Background: In recent decades, more women are delaying childbirth, with advanced maternal age linked to higher risks of adverse pregnancy outcomes. Prior studies have shown associations between older maternal age and gestational diabetes (GDM), gestational hypertension (GHTN), type 2 diabetes (T2DM), chronic hypertension (CHTN), and preeclampsia (PreE).

Objective: This study assessed whether maternal age remains a significant predictor of gestational and chronic diseases in a Southeastern U.S. urban area with a large African American population.

Study Design: A retrospective analysis of 22,730 singleton live births (2020–2024) was conducted using electronic medical records from Epic. Maternal age was analyzed categorically. Odds ratios measured disease likelihood across age cohorts, and chi-square tests examined associations between race and disease development.

Results: The odds of developing GDM increased with age. Among White women, those aged 30–34 (OR 1.58), 35–39 (OR 1.96), and over 40 (OR 2.91) had higher odds compared to ages 18–29. Similar trends appeared in African American women aged 30–34 (OR 1.71), 35–39 (OR 2.83), and over 40 (OR 3.68). No significant association was found between maternal age and GHTN. White women over 40 had higher odds of PreE (OR 1.8). African American women aged 34–39 (OR 1.19) and 35–39 (OR 1.57) also had increased PreE risk. Both groups over age 30 had higher odds of T2DM and CHTN.

Conclusion: Advanced maternal age is significantly associated with increased risk of GDM, T2DM, CHTN, and PreE. As delayed childbirth trends continue, targeted prenatal care and early detection are critical to manage risks. Future prospective studies are needed to clarify mechanisms and develop interventions to improve outcomes.