Advanced maternal age and adverse pregnancy outcome: evidence from a large contemporary cohort

Louise C Kenny, Tina Lavender, Roseanne McNamee, Sinéad M O'Neill, Tracey Mills, Ali S Khashan, Louise C Kenny, Tina Lavender, Roseanne McNamee, Sinéad M O'Neill, Tracey Mills, Ali S Khashan

Abstract

Background: Recent decades have witnessed an increase in mean maternal age at childbirth in most high-resourced countries. Advanced maternal age has been associated with several adverse maternal and perinatal outcomes. Although there are many studies on this topic, data from large contemporary population-based cohorts that controls for demographic variables known to influence perinatal outcomes is limited.

Methods: We performed a population-based cohort study using data on all singleton births in 2004-2008 from the North Western Perinatal Survey based at The University of Manchester, UK. We compared pregnancy outcomes in women aged 30-34, 35-39 and ≥40 years with women aged 20-29 years using log-linear binomial regression. Models were adjusted for parity, ethnicity, social deprivation score and body mass index.

Results: The final study cohort consisted of 215,344 births; 122,307 mothers (54.19%) were aged 20-29 years, 62,371(27.63%) were aged 30-34 years, 33,966(15.05%) were aged 35-39 years and 7,066(3.13%) were aged ≥40 years. Women aged 40+ at delivery were at increased risk of stillbirth (RR = 1.83, [95% CI 1.37-2.43]), pre-term (RR = 1.25, [95% CI: 1.14-1.36]) and very pre-term birth (RR = 1.29, [95% CI:1.08-1.55]), Macrosomia (RR = 1.31, [95% CI: 1.12-1.54]), extremely large for gestational age (RR = 1.40, [95% CI: 1.25-1.58]) and Caesarean delivery (RR = 1.83, [95% CI: 1.77-1.90]).

Conclusions: Advanced maternal age is associated with a range of adverse pregnancy outcomes. These risks are independent of parity and remain after adjusting for the ameliorating effects of higher socioeconomic status. The data from this large contemporary cohort will be of interest to healthcare providers and women and will facilitate evidence based counselling of older expectant mothers.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Number of births, inclusions and…
Figure 1. Number of births, inclusions and exclusions during the study period.

