Adverse Maternal and Neonatal Outcomes Among Women of Advanced Maternal Age in a Tertiary-Care Setting in Bangladesh: A Cross-Sectional Study.

Background and Aims: Pregnancy at advanced maternal age is increasing globally, yet risks related to hypertensive disorders, prematurity, and impaired fetal growth remain substantial, particularly in tertiary-care settings. This study aimed to quantify maternal and neonatal complications among women aged ≥ 35 years delivering in tertiary hospitals in Dhaka, Bangladesh, and to examine factors associated with adverse maternal and neonatal outcomes. Methods: We conducted an analytical cross-sectional study at discharge in two tertiary referral hospitals. Consecutive eligible women aged ≥ 35 years were enrolled ( Results: Maternal adverse outcomes occurred in 97.7% of women, most commonly preeclampsia (27.3%), premature rupture of membranes (26.0%), and oligohydramnios (23.2%). Neonatal adverse outcomes affected 80.5% of births, dominated by prematurity (72.9%), preterm delivery (74.0%), and low birthweight (52.3%). Very-low birthweight was markedly more frequent among infants of mothers aged ≥ 40 years than 35-39 years (51.9% vs. 7.6%; Conclusion: In this tertiary referral context, maternal complications were nearly universal, while neonatal risk was strongly structured by birthweight. These findings support age-attuned antenatal surveillance and preparedness for small-baby care among women of advanced maternal age.