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Maternal and neonatal outcomes of spontaneously conceived pregnancies in mothers over 45 years: a review of the literature

  • Reproductive Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

There is little published data on pregnancy outcomes in women who had conceived spontaneously after age 45 years. The aim of this review is to provide accurate information on the risks and probable outcomes of spontaneously conceived pregnancies in women over the age of 45 years, which will enable clinicians to counsel such women appropriately, carry out adequate risk assessment, and ensure better care for pregnancies in this population.

Design

A literature search was performed using EmBase and PubMed for English language articles published between 1970 and 2011, with extractable data on mothers aged ≥45 at the time of delivery and with ≥95% spontaneous conception in the study population.

Results

Six such studies with a total pooled number of 505 women were identified. Overall, there is increased maternal morbidity and rates of caesarean section, as well as higher incidence of premature births and admission to special care baby unit. Contrary to popular belief, career is not always an important factor in delaying childbearing, especially in developing countries. Other factors may include cultural acceptance of large families and lack of contraception, although more research may be carried out in order to explain these hypotheses.

Conclusion

Pooled retrospective data suggest that women who conceived spontaneously after the age of 45 years have increased maternal morbidity and rates of caesarean section, as well as higher incidence of premature births and admission to special care baby unit.

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References

  1. Hammarberg K, Clarke VE (2005) Reasons for delaying childbearing—a survey of women aged over 35 years seeking assisted reproductive technology. Aust Fam Physician 34(3):187–188, 206

    Google Scholar 

  2. Carolan M, Frankowska D (2010) Advanced maternal age and adverse perinatal outcome: a review of the evidence. Midwifery. Sep 29 (Epub ahead of print)

  3. Office for National Statistics (2010) Births and deaths in England and Wales 2009, statistical bulletin, [online] (Published 26 November 2010). http://www.statistics.gov.uk/pdfdir/bdths0710.pdf. Accessed 7 June 2011

  4. Gilbert WM, Nesbitt TS, Danielsen B (1999) Childbearing beyond age 40: pregnancy outcome in 24,032 cases. Obstet Gynecol 93(1):9–14

    Article  PubMed  CAS  Google Scholar 

  5. Salem Yaniv S, Levy A, Wiznitzer A, Holcberg G, Mazor M, Sheiner E (2011) A significant linear association exists between advanced maternal age and adverse perinatal outcome. Arch Gynecol Obstet 283(4):755–759

    Article  PubMed  Google Scholar 

  6. Aliyu MH, Luke S, Wilson RE, Saidu R, Alio AP, Salihu HM, Belogolovkin V (2010) Obesity in older mothers, gestational weight gain, and risk estimates for preterm phenotypes. Maturitas 66(1):88–93

    Article  PubMed  Google Scholar 

  7. Bae HS (2011) Lifestyle, nutrient intake, iron status, and pregnancy outcome in pregnant women of advanced maternal age. Nutr Res Pract 5(1):52–59

    Article  PubMed  CAS  Google Scholar 

  8. Yogev Y, Melamed N, Bardin R, Tenenbaum-Gavish K, Ben-Shitrit G, Ben-Haroush A (2010) Pregnancy outcome at extremely advanced maternal age. Am J Obstet Gynecol 203(6):558.e1-7

    Article  PubMed  Google Scholar 

  9. Glasser S, Segev-Zahav A, Fortinsky P, Gedal-Beer D, Schiff E, Lerner-Geva L (2011) Primiparity at very advanced maternal age (≥45 years). Fertil Steril (Epub ahead of print)

  10. Jackson RA, Gibson KA, Wu YW, Croughan MS (2004) Perinatal outcomes in singletons following in vitro fertilization: a meta-analysis. Obstet Gynecol 103(3):551–563

    Article  PubMed  Google Scholar 

  11. Nugent D, Balen AH (2001) The effects of female age on fecundity and pregnancy outcome. Hum Fertil (Camb) 4(1):43–48

    Article  CAS  Google Scholar 

  12. Ng EH, Ho PC (2007) Ageing and ART: a waste of time and money? Best Pract Res Clin Obstet Gynaecol 21(1):5–20

    Article  PubMed  Google Scholar 

  13. Abu-Heija AT, Jallad MF, Abukteish F (2000) Maternal and perinatal outcome of pregnancies after the age of 45. J Obstet Gynaecol Res 26(1):27–30

    Article  PubMed  CAS  Google Scholar 

  14. Callaway LK, Lust K, McIntyre HD (2005) Pregnancy outcomes in women of very advanced maternal age. Aust N Z J Obstet Gynaecol 45(1):12–16

    Article  PubMed  Google Scholar 

  15. Donoso E, Carvajal JA (2008) Maternal, perinatal and infant outcome of spontaneous pregnancy in the sixth decade of life. Maturitas 59(4):381–386

    Article  PubMed  Google Scholar 

  16. Narayan H, Buckett W, McDougall W, Cullimore J (1992) Pregnancy after fifty: profile and pregnancy outcome in a series of elderly multigravidae. Eur J Obstet Gynecol Reprod Biol 47(1):47–51

    Article  PubMed  CAS  Google Scholar 

  17. Dildy GA, Jackson GM, Fowers GK, Oshiro BT, Varner MW, Clark SL (1996) Very advanced maternal age: pregnancy after age 45. Am J Obstet Gynecol 175(3 Pt 1):668–674

