Women are generally delaying the age of childbirth. At the same time, in recent years, the national fertility policy has been significantly adjusted, and the birth restriction of “two separate children” has been fully liberalized, resulting in a large number of older women giving birth again. How to protect the health of mothers and babies during pregnancy, delivery and postpartum is a real problem that obstetrics professionals must face. It is generally believed that older women over 35 years of age have better educational background, higher socioeconomic status and better health care coverage, and should have good pregnancy outcomes. However, this is not the case, and a large body of evidence suggests that advanced age is an independent risk factor for poor pregnancy outcomes. As maternal age increases, complications during pregnancy and intrapartum complications increase in parallel. Complications during pregnancy include overweight/obesity, gestational diabetes mellitus (GDM), gestational hypertension/pre-eclampsia (PE), antepartum hemorrhage, placental implantation, premature rupture of membranes, and preterm delivery; complications during labor include fetal previa, cephalopelvic disproportion, labor force abnormalities, and cesarean section. The complications during labor include abnormal preeclampsia, cephalopelvic disproportion, abnormal labor force, cesarean delivery, instrumental delivery, soft birth canal injury, postpartum hemorrhage, intrauterine distress, stillbirth, low birth weight, small for gestational age, birth asphyxia, and perinatal death. As early as 1992, Cnattingius S et al. conducted a large sample size (173,715 cases) study on adverse pregnancy outcomes in older pregnant women and found that late fetal death (OR 1.4), very low birth weight (<1,500 g, OR 1.2), low birth weight (1,500-2,499 g, OR 1.4), early preterm birth (<1,500-2,499 g, OR 1.4), early preterm birth (<1,500 g, OR 1.4), and early preterm birth (<1,500 g, OR 1.4) were more common in 30-34 year olds than in 20-24 year olds. The risk of very low birth weight (OR 1.8), low birth weight (OR 2.0), early preterm birth (OR 9), late preterm birth (OR 1.5) and small for gestational age (OR 1.4) is significantly higher in women over 40 years of age. The risk of pregnancy complications was even higher. Louise C et al. 2013 reported a large sample size of 214,296 cases in a case-control study, in which 54. 19% of pregnant women aged 20-29 years, 27. 63% aged 30-34 years, 15. 05% aged 35-39 years and 3. 13% aged 40 years or older were at risk of adverse pregnancy outcomes, after excluding pregnancy complications and other risk factors. Among them, stillbirth (RR 1. 83, 95% CI 1.37-2. 43), preterm birth (RR 1. 25, 95% CI 1. 14-1. 36), early preterm birth (RR 1. 29, 95% CI 1. 08-1. 55), large infant (RR 1. 31, 95% CI 1. 12-1. 54), older than gestational age (RR 1. 40, 95% CI 1. 25), and gestational age (RR 1. 25, 95% CI 1. 25) occurred in women over 40 years of age. Vaughan DA et al. 2013, in a study of 36,916 singleton primigravida from 2000 to 2011, found that the risk of neonatal NICU admission was significantly higher in women aged 40 years or older compared to those aged 20 to 34 years. In a study of 36,916 singleton primigravida from 2000 to 2011, Vaughan DA et al. 2013 found a significantly higher rate of neonatal NICU admission (OR 1. 35, 95% CI 1. 06 to 1. 72), birth defects (OR 1. 71, 95% CI 1. 07 to 2. 76), and cesarean delivery (OR 3. 24, 95% CI 2. 67 to 3. 94) among pregnant women older than 40 years. Mary Carolan et al. 2011 reviewed the literature published from 2000 to 2010 and found that the risk of stillbirth was significantly higher in older women over 35 years of age. To investigate the effect of advanced age on stillbirth, FrettsRC et al. published their study in the New England Journal of Medicine in 1995, in which they summarized and analyzed 94,346 pregnancies delivered between 1961 and 1993, in which the mean age at delivery increased from 27 years in 1961 to 30 years in 1993, and the incidence of GDM and gestational hypertension increased fivefold The risk of stillbirth was significantly higher between 35 and 39 years of age compared to those under 30 years of age (OR 1. 