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PubMed1979

Reducing birth defect risk in advanced maternal age.

The incidence of birth defects increases with maternal age. Recent advances in fetal diagnosis, coupled with elective abortion, offer the older pregnant woman an opportunity to reduce this risk. To determine the magnitude of potential risk reduction, we reviewed the maternal age-specific incidence of infants born with one or more severe birth defects in metropolitan Atlanta from 1968 to 1975, removing from analysis certain anomalies that were preventable by currently available methods. For women aged 35 to 44 years, the risk of bearing an infant with a severe birth defect was reduced to a level comparable with that for younger women. Despite prenatal diagnosis and elective abortion, the risk for women aged 45 years or older, although reduced considerably, was two times greater than that for women aged 34 years or younger.

Adult↗
PubMed1992

Evaluation of the Health Belief Model and decision making regarding amniocentesis in women of advanced maternal age.

The Health Belief Model (HBM) was developed as an attempt to explain an individual's decision regarding obtaining preventive health care. This model was applied to predict the decisions of women of advanced maternal age regarding their obtaining amniocentesis in a one-year study conducted in Toledo, Ohio. A questionnaire based on the HBM was administered to a sample of 98 pregnant women of advanced maternal age. A total of 96 questionnaires were eligible for inclusion in the study. Sixty-one women reported that they would have amniocentesis, 22 would not, and 13 were unsure. A multivariate analysis of variance among amniocentesis decision groups was performed using the health belief components (perceived susceptibility, perceived seriousness, perceived benefit, perceived barrier) and knowledge as variables. There was a significant difference (Wilks' criterion, p less than .0001) among the three decision groups, but the differences were in the health belief components and not in knowledge. A stepwise discriminant function analysis was used to classify subjects on the amniocentesis decision. Of the variables examined, only the HBM component perceived benefit factor was a significant discriminant (p = .0001). It is not necessarily the lack of knowledge that prevents women who are at risk because of advanced maternal age from having amniocentesis but their perceptions regarding amniocentesis. Genetic counselors need to focus more on exploring the perceptions of amniocentesis benefits in this population to facilitate the decision making process.

Adult↗
PubMed1995

Early amniocentesis and fetal nuchal translucency in women requesting karyotyping for advanced maternal age.

Fetal nuchal translucency was measured at 11-14 weeks' gestation in 97 pregnancies referred for early amniocentesis for advanced maternal age. The nuchal translucency was abnormal in 11 fetuses and the fetal karyotype was abnormal in five of these 11 cases. The karyotype was normal in 86 cases with normal nuchal translucency. The culture failure and miscarriage rates associated with early amniocentesis were 3.3 per cent and 2.2 per cent respectively. Amniotic fluid leakage occurred in 6 per cent of cases. In women requesting fetal karyotyping for advanced maternal age without additional biochemical screening, fetal nuchal translucency should be measured at 11-14 weeks. If the nuchal thickness is > or = 3 mm, a first-trimester diagnostic procedure is indicated; however, if it is < 3 mm, amniocentesis should be delayed until 16 weeks' gestation.

Adult↗
PubMed1978

[Prenatal diagnosis in pregnancies at advanced maternal age (author's transl)].

Among 113 prenatal diagnoses in pregnancies at advanced maternal age (mothers older than 37 years) 7 aberrant fetal karyotypes were found (6.2%). Detailed reports of one case of trisomy 21, 18 and 13 each, as well as of XXY-, XYY- and XXX gonosomal constitution respectively are presented in the following. The frequency and severity of chromosome aberrations occurring in fetuses from elder women are discussed with respect to data from the literature. It seems that this group bears a higher risk for chromosomally abnormal offspring than has been suggested before.

Abnormalities, Multiple↗
PubMed2005

Advanced maternal age and fetal growth inhibition in triplets.

OBJECTIVE: To determine whether advanced maternal age is associated withfetal growth inhibition in triplets. STUDY DESIGN: We conducted a retrospective cohort study on triplet live births in the United States from 1995 through 1998. The outcomes of fetal growth inhibition measured were low birth weight, very low birth weight, preterm birth, very preterm birth and smallnessfor gestational age. We generated adjusted ORs after taking into account intracluster correlations using the generalized estimating equation framework. RESULTS: As compared to women of younger maternal age (20-29), mature (30-39) and older women (> or =40 years) with triplet gestations tended to have a lower likelihood offetal growth inhibition. Mean birth weight and mean gestational age at delivery increased with increasing maternal age in a dose-dependent pattern (p for trend < 0.0001). As compared to triplets born to younger mothers, those of older women were less likely to have low birth weight (OR=0.51, 95% CI=0.37-0.69) or very low birth weight (OR = 0.58, 95% CI = 0.47-0.72) or to be preterm (OR = 0.39, 95% CI = 0.27-0.56) or very preterm (OR = 0.67, 95% CI = 0.55-0.80). The riskfor small-for-gestational-age infants was comparable. CONCLUSION: Older maternal age is associated with morefavorable triplet fetal growth parameters, although the exact mechanisms of this paradox remain poorly understood.

Adult↗
PubMed2001

Increased risk of cesarean delivery with advancing maternal age: indications and associated factors in nulliparous women.

OBJECTIVE: To investigate factors that contribute to the increased risk of cesarean delivery with advancing maternal age. STUDY DESIGN: We reviewed demographic and ante- and intrapartum variables from a data set of term, nulliparous women who delivered at Brigham and Women's Hospital in 1998 (n = 3715). RESULTS: Cesarean delivery rates increased with advancing maternal age (< 25 years, 11.6%; > or = 40 years, 43.1%). Older women were more likely to have cesarean delivery without labor (< 25 years, 3.6%; > or = 40 years, 21.1%). Malpresentation and prior myomectomy were the indications for cesarean delivery without labor that were more prevalent in our older population as compared to our younger population. Even among women with spontaneous or induced labor, cesarean delivery rates increased with maternal age (< 25 years, 8.3%; > or = 40 years, 30.6%). Cesarean delivery rates were higher with induced labor, and rates of induction rose directly and continuously with maternal age, especially the rate of elective induction. Cesarean delivery for failure to progress or fetal distress was more common among older parturients, regardless of whether labor was spontaneous or induced. Among women who underwent cesarean delivery because of failure to progress, use of oxytocin and length of labor did not vary with age. CONCLUSIONS: Older women are at higher risk for cesarean delivery in part because they are more likely to have cesarean delivery without labor. However, even among those women who labor, older women are more likely to undergo cesarean delivery, regardless of whether labor is spontaneous or induced. Part of the higher rate among older women who labor is explained by a higher rate of induction, particularly elective induction. Among women in both spontaneous and induced labor, cesarean delivery for the diagnoses of failure to progress and fetal distress was more frequent in older patients, although management of labor dystocia for these patients was similar to that for younger patients.

Adult↗
PubMed2001

Role of ultrasound for Down syndrome screening in advanced maternal age.

OBJECTIVE: To determine the sensitivity and false-positive rate of Down syndrome screening by use of maternal serum screen and the genetic sonogram in women > or =35 years of age. STUDY DESIGN: We searched our perinatal databases retrospectively from January 1992 to January 2000 for the following criteria: known Down syndrome fetus or newborn, advanced maternal age, and genetic sonogram from 14-24 weeks' gestation. The a priori maternal age or maternal serum screen risk was modified by likelihood ratios for ultrasound markers. Without markers the risk was reduced by 50%. The cut-off was 1:270. RESULTS: Age and maternal serum screen had a sensitivity of 90.5% and a false-positive rate of 27.1%. Age and ultrasound had a 95.2% sensitivity and 43.5% false-positive rate, whereas the combination of age, maternal serum screen, and ultrasound had a 97.6% sensitivity and a 22.0% false-positive rate. CONCLUSION: The combination of age, maternal serum screen, and ultrasound improves the sensitivity for Down syndrome detection in the advanced maternal age population.

Adult↗
PubMed2001

Consanguinity and advanced maternal age as risk factors for reproductive losses in Alexandria, Egypt.

BACKGROUND: Consanguinity has been a long-standing social habit among Egyptians. Estimates of consanguinity ratios in different parts of Egypt ranged from 29 to 50%. This study aimed at delineating the role of consanguinity and advanced maternal age on reproductive losses in Alexandria, Egypt. METHODS: A case-control study, on 730 couples with history of reproductive losses and 2,081 normal couples, was done during the period October, 1998 until August, 2000. RESULTS: Of the 730 couples with reproductive losses, consanguinity frequency was 68.8% with 56.2% first cousins. Prenatal loss and infant deaths were highly encountered among consanguineous marriages (p < 0.0001). In a multivariate logistic regression analysis, consanguinity between couples increased the relative risk of repeated abortion (OR: 3.95; 95% CI: 3.04-5.14), stillbirths (OR: 10.6; 95% CI: 6.7-17.0), neonatal death (OR: 17.2; 95% CI: 10.8-27.3), post-neonatal death (OR: 14.5; 95% CI: 10.6-19.9) and total reproductive losses (OR: 8.3; 95% CI: 6.9-10.1). A positive association was found between advanced maternal age and repeated abortion (OR: 3.19; 95% CI: 2.04-4.97) as well as total reproductive losses (OR: 2.37; 95% CI: 1.74-3.2). CONCLUSION: This study, the largest-reported case-control study on reproductive losses in Alexandria, strongly suggests that consanguinity may play a major role in the high rates of prenatal and infant mortality while advanced maternal age has a significant role in the causation of repeated abortion, and they must be taken into account for genetic counseling in Egypt. Because of the possibility of controlling, the study gives clear indications for prevention.

