{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T14:58:14Z","timestamp":1790089094904,"version":"4.0.1"},"reference-count":34,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2021,12,12]],"date-time":"2021-12-12T00:00:00Z","timestamp":1639267200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Maternal age is related to a higher risk of adverse maternal, fetal, and neonatal outcomes in twin pregnancies. However, whether this increase in adverse outcomes is due solely to age or due to risk factors that are more common in women over 40 remains unknown. The aim of this study is to assess if maternal age over 40 years old is an independent risk factor for obstetric adverse outcomes in dichorionic diamniotic twin gestations. In this single-center retrospective cohort study, we compared the obstetric outcomes of women with dichorionic diamniotic twin pregnancies below and over 40 years of age. A twin pregnancy cohort enrolled between 2013 and 2019 was included in the study. Maternal, fetal, and labor complications were recorded. A total of 510 women were analyzed in two groups: 266 women below 40 years old and 244 women over 40 years old. Maternal age over 40 increased the odds of maternal (aOR = 1.9 (1.3; 2.9); p-value = 0.002), fetal (aOR = 1.8 (1.0; 3.0); p-value = 0.037), and labor complications (aOR = 2.5 (1.3; 4.6); p-value = 0.004). Maternal age over 40 years was the most important factor increasing the odds of having a caesarean section (C-section). Over 40 years old was an independent risk factor for complications in dichorionic diamniotic twin pregnancies.<\/jats:p>","DOI":"10.3390\/ijerph182413117","type":"journal-article","created":{"date-parts":[[2021,12,13]],"date-time":"2021-12-13T01:28:11Z","timestamp":1639358891000},"page":"13117","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Women Aged over 40 with Twin Pregnancies Have a Higher Risk of Adverse Obstetrical Outcomes"],"prefix":"10.3390","volume":"18","author":[{"given":"Mar\u00eda","family":"De la Calle","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Hospital Universitario La Paz, 28046 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose L.","family":"Bartha","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Hospital Universitario La Paz, 28046 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Garc\u00eda","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Hospital Universitario Gregorio Mara\u00f1\u00f3n, 28007 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8013-4732","authenticated-orcid":false,"given":"Marcos J.","family":"Cuerva","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Hospital Universitario La Paz, 28046 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7442-1586","authenticated-orcid":false,"given":"David","family":"Ramiro-Cortijo","sequence":"additional","affiliation":[{"name":"Department of Physiology, Faculty of Medicine, Universidad Autonoma de Madrid, 28029 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,12,12]]},"reference":[{"key":"ref_1","first-page":"w14330","article-title":"Postponed Pregnancies and Risks of very Advanced Maternal Age","volume":"146","author":"Haslinger","year":"2016","journal-title":"Swiss Med. Wkly."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1111\/1471-0528.12659","article-title":"Advanced Maternal Age and Pregnancy Outcomes: A Multicountry Assessment","volume":"121","author":"Laopaiboon","year":"2014","journal-title":"BJOG"},{"key":"ref_3","first-page":"61","article-title":"Social Influence and the Timing of Parenthood","volume":"3","year":"2009","journal-title":"Interpersona Int. J. Pers. Relatsh."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1111\/j.1552-6909.2006.00079.x","article-title":"Factors Influencing Women\u2019s Decisions about Timing of Motherhood","volume":"35","author":"Benzies","year":"2006","journal-title":"J. Obstet. Gynecol. Neonatal Nurs."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Ruspini, E., and Dale, A. (2002). The role of education on postponement of maternity in Britain, Germany, The Netherlands and Sweden. The Gender Dimension of Social Change, Policy Press.","DOI":"10.56687\/9781847425478"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"848","DOI":"10.1093\/humupd\/dmr026","article-title":"Why do People Postpone Parenthood? Reasons and Social Policy Incentives","volume":"17","author":"Mills","year":"2011","journal-title":"Hum. Reprod. Update"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1111\/j.1600-0412.2011.01335.x","article-title":"Characteristics of Women Who are Pregnant with their First Baby at an Advanced Age","volume":"91","author":"Nilsen","year":"2012","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1097\/01.AOG.0000158118.75532.51","article-title":"Impact of Maternal Age on Obstetric Outcome","volume":"105","author":"Malone","year":"2005","journal-title":"Obstet. Gynecol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1097\/GCO.0b013e3280825603","article-title":"Increased Risk in the Elderly Parturient","volume":"19","author":"Montan","year":"2007","journal-title":"Curr. Opin. Obstet. Gynecol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.ejogrb.2006.10.030","article-title":"Pregnancy Outcome in Primiparae of Advanced Maternal Age","volume":"135","author":"Delbaere","year":"2007","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1111\/aogs.13769","article-title":"Pregnancy Complications and Risk of Preterm Birth According to Maternal Age: A Population-Based Study of Delivery Hospitalizations in Alberta","volume":"99","author":"Scime","year":"2020","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1235","DOI":"10.1111\/1471-0528.14368","article-title":"Advanced Maternal Age Increases the Risk of very Preterm Birth, Irrespective of Parity: A Population-Based Register Study","volume":"124","author":"Waldenstrom","year":"2017","journal-title":"BJOG"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"855","DOI":"10.3109\/09513590.2010.501889","article-title":"Ageing and Infertility: An Overview","volume":"26","author":"Balasch","year":"2010","journal-title":"Gynecol. Endocrinol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1016\/j.clp.2005.04.002","article-title":"Epidemiology and Biology of Multiple Gestations","volume":"32","author":"Endres","year":"2005","journal-title":"Clin. Perinatol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1053\/sper.2002.34775","article-title":"Trends in the Occurrence, Determinants, and Consequences of Multiple Births","volume":"26","author":"Blondel","year":"2002","journal-title":"Semin. Perinatol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.ogc.2004.10.010","article-title":"The Paradox of Old Maternal Age in Multiple Pregnancies","volume":"32","author":"Oleszczuk","year":"2005","journal-title":"Obstet. Gynecol. Clin. N. Am."