9, 95% CI 1. 3 to 2. 7) and even higher over 40 years of age (OR 2. 4, 95% CI 1. 3 to 4. 5), suggesting that advanced maternal age is a risk factor for stillbirth. Another study found that 31,662 women aged 40-44 years had a significantly higher risk of intrauterine death (OR 2. 1, 95% CI 1. 8 to 2. 4) compared to 876,361 women aged 20-29 years, and 1,205 women aged 45 years or older (OR 3. 8, 95% CI 2. 2 to 6. 4); and the risk of perinatal death in women aged 45 years or older was 2. 2 times higher than in women aged 20-29 years. The risk of perinatal death was 2.4 times higher in women aged 20-29 years (95% CI 1.5-4.0) and 1.7 times higher in women aged 40-44 years (95% CI 1.5-1.9) than in women aged 20-29 years. The incidence of preterm delivery and cesarean delivery due to advanced age was found to increase fourfold and cesarean delivery fivefold in older women aged 35 years or older compared to younger women aged 20-25 years, with a concomitant increase in the incidence of severe PE and perinatal mortality. Joseph et al. 2005 found that age was an independent risk factor for cesarean delivery [total cesarean delivery (OR 1. 07, 95% CI 1. 04 to 1. 09); elective cesarean delivery (OR 1. 04, 95% CI 1. 01 to 1. 08); and emergency cesarean delivery (OR 1. 11, 95% CI 1. 08 to 1. 15)]. A large sample size (157,445) of Joseph et al. 2005 found that older women over 35 years of age were more likely to have gestational hypertension, GDM, placenta abruptio and placenta praevia than women 20-24 years of age; the risk of preterm delivery was 1. 61 (95% CI 1. 42-1. 82) for women 35-39 years of age and 1. 80 (95% CI 1. 37-2. 36) for women over 40 years of age. Favilli A et al. 2012 retrospective cohort study found that the incidence of GDM (OR 3. 820, 95% CI 1. 400-10. 400), preterm delivery (OR 1. 847, 95% CI 1. 123-3. 037) and cesarean section (OR 3. 234, 95% CI 2. 266-4. 617) in pregnant women over 40 years of age compared to those between 20 and 30 years of age. Treacy A et al. found that the incidence of obstructed labor increased with maternal age in 10,737 primigravida deliveries from 1998 to 2002, and the resulting cesarean delivery rate increased significantly with maternal age. The results of a large sample size (502,524 singleton pregnancies) in Taiwan in 2004 also showed a significant positive association between maternal age and cesarean delivery after excluding medical influences. Jacobsson B et al. 2004 found that the risk of perinatal death was 2.4 times (95% CI 1.5-4.0) higher in pregnant women aged 45 years or older than in those aged 20-29 years, and 1.7 times (95% CI 1.5-4.0) higher in those aged 40-44 years than in those aged 20-29 years. The risk of perinatal death was 1.7 times higher for women aged 40 to 44 years than for women aged 20 to 29 years (95% CI 1.5 to 1.9). In a large sample size study in Canada, the risk of perinatal morbidity and mortality was significantly higher among pregnant women aged ≥35 years compared to those aged 20-24 years, with a risk of perinatal morbidity and mortality of 1. 46 (95% CI 1. 11-1. 92) for those aged 35-39 years and 1. 95 (95% CI 1. 13-3. 35) for those aged 40 years and older. Joseph et al. 2005 also found that perinatal mortality/morbidity was significantly higher in women aged 35 to 39 years compared to those aged 20 to 24 years (OR 1. 46, 95% CI 1. 11 to 1. 92) and even higher in women aged 40 years and older (OR 1. 95, 95% CI 1. 13 to 3. 35), suggesting that advanced age is strongly associated with perinatal mortality/morbidity. This suggests that advanced age is closely associated with perinatal mortality/morbidity. The long-term postpartum risks of older pregnant women are mainly related to maternal and fetal complications during pregnancy, such as PE, GDM, gestational obesity (especially pre-pregnancy obesity), and cardiovascular metabolic risks of mothers and offspring in the distant future, such as children older than gestational age and children younger than gestational age. Numerous prospective studies have confirmed that women with a history of PE are at significantly higher risk of developing multiple cardiovascular diseases. One study showed that the prevalence