beeckman et al., 2012). Mode of current labour is significantly associated with adverse pregnancy outcome. Most mothers who came to this hospital were referred from health center with complication that leads to caesarian section. Mothers who deliver by caesarian section were more risky to develop adverse pregnancy outcome than those who delivered by spontaneous vaginal delivery. Caesarian section is a major operation which can be associated with significant maternal and fetal, morbidity and mortality. This can be due to the fact that bleeding in caesarian section is higher than vaginal delivery, this can lead mother to risk of death (Arulkumaran, 2016).

 

In this study, adverse pregnancy outcome is high in advanced maternal age. Postpartum hemorrhage and Hypertensive disorders are mostly observed adverse outcomes  in  advanced  maternal  age.   Age,   antenatal follow up, mode of current delivery and previous caesarian section are risk factors for adverse pregnancy outcome.

 

The authors have not declared any conflict of interests.