Cardiovascular Evaluation and Considerations for Women of Advanced Maternal Age Desiring Pregnancy

Abstract

Pregnancy in women of advanced maternal age (AMA) is increasingly common. Women of AMA have higher pregnancy risks, including higher risk of cardiovascular complications such as hypertensive disorders of pregnancy. This review highlights recent data comparing pregnancy risks in both younger women and women of AMA, as well as how these risks are influenced using assisted reproductive therapies (ART). It highlights long-term cardiovascular risks in women of AMA and suggestions on how to perform cardiovascular evaluations both preconception and during pregnancy in this group of women. It also highlights the importance of comprehensive cardio-obstetrics care in providing optimal preconception, pregnancy, and postpartum care for women of AMA. Though data on evaluating pregnancy risk in women of AMA are limited, what data are available suggest higher rates of hypertensive disorders of pregnancy, gestational diabetes, and multiple other cardiovascular complications. The absolute risk however remains low. These risks are amplified by ART use. Increasing attention is being paid to optimizing preconception health, especially preconception obesity and hypertension. More work is required to better characterize the risks of AMA in pregnancy and how to optimally care for these patients. What research is available emphasizes the importance of optimizing prepregnancy health. A multidisciplinary cardio-obstetrics may play an especially integral part in optimizing the safety of pregnancy in women of AMA.