    Article  PubMed  CAS  Google Scholar 

  18. Kale A, Kuyumcuoğlu U, Güzel A (2009) Is pregnancy over 45 with very high parity related with adverse maternal and fetal outcomes? Clin Exp Obstet Gynecol 36(2):120–122

    PubMed  CAS  Google Scholar 

  19. Salihu HM, Shumpert MN, Slay M, Kirby RS, Alexander GR (2003) Childbearing beyond maternal age 50 and fetal outcomes in the United States. Obstet Gynecol 102(5 Pt 1):1006–1014

    Article  PubMed  Google Scholar 

  20. Jacobsson B, Ladfors L, Milsom I (2004) Advanced maternal age and adverse perinatal outcome. Obstet Gynecol 104(4):727–733

    Article  PubMed  Google Scholar 

  21. Mehta S, Tran K, Stewart L, Nauta M, Yoong W (correspondence). Response to Bakker R, Steegers E, Biharie A, Mackenbach J, Hofman A, Jaddoe V (2011) Explaining differences in birth outcomes in relation to maternal age: the Generation R Study. BJOG 2011; 118(4):500–509

    Google Scholar 

  22. World Health Organisation (2005) The world health report 2005: make every mother and child count (online) (Published 2005). http://www.who.int/whr/2005/whr2005_en.pdf

  23. Health Survey for England, (2006) Vol 1: Cardiovascular disease and risk factors in adults. A survey carried out on behalf of The Information Centre. (Joint Health Surveys Unit: National Centre for Social Research, Department of Epidemiology and Public Health at the Royal Free and University College Medical School) (online) (Published 2008). http://www.ic.nhs.uk/webfiles/publications/HSE06/HSE%2006%20report%20VOL%201%20v2.pdf. Accessed 13 June 2011

  24. Duckitt K, Harrington D (2005) Risk factors for pre-eclampsia at antenatal booking: systematic review of controlled studies. BMJ 330(7491):565

    Article  PubMed  Google Scholar 

  25. Moore TR (2011) Diabetes mellitus and pregnancy (online) (Updated: 13 Apr 2011). http://emedicine.medscape.com/article/127547-overview. Accessed 13 June 2011

  26. NICE Clinical Guideline 63 (2008) Diabetes in pregnancy: management of diabetes and its complications from pre-conception to the postnatal period. Developed by the National Collaborating Centre for Women’s and Children’s Health (online) (Issued March 2008, reissued July 2008). http://www.nice.org.uk/nicemedia/live/11946/41342/41342.pdf. Accessed 13 June 2011

  27. World Health Organisation (2010) Trends in maternal mortality: 1990 to 2008. Estimates developed by WHO, UNICEF, UNFPA and The World Bank (online) (Published 2010). http://whqlibdoc.who.int/publications/2010/9789241500265_eng.pdf. Accessed 13 June 2011

  28. NICE Clinical Guideline (2004) Caesarean section. (National Collaborating Centre for Women’s and Children’s Health, Commissioned by the National Institute for Clinical Excellence) [online] (Published April 2004). http://www.nice.org.uk/nicemedia/live/10940/29334/29334.pdf. Accessed 13 June 2011 

  29. Schoen C, Rosen T (2009) Maternal and perinatal risks for women over 44—a review. Maturitas 64(2):109–113

    Article  PubMed  Google Scholar 

  30. Sauer MV, Paulson RJ, Lobo RA (1996) Oocyte donation to women of advanced reproductive age: pregnancy results and obstetrical outcomes in patients 45 years and older. Hum Reprod 11(11):2540–2543

    PubMed  CAS  Google Scholar 

  31. World Health Organisation (2006) Neonatal and perinatal mortality: country, regional and global estimates (online) (Published 2006). http://www.who.int/making_pregnancy_safer/publications/neonatal.pdf. Accessed 13 June 2011

  32. Sibai B, Dekker G, Kupferminc M (2005) Pre-eclampsia. Lancet 365(9461):785–799

    PubMed  Google Scholar 

  33. Mitanchez D (2010) Foetal and neonatal complications in gestational diabetes: perinatal mortality, congenital malformations, macrosomia, shoulder dystocia, birth injuries, neonatal complications. Diabetes Metab 36(6 Pt 2):617–627

    Google Scholar 

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. UCL Medical School, Gower St, London, WC1 6BT, UK

    Li-An Wong-Taylor, Alexandra Lawrence & Sophie Cowen

  2. North Middlesex University Hospital, London, N18 1QX, UK

    Hetty Jones

  3. Morris House Surgery, Tottenham, London, N17 6AA, UK

    Maud Nauta

  4. Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London, N18 1QX, UK

    Zeudi Ramsay-Marcelle & Wai Yoong

Authors
  1. Li-An Wong-Taylor
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  2. Alexandra Lawrence
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  3. Sophie Cowen
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  4. Hetty Jones
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  5. Maud Nauta
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  6. Zeudi Ramsay-Marcelle
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  7. Wai Yoong
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Corresponding author

Correspondence to Wai Yoong.

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Wong-Taylor, LA., Lawrence, A., Cowen, S. et al. Maternal and neonatal outcomes of spontaneously conceived pregnancies in mothers over 45 years: a review of the literature. Arch Gynecol Obstet 285, 1161–1166 (2012). https://doi.org/10.1007/s00404-012-2219-4

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  • DOI: https://doi.org/10.1007/s00404-012-2219-4

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