of hypertension in women with a history of PE was more than 50% 14 years postpartum, which was 3-4 times higher than that in women with non-PE; more seriously, women with a history of PE had a 2-fold increased risk of dying from cardiovascular disease, especially in women with PE before 34 weeks of gestation, which was 4-8 times higher than that in women with normal pregnancy. Niu et al. conducted a prospective case-control study to investigate the postpartum cardiovascular metabolic risk in 651 PE patients and 2,684 normal pregnant women with long term postpartum follow-up. The pre-pregnancy body mass index (BMI), maternal systolic blood pressure, maternal triglycerides and maternal fasting glucose were closely related to postpartum hypertension, suggesting that PE patients have an increased risk of postpartum hypertension and that abnormal maternal blood pressure and glucolipid metabolism are closely related to the occurrence of hypertension. GDM is a major risk factor for type 2 diabetes in women, and about 20% to 60% of pregnant women with GDM develop type 2 diabetes within 5 years after delivery. Women with a history of GDM are also at increased risk for other cardiovascular diseases, such as obesity, hypertension, dyslipidemia, subclinical atherosclerosis, and metabolic syndrome. The risk of postpartum distant cardiovascular events in GDM was 1.71, with a significantly increased risk of CVD in women with GDM compared to women without GDM. Based on this, the 2011 American Heart Association guidelines for the prevention and treatment of heart disease in women explicitly included women with a history of PE and GDM as risk factors for CVD for the first time. Also, hyperglycemia during pregnancy leads to impaired fetal islet development, an effect that can persist into adulthood. The Reece EA study found that the offspring of mothers with GDM had a significantly increased risk of macrosomia, respiratory distress, insulin resistance, type 2 diabetes, obesity, and metabolic syndrome. Charlotte M et al. 2005 found that the risk of metabolic syndrome was increased in the offspring of pregnant women with simple obesity, suggesting that other metabolic factors besides abnormal glucose metabolism, such as abnormal lipid metabolism and insulin resistance, may affect the offspring through changes in the intrauterine environment. The risk of metabolic syndrome in offspring is also increased. In 2004, Whitaker RC, a retrospective cohort study of 8,400 children born in the early 1990s, found that children born to mothers with a BMI ≥30 in early gestation had an increased risk of obesity at ages 2, 3, and 4 years compared to those born to mothers with a normal BMI. The prevalence of obesity in children aged 2, 3 and 4 years was 15.1%, 20.6% and 24.1%, respectively. 6. To summarize, advanced age can lead to multiple adverse pregnancy outcomes such as overweight/obesity during pregnancy, GDM, gestational hypertension/PE, antepartum hemorrhage, placental implantation, premature rupture of membranes, preterm delivery, stillbirth, fetal previa abnormalities, cephalopelvic disproportion, labor abnormalities, cesarean delivery, postpartum hemorrhage, intrauterine distress, stillbirth, low birth weight, children younger than gestational age, children older than gestational age, birth asphyxia, perinatal death, maternal perinatal morbidity/perinatal death The risk of multiple adverse pregnancy outcomes is high. Adverse pregnancy outcomes in older women are strongly associated with cardiometabolic risks such as hypertension, type 2 diabetes, metabolic syndrome, atherosclerosis, and adolescent obesity in the mother and offspring in the distant future. Therefore, there is a need to enhance perinatal care and prevention of cardiometabolic risks in the distant postpartum period in older pregnant women. Obstetricians should manage women's lifelong health not only up to 42 days after delivery, but also jointly with cardiovascular and endocrinologists. There is a need to strengthen multicenter clinical studies of older pregnant women to provide evidence-based medical evidence for the adjustment of family planning policies and better protection of maternal and infant health.