Pregnancy at very advanced maternal age: a UK population‐based cohort study

Abstract

ObjectivesTo describe the characteristics, management and outcomes of women giving birth at advanced maternal age (≥48 years).DesignPopulation‐based cohort study using the UK Obstetric Surveillance System (UKOSS).SettingAll UK hospitals with obstetrician‐led maternity units.PopulationWomen delivering at advanced maternal age (≥48 years) in the UK between July 2013 and June 2014 (n = 233) and 454 comparison women.MethodsCohort and comparison group identification through the UKOSS monthly mailing.Main outcome measuresPregnancy complications.ResultsOlder women were more likely than comparison women to be overweight (33% versus 23%, P = 0.0011) or obese (23% versus 19%, P = 0.0318), nulliparous (53% versus 44%, P = 0.0299), have pre‐existing medical conditions (44% versus 28%, P < 0.0001), a multiple pregnancy (18% versus 2%, P < 0.0001), and conceived following assisted conception (78% versus 4%, P < 0.0001). Older women appeared more likely than comparison women to have pregnancy complications including gestational hypertensive disorders, gestational diabetes, postpartum haemorrhage, caesarean delivery, iatrogenic and spontaneous preterm delivery on univariable analysis and after adjustment for demographic and medical factors. However, adjustment for multiple pregnancy or use of assisted conception attenuated most effects, with significant associations remaining only with gestational diabetes (adjusted odds ratio [aOR] 4.81, 95% CI 1.93–12.00), caesarean delivery (aOR 2.78, 95% CI 1.44–5.37) and admission to an intensive care unit (aOR 33.53, 95% CI 2.73–412.24).ConclusionsWomen giving birth at advanced maternal age have higher risks of a range of pregnancy complications. Many of the increased risks appear to be explained by multiple pregnancy or use of assisted conception.Tweetable abstractThe pregnancy complications in women giving birth aged 48 or over are mostly explained by multiple pregnancy.

Childbearing at very advanced maternal age, the challenges and complications: A report of two cases

“…The number of women seeking to achieve a pregnancy at very advanced maternal age (VAMA) is progressively increasing [1,2]. This is due to various factors [4,5,9] making delayed childbirth possible and desirable at such ages.…”

“…The desire for childbearing at very advanced maternal age (defined as maternal age ≥45 years at the time of delivery) is becoming increasingly common [1][2][3]. This is partly due to better access to safe, effective and reversible contraception, longer education, higher career goals, later marriage, desire for financial stability and the advances in reproductive technology [3][4][5].…”

Maternal nutrition and weight management in pregnancy: A nudge in the right direction

“…), associated comorbidities and multiple births (Fitzpatrick et al . ). This has implications for practice as women with multiple births are more likely to experience excessive GWG (Melzer & Schultz ), and rates of GDM are five times higher (Fitzpatrick et al .…”

“…As a significant number of women nowadays enter pregnancy in higher age brackets and with comorbidities (Fitzpatrick et al . ), clearer recommendations for women with other conditions, such as type 2 diabetes (Parellada et al . ), are also required.…”

“…In the UK, the number of women having babies at >40 years trebled between 1989 and 2009 (Sutcliffe et al 2012). Women of advanced maternal age are more likely to have a higher BMI at the start of pregnancy (Afshin et al 2017;Fitzpatrick et al 2017), associated comorbidities and multiple births (Fitzpatrick et al 2017). This has implications for practice as women with multiple births are more likely to experience excessive GWG (Melzer & Schultz 2010), and rates of GDM are five times higher (Fitzpatrick et al 2017).…”