This is a longitudinal observational study conducted in the maternity ward of Laquintinie Hospital in Douala. The study was carried out over a period of 8 months from January to August 2025.

The study included all women who gave birth during the study period and met the following criteria:

An exhaustive sampling was conducted, including all geriatric pregnancies recorded in the obstetrical register. The final sample size was N = 234.

The primary dependent variable, “adverse neonatal outcome,” was defined as a composite endpoint including one or more of the following:

Overall, 81 newborns (34.6%) met at least one of these criteria

Data was collected using a structured data sheet, developed from obstetric and neonatal records and interactions with the pregnant women.

Data was entered and analyzed using SPSS software version 26.0. Quantitative variables were presented as mean ± standard deviation. Qualitative variables were expressed in numbers and percentages. Associations between independent variables and adverse neonatal outcomes were tested using Pearson’s χ² or Fisher’s exact test, as appropriate. Significant variables in the bivariate analysis (p < 0.20) were included in a multivariate logistic regression to identify independent predictive factors. The significance threshold was set at p < 0.05.

The prospective nature of the data required the individual consent of participants, and confidentiality was ensured at all stages of data processing.

The analysis of neonatal outcomes highlights contrasting results, combining an overall good delivery process with significant fetal morbidity.

Among the 234 births, 50.8% were cesarean deliveries, while 49.2% were vaginal deliveries. This high rate of cesarean sections reflects the cautious obstetrical approach typically adopted for older women, who often have comorbidities or antenatal complications.

The majority of births occurred at term (37 - 41 weeks of amenorrhea), representing 73.9% of cases. However, premature births accounted for 23.8% of the total, including 17.5% late preterm (33 - 36 weeks) and 6.3% early and moderate preterm (22 - 32 weeks). Post-term births (≥42 weeks) were infrequent (3.4%). These figures indicate a notable proportion of preterm births.

Most newborns had a weight between 2500 and 4000 g (74.8%), indicating satisfactory fetal growth for the majority of pregnancies. Low birth weight newborns (<2500 g) represented 21.8%, a proportion higher than the expected standards for the general population, highlighting the fetal vulnerability associated with advanced maternal age. Macrosomia (≥4000 g) was rare (3.4%).

Nearly one-third of the newborns (34.6%) presented at least one fetal or neonatal complication. The most frequent complications were prematurity (20.9%), followed by intrauterine fetal deaths (7.3%), acute neonatal asphyxia (4.7%), and perinatal deaths (3.8%). Hypotrophy (3.4%) and macrosomia (2.6%) reflected growth imbalances related to placentation or maternal metabolism. Neonatal infections (0.9%) and jaundice (0.4%) were rare ( Table 1 ).

Bivariate analyses were first performed to explore unadjusted associations between maternal characteristics and adverse neonatal outcomes. Variables with a p-value < 0.20 were subsequently entered into a multivariate logistic regression model to identify independent predictors.

The logistic analysis highlights the clear influence of sociodemographic characteristics on the neonatal prognosis of geriatric pregnancies in Douala.

The analysis of obstetric and medical history reveals several significant risk factors for adverse neonatal outcomes among geriatric pregnant women in Douala.

1) Parity

Nulliparous women have more than double the risk of an adverse neonatal outcome (OR = 2.3 (1.0 - 5.5); p = 0.048), probably linked to cervical immaturity, prolonged labor, or more frequent induction. Grand multiparous women (>4) are even more at risk (OR = 6.0 (1.2 - 29.6); p = 0.027), reflecting the impact of uterine fatigue and complex obstetric history.

2) Medical History

The presence of a medical history quadruples the risk of adverse neonatal outcomes (OR = 4.2 (2.1 - 8.1); p < 0.001). Among these conditions, HIV emerges as the most determining factor (OR = 5.7 (1.2 - 27.1); p = 0.027), followed by hypertension (OR = 3.9 (0.8 - 18.7); non-significant trend). Although individual conditions such as hypertension and diabetes showed variable trends, the final adjusted model considered “medical history” as a composite variable encompassing hypertension, HIV infection, and diabetes. Collectively, this composite factor increased the risk of adverse neonatal outcomes nearly fourfold (adjusted OR = 3.9; p < 0.001).

