Impact Of Advanced Maternal Age Research Articles

Advanced Paternal Age Affects Sperm Count and Anogenital Distance in Mouse Offspring.

In Western society, couples increasingly delay parenthood until later in life. Overall, studies have focused on the reproductive performance of older parents or the impact of advanced maternal age on pregnancy outcomes, but few studies have examined how advanced paternal age (APA) affects offspring health. The aim of this study was to investigate the impact of increasing paternal age on offspring reproductive performance and long-term metabolic health in a mouse model. Here, the same adult B6D2F1/J male mice were mated at 4, 12, and 18 months of age with 6- to 10-week-old naturally cycling CF1 females to generate 3 offspring cohorts conceived at increasing paternal ages PA4, PA12, and PA18. The offspring resulting from mating the same fathers at different ages (n = 20 per age; 10 males and 10 females) were maintained up to 20 weeks of age and morphometric parameters, growth curve, and glucose tolerance were measured. We found that increasing paternal age was associated with a trend toward longer time to conception. Litter sizes were not significantly different. Reassuringly, metabolic parameters and growth curve were not different in the 3 cohorts of offspring. Most importantly, increased paternal age (PA4 vs PA18) was associated with a statistically significant decrease in sperm concentration, sperm motility, and anogenital distance in offspring. These changes raise concerns about the potential impact of APA on the reproductive fitness in males of the next generation.

Is paternal age associated with embryo aneuploidy?

Although the impact of advanced maternal age on embryo aneuploidy has been investigated extensively, minimal research has focused on the association between advanced paternal age (APA) and embryo aneuploidy. Previous studies of chromosomal abnormalities in human sperm have shown an increased incidence of aneuploidy involving chromosomes 21 and 22, as well as the sex chromosomes,1 but no study to date has evaluated if a positive association exists between APA and the rate/type of embryonic aneuploidy.

The impact of advanced maternal age on the outcome of twin pregnancies.

To assess the effect of advanced maternal age on the obstetrics and neonatal outcome of twin pregnancies. A retrospective study of 716 dichorionic-diamniotic twin pregnancies delivered at our institute. The study population was divided into two groups: women aged 35-39years (group A, n=142) and women aged≥40years (Group B, n=48). The control group consisted of women younger than 35years (group C, n=516). The rate of cesarean section (CS) was significantly higher among women older than 35years compared to the control group (A 76.8% and B 87.5% vs C 65.7%, P=0.001). Women older than 35years were also at higher risk for developing hypertensive disorders (A 7.0%, B 14.6%, vs C 5.4%, P=0.04). On multivariate regression analysis, maternal age was found to be independently associated with a higher rate of CS (odds ratio vs reference group C: group A 1.6, 95% CI 1.08-2.6; group B 3.2, 95% CI 1.3-7.8). There was no difference between the groups in the rate of neonatal complications. Women with twin pregnancy, older than 35years, have a significantly higher rate of CS and hypertensive disorder. This rate increases with maternal age, with no increased rate of neonatal complications.

Perinatal Outcomes in Advanced Age Pregnancies

Objective: The aim of this study is to evaluate the impact of advanced maternal age on pregnancy outcomes Methods: A retrospective analysis of 951 birth registry records of Zeynep Kamil Hospital, were analyzed between Janu­ary 2003 and December 2007. Study group was made up of women ≥40 years old and control group was made up of women younger than 40 years. Results: Mean maternal age was 41.48 years in the study group and 26.41 years in the control group. Mean gesta­tional age at the time of delivery is 37.73 weeks in study group and 38.10 weeks in the control group. There was no statistical difference in terms of preterm delivery, multiple pregnancy, fetal anomaly, IUGR, superimpose preeclampsia oligohidramnios, presentation anomaly and placenta previa rates between the study and control groups. Incidence of preeclampsia (p=0.041), Chronic hypertension (p=0.001), GDM (p= 0.003),is found to be higher in study group. Cesar­ean birth rate is higher (p<0.05) and hospitalization time is longer in study group (p=0.001). 1st minute and 5th minute APGAR scores of the study group (6.99±2, 8.27±2) was lower than the 1st minute and 5th Minutes APGAR scores of the control group (7.38±1.6, 8.58±1.7). Neonatal intensive care unit administration rate is seen also higher in study group (p<0.01). Conclusion: Advanced maternal age was related to increased pregnancy complications and poor perinatal outcome. Preeclampsia, GDM, chronic hypertension is seen more common in advanced age pregnancies. Neonatal intensive care administration is higher and APGAR scores are lower; cesarean delivery was performed more common, and hospitaliza­tion time was longer in advanced age pregnancies.

