EC Gynaecology

Background: Adolescents (≤ 19 years) and women of advanced maternal age (≥ 35 years) with obesity represent vulnerable groups. We propose a practical "risk-age" grouping to evaluate their combined cardiometabolic risk profile.

Methods: A cross-sectional analytical study was conducted in 404 pregnant women with a BMI ≥ 25 kg/m². Participants were stratified into two groups: Central reproductive age (20 - 34 years, n = 252) and risk-age (≤ 19 and ≥ 35 years, n = 152). Anthropometric (waist circumference, waist-to-height ratio - WHtR), biochemical (lipid profile), and perinatal outcome data were analyzed.

Results: The risk-age group exhibited a significantly worse cardiometabolic profile, including a higher prevalence of visceral adiposity (WHtR > 0.53: 97.4% vs. 93.3%, p < 0.05) and hypertriglyceridemia (69.7% vs. 55.6%, p = 0.004). While perinatal outcomes did not differ significantly between groups in isolation, a powerful interaction was found. The combination of belonging to the risk-age group and having class II-III obesity was associated with an odds ratio of 5.8 (95% CI: 1.1 - 29.5, p = 0.035) for fetal death. A high WHtR was a strong independent predictor for fetal macrosomia (OR = 4.5).

Conclusion: Grouping pregnant women with obesity at the extremes of reproductive age identifies a cohort with heightened cardiometabolic risk. The synergy between this "risk-age" status and severe obesity is associated with a sharply increased risk of fetal death, advocating for targeted clinical surveillance in this population.

 Keywords: Gestational Obesity; Advanced Maternal Age; Adolescence; Cardiometabolic Risk; Perinatal Outcomes

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