Abstract
BackgroundRecent 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.MethodsWe 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.ResultsThe 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]).ConclusionsAdvanced 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.
Highlights
The past three decades have seen significant increases in maternal age at childbirth in many high-income countries. [1] The proportion of first births to women aged 35 years and over in the United States increased nearly eight times from 1970 to 2006
Advanced maternal age continues to be associated with a range of adverse pregnancy outcomes including low birth weight [7] [8,9] pre-term birth [7,8] [10], stillbirth and unexplained fetal death [11,12,13] and increased rates of Caesarean section [14]
Older women who become pregnant are more often primiparous and of better socio-economic status while in the past they were more often multiparous and of low socio-economic status. [21,22] few contemporary studies control for socioeconomic status and other variables, such as body mass index (BMI) and parity that may influence pregnancy outcome
Summary
The past three decades have seen significant increases in maternal age at childbirth in many high-income countries. [1] The proportion of first births to women aged 35 years and over in the United States increased nearly eight times from 1970 to 2006. There is limited consensus among studies as to the precise maternal age when the increase in the risk of adverse pregnancy outcome becomes clinically important. Some studies have reported that the association only becomes significant at age greater than 40 years [17] while others suggest that age $35 years is the cut-off for increased risk [18] [10] These conflicting findings may in part reflect the fact that many of the datasets reported in the literature contain data on births from 25–30 years ago 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
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