Outcome of Twin pregnancy in women ≥45 years old: A retrospective cohort study

Objective: To investigate prematurity rate in women aged ≥45 carrying a twin pregnancy. Other maternal and neonatal outcomes are also described. Design: Retrospective cohort study. Setting: Women delivering a twin pregnancy at a single tertiary medical center. Population: The study included all women aged 45 years and over carrying a twin pregnancy who delivered at 20 weeks gestation or beyond over a 9-year period from May 2000 to May 2009. Methods: Women aged 45 years and over were identified, all conceived by in vitro fertilization with ovum donation. The study group was compared to a control group of women <40 years with twin pregnancies conceived by IVF who delivered during the same time period. Main outcome measure(s): Maternal complications during pregnancy and neonatal outcome. Results: During the study period 32 women ≥45 years delivered twins. The control group included 109 women. The rate of delivery before 37 weeks as well as before 32 weeks were very high in our study group (65% versus 40%, p=0.01 and 15% versus 5.0%, p=0.05, respectively). The rate of maternal life-threatening complications including blood product transfusion and maternal admission to the intensive care unit were also significantly higher in our study group compared to the control group (18% versus 2%, p=0.018 and 6.3% versus none, p=0.05). Conclusions: Women ≥45 years old with twin pregnancy carry a higher risk of maternal and perinatal complications.