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Poster Session 4

Category: Clinical Obstetrics

Poster Session 4

(1294) Rethinking Advanced Maternal Age: Stratified Analysis of Severe Maternal Morbidity in Individuals Aged 35–69

Thursday, February 12, 2026

3:30 PM - 5:00 PM

Submitting Author and Presenting Author(s)

Yanling Dong, MD

Maternal Fetal Medicine Fellow
Johns Hopkins University
Baltimore, Maryland, United States

Coauthor(s)

Shriddha Nayak, MD

Johns Hopkins University
Baltimore, Maryland, United States
Alexandra D. Forrest, MD (she/her/hers)

Maternal-Fetal Medicine Fellow
Johns Hopkins University
Baltimore, Maryland, United States
Arthur Jason Vaught, MD

Johns Hopkins University
Baltimore, Maryland, United States
Marika Toscano, MD

Assistant Professor
Johns Hopkins University
Baltimore, Maryland, United States

Objective:
With delayed childbearing and increasing use of in vitro fertilization, pregnancies among individuals approaching perimenopause and menopause are more common. Advanced maternal age (AMA), broadly defined as ≥35 years, encompasses a heterogeneous population with varying risk profiles. This study evaluated the odds of severe maternal morbidity (SMM) across stratified AMA age groups.

Study Design:
This retrospective cohort study used TriNetX, a global network of de-identified electronic health records from 106 healthcare organizations. Pregnant individuals aged 12–69 years from July 2020 to July 2025 were included. Eight cohorts were constructed: one reference group (age 20–34) and seven AMA groups (ages 35–39 through 65–69). Cohorts were propensity score matched 1:1 by race, ethnicity, hypertension, pregestational diabetes, obesity, asthma, cardiovascular disease, chronic kidney disease, tobacco use, and multiple gestation. SMM was defined using the CDC’s 21 indicators and ICD-10 codes. The primary outcome was adjusted odds ratio (aOR) for composite SMM within one year of pregnancy; secondary outcomes included aORs for individual indicators.

Results:
The unmatched reference cohort included 1,601,993 pregnancies. Before matching, unadjusted odds of composite SMM were markedly elevated among individuals aged 50–69 (OR 3–8). After matching, the aOR of composite SMM increased progressively with age (Table 1). Higher age was also associated with increased odds of specific indicators (Figure 1). P</span>uerperal cerebrovascular disorders were strongly associated with age ≥50. Myocardial infarction, hysterectomy, and venous thromboembolism showed modest associations and increasing effect sizes with age. Indicators with low event rates were excluded from the heatmap.

Conclusion:
AMA is not a uniform risk category—odds of composite SMM progressively increase with age. The significantly elevated unadjusted odds of SMM among individuals ≥50 likely reflect cumulative comorbidities and may better capture real-world risk. These findings support individualized counseling and care planning for older pregnant individuals.