References

    1. Huang L, Sauve R, Birkett N, Fergusson D, van Walraven C (2008) Maternal age and risk of stillbirth: a systematic review. CMAJ 178: 165–172.
    1. Mathews T, Hamilton B (2002.) Mean age of mother, 1970–2000. National Vital Statistics Reports vol 50 no. 1. Hyattsville, Maryland: National Center for Health Statistics.
    1. Martin J, Hamilton B, Sutton P, Ventura S, Menacker F, et al... (2009) Births: Final data for 2006. National Vital Statistics Reports vol 57 no. 7. Hyattsville, Maryland: National Center for Health Statistics.
    1. Martin J, Hamilton B, Ventura S, Osterman M, Kirmeyer S, et al... (2011) Births: Final Data for 2009. National Vital Statistics Reports vol 60 no. 1. Hyattsville, Maryland: National Center for Health Statistics.
    1. European Commission: eurostat. Fertility statistics (, accessed on 20/01/2013).
    1. Office for National Statistics (2011) Frequently asked questions: births & fertility. section 1; UK births-general: 1.5 How many live births were there in specific age groups in 2010? How do these figures compare with 2008 and 2009?.
    1. Jolly M, Sebire N, Harris J, Robinson S, Regan L (2000) The risks associated with pregnancy in women aged 35 years or older. Hum Reprod 15: 2433–2437.
    1. Joseph KS, Allen AC, Dodds L, Turner LA, Scott H, et al. (2005) The perinatal effects of delayed childbearing. Obstet Gynecol 105: 1410–1418.
    1. Aliyu MH, Salihu HM, Wilson RE, Alio AP, Kirby RS (2008) The risk of intrapartum stillbirth among smokers of advanced maternal age. Arch Gynecol Obstet 278: 39–45.
    1. Delbaere I, Verstraelen H, Goetgeluk S, Martens G, De Backer G, et al. (2007) Pregnancy outcome in primiparae of advanced maternal age. Eur J Obstet Gynecol Reprod Biol 135: 41–46.
    1. Hoffman MC, Jeffers S, Carter J, Duthely L, Cotter A, et al. (2007) Pregnancy at or beyond age 40 years is associated with an increased risk of fetal death and other adverse outcomes. Am J Obstet Gynecol 196: e11–13.
    1. O’Leary CM, Bower C, Knuiman M, Stanley FJ (2007) Changing risks of stillbirth and neonatal mortality associated with maternal age in Western Australia 1984–2003. Paediatr Perinat Epidemiol 21: 541–549.
    1. Flenady V, Koopmans L, Middleton P, Froen JF, Smith GC, et al. (2011) Major risk factors for stillbirth in high-income countries: a systematic review and meta-analysis. Lancet 377: 1331–1340.
    1. Janssens S, Wallace KL, Chang AM (2008) Prepartum and intrapartum caesarean section rates at Mater Mothers’ Hospital Brisbane 1997–2005. Aust N Z J Obstet Gynaecol 48: 564–569.
    1. Berkowitz GS, Skovron ML, Lapinski RH, Berkowitz RL (1990) Delayed childbearing and the outcome of pregnancy. N Engl J Med 322: 659–664.
    1. Wang Y, Tanbo T, Abyholm T, Henriksen T (2011) The impact of advanced maternal age and parity on obstetric and perinatal outcomes in singleton gestations. Arch Gynecol Obstet 284: 31–37.
    1. Nybo Andersen AM, Wohlfahrt J, Christens P, Olsen J, Melbye M (2000) Maternal age and fetal loss: population based register linkage study. BMJ 320: 1708–1712.
    1. Cnattingius S, Forman MR, Berendes HW, Isotalo L (1992) Delayed childbearing and risk of adverse perinatal outcome. A population-based study. JAMA 268: 886–890.
    1. Carolan M (2003) The graying of the obstetric population: implications for the older mother. J Obstet Gynecol Neonatal Nurs 32: 19–27.
    1. Ales KL, Druzin ML, Santini DL (1990) Impact of advanced maternal age on the outcome of pregnancy. Surg Gynecol Obstet 171: 209–216.
    1. Carolan M, Frankowska D (2011) Advanced maternal age and adverse perinatal outcome: a review of the evidence. Midwifery 27: 793–801.
    1. Chan BC, Lao TT (2008) Effect of parity and advanced maternal age on obstetric outcome. Int J Gynaecol Obstet 102: 237–241.
    1. Khashan A, Kenny L (2009) The effects of maternal body mass index on pregnancy outcome. European Journal of Epidemiology 24: 697–705.
    1. Khashan AS, Baker PN, Kenny LC (2010) Preterm birth and reduced birthweight in first and second teenage pregnancies: a register-based cohort study. BMC Pregnancy Childbirth 10: 36.
    1. Office of Deputy Prime Minister (2004) The English Indices of Deprivation (revised), download via: accessed on 20/01/2012.
    1. Fretts RC (2005) Etiology and prevention of stillbirth. Am J Obstet Gynecol 193: 1923–1935.
    1. Silver RM (2007) Fetal death. Obstet Gynecol 109: 153–167.
    1. Wildschut H (1999) Sociodemographic factors: age, parity, social class and ethnicity. In: James D, Steer P, Weiner C, Gonik B, editors. High Risk Pregnancy. London: W.B. Saunders. 39–52.
    1. Cleary-Goldman J, Malone FD, Vidaver J, Ball RH, Nyberg DA, et al. (2005) Impact of maternal age on obstetric outcome. Obstet Gynecol 105: 983–990.
    1. Bell JS, Campbell DM, Graham WJ, Penney GC, Ryan M, et al. (2001) Do obstetric complications explain high caesarean section rates among women over 30? A retrospective analysis. BMJ 322: 894–895.
    1. Bahtiyar MO, Funai EF, Rosenberg V, Norwitz E, Lipkind H, et al. (2008) Stillbirth at term in women of advanced maternal age in the United States: when could the antenatal testing be initiated? Am J Perinatol 25: 301–304.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever