Maternal mortality, fetal death, congenital anomalies and infant mortality at an advanced maternal age

Abstract

Recent economic, technological, and social changes in Hungary have altered the role of women and thus patterns of childbearing. In 1986, 65.9% of births in Hungary involved mothers in the 20-29-year age group--generally regarded as the optimal period for childbearing. The distribution of the remaining births by age group was as follows: 19 years or under, 13.6%; 30-34 years, 15.3%; 35-39 years, 4.5%; and 40-49 years, 0.7%. Advanced maternal age has been a significant risk factor in maternal mortality in Hungary: of the 281 maternal deaths in 1977-86, 41 (14.6%) occurred in the 35-39-year age group and 24 (8.5%) involved women 40-49 years of age. Women in the 30-49-year age group have a 1.4-1.5 times higher risk of stillbirth, a 2.0-2.4 times greater risk of perinatal mortality, and a 2.6-4.3 times higher risk of infant mortality than women 20-29 years old. The risk of spontaneous abortion is 1.7 times higher for those 30-34 years old, 2.8 times higher for mothers 35-39 years of age, and 16.4 times higher for those 40-49 years old than for those in the optimal 20-29-year age range. The distribution of mean birthweight according to maternal age again indicates a detrimental effect of advanced maternal age. Finally, congenital anomalies such as neural tube defect, cleft lip or palate, congenital inguinal hernia, and especially Down's syndrome are more prevalent with increasing maternal age. On the other hand, the majority of these documented risks of birth defects at advanced maternal ages are now preventable through fetal diagnosis and other high-technology prenatal care measures. Most of the deleterious effect of advanced maternal age is a result of social factors (especially educational status) rather than biological factors. As the status of women in Hungary continues to improve, it should become obvious that the 20-29-year age range no longer constitutes the sole period for successful reproduction.