Evidence map›Paper›PMID 40069659›Full record

ArticleBMC pregnancy and childbirth2025

Maternal and neonatal outcomes at delivery in nulliparous women with advanced maternal age.

Achuo Ascensius Ambe Mforteh, Abigail Kra-Friedman, Gilad Karavani, Hila Hochler, Michal Lipschuetz, Ronit Calderon-Margalit, Joshua I Rosenbloom

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Article in BMC pregnancy and childbirth, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

7 authors.

Achuo Ascensius Ambe MfortehBraun School of Public Health and Community Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Abigail Kra-FriedmanHenrietta Szold Hadassah School of Nursing, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel. abbykrafriedman@gmail.com.
Gilad KaravaniDepartment of Obstetrics and Gynecology, Faculty of Medicine, Hadassah University Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel.
Hila HochlerDepartment of Obstetrics and Gynecology, Faculty of Medicine, Hadassah University Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel.
Michal LipschuetzHenrietta Szold Hadassah School of Nursing, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Ronit Calderon-Margalit *Braun School of Public Health and Community Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Joshua I Rosenbloom *Department of Obstetrics and Gynecology, Faculty of Medicine, Hadassah University Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe age at first delivery is rising leading to an increasing proportion of women with advanced maternal age (AMA) which is defined as greater than or equal to 35 years at time of delivery. Previous studies have associated AMA with adverse maternal and neonatal outcomes leading to an arbitrary increased rate of cesarean sections amongst AMA women without clear medical indications.

objectiveTo determine the associations between AMA and adverse maternal and neonatal outcomes in nulliparous women in a large cohort.

methodsOur retrospective cohort study looked at 44,295 nulliparous women (39,496 < 35years and 4,799 ≥ 35years) with term singleton gestation who delivered in the obstetrical units of Hadassah Medical Organization in Jerusalem, Israel, between 2003 and 2017. Data on maternal characteristics and outcomes, and neonatal outcomes were extracted from the electronic database. Outcomes were compared between women with AMA and women < 35 using Chi square, Fisher exact and t-tests. Multivariable logistic regressions estimated odds ratios (OR) for outcomes, controlling for confounders. We reported two-sided p-values, adjusted odds ratio (aOR), and 95% confidence intervals (CI).

resultsWomen with AMA were more likely to have c-sections compared to women < 35 years in the whole study population (aOR:2.29, 95% CI: 2.13-2.47, p < 0.0001) including women having inductions (aOR:1.38, 95% CI:1.25-1.53, p < 0.0001). Self-requested c-sections were significantly higher among women with AMA (16.8% vs. 2.8%, OR:6.9, 95% CI:5.5-8.8). AMA did not increase the risk of postpartum hemorrhage (aOR: 0.82, 95% CI: 0.72-0.94) and decreased likelihood of instrumental delivery (aOR:0.81, 95% CI: 0.73-0.89, p < 0.0001). Fewer women with AMA had 3rd- and 4th-degree tears (0.35% for ≥ 35years vs. 0.71% for < 35 years, RR:0.50, 95% CI:0.29-0.87, p = 0.012). Women with AMA were more than three times likely to have an intrauterine fetal demise (RR:3.53, 95% CI:2.54-4.90, p < 0.0001), but were not more likely to have low neonatal 5-minute APGAR scores (RR:0.79, 95% CI: 0.43-1.46, p value:0.44) or NICU admissions (RR:0.84, 95% CI: 0.61-1.17, p = 0.30).

conclusionsManagement of nulliparous AMA patients should be based on obstetric considerations and not solely on AMA status. Shared decision making is preferred to reduce the risks associated with AMA.

Indexed as

Cesarean SectionDelivery, ObstetricMaternal AgePregnancy OutcomeAdultAdvanced Maternal AgeFemaleHumansInfant, NewbornIsraelParityPregnancyRetrospective StudiesAdvanced maternal ageAPGAR scoreCesarean sectionsIntrauterine fetal demiseNICUNulliparousWomen

Identifiers

PMID40069659
PMCPMC11899165

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.