(182) Advanced maternal age among primigravida as a risk factor for long-term cardiovascular disease

The rising global trend of women delaying childbirth has prompted investigation into the impact of advanced maternal age at first delivery on long-term maternal health. This study focuses on the influence on maternal cardiovascular diseases.

Study Design:

A retrospective population-based cohort study including all primigravida between the years 1991-2019, stratified by age (up to vs. over 35 years at delivery) was conducted. Women with cardiovascular disease prior to delivery were excluded as were those with preeclampsia. Data were collected from medical records according to pre-defined ICD-9 codes. The incidence of cardiovascular outcomes were compared and analyzed according to maternal age. Kaplan-Meier survival curves compared cardiovascular morbidity, and a Cox regression model controlled for confounders.

Results:

Of 43,344 first deliveries, 749 (1.7%) were over age 35. Elderly primigravida suffered from a higher incidence of hypertension (5.7% vs 1.0%, p< 0.01) as well as ischemic heart disease (IHD, 0.6% vs. 0.2%, p=0.024) and composite cardiovascular diseases (5.8% vs 1.1%, p< 0.01). The Kaplan-Meier survival curves confirmed an increased risk of cardiovascular disease among elderly primigravida (Figure, log-rank test p< 0.01). Multivariate analysis, controlling for gestational hypertension, preeclampsia, diabetes, and fertility treatment showed that elderly primigravida had an adjusted hazard ratio (aHR) of 4.935 (95%CI 3.443-7.073, P< 0.001) for long-term cardiovascular disease compared to those up to age 35 at first delivery.

Conclusion:

Our study highlights that elderly primigravida face an elevated lifetime risk of cardiovascular disease, specifically hypertension and IHD. These findings underscore the importance of family planning decisions in relation to long-term health.