Inseminación intrauterina en mayores de 38 años, ¿vale la pena?

Objetivos: Realizar un análisis costo-eficiencia de los resultados obtenidos con inseminación intrauterina homóloga (IIU) en parejas infértiles cuyas mujeres fueran 38 años o mayores, en una unidad de reproducción humana, y comparar dicho rendimiento con lo publicado para el mismo grupo etario con técnicas de alta complejidad, en el Registro Latinoamericano de Reproducción Asistida (RedLARA). Diseño: Estudio retrospectivo, comparativo. Institución: Unidad de Reproducción Humana, Pontificia Universidad Católica de Chile, Santiago, Chile. Participantes: Mujeres mayores de 38 años tratadas con inseminación intrauterina homóloga. Intervenciones: Se revisó los resultados obtenidos en 5 421 ciclos de inseminación intrauterina homóloga (IIU) realizados entre enero 2000 y septiembre de 2011. Con el fin de analizar el impacto de la avanzada edad reproductiva, se comparó los resultados obtenidos en mujeres menores de 38 años (4 000 ciclos) y en aquellas de 38 años y más (1 421 ciclos). Se describe las tasas de embarazo clínico obtenidas con los distintos protocolos de estimulación ovárica. El análisis costo-eficiencia al intentar tres ciclos de IIU previo a optar por fertilización in vitro (FIV) en mujeres mayores de 38 años, en lugar de ir directamente a FIV, fue comparado con los datos publicados en la Red Latinoamericana de Reproducción Asistida 2009 para ciclos de FIV/ICSI en mujeres de edad reproductiva avanzada. Principales medidas de resultados: Análisis costo-eficiencia de intentar tres ciclos de IIU previo a optar por FIV, en mujeres mayores de 38 años. Resultados: Se incluyó 600 embarazos clínicos en toda la serie, lo que correspondió a una tasa de embarazo clínico de 11,1%, con multigestación de 5,3%. En mujeres de 38 años y más hubo significativo descenso de las mismas tasas (7,5% y 2,8%, respectivamente). Resultó evidente el aporte que implican los esquemas con gonadotropinas en las tasas de embarazo clínico obtenidas con los distintos protocolos de estimulación ovárica. El análisis costo-eficiencia demostró un beneficio en intentar 3 ciclos de IIU, cuando se reúne los criterios de inclusión, previo a optar por fertilización in vitro (FIV), en lugar de ir directamente a FIV. Conclusiones: En mujeres de 38 años y más disminuyeron las tasas de embarazo clínico y multigestación. El análisis costo-eficiencia demostró un beneficio en intentar tres ciclos de IIU, cuando se reúnelos criterios de inclusión, previo a optar por fertilización in vitro (FIV), en lugar de ir directamente a FIV.

781: Impact of advanced maternal age on preterm birth

781: Impact of advanced maternal age on preterm birth

Perinatal Mortality and Advanced Maternal Age

Objective: To investigate the impact of advanced maternal age on the rate of perinatal mortality. Design: Retrospective cohort study including all 56,517 singleton hospital deliveries between 1999 and 2008. Methods: Data were analyzed according to maternal age at delivery in 3 groups of women, 25-34 years, 35-39 years and ≥40 years, using the youngest as the reference group. Results: Odds ratios (ORs) for antenatal deaths were 0.98 (CI: 0.67-1.43) and 2.57 (CI: 1.57-4.22) for age groups 35-39 years and ≥40 years, respectively. Significant differences in neonatal mortality rates between the age groups were not found. Significant amendable risk factors were attendance of <4 health care visits (OR = 15.55, CI: 9.47-25.51 in age group 35-39 years; OR = 16.38, CI: 9.78-27.43 in the age group ≥40 years) and obesity (OR = 1.85, CI: 1.27-2.70 in age group 35-39 years; OR = 1.83, CI: 1.22-2.74 in the age group ≥40 years). In the multivariate regression analysis, the adjusted ORs for perinatal mortality were 1.03 (95% CI: 0.77-1.39) and 1.66 (95% CI: 1.03-2.66) for age groups 35-39 and ≥40, respectively. Conclusions: Women older than 40 years carry an increased risk for stillbirth. Important amendable risk factors are obesity and poor antenatal care.

PP.84 The Impact of Maternal Age and Chorionicity on Obstetric Outcome in Twin Pregnancy

IntroductionThe number of twins born in Ireland has increased from 11.8 sets per 1,000 live births in 1988 to 17.9 in 2011. This study aims to investigate the impact of...