3) History of Cesarean Section

Women with a history of cesarean section have nearly three times the risk of adverse neonatal outcomes (OR = 2.9 (1.5 - 5.4); p = 0.001) ( Table 3 ).

The analysis highlights a close connection between the quality of prenatal care and the occurrence of adverse neonatal outcomes among geriatric women in Douala.

1) Frequency of Prenatal Consultations

Women who did not have at least one prenatal consultation per month have a nine times higher risk of adverse neonatal outcomes (OR = 9.2; p < 0.001). This underscores the crucial role of regular and frequent monitoring in the early detection of complications such as hypertension, infections, and intrauterine growth restriction (IUGR).

2) Multiple Pregnancies

Although rare (3%), multiple pregnancies are associated with a 5.4-fold increased risk of adverse neonatal outcomes (p = 0.034), primarily due to prematurity and fetal growth restriction.

3) Supplementation and Prevention

The absence of iron and folic acid supplementation increases the risk of adverse outcomes by a factor of 7 (p = 0.018). Similarly, women who did not receive intermittent preventive treatment for malaria (IPTp) have a doubled risk (p = 0.049). These findings confirm the importance of preventive measures in reducing neonatal morbidity.

4) Calcium and Aspirin

The lack of calcium supplementation is a significant risk factor (OR = 4.1; p < 0.001), possibly related to preeclampsia and fetal growth restriction. In contrast, the prescription of low-dose aspirin does not show a significant effect (p = 0.69), probably due to the small number of affected individuals.

5) Pathologies Discovered During Pregnancy

Patients who developed an intercurrent pathology during pregnancy have a 3.5-fold increased risk of adverse neonatal outcomes (p < 0.001). Gestational hypertension appears as the dominant factor (OR = 4.8; p < 0.001), confirming its major role in perinatal morbidity and mortality ( Table 4 ).

After adjusting for confounding variables, the factors independently associated with adverse neonatal outcomes are as follows:

1) Maternal Age ≥ 40 Years

Women aged 40 or older have a 2.4 times higher risk (p = 0.012). This association reflects the vascular and placental fragility associated with aging.

2) Extreme Parity

Extremes of parity were defined as nulliparity (no previous delivery) and grand multiparity (five or more previous deliveries), both associated with higher neonatal risk. Both nulliparity and grand multiparity emerge as independent factors (OR = 2.7; p = 0.008), indicating that obstetric extremes (first or many pregnancies) expose individuals to increased perinatal morbidity (prematurity, asphyxia, intrauterine fetal death).

3) Medical History

Patients with chronic hypertension, HIV, or diabetes have a fourfold increased risk of adverse neonatal outcomes (OR = 3.9; p < 0.001). These conditions disrupt placental perfusion and impair fetal growth and vitality.

4) History of Cesarean

A previous cesarean remains an independent factor (OR = 2.1; p = 0.024), indicating persistent obstetric fragility (placenta previa, placental abruption, uterine rupture, urgent extraction).

5) Quality of Prenatal Care

Women who have not had at least one prenatal consultation per month have a 6.5 times higher risk of adverse neonatal outcomes (p < 0.001). This factor, the most powerful in the model, illustrates the crucial importance of regular monitoring in detecting and preventing complications.

6) Supplementation

The absence of iron-folic acid (OR = 4.8; p = 0.017) and calcium (OR = 3.2; p = 0.003) significantly increases neonatal risk, emphasizing the importance of systematic supplementation in preventing anemia, growth restriction, and preeclampsia.

7) Intercurrent Pathologies

The occurrence of a pathology during pregnancy, mainly gestational hypertension or malaria, increases the risk of adverse outcomes by 3.7 times (p < 0.001). These conditions directly compromise placental perfusion and fetal vitality.

8) Multiple Pregnancies

Twin pregnancies represent a major independent factor (OR = 5.0; p = 0.037), confirming the increased risk of prematurity, growth restriction, and neonatal distress ( Table 5 ).

