International Institute for Population Sciences
Deemed to be University (An Autonomous Organization of Ministry of Health & Family Welfare, Government of India)

Background: Advanced maternal age (AMA) is typically defined as age ≥ 35 years at the time of childbirth. This study aimed to review the impact of maternal age on the first pregnancy and adverse pregnancy outcomes to assist in the accurate counselling of women considering delaying pregnancy or those who are already pregnant and concerned about the risk of developing complications due to their age. Methods: This cross-sectional study used data from the National Family Health Survey (NFHS-5, 2019–21). The study analysed a weighted sample of 207,210 women aged 24 years and above at their first birth. Participants were categorized into two groups: adult (24–34 years) and advanced maternal age (≥35 years). The key APOs examined included preterm birth (PTB), low birth weight (LBW), and early neonatal death (ENND). Binary logistic regression models were used to examine the association between AMA (≥35 years) and APOs, adjusting for socio-demographic and obstetric factors. Results: Compared to younger adult mothers, AMA mothers showed significantly higher adjusted odds of LBW (AOR=1.407), PTB (AOR=1.464), and ENND (AOR=1.969). Inadequate antenatal care, lower IFA intake, and non-institutional deliveries were also significantly associated with an increased risk of APOs. C-section deliveries showed higher odds of LBW and PTB, whereas institutional deliveries were protective against ENND. Conclusion: Advanced maternal age is a significant predictor of adverse perinatal outcomes in India. Enhanced prenatal care, targeted counselling, and health system readiness are essential for mitigating risks among older mothers. Public health interventions should also address socioeconomic disparities to improve maternal and neonatal health outcomes.