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PubMed1990

Prenatal diagnosis for psychological reasons: comparison with other indications, advanced maternal age and known genetic risk.

In Sweden, about 20 per cent of women undergoing prenatal diagnosis (PND) have the test for 'psychological reasons', which means that they strongly fear giving birth to a disabled child, but have not reached the age limit. Women undergoing amniocentesis or chorionic villus biopsy for these reasons (n = 38) were studied by questionnaires with regard to distress during test procedures. They were compared to women examined because of a known or strongly suspected high risk of giving birth to a congenitally disabled child (n = 27) and to women examined because of an age more than 37 years (n = 144). The most distressed were women who had a high genetic risk. The women who had the test because of their age reported less distress. Women examined for psychological reasons, were moderately distressed, but reported the highest frequency of influence by the distress on their daily living. Women in all groups, however, felt a similar support by the normal test result and reported the whole procedure as rather easy. Different psychological determinants of anxiety of giving birth to a disabled child are discussed. The 'psychological indication' for PND means that the women's private interpretation of her risk, and not only the statistical limit, motivates PND.

Anxiety↗
PubMed1994

A quantitative estimation of the effect of prenatal diagnosis in dizygotic twin pregnancies in women of advanced maternal age.

Genetic counselling in a dizygotic twin pregnancy is complicated by the large number of possible pregnancy outcomes and by the conceivable differences in the parental valuation of these outcomes. We present the probability distributions of the pregnancy outcomes in dizygotic twin pregnancies for women from 35 to 45 years old without prenatal diagnosis and with transabdominal chorionic villus sampling (TA-CVS) or amniocentesis (AC), using data from the literature. TA-CVS always gives a higher probability of a favourable pregnancy outcome (the birth of one or two infants with a normal karyotype) than AC. For a 35-year-old woman, a 0.7 per cent risk of an unfavourable pregnancy outcome without prenatal diagnosis has to be weighed against the 2.1 per cent excess risk of loss of the entire pregnancy after TA-CVS. For a 45-year-old woman, a 10.2 per cent risk of an unfavourable pregnancy outcome without TA-CVS has to be balanced against a 4.4 per cent excess risk of pregnancy loss after TA-CVS. This study provides a quantitative tool for the support of individual parents with respect to the decision to undergo prenatal diagnosis in a dizygotic twin pregnancy.

Abortion, Induced↗
PubMed1995

New estimates of Down syndrome risks at chorionic villus sampling, amniocentesis, and livebirth in women of advanced maternal age from a uniquely defined population.

Current measures of livebirth prevalence of Down syndrome are derived from data obtained up to 20 years ago, before the introduction of the prenatal diagnostic tests amniocentesis and chorionic villus sampling (CVS). For women aged 36-52 years, but who were not tested prenatally, we proposed to make a direct estimate of current livebirth prevalence of Down syndrome. We could also determine prevalence at the time of CVS and amniocentesis in women of the same age undergoing prenatal testing. Differences in these prevalences allow an estimation of the relative loss of Down syndrome during pregnancy. In Victoria, Australia, we identified 3041 women having CVS, 7504 having amniocentesis, and 13,139 having no test. Smoothed regression estimates of age-specific livebirth prevalence were found to be higher than in the early studies. The estimate of spontaneous loss was 17 per cent between the time of CVS and amniocentesis, and 18 per cent after the time of amniocentesis. The latter figure is lower than previous estimates and may be explained by a greater likelihood of a Down syndrome fetus surviving to be liveborn, given the modern approach to early obstetric intervention. These current risk estimates of livebirth may be useful updates for genetic counselling, but perhaps more importantly, may be used as precise maternal age-related risk figures, necessary in the design and implementation of prenatal screening programmes for Down syndrome.

Adult↗
PubMed2002

A negative second trimester triple test and absence of specific ultrasonographic markers may decrease the need for genetic amniocentesis in advanced maternal age by 60%.