Adult↗
PubMed1991

Advanced maternal age as a risk factor for cesarean delivery.

The rate of delivery by cesarean has increased steadily in the United States since the 1970s. The reasons for this increase are not fully established. Improved diagnosis of maternal and fetal complications, medicolegal concerns, and the changing age composition of childbearing women have been cited as contributing factors. To assess whether advanced maternal age by itself is an indicator for a primary cesarean delivery, we analyzed data from the vital records of all female residents of King County, Washington 35 years and older (N = 2985) who had a live singleton birth in 1986 or 1987. These women were compared with a sample of women 20-29 years old (N = 6140) who gave birth in the same time period and geographic area. Primiparous and multiparous women 35 years and older were at a similar increased risk of cesarean (relative risk = 1.6, 95% confidence interval 1.1-2.4). Primiparous women of all ages experienced more complications of pregnancy and labor and higher cesarean delivery rates. However, among primiparous mothers with no recorded complications, older women were at significantly increased risk of cesarean birth (relative risk = 2.5, 95% confidence interval 1.8-3.5). This analysis suggests that advanced maternal age alone may influence a physician's decision regarding method of delivery, thereby placing some older women at an unnecessary risk of cesarean.

Adult↗
PubMed1999

Germline origins in the human F9 gene: frequent G:C-->A:T mosaicism and increased mutations with advanced maternal age.

The factor IX gene (F9) is an advantageous system for analyzing recent spontaneous germline mutation in humans. Herein, the male:female ratio of mutation ("r") in F9 have been estimated by Bayesian analysis from 59 germline origin families. The overall "r" in F9 was estimated at 3.75. The "r"s varied with the type of mutation. The "r"s ranged from 6.65 and 6.10 for transitions at CpG and A:T to G:C transitions at non-CpG dinucleotides, respectively, to 0.57 and 0.42 for microdeletions/microinsertions and large deletions (>1 kb), respectively. The "r" for the two subtypes of non-CpG transitions differed (6.10 for A:T to G:C vs 0.80 for G:C to A:T). Somatic mosaicism was detected in 11% of the 45 origin individuals for whom the causative mutation was visualized directly by genomic sequencing of leukocyte DNA (estimated sensitivity of approximately one part in 20). Four of the five defined somatic mosaics had G:C to A:T transitions at non-CpG dinucleotides, hinting that this mutation subtype may occur commonly early in embryogenesis. The age at conception was analyzed for 41 US Caucasian families in which the age of the origin parent and the year of conception for the first carrier/hemophiliac were available. No evidence for a paternal age effect was seen. However, an advanced maternal age effect was observed (P=0.03) and was particularly prominent for transversions (average of the 79th percentile when maternal age was normalized for the year of conception). This suggests that an increased maternal age results in a higher rate of transmitted mutation, whereas the increased number of mitotic replications associated with advanced paternal age has little, if any, effect on the rate of transmitted mutation.

Adolescent↗
PubMedDate not supplied

Temporal changes in the utilization of amniocentesis for prenatal diagnosis by women of advanced maternal age, 1976-1983.

Utilization of amniocentesis for prenatal diagnosis because of the indication of advanced maternal age (greater than or equal to 35 years at delivery) was examined in the population of B.C. over an 8-year period (1976-1983). As of 1983, approximately one out of three eligible women (greater than or equal to 35 years at delivery) is having the test. In the older group (greater than or equal to 38 years at delivery) approximately one out of two eligible women is having the test. The data do not indicate that the proportion of eligible women having amniocentesis has reached a plateau; utilization is continuing to increase. It appears that prenatal diagnosis is an ethically acceptable alternative for a large proportion of the population.

Adult↗
PubMed1994

The influence of serum screening on the amniocentesis rate in women of advanced maternal age.

