Pregnancy Women in Older of Reproductive Age: the State of the Problem, Features of the Course, Perinatal Consequences

In today's world, the trend towards later childbirth is increasingly common in developed countries. In the age structure of pregnant women there was a significant shift towards an increase in the share of women of older reproductive age (over 35 years) compared to young pregnant women against the background of a decrease in the total number of births. Purpose: the identification of the main risk factors for obstetric and perinatal complications in women of older reproductive age (35+) in modern realities. Materials and methods of research. In the dynamics of pregnancy was examined 75 pregnant women over the age of 35, who were treated and delivered in the Department of Pathology of Pregnancy and Childbirth SI “Academician O.M. Lukyanova IPOG of the NAMS of Ukraine”. The distribution of women by age category was as follows: 1st group – 43 women aged 35–39 years, 2nd group – 43 women aged 40 years and older (3 women were aged 45, 50 and 56 years). The comparison group consisted of 39 pregnant women under the age of 35 with a physiological course of pregnancy (group 3). Research results. All women in groups 1 and 2 had low levels of vitamin D – deficiency was found in 55.6 % of women in group 1, 41.7 % of women in group 2 and 73.7 % – in the control group. The optimal indicators of estradiol levels were in women of the control group – (67.4 ± 1.1) nmol/l, which is 6.1 % more than in pregnant women of group 1 and 15.8 % more than in group 2. The concentration of progesterone in the serum of women over 40 years was reduced and amounted to (433.2 ± 9.2) nmol/l, which was significantly different from the women of group 1 and control group: (467.2 ± 13.2) nmol/l and (553.2 ± 14.6) nmol/l, respectively. Placental dysfunction was observed in every second pregnant woman (55.0 %) of group 2, fetal distress – in every fourth pregnant woman of groups 1 and 2. Anxious variant of the psychological component of gestational dominance was observed in 25.0 % of pregnant women in group 2 and in 14.3 % of women in group 1. Urgent childbirth among both groups of respondents occurred in 36.7 % of women, in group 3 urgent childbirth occurred in 84.2 % of women. In group 1 there were significantly more urgent births compared to group 2 – 55.5 % and 8.3 %, respectively (p < 0.05); in the control group there were also more urgent births, compared with group 2 – 84.2 % and 8.3 % (p < 0.05). Conclusions. The number and severity of complications of gestation is directly proportional to the age of the pregnant woman. There are greater manifestations of obstetric pathology in older women and firstborns. These women have a history of many inflammatory diseases, especially of the genital area; more women were overweight (33.3 %). As a prevention of complicated pregnancy and childbirth in women of older reproductive age, it is proposed to further develop a comprehensive system of pre-pregnancy training. Key words: late reproductive age, pregnancy, childbirth, complications, obesity, micronutrient metabolism, hormonal homeostasis, fetoplacental complex, prevention, pre-pregnancy training.