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1016\/0029-7844(94)00455-M","article-title":"The Origin and Outcome of Preterm Twin Pregnancies","volume":"85","author":"Gardner","year":"1995","journal-title":"Obstet. Gynecol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1097\/AOG.0000000000001338","article-title":"Twin Pregnancy and Severe Maternal Outcomes: The World Health Organization Multicountry Survey on Maternal and Newborn Health","volume":"127","author":"Santana","year":"2016","journal-title":"Obstet. Gynecol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1111\/j.1600-0412.2004.00279.x","article-title":"Maternal Risks and Perinatal Outcome in a Danish National Cohort of 1005 Twin Pregnancies: The Role of in Vitro Fertilization","volume":"83","author":"Pinborg","year":"2004","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1016\/S0002-9378(00)70350-4","article-title":"Hypertensive Disorders in Twin Versus Singleton Gestations. National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units","volume":"182","author":"Sibai","year":"2000","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1007\/s00404-003-0483-z","article-title":"Risk for Gestational Diabetes and Hypertension for Women with Twin Pregnancy Compared to Singleton Pregnancy","volume":"269","author":"Buhling","year":"2003","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/S0020-7292(03)00314-X","article-title":"Maternal Complications of Twin Pregnancy","volume":"84","author":"Campbell","year":"2004","journal-title":"Int. J. Gynaecol. Obstet."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1111\/j.1600-0412.2011.01232.x","article-title":"Older Mothers do Not Confer Greater Perinatal Risk to Dichorionic Diamniotic Twins","volume":"91","author":"Mullins","year":"2012","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"80.e1","DOI":"10.1016\/j.ajog.2017.03.002","article-title":"The Role of Maternal Age in Twin Pregnancy Outcomes","volume":"217","author":"McLennan","year":"2017","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1080\/14767050902801819","article-title":"Outcomes of Multiple Gestations with Advanced Maternal Age","volume":"22","author":"Fox","year":"2009","journal-title":"J. Matern. Fetal. Neonatal Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1016\/j.annepidem.2013.05.005","article-title":"Effect of Advanced Maternal Age on Perinatal Outcomes in Twins: The Impact of Chorionicity","volume":"23","author":"Lisonkova","year":"2013","journal-title":"Ann. Epidemiol."},{"key":"ref_27","first-page":"238","article-title":"Association between Maternal Age and Adverse Pregnancy Outcome in Twin Pregnancy","volume":"22","author":"Yang","year":"2020","journal-title":"Chin. J. Contemp. Pediatrics"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"de la Calle, M., Bartha, J.L., Lopez, C.M., Turiel, M., Martinez, N., Arribas, S.M., and Ramiro-Cortijo, D. (2021). Younger Age in Adolescent Pregnancies is Associated with Higher Risk of Adverse Outcomes. Int. J. Environ. Res. Public. Health, 18.","DOI":"10.3390\/ijerph18168514"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1080\/00016340701417323","article-title":"Increasing Twinning Rates in Norway, 1967\u20132004: The Influence of Maternal Age and Assisted Reproductive Technology (ART)","volume":"86","author":"Tandberg","year":"2007","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1097\/AOG.0b013e3181bb14c8","article-title":"Optimal Nutrition for Improved Twin Pregnancy Outcome","volume":"114","author":"Goodnight","year":"2009","journal-title":"Obstet. Gynecol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.siny.2017.11.008","article-title":"Ultrasound Screening for Complications in Twin Pregnancy","volume":"23","author":"Townsend","year":"2018","journal-title":"Semin. Fetal. Neonatal Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2145","DOI":"10.1093\/humrep\/den134","article-title":"Perinatal Outcome of Twin Pregnancies in Women of Advanced Age","volume":"23","author":"Delbaere","year":"2008","journal-title":"Hum. Reprod."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"ACOG (2019). Committee Opinion no. 761: Cesarean Delivery on Maternal Request. Obstet. Gynecol., 133, e73\u2013e77.","DOI":"10.1097\/AOG.0000000000003006"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1007\/s00404-005-0724-4","article-title":"The Changing Motives of Cesarean Section: From the Ancient World to the Twenty-First Century","volume":"271","author":"Lurie","year":"2005","journal-title":"Arch. Gynecol. Obstet."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/24\/13117\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:46:06Z","timestamp":1760168766000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/24\/13117"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,12]]},"references-count":34,"journal-issue":{"issue":"24","published-online":{"date-parts":[[2021,12]]}},"alternative-id":["ijerph182413117"],"URL":"https:\/\/doi.org\/10.3390\/ijerph182413117","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,12]]}}}