We investigated the effect of maternal serum screening on the amniocentesis (AC) rate in women of advanced maternal age. The AC rate after maternal serum screening was compared in two groups of women with a singleton pregnancy, 855 women of 30-35 years and 98 of 36 years and older. In our population, 34.1 per cent of the women of 36 years or older were 'screen-positive' for Down syndrome. Only 41.2 per cent of these women chose to undergo AC as opposed to 88.2 per cent in the younger age group. Within the older age group, the tendency to avoid AC increased with increasing age. Maternal serum screening led to a significant decrease in the AC rate in the older women. In this group, a comparison between the 'a priori' and the calculated risk might have had more influence on the decision to undergo AC than being screen-positive or screen-negative as such. We conclude that maternal serum screening had a major effect on the AC rate in women of advanced maternal age. This is of importance in a society in which the average maternal age is steadily increasing.

Adult↗
PubMed2001

The genetic sonogram: its use in the detection of chromosomal abnormalities in fetuses of women of advanced maternal age.

Real-time and color Doppler ultrasound were used to examine 103 second trimester fetuses with abnormal chromosomes (trisomies 13, 18, 21 and sex aneuploidy =86; other =17) and 2000 controls from women of advanced maternal age who electively underwent genetic amniocentesis. Ten ultrasound markers were analyzed and likelihood ratios were computed for each abnormal ultrasound finding and for a normal ultrasound study if none of the ten markers were present. Abnormal ultrasound markers were present in 81% of fetuses with abnormal karyotypes. The false-positive rate was 13%. The likelihood ratios and the 5% and 95% confidence limits for each of the ultrasound markers were as follows: choroid plexus cyst(s) 1.5 (0.7-3.6); central nervous system abnormalities 16.2 (4.4-60.3); abnormal nuchal skin fold 20.9 (8.4-52.1); ventricular septal defect 8.3 (4.7-14.9); outflow tract defects of the heart 3.6 (0.9-14.6); right-to-left chamber disproportion of the heart 36.9 (14.4-94.5); pericardial effusion 7.2 (3.2-16.1); tricupsid regurgitation 4.7 (2.1-10.7); hyperechoic bowel 3.7 (1.8-7.7); and pyelectasis 2.7 (1.0-7.7). All ultrasound markers were independent of each other. The likelihood ratio following a normal ultrasound study was 0.20. Isolated ultrasound markers were present in 20.4% (n=21) of fetuses. When all markers were compared to non-cardiovascular markers, the detection rate for fetuses with a chromosomal abnormality decreased from 81% to 52% (p<0.01). Given the above data, the posterior risk following an ultrasound examination using the ultrasound markers evaluated in this study can be used to compute the risk for an abnormal karyotypes in women of advanced maternal age.

Adult↗
PubMed2006

Advanced maternal age is an independent risk factor for intrauterine growth restriction.

Reports on the association between advanced maternal age (AMA) and intrauterine growth restriction (IUGR) are conflicting. Our objective was to determine if AMA is an independent risk factor for IUGR. Our case-control study compared cases with IUGR (birthweight<10th percentile for gestational age) and a control group without IUGR. Gestational ages were all confirmed by ultrasound. The study included only singletons and fetal anomalies were excluded. Both groups were evaluated for maternal demographics and clinical risk factors. AMA was defined as maternal age>35 years. Univariate and multivariate analyses were used to examine associations. During the study period, there were 824 cases with IUGR meeting the inclusion criteria; these were compared with 1648 controls (no IUGR) randomly selected from the same population during the same study period. The significant factors associated with IUGR multivariate analyses were black race (odds ratio [OR], 22.4; 95% confidence interval [CI], 17.8 to 28); chronic hypertension (OR, 2.2; 95% CI, 1.5 to 3.2); pregestational diabetes (OR, 3.3; 95% CI, 1.6 to 7) illicit drug use (OR, 3.3; 95% CI, 2.2 to 5.2), and AMA (OR, 1.4; 95% CI, 1.1 to 1.8). There was a positive dose-response association between increasing maternal age and increasing risk for IUGR. At maternal age of 40 years or older, the OR and 95% CI for IUGR was 3.2 and 1.9 to 5.4, respectively. AMA is an independent risk factor for IUGR. Our findings suggest that screening for IUGR is indicated in women age 35 years or older.

Adolescent↗
PubMed2006

[Pregnancy outcomes in women of advanced maternal age].

