“Advanced Maternal Age” – What Are the Risks?

I recently was reading about advanced maternal age, and some commenters were ranting.  I can understand.  I *hope* to have another baby at some point, but likely after 30.  Yet my husband and I agree that at 35 he’s getting a vasectomy.  (He doesn’t like to talk about it, but yes, he says he wants to do it.  Just never to think about it.)

So why is “advanced maternal age” such a big deal?  And why age 35?  Age 35 is the cutoff used for all of my studies cited below, and is repeatedly given as an age where risks tend to increase when research is done.

1. Mothers of advanced maternal age have a higher incidence of c-section.  Wait…. doesn’t this just prove what some are ranting about?  We make women “high risk” and of COURSE they are going to have a higher c-section rate, because OB’s are “scalpel happy”.  Yet it’s important to also notice that the elective c-section rate was also higher in older mothers.  While some may argue this following statement, I stand behind it – OB’s see those who request c-sections as a higher risk, because there is a lot that can go wrong.  In fact, most OB’s I know would prefer you go into labor naturally, believe it or not.  While there are exceptions to every rule, elective c-sections are getting poorer and poorer reputations by the minute.

(Bayrampour H, Heaman M. Advanced Maternal Age and the Risk of Cesarean Birth: A Systematic Review. Birth: Issues In Perinatal Care [serial online]. September 2010;37(3):219-226. Available from: Academic Search Premier, Ipswich, MA. Accessed November 11, 2011.)

2. Higher neonatal mortality rates.  One study found that mothers of multiples at an increased maternal age had a significantly higher rate of neonatal mortality in pregnancy with multiples.  This is definitely something to consider at an advanced age.  Since often the risk of having multiples increases with age, it is important to know that there is also an increased risk of losing a baby or babies.  Another study found an increased risk of stillbirth among mothers of advanced age (greater than 35).

(Kristensen S, Salihu H, Keith L, Kirby R, Pass M, Fowler K. Impact of advanced maternal age on neonatal survival of twin small-for-gestational-age subtypes. Journal Of Obstetrics & Gynaecology Research [serial online]. June 2007;33(3):259-265. Available from: Academic Search Premier, Ipswich, MA. Accessed November 11, 2011.

Salihu H, Wilson R, Alio A, Kirby R. Advanced maternal age and risk of antepartum and intrapartum stillbirth. Journal Of Obstetrics & Gynaecology Research [serial online]. October 2008;34(5):843-850. Available from: Academic Search Premier, Ipswich, MA. Accessed November 11, 2011.)

3. Risk of Down Syndrome Increases.  Many studies support this finding.  In Norway, a population based study showed the significantly higher association of Down Syndrome and maternal age.  They also explain that the higher rates of Down Syndrome are related to our older maternal age overall when having children.  It’s also important to note that studies are now showing that advanced paternal age is also proving to be associated with an increased risk of Down Syndrome – so it’s not just moms we need to consider when looking at risk factors.

(Melve K, Lie R, Irgens L, et al. Registration of Down syndrome in the Medical Birth Registry of Norway: Validity and time trends. Acta Obstetricia Et Gynecologica Scandinavica[serial online]. August 2008;87(8):824-830. Available from: Academic Search Premier, Ipswich, MA. Accessed November 11, 2011.

Dzurova D, Pikhart H. Down syndrome, paternal age and education: comparison of California and the Czech Republic. BMC Public Health [serial online]. January 2005;5:69-10. Available from: Academic Search Premier, Ipswich, MA. Accessed November 11, 2011.)

4. Increased age and autism.  Again, we’re not just talking about mothers.  My cited study shows that maternal age is a bigger risk factor for autism, but paternal age is still a risk factor as well.

(King M, Fountain C, Dakhlallah D, Bearman P. Estimated Autism Risk and Older Reproductive Age. American Journal Of Public Health [serial online]. September 2009;99(9):1673-1679. Available from: Academic Search Premier, Ipswich, MA. Accessed November 11, 2011.)

5. Testing Increases Risks.  Often more testing will be done when a mother is of a higher age.  This includes amniocentesis and other tests that have risks associated with them. It’s also important to note, though, that research shows we don’t need to go crazy with the testing.  A study that began in 2006 shows that by changing policy from offering routine invasive screening to only offering when there was a positive screening result or an abnormality in an ultrasound the invasive testing was decreased significantly.  I cite this so you can go prepared, and be confident in your decision to test or not to test – as it can be an overwhelming decision to make!

(Tsz Kin L, Fung King L, Wing Cheong L, Wai Lam L, Lawrence Chang Hung T, Robert Kien Howe C. A new policy for prenatal screening and diagnosis of Down syndrome for pregnant women with advanced maternal age in a public hospital. Journal Of Maternal-Fetal & Neonatal Medicine [serial online]. August 2010;23(8):914-919. Available from: Academic Search Premier, Ipswich, MA. Accessed November 11, 2011.)

I hope that gives a little insight into why advanced maternal age is considered a risk.  There are other associated risks, and I encourage every mama to do research and know what she is facing when at an advanced maternal age (or paternal age!)

Questions?  Ask!  I’m happy to address and support any questions you might have in the effort to promote educated birth.  Go forth, ladies, and have FANTASTIC pregnancies, births, and babies!

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