Pregnancy at Advanced Maternal Age

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Key points

  • Childbearing at advanced maternal age is becoming increasingly common in high income countries. Furthermore, developments in assisted reproductive technologies may contribute to an increasing incidence of pregnancies in women outside of the normal reproductive age.
  • Many studies have reported an association between advanced maternal age and adverse maternal and infant outcomes. However, few studies have quantified the risks in women of very advanced maternal age.
  • This study will describe the characteristics, management and outcomes of women giving birth at very advanced maternal age in the UK and will estimate the risk of adverse outcomes attributable to advanced maternal age (48 years or over).

Surveillance Period

1st July 2013 – 30th June 2014

Background

Childbearing at advanced maternal age is becoming increasingly common in high income countries. Furthermore, developments in assisted reproductive technologies, including IVF and egg donation, may contribute to an increasing incidence of pregnancies in women outside of the normal reproductive age. In England and Wales the average age at childbearing has increased steadily since the mid-1970s from 26.4 to 29.5 in 2010, with a corresponding rise in the proportion of women delivering in their 30s and 40s[1].

Many studies have reported an association between advanced maternal age and adverse maternal and infant outcomes[2][3][4]. However, the majority of studies have reported outcomes in women aged ≥35 years or women aged ≥40 years. These studies therefore include only a small number of the oldest mothers and have not specifically addressed the risks associated with advanced maternal age. Carolan[5] recently reviewed the literature published between 2001 and 2011 on maternal and perinatal outcomes in high-income countries in relation to advanced maternal age (≥45 years). Only ten studies were identified: most were conducted over a long time-periods; very few made any attempt to control for potential confounding factors; the control groups used for comparison varied widely; and none of the studies were conducted in the UK.

Objective

To use the UK Obstetric Surveillance System to describe the epidemiology of pregnancy at advanced maternal age in the UK.

Research questions

  • What are the characteristics of women giving birth at advanced maternal age in the UK?
  • What proportion of pregnancies in these women follow assisted reproductive technologies?
  • How are these women managed?
  • What are the risks of adverse outcomes for mother and infant associated with advanced maternal age?

Case definition

All pregnant women in the UK of 20 weeks gestation or more, who are aged 48 years or older at their estimated date of delivery.

Funding

This study has been funded by the National Institute for Health Research as part of the UK National Maternal Near-miss Surveillance Programme (UKNeS).

Ethics committee approval

This study has been approved by the North London REC1 (REC Ref. Number: 10/H0717/20).

Investigators

Kate Fitzpatrick, Marian Knight, Jenny Kurinzcuk, NPEU

Derek Tuffnell, Bradford Teaching Hospitals NHS Foundation Trust

Download the Data Collection Form (DCF)

UKOSS Advanced Maternal Age - Case Form

References

  1. ^ Office for National Statistics, Live Births in England and Wales by Characteristics of Mother 1, 2010, 2011.
  2. ^ Balasch, J. and E. Gratacos, Delayed childbearing: effects on fertility and the outcomes of pregnancy. Current opinion in obstetrics & gynecology, 2012. 24(3): p. 187-93.
  3. ^ Montan, S., Increased risk in elderly parturient. Current opinion in obstetrics & gynecology, 2007. 19(2): p.110-2.
  4. ^ Hansenm J.P., Older maternal age and pregnancy outcome: a review of the literature. Obstetrical & Gynecological Survery, 1986. 41(11): p. 726-42.
  5. ^ Carolan, M., Maternal age ≥45 years and maternal and perinatal outcomes: A review of the evidence. Midwifery, 2012.

Updated: Tuesday, 07 July 2020 14:29 (v5)