Original research
Childbearing beyond maternal age 50 and fetal outcomes in the United States

https://doi.org/10.1016/S0029-7844(03)00739-7Get rights and content

Abstract

Objective

To estimate whether achieving pregnancy beyond maternal age of 50 years compromises fetal well-being and survival.

Methods

This was a retrospective study on all deliveries in the United States from 1997 to 1999. Four maternal age groups of 20–29 (young), 30–39 (mature), 40–49 (very mature), and 50 or more years (older) were constructed to assess risk gradients for fetal morbidity and mortality.

Results

A total of 539 deliveries among older mothers (aged 50 and above) were documented (four per 100,000). Among singleton gestations, the risks for low birth weight, preterm, and very preterm were tripled among older mothers, whereas the occurrence of very low birth weight, small size for gestational age, and fetal mortality were approximately doubled compared with those for young mothers. Older mothers also had greater risks for fetal morbidity and mortality than their immediate younger counterparts (40–49 year olds) except for very low birth weight. Among multiple gestations, the differences in risk between older and young mothers were lower than those noted among singletons. Still, compared with young mothers, older mothers had significantly higher risks of low birth weight, very low birth weight, very preterm, and small size for gestational age. Older mothers also had higher risk estimates for multiples than 40–49-year-old gravidas in terms of all fetal morbidity and mortality indices.

Conclusion

Pregnancy beyond age 50 was associated with increased risks for the fetus. Our findings suggest that this age group is a distinct obstetric high-risk entity that requires special counseling before and after conception.

Section snippets

Materials and methods

Two sets of National Center for Health Statistics public-access vital record files were used in this study—the 1997–1999 natality files and the 1997–1999 fetal death files. Expanded reporting of maternal age from 49+ years to individual years of age from 49–54 was initiated in 1997. The 1997–1999 period represents the years for which US data were available at the time of this study. The completeness of reporting live births on US vital records is excellent (approximately 99%). The procedures

Results

Of 12,066,854 deliveries that resulted in live births or fetal deaths in the United States between 1997–1999 inclusive, 539 were to women aged 50 and older (four per 100,000). The proportion of young (20–29), mature (30–39), and very mature (40–49) mothers was 52%, 33.5%, and 2.2% respectively. The sociodemograhic characteristics of pregnant women achieving pregnancy at 50 years and older are summarized in Table 1 and compared with the other age groups. Older mothers belonged to three broad

Discussion

We found the rates of maternal complications, (cardiac disease, chronic hypertension, diabetes, preeclampsia, abruptio placentae, and placenta previa) to be consistently elevated with increase in maternal age. This is in agreement with most published results of studies on advanced maternal age and pregnancy outcomes.17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28 The increased incidence of cardiac disease, chronic hypertension, and diabetes is evidently related to the aging process in the mother.

References (40)

  • D.K. Lehmann et al.

    Pregnancy outcome in medically complicated and uncomplicated patients aged 40 years or older

    Am J Obstet Gynecol

    (1987)
  • M. Milner et al.

    The impact of maternal age on pregnancy and its outcome

    Int J Gynaecol Obstet

    (1992)
  • V. Edge et al.

    Pregnancy outcome in nulliparous women aged 35 or older

    Am J Obstet Gynecol

    (1993)
  • M. Prysak et al.

    Pregnancy outcome in nulliparous women 35 years and older

    Obstet Gynecol

    (1995)
  • J. Zhang et al.

    Multifetal pregnancy in older women and perinatal outcomes

    Fertil Steril

    (2002)
  • T. Tanbo et al.

    Obstetric outcome in singleton pregnancies after assisted reproduction

    Obstet Gynecol

    (1995)
  • A.A. Zuppa et al.

    Neonatal outcome of spontaneous and assisted twin pregnancies

    Eur J Obstet Gynaecol

    (2001)
  • J.A. Martin et al.

    The national fetal data file

    Semin Perinatol

    (2002)
  • M.J. Schroeder

    Common origin of life and its common characteristics

    M Rec Ann

    (1932)
  • R.J. Paulson et al.

    Pregnancy in the sixth decade of lifeObstetric outcomes in women of advanced reproductive age

    JAMA

    (2002)
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