Advanced maternal age

Abstract

During the last decades, couples in Europe have been delaying parenthood, since 1970. Advanced age of childbearing has been related to socio-demographic factors, such as increased rates of university education and employment in women and poorer financial status.Fertility potential declines with advancing age, especially after the mid-30s, alongside with an increased risk of pregnancy complications. In contrast to men, age has long been recognized as the most significant risk factor for infertility in women. The ovarian reserve diminishes, the hormonal environment is altered and oocyte quality (specifically, chromosomal, morphologic and functional abnormalities) worsens with age. Women of advanced age are more likely to have acquired infections affecting tubal patency and function or suffer from endometriosis, uterine fibroids and endometrial polyps. Deterioration in lifestyle, such as lack of physical exercise also affect female fertility. Management of infertility should start early. Thus, it has been suggested that a woman should seek medical investigation as soon as six months after regular unprotected intercourse without conception, when 35–40 years of age, and immediately, when over 40 years.Advanced maternal age, traditionally defined as over 35 years of age, is a well-recognized risk factor for pregnancy complications, such as miscarriage, ectopic pregnancy, multiple gestation, and intrauterine growth retardation (IUGR).Fetal and neonatal morbidity and mortality are higher as well. Since the rate of chromosomal and gene abnormalities as well as congenital mal- formations is high in offspring of women of advanced age, prenatal diagnostic procedures should be encouraged.Both maternal and paternal advanced age has been associated with various conditions and diseases in the offspring. A recent, large, population study demonstrated that offspring born to mothers younger than 25 or older than 35 years of age have worse outcomes,.In case of pregnancy, both paternal and maternal advanced age are associated to pregnancy complications during early and late pregnancy, as well as to long-term offspring health, by affecting immune, neuro-developmental, psychological and cognitive parameters. Thus, all adults of reproductive age should receive counseling on the risks of advanced maternal age, so they can make informed decisions about the timing of childbearing.