**6.2. Post-partum care**

When obstetric complications such as preeclampsia or diabetes mellitus presented during pergnancy, persistence of medical conditions such as chronic hypertension and type 2 diabetes (T2DM) should be monitored after delivery. Chronic hypertension in women affected by gestational hypertension or preeclampsia is a common event, usually developing years after delivery [101]. Age at pregnancy might reduce this time interval, but this has not been studied before. Likewise, age does not increase the odds of post-partum eclampsia [102]. Age at pregnancy is a risk factor for the development of T2DM when GDM is present [103]. Anyhow, advanced maternal age is a risk factor for developing cardiovascular complications during pregnancy and for developing severe morbidity due to cardiovascular disease [104], so strict and long-term follow-up strategies should be put in place.

Secondary post-partum haemorrhage is increased in women affected by primary post-partum haemorrhage and in women ≥35 years old, both risk factors being independently associated with the event [105].

Maternal age at delivery >35 years has been indicated as a risk factor for venous thromboembolism in the post-partum period and later in life [106]. However, its contribution is probably small when compared to other factors, such as caesarean delivery [107].

Twin pregnancies are also associated with all the complications mentioned above. Again, this specific population is particularly vulnerable for developing post-partum complications.

Various studies suggest that advanced maternal age at the time of delivery is associated with a higher risk of developing stress urinary incompetence (SUI) in the post-partum period [108, 109]. Suspected aetiological mechanisms are many and they are thought to start developing during pregnancy. Some studies suggest that vaginal delivery may worsen SUI, particularly in elderly women, and advise a caesarean delivery in this population when SUI is already present during pregnancy [108]. However, this protective effect is not consistent in literature, so currently, such a recommendation is controversial [110]. Of course, pelvic floor changes are greater in twin pregnancies, as abdominal pressure on it is irredeemably higher [111]. Anyhow, elderly mothers carrying a twin pregnancy are at higher risk of developing pelvic floor disorders, so preventive strategies should be enforced during pregnancy and early investigation and proper treatment in the post-partum period.

Advanced maternal age is considered to be a risk factor for post-partum depression [112]. This is a poorly studied condition, which can be devastating for the mothers, children, and family. On the other hand, parents of twins frequently experience higher levels of anxiety and depression and are at higher risk for post-partum depression and for marital decline [113, 114]. Post-partum depression has also been linked to preterm birth, so common among twins, due to a lesser mother-infant interaction and parents' concern for both medical and economic subsequent issues [115]. Sleeping disorders 3 months post-partum are more frequent in mothers older than 35 years old [116]. Psychosocial and physical support should be provided.
