Changing risks of stillbirth and neonatal mortality associated with maternal age in Western Australia 1984-2003

There has been a trend over the past two decades in some Western countries for women to delay childbearing, a factor associated with an increased risk of perinatal mortality (stillbirth and neonatal death). While the rates of stillbirth and neonatal mortality have improved in some countries, it has not been established whether maternal age remains a risk factor for perinatal mortality in Australia. The Western Australian Maternal and Child Health Research Database (MCHRDB) was used to examine the effect of maternal age on perinatal death in the periods 1984-93 and 1994-2003 after adjustment for parity and sociodemographic factors. Stillbirths and neonatal deaths were analysed separately. The crude rate of stillbirth has shown little change over the 20 years examined remaining at around 7.5 per 1000 total births, while the rate of neonatal death has decreased steadily from 5.4 per 1000 livebirths in 1984 to 2.0 in 2003. Older maternal age remains a risk factor for stillbirth but the relative risk has declined. After adjustment for parity and sociodemographic factors the relative risk of stillbirth for a woman aged over 40 years (compared with a woman aged 25-29 years) decreased from 2.6 in the period 1984-93, to 1.9 in the period 1994-2003. The increased risk of stillbirth associated with teenage mothers was fully explained by sociodemographic factors in both time periods. No increased risk of neonatal death was evident in the recent period 1994-2003 for teenage or older mothers after adjustment for parity and sociodemographic factors. In spite of some improvements over the past 20 years, women 30 years of age and older continue to be at increased risk of stillbirth. The risk of neonatal death is no longer associated with increased maternal age; however, the small number of cases in the older maternal age groups may be a result of the increased prevalence of antenatal screening and terminations for birth defects.