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Maternal age and risk of stillbirth: a systematic review

From the Health Surveillance and Epidemiology Division (Huang), Centre for Health Promotion, Public Health Agency of Canada, Ottawa, Ont.; the Departments of Paediatrics and of Epidemiology and Community Health Sciences (Sauve), University of Calgary, Calgary, Alta.; the Department of Epidemiology and Community Medicine (Birkett) and the Centre for Transfusion Research (Fergusson), University of Ottawa, Ottawa, Ont.; and the Clinical Epidemiology Program (Fergusson, van Walraven), Ottawa Health Research Institute, Ottawa, Ont.

Correspondence to: Dr. Carl van Walraven, Clinical Epidemiology Program, Ottawa Health Research Institute, Rm. C405, Ottawa Hospital, Civic Campus, 1053 Carling Ave., Ottawa ON K1Y 4E9; fax 613 761-5492; carlv{at}ohri.ca

Background: The number of women who delay childbirth to their late 30s and beyond has increased significantly over the past several decades. Studies regarding the relation between older maternal age and the risk of stillbirth have yielded inconsistent conclusions. In this systematic review we explored whether older maternal age is associated with an increased risk of stillbirth.

Methods: We searched MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews for all relevant articles (original studies and systematic reviews) published up to Dec. 31, 2006. We included all cohort and case–control studies that measured the association between maternal age and risk of stillbirth. Two reviewers independently abstracted data from all included studies using a standardized data abstraction form. Methodologic and statistical heterogeneities were reviewed and tested.

Results: We identified 913 unique citations, of which 31 retrospective cohort and 6 case–control studies met our inclusion criteria. In 24 (77%) of the 31 cohort studies and all 6 of the case–control studies, we found that greater maternal age was significantly associated with an increased risk of stillbirth; relative risks varied from 1.20 to 4.53 for older versus younger women. In the 14 studies that presented adjusted relative risk, we found no extensive change in the direction or magnitude of the relative risk after adjustment. We did not calculate a pooled relative risk because of the extreme methodologic heterogeneity among the individual studies.

Interpretation: Women with advanced maternal age have an increased risk of stillbirth. However, the magnitude and mechanisms of the increased risk are not clear, and prospective studies are warranted.

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