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Advanced maternal age and adverse perinatal outcome
Bo Jacobsson1, Lars Ladfors, Ian Milsom
1Perinatal Centre, Department of Obstetrics and Gynecology, Sahlgrenska University Hospital/Ostra, S-416 85 Göteborg, Sweden. bo.jacobsson@obgyn.gu.se
Obstetrics and Gynecology
|October 2, 2004
Summary
Advanced maternal age (40 and older) is linked to increased risks of perinatal mortality and fetal death. While pregnancy complications rise with age, they don't fully account for the elevated mortality risk in older mothers.
Area of Science:
- Reproductive Health
- Obstetrics and Gynecology
- Perinatal Medicine
Background:
- Maternal age is a significant factor influencing pregnancy outcomes.
- Older maternal age (40 years and above) is associated with potential adverse obstetric and perinatal events.
- Understanding these risks is crucial for optimizing maternal and infant care.
Purpose of the Study:
- To investigate the impact of advanced maternal age (40-44 and 45+ years) on perinatal and obstetric outcomes.
- To determine if intercurrent illnesses and pregnancy complications contribute to adverse outcomes in older mothers.
- To compare outcomes in older maternal age groups with a younger control group (20-29 years).
Main Methods:
- A national prospective, population-based cohort study.
- Inclusion of women aged 40-44, 45+, and a control group aged 20-29 delivering between 1987-2001.
- Adjusted odds ratios (OR) calculated for perinatal mortality, intrauterine fetal death, neonatal death, preterm birth, and preeclampsia, controlling for malformations, pre-existing diseases, and smoking.
Main Results:
- Perinatal mortality rates were 0.5% (20-29 yrs), 1.0% (40-44 yrs), and 1.4% (45+ yrs).
- Adjusted OR for perinatal mortality was 1.7 (40-44 yrs) and 2.4 (45+ yrs) compared to younger mothers.
- Adjusted OR for intrauterine fetal death was 2.1 (40-44 yrs) and 3.8 (45+ yrs).
- Preterm birth, gestational diabetes, and preeclampsia were more frequent in older maternal age groups.
- While intercurrent illness and complications increased with age, they did not fully explain the heightened perinatal mortality.
Conclusions:
- Perinatal mortality, intrauterine fetal death, and neonatal death significantly increase with advanced maternal age.
- Pregnancy complications and intercurrent illnesses also rise with maternal age.
- The increased risks associated with advanced maternal age are not solely attributable to complications or illnesses.