The impact of advanced maternal age and parity on obstetric and perinatal outcomes in singleton gestations

ObjectiveTo investigate the effect of advanced maternal age (AMA) separately in nulliparous and multiparous women on obstetric and perinatal outcomes in singleton gestations.Study designA historical cohort study on data from 6,619 singleton pregnancies between 2004 and May 2007 was performed. AMA was defined as 35 years and older. Obstetric and perinatal outcomes in AMA versus women younger than 35 years (non-AMA) were compared for both nulli- and multiparae with Student’s t-test and Chi-square test in univariate analysis. Multiple logistic regression analysis was performed to examine the independent effect of AMA.ResultsOut of 6,619 singleton pregnancies, the frequency of nulliparity was 42.7 and 33.4% of the parturients were of AMA. Among nulliparous women, AMA was significantly associated with a higher frequency of caesarean section both before labour (OR 2.26 with 95% CI 1.74–2.94), in labour (OR 1.44 with 95% CI 1.07–1.93), and more instrumental vaginal deliveries (ORs 1.49 with 95% CI 1.13–1.96). Among multiparous women, AMA was only significantly associated with a higher caesarean section rate before labour (ORs 1.42, 95% CI 1.19–1.69). There were no significant differences between the two age groups in the prevalence of other adverse obstetric outcomes and adverse perinatal outcomes.ConclusionsOperative delivery is increased in AMA, including caesarean sections, as well as instrumental vaginal deliveries in nulliparous women. In multiparous women, however, only the rate of caesarean section before labour was increased. AMA had no significant effect on other adverse obstetric and perinatal outcomes irrespective of parity.

Prolonged time to pregnancy is associated with a greater risk of adverse outcomes

Births with known time to pregnancy (TTP) during the period 1989-2007 (n=17,114) were analyzed to investigate associations between TTP and pregnancy outcome among couples that conceived spontaneously. The adjusted odds ratio (95% confidence interval) for poor neonatal health, including low Apgar score, low umbilical vein pH, and need for neonatal intensive care, was 1.51 (1.09-2.09) in women who had a TTP of 25-36 months and 1.60 (1.18-2.19) in women who had a TTP of >or=37 months compared with women with a TTP of 0-6 months.

The risk of intrapartum stillbirth among smokers of advanced maternal age

The effects of advanced maternal age and smoking in pregnancy on fetal survival have previously been reported. However, whether advanced maternal age modifies the relationship between smoking in pregnancy and intrapartum stillbirth remains unknown. We therefore set out to determine the impact of advanced maternal age (> or =35 years) on the association between smoking during pregnancy and intrapartum stillbirth by employing retrospective analysis of birth registry data. We used a cohort of singleton births in Missouri from 1978 through 1997 (N = 1,436,628) to compute the risk of total, antepartum, and intrapartum stillbirth in smoking mothers. We categorized mothers into two age groups: "younger" (<35 years), and "older" (> or =35 years). Non-smoking mothers age <35 years were the referent category. Cox regression models were used to generate independent measures of association between intrauterine tobacco exposure and the risk of total, antepartum, and intrapartum stillbirth in each age group. A total of 5,772 counts of stillbirth were identified, yielding a stillbirth rate of 4.0 per 1,000. Approximately 33% (N = 1,900) occurred among older smokers resulting in a stillbirth rate of 9.1 per 1,000. The probability of intrapartum stillbirth was greatest among older smokers, followed by younger smokers and lowest among younger non-smokers (P < 0.01). As compared to non-smoking younger gravidas, younger smoking mothers had a 30% greater likelihood for both antepartum and intrapartum stillbirth (adjusted hazard ratio [95% confidence interval]: 1.3 [1.2-1.4] and 1.3 [1.2-1.5], respectively). Among older smokers the risk for intrapartum stillbirth was three times that of the referent group (adjusted hazard ratio: 3.2, 95% confidence interval: 2.2-4.5). The risk of intrapartum stillbirth associated with smoking in pregnancy is potentiated by the age of the mother. This information will help policy makers develop targeted smoking cessation campaigns and positively impact quit rates in older mothers.

