Obstetric complications of primiparity at advanced maternal age

Primiparity at advanced maternal age has become an increasingly common phenomenon in modern obstetrics. The rising maternal age is associated with a higher prevalence of comorbidities and raises important questions regarding its impact on obstetric and perinatal outcomes over time. The aim of this study was to analyse temporal changes in maternal characteristics, comorbidities, and obstetric and perinatal outcomes among older primiparous women by comparing two periods separated by a decade. A retrospective comparative study was conducted at the Obstetrics and Gynaecology Clinic in Târgu Mureș. A total of 592 older primiparous women were included in the analysis (2010–2014: n = 299; 2020–2024: n = 293). Descriptive statistics and comparative analyses were performed using Microsoft Excel and GraphPad software, and effect sizes were calculated for statistically significant findings. During the later period, both maternal age and the prevalence of comorbidities increased significantly, with thrombophilia showing the most pronounced rise. The proportion of primigravid women also increased, whereas the rates of assisted reproduction and twin pregnancies remained unchanged. Median gestational age increased, and post-term pregnancy became more frequent, while the incidence of preterm birth showed no significant change. Overall, the prevalence of obstetric complications remained stable; however, the pattern of individual complications shifted, accompanied by greater medicalization of labour management. The rate of caesarean delivery decreased significantly. Perinatal outcomes also remained stable overall, although heterogeneous changes were observed across individual outcomes. Over the past decade, the risk profile of older primiparous women has become less favourable; nevertheless, this was not accompanied by an overall increase in obstetric or perinatal complications. Instead, temporal changes were reflected in a redistribution of complication patterns, suggesting a compensatory effect of advances in perinatal care.