Pregnancy in the late 30′s and 40′s – a matter of good counselling prior to fertility therapy

Abstract

OBJECTIVE: To establish the pregnancy outcomes in two groups of women (fertile and infertile) attending a teaching, tertiary referral maternity hospital in Dublin, Ireland. We aimed to characterise outcomes according to female age and use the findings to advise infertile couples seeking fertility therapy.DESIGN: This is a retrospective database cohort study.MATERIALS AND METHODS: We retrieved data on all women delivered at a single site (Rotunda Hospital Dublin) between the years 2001 and 2005, inclusive. Patients were divided in age groups < 35, 35 to 39 and > 40 years. The following parameters were analysed: maternal age, previous history of infertility, delivery gestation and method, outcome description, Apgar scores at 1 and 5 minutes and newborn gender.RESULTS: Of 37,115 deliveries analysed, 21% were in women over 35 years old. The average age at delivery was 29.2 years. There was no difference in the likelihood of a live-born birth between the age groups. Labour onset method was significantly related (p<0.01) to age group with induction of labour, elective and emergency caesarean section higher and the rate of spontaneous labour lower in women over 40 years. There was a significant relationship in mean birth weight (p=0.022) and gestation at delivery between age groups. Apgar scores at 1 and 5 minutes and newborn gender were not significantly related to age differences. Of all women delivered 5% had a previous history of infertility. Women with a history of infertility were significantly more likely to have an elective or emergency caesarean section (p<0.01). Regression analysis showed that birthweight was significantly related to a previous history of infertility, induction of labour, parity and advanced maternal age.CONCLUSIONS: Women over 35 and in particular those over 40 should be counselled appropriately in relation to the risks of pregnancy for both the mother and baby. Relevant information is now available to allow quantification of risk. Premature delivery, low birth weight and operative delivery rates become significantly higher as maternal age advances. Women with a history of infertility are at a particular increased risk for all the above complications. OBJECTIVE: To establish the pregnancy outcomes in two groups of women (fertile and infertile) attending a teaching, tertiary referral maternity hospital in Dublin, Ireland. We aimed to characterise outcomes according to female age and use the findings to advise infertile couples seeking fertility therapy. DESIGN: This is a retrospective database cohort study. MATERIALS AND METHODS: We retrieved data on all women delivered at a single site (Rotunda Hospital Dublin) between the years 2001 and 2005, inclusive. Patients were divided in age groups < 35, 35 to 39 and > 40 years. The following parameters were analysed: maternal age, previous history of infertility, delivery gestation and method, outcome description, Apgar scores at 1 and 5 minutes and newborn gender. RESULTS: Of 37,115 deliveries analysed, 21% were in women over 35 years old. The average age at delivery was 29.2 years. There was no difference in the likelihood of a live-born birth between the age groups. Labour onset method was significantly related (p<0.01) to age group with induction of labour, elective and emergency caesarean section higher and the rate of spontaneous labour lower in women over 40 years. There was a significant relationship in mean birth weight (p=0.022) and gestation at delivery between age groups. Apgar scores at 1 and 5 minutes and newborn gender were not significantly related to age differences. Of all women delivered 5% had a previous history of infertility. Women with a history of infertility were significantly more likely to have an elective or emergency caesarean section (p<0.01). Regression analysis showed that birthweight was significantly related to a previous history of infertility, induction of labour, parity and advanced maternal age. CONCLUSIONS: Women over 35 and in particular those over 40 should be counselled appropriately in relation to the risks of pregnancy for both the mother and baby. Relevant information is now available to allow quantification of risk. Premature delivery, low birth weight and operative delivery rates become significantly higher as maternal age advances. Women with a history of infertility are at a particular increased risk for all the above complications.