UNLABELLED: During the last decade there is a trend all over the world women at advanced age/older than 35 years old/ and especially educated ones to postpone their reproductive plans. Pregnancy and birth outcomes in women >35 years old I traditionally associated with increasing risk of complications both for the mother and the foetus. OBJECTIVE: To study the frequency and the obstetric outcome of pregnancy at advanced age women in the University Hospital "St. George" Plovdiv. SUBJECTS AND METHODS: Women who at the period of the delivery were at more than 35 years old and were seen at the obstetric unit of the above hospital were recruited into the study. Observed complications during the pregnancy and delivery were also calculated. RESULTS: For the period of 10 years the teenage pregnancy rate was 5.10% /n= 594/5.10% of all 11657 deliveries /94.90%/. 504 of the patients were aged 35 to 39 years /4. 32%/ while only 90 /0.78%/ were aged > 40 years old. In 54.88% of the cases the deliveries were not complicated; in the rest of the cases there were complications or the delivery ended surgicaly. CONCLUSIONS: The increasing frequency of the advanced age pregnancy and deliveries and improved pre and intranatal counseling has made advanced maternal age compatible with successful pregnancy for the great majority of such women.

Adult↗
PubMed1985

Advanced maternal age: the mature gravida.

A 3-year study of women ages 35 years and older who were delivered at Women's Hospital of Long Beach from January 1, 1981, to December 31, 1983, was performed to study the risks involved with advanced maternal age. The study group included 1023 women who were 35 years and older, and they were divided into parous and nulliparous groups. A control group consisting of 5343 women aged 20 to 25 years was used for comparison. Each group was analyzed for the following parameters: pregnancy complications, labor complications, delivery factors, and neonatal outcome. The results show very few statistical differences in the factors analyzed. On the basis of this 3-year study it appears that pregnancies in women of advanced maternal age in the 1980s who are delivered in a modern tertiary care center may be of no higher risk for adverse outcome than pregnancies in younger parturients.

Adult↗
PubMed1997

[Advanced maternal age and pregnancy: how much is too much?].

Perinatal evolution was compared and two study groups in women with advanced maternal age and pregnancy. 626 were included from a total of 778 with age 35 years, who resolved their pregnancy during 1995. They were classified, according to age, in two groups: 1) maternal age of 35-39 year; they were considered primigestas and multigestas. Perinatal complications were classified in personal antecedent, antepartum and intrapartum complications. To analyze the association between maternal age and parity with perinatal complications, X2 or exact test of Fisher, was used. Percentage of women with advanced age and pregnancy was 13.6%. Main perinatal complications were: preeclapmsia, gestational diabetes, preterm delivery threat, and membranes rupture. There were no significant differences as to complications by age and parity. There were 90% of children with 2500 g, and Apgar of 97%. Perinatal death was 0.4%, and fetal malformation 0.6%. Cesarean frequency, was over 90% in primigestas and in more of 60% in multigestas. Perinatal evolution in advanced age and pregnancy is adequate, if she starts prenatal control early enough.

Adult↗
PubMed2006

Advancing maternal age and infant birth weight among urban African Americans: the effect of neighborhood poverty.

OBJECTIVE: This study sought to determine whether neighborhood poverty modifies the relationship between maternal age and infant birth weight among urban African Americans. DESIGN: Stratified analyses were performed on the vital records of African Americans born in Chicago by means of 1992-1995 computerized birth file with appended 1990 US Census income and 1995 Chicago Department of Public Health data. Four neighborhood-level variables (low median family income, high rates of unemployment, homicide, and lead poisoning) were analyzed. SETTING: This is a population-based study. RESULTS: Twenty-one percent (n=21,811) of women resided in nonimpoverished neighborhoods (zero ecologic risk factors); 23% (n=24,914) of women lived in extremely impoverished neighborhoods (four ecologic risk factors). In nonimpoverished neighborhoods, 30-34 year old women had a moderately low birth weight (1500-2499 g) rate of 13.9% compared to 10.3% for women aged 20-24 years; risk difference (95% confidence interval [CI])=3.5 (2.2-4.6). In contrast, extremely impoverished women aged 30-34 years had a moderately low birth weight rate of 19.8% compared to 11.8% for women aged 20-24 years; risk difference (95% CI)=7.7 (6.1-9.3). This trend persisted among women who received early prenatal care and were primagravids or of low parity. Neighborhood poverty did not modify the association of advancing maternal age and the risk of very low birth weight (<1500 g). CONCLUSIONS: Neighborhood poverty accelerates the rise in moderately low birth weight but not very low birth weight; rates were associated with advancing maternal age among urban African Americans.

Adult↗