Impact of advanced maternal age on neonatal survival of twin small-for-gestational-age subtypes

We examined the impact of advanced maternal age (>40 years old) on the survival of twin small-for-gestational-age (SGA) infants, that is, infants who were smaller in size than was expected for the baby's sex, genetic heritage, and gestational age. The present study was a retrospective cohort study on twin live births in the USA from 1995 to 1998 inclusive. Two categories of SGA babies were defined: discordant (when only one of a twin pair was SGA) and concordant (when both were SGA). Otherwise, the twin pair was appropriate-for-gestational-age (AGA) concordant. 192,195 twin pairs were analyzed. The incidence of SGA discordance and concordance was 11.8% and 3.9%, respectively. The occurrence of both SGA subtypes tended to decrease with increasing maternal age. The unadjusted risk for neonatal mortality increased when both twins were affected (15.8: 22.8 and 56.6 per 1000 among AGA concordant, SGA discordant and SGA concordant twins; P-value for trend < 0.0001). Using maternal-age-specific AGA babies as reference, the adjusted risk for neonatal mortality climbed progressively with advancing maternal age in a dose-dependent pattern, being lowest among teenagers and highest in mothers aged > or =40 years. SGA discordance and concordance declined with advancing maternal age. In contrast, neonatal mortality of both SGA subtypes worsened with the increase in maternal age compared with that of the age-specific AGA infants. These findings are potentially useful to care providers in counseling older women, a group that is progressively increasing in size and is most susceptible to twining.

Effect of women's first childbearing age on the risk of low birth weight

Purpose : The aim of this study was to investigate the risk of low birth weight associated with delayed first childbearing in Korea. Methods : The national birth certificate data of the singletons and first babies in Korea from January 2001 to December 2003 (n=736,167) was used. Outcome measures were rates of low birth weight infant, very low birth weight infant between 6 maternal age group (35years). Odd ratios were calculated by multiple logistic regression on marital state, maternal education, maternal occupation, paternal occupation, duration of marriage and address. Results : Compared with women aged 25 to 29 years, women aged 30-35 years, 35-40 years and over 40 years had higher odds ratios of low birth weight, odd ratios were 1.3, 2.1, 2.4 respectively. Even though adjusted by marital state, maternal education, maternal occupation, paternal occupation, duration of marriage and address, odds ratios were 1.3, 1.9, 2.0 respectively. Compared with women aged 25 to 29 years, women aged 30-35 years, 35-40 years and over 40 years had higher odds ratios of very low birth weight, odd ratios were 1.8, 3.3, 3.7 respectively. Even though adjusted, odd ratios were 1.6, 2.7, 2.6 respectively. Compared with the incidence of low birth weight in each maternal age, maternal education, marital state, married, high school graduated thirties women was lower incidence than unmarried, high school graduated twenties women. Conclusion : These findings suggest that delayed childbearing increase the risk of low birth weight and very low birth weight, but if pregnant women have better socioeconomic condition, the impact of advanced maternal age on the risk of low birth weight will be decreased.

Advanced maternal age: a literature review

This literature review analyses and evaluates the impact of advanced maternal age on women's health with recommendations on how to address the issue within the wider public health arena. It includes an in depth synthesis of the issues surrounding advanced maternal age, incorporating the physical, psychological and sociological impacts on women's health.

The impact of advanced maternal age (> or = 40 years) on birth outcomes among triplets: a population study.

The objective was to determine the impact of advanced maternal age on the birth outcomes of triplet gestations. A retrospective cohort study on 15,795 triplets born in the United States from 1995 to 1997. The generalized estimating equations framework was used to generate relative risks after capturing the effect of sibling correlations within triplet clusters. There was a 40% higher likelihood for stillbirths among older gravidas (> or = 40 years) as compared to younger mothers (20-29 years) although this was statistically non-significant. By contrast, we noted a significantly lower level of neonatal mortality (OR=0.36, 95% CI=0.19-0.67), perinatal mortality (OR=0.53; 95% CI=0.32-0.89) and infant mortality (OR=0.37; 95% CI=0.20-0.67) among older mothers. Our findings demonstrate a "shifting phenomenon" whereby a higher level of intra-uterine demise was compensated by a higher rate of extra-uterine survival among triplets born to older mothers.

Impact of advanced maternal age on pregnancy outcome.

The aim of this study was to compare the pregnancy outcome and delivery complications in women 40 years or older (cases) to that of women 20 to 30 years old (controls). Over a 5-year period, 319 cases had a singleton delivery in our institution. These women were compared with 326 controls. Parity was significantly higher in cases compared with controls (3.2 vs. 1.8). Advanced maternal age, compared with younger age, was associated with significantly higher rates of preterm delivery (16.0 vs. 8.0%), cesarean delivery (CS) (31.3 vs. 13.5%), and the occurrence of one or more antepartum complications (29.5 vs. 16.6%). When the two groups were subdivided according to parity, rates of preterm delivery, CS, preeclampsia, gestational diabetes, chronic hypertension, and labor induction were each significantly higher among older multiparas compared with control multiparas. However, only preterm delivery, CS rates, and uterine fibroids were found to be significantly higher in older nulliparous compared with young nulliparous women. We conclude that multiparous women at least 40 years old have a higher antepartum complication rate including intrauterine fetal death compared with younger women.