The main independent factors for adverse neonatal outcomes among geriatric women in Douala are:

The significant association between advanced maternal age and adverse neonatal outcomes (OR = 2.4; p = 0.012) confirms the international literature. Women over the age of 40 exhibit major physiological alterations: vascular stiffness, reduced placental perfusion, and increased chromosomal abnormalities affecting fetal growth and vitality [8] - [10] . Studies conducted in Nigeria [11] , Ghana [12] , and Cameroon [13] also report an elevated risk of prematurity, asphyxia, and intrauterine fetal death beyond 40 years. According to the WHO, advanced maternal age doubles the risk of perinatal mortality, regardless of the level of obstetric care [14] . These findings are consistent with our results and underscore that maternal aging is a biological marker of fetal vulnerability. While marital status and educational level were associated with neonatal outcomes in unadjusted analyses, these associations did not remain significant after multivariate adjustment, suggesting that their influence is largely mediated by socioeconomic conditions and the quality of prenatal care.

Nulliparous women and grand multiparas have an increased risk (OR = 2.7; p = 0.008). In older nulliparous women, the cervix is often rigid, labor is longer, and instrumental deliveries are more frequent, exposing the newborn to hypoxia [15] . In grand multiparas, uterine distension and presentation anomalies increase the likelihood of acute fetal distress and iatrogenic prematurity [16] . Ethiopian and Ghanaian studies have shown that high multiparity is associated with two to three times higher perinatal morbidity compared to intermediate parity [17] [18] .

In the adjusted model, medical history was treated as a composite variable, reflecting the cumulative impact of chronic maternal conditions rather than each disease individually. Hypertension impairs uteroplacental perfusion, promoting intrauterine growth restriction (IUGR) and intrauterine fetal death (IUFD) [19] . Similarly, HIV positivity is associated with an increased risk of prematurity and low birth weight, regardless of antiretroviral treatment [20] . Our results align with those of Mboudou et al. [21] in Yaounde, who found a 22% prevalence of neonatal complications in hypertensive older mothers. A history of cesarean section also doubles the neonatal risk (OR = 2.1; p = 0.024), likely due to the increased frequency of placental anomalies (placenta previa, placental abruption) and emergency extractions [22] .

The absence of monthly prenatal care increases the risk of neonatal complications sixfold (p < 0.001), corroborating the observations of Tchente Nguefack et al. [23] in Cameroon and Adegbola et al. [24] in Nigeria. Insufficient care prevents the early detection of gestational pathologies and nutritional deficiencies. Additionally, the lack of iron, folic acid, and calcium supplementation significantly increases neonatal risk (OR = 3 - 5). Iron and folic acid prevent maternal anemia, reducing the risk of fetal growth restriction and asphyxia [25] , while calcium decreases the occurrence of preeclampsia and intrauterine growth restriction (IUGR) [26] . These findings reinforce the need for strict adherence to prenatal supplementation protocols in maternal health programs.

Pathologies discovered during pregnancy (gestational hypertension, malaria) are independent determinants (OR = 3.7; p < 0.001). Gestational hypertension remains the leading cause of fetal morbidity and mortality in the sub-Saharan region, accounting for nearly 30% of severe obstetric complications [27] . Regarding malaria, it compromises placental perfusion and promotes prematurity and neonatal growth restriction [28] . Finally, multiple pregnancies increase the risk of adverse outcomes fivefold (OR = 5.0; p = 0.037), supporting the conclusions of Bello et al. [29] in Nigeria and Foumane et al. [30] in Cameroon, where prematurity is the primary cause of neonatal morbidity in twin pregnancies.

These findings highlight that poor neonatal outcomes in geriatric women are largely preventable. Most identified factors are modifiable: improving prenatal care, early detection of comorbidities, systematic supplementation, and anticipatory obstetric planning. Maternity services should adopt a multidisciplinary and anticipatory approach for these high-risk patients, involving obstetricians, pediatricians, internists, and nutritionists. Enhancing prenatal coverage and raising awareness about family planning could ultimately reduce the perinatal morbidity and mortality associated with late pregnancies considerably.