OBJECTIVE: A study was conducted to evaluate the sensitivity of combining a second trimester triple test and targeted ultrasound in order to detect Down syndrome in women undergoing amniocentesis over 35 years of age. METHODS: Women over 35 years of age underwent a triple test and an ultrasound examination for chromosomal markers immediately prior to genetic amniocentesis. RESULTS: One thousand and six women were examined. Four hundred and thirty seven were triple test-positive and in 195 cases ultrasonographic abnormalities were observed. Thirteen had Down syndrome and eight had other chromosomal abnormalities. All women with Down syndrome babies were triple test-positive and seven also had ultrasonographic markers. Three of eight women who had babies with chromosomal aberrations other then Down syndrome were also triple test-positive. CONCLUSIONS: The use of the triple test as a screening tool in our population would reduce the number of amniocenteses by 60%, while no cases of Down syndrome would be missed. Ultrasonographic markers have added little to this population. Three non-Down syndrome chromosomal abnormalities and two Down syndrome mosaic cases would be missed by this approach.

Adult↗
PubMed1983

Oocyte sensitivity to induced meiotic nondisjunction and its relationship to advanced maternal age.

Several potential chromosomal mutagens were employed in an effort to induce mouse oocyte meiotic nondisjunction. Rat follicle-stimulating hormone, clomiphene citrate, and methotrexate each failed to increase the incidence of oocyte metaphase aneuploidy. A "temperature stress" system produced a marked increase in meiotic nondisjunction. Increased maternal age did not cause an increase in susceptibility to this chromosome mutagen model. This suggests that the maternal age relationship to aneuploidy is not likely to be due to an increased sensitivity of oocytes from older females to chromosomal mutagens.

Aneuploidy↗
PubMed1990

Spontaneous abortion rate and advanced maternal age: consequences for prenatal diagnosis.

Maternal age related and procedure-related fetal abortion rates were studied in 384 women aged 36 and over scheduled for transabdominal chorionic villus sampling (TA-CVS) at 12-14 weeks of gestation. The pre-TA-CVS abortion rate within 30 days of intake (at 6-10 weeks of gestation) rose from 1.9% at age 35-36 years to 10.9% at 40 years and older. Women entering in the 6th week of gestation had a greater probability of aborting before TA-CVS than women entering after day 48. 26 women aborted spontaneously before TA-CVS, the majority of abortions occurring at 10-12 weeks. TA-CVS was done in 346 women. 11 pregnancies were terminated because of genetic anomalies, and 8 women had spontaneous fetal loss. These findings justify delaying prenatal diagnosis in older pregnant women until 12 weeks of gestation.

Abortion, Spontaneous↗
PubMed2005

Is advanced maternal age an independent risk factor for uteroplacental insufficiency?

OBJECTIVE: To determine whether maternal age 35 years or older is an independent risk factor for uteroplacental insufficiency and thus an independent indication for antepartum testing. STUDY DESIGN: A retrospective cohort analysis was performed of all deliveries at Los Angeles County-University of Southern California Women's and Children's Hospital between August 1, 1995, and September 1, 2003. Women with documented indications for antepartum testing, fetal anomalies, or delivery prior to 34 weeks were excluded from analysis. Markers of uteroplacental insufficiency included stillbirth, birth weight less than the 10th percentile, fetal distress, cesarean section for fetal distress, oligohydramnios, meconium passage, and 5-minute Apgar score less than 7. RESULTS: Indications for antepartum testing were significantly more common in women 35 years or older (33.2% versus 27.0%). After excluding women with indications for antepartum testing, anomalous fetuses, and women delivering prior to 34 weeks, stillbirth was twice as common in women 35 years and older. However, among stillbirths, growth restriction occurred with similar frequency in the older (28.6%) and younger (25.0%) cohorts. Among live births, 2 markers of uteroplacental insufficiency, intrapartum fetal distress (5.7% versus 4.1%) and cesarean delivery for fetal distress (4.0% versus 2.4%) were significantly more common in the older cohort. All other markers of uteroplacental insufficiency were observed with similar frequency in the 2 groups. CONCLUSIONS: After excluding women with other indications for antepartum testing, fetal anomalies, and delivery prior to 34 weeks, stillbirth was twice as common in women 35 years of age or older as in those younger than 35 years. The increased rate of stillbirth does not appear to be explained by a higher rate of uteroplacental insufficiency.

Adult↗
PubMed2006

Dystocia increases with advancing maternal age.

OBJECTIVE: The purpose of this study was to assess the influence of maternal age on obstetric indices of uterine efficiency in spontaneous nulliparous labor managed according to a standardized protocol in order to determine whether increasing maternal age is more commonly associated with dystocia. STUDY DESIGN: Information was collected prospectively and retrieved retrospectively from an obstetric database for a 5-year period on a consecutive series of nulliparas in spontaneous term (> or = 37 weeks' gestation) labor with singleton cephalic presentations. All women were managed according to an established Active Management protocol. Indices for dystocia, including need for oxytocin augmentation, prolonged labor (> 12 hr), instrumental delivery, and cesarean section were compared between 5 maternal age categories (< 20 years, 20-24, 25-29, 30-34, and > or = 35 years). RESULTS: The obstetric outcomes of 10,737 consecutive nulliparas in spontaneous term labor were analyzed for the 5 years 1998 to 2002. The incidences of oxytocin augmentation, prolonged labor, instrumental delivery, and intrapartum cesarean section including cesareans for dystocia all increased significantly and progressively with increasing maternal age. Mean gestational age and birth weight were similar in each age category. CONCLUSION: In a context of uniform labor management, all 4 indices of dystocia examined were increased progressively with maternal age, although oxytocin augmentation proved a generally effective intervention in all age categories. These findings have implications for the analysis of intervention rates by health care providers, particularly in developed countries where the proportion of older nulliparas is increasing.

Adult↗
PubMed2006

Pregnancy outcome in primiparae of advanced maternal age.

OBJECTIVE: To investigate the impact of maternal age on singleton pregnancy outcome, taking into account intermediate and confounding factors. STUDY DESIGN: In this population-based retrospective cohort study, perinatal data of primiparous women aged 35 years or more (n = 2970), giving birth to a singleton child of at least 500 g, were compared to data of primiparous women aged 25-29 years old (n = 23,921). Univariate analysis was used to assess the effect of maternal age on pregnancy outcomes. The effects of intermediate (hypertension, diabetes and assisted conception) and confounding factors (level of education) were assessed through multivariable logistic regression analysis. RESULTS: Older maternal age correlated, independently of confounding and intermediate factors, with very preterm birth (gestational age <32 weeks) [adjusted odds ratio (AOR) 1.51, 95% confidence intervals (CI) 1.04-2.19], low birth weight (birth weight <2500 g) (AOR 1.69, 95% CI 1.47-1.94) and perinatal death (AOR 1.68, 95% CI 1.06-2.65). CONCLUSION: Maternal age is an important and independent risk factor for adverse pregnancy outcome.

Adult↗
PubMed1997

Does advanced maternal age affect pregnancy outcome in women with mild hypertension remote from term?

OBJECTIVES: Our purpose was to compare maternal and perinatal outcomes of mature women with those in younger women with pregnancies complicated by mild hypertension remote from term. STUDY DESIGN: A matched cohort design was used. A total of 379 mature pregnant women (> or = 35 years old) with mild hypertension remote from term were matched for race, gestational age, and proteinuria status at enrollment with 379 adult controls aged 20 to 30 years also with mild hypertension remote from term. All were enrolled in an outpatient management program that included automated blood pressure measurements and daily assessment of weight, proteinuria, and fetal movement. RESULTS: The mean gestational age at enrollment was 32.7 +/- 3.0 weeks for both groups (range 24 to 36 weeks). By matching 20.6% of patients in each group had > or = 1+ proteinuria on urinary dipstick at enrollment, and 77.3% of patients in each group were white. Chronic hypertension was more common in the mature group (22.4% vs 14.5%, p = 0.007). The mean gestational age at delivery (37.2 +/- 2.3 vs 37.2 +/- 2.2 weeks), the mean pregnancy prolongation (28.1 +/- 21.0 vs 28.4 +/- 22.0 days), and the mean birth weights (2864 +/- 770 vs 2906 +/- 788 gm) were similar between the mature and younger groups (all p > 0.05). There were no differences regarding abruptio placentae (2 vs 3 cases) or thrombocytopenia or HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome (7 vs 9 cases), and there were no cases of eclampsia. There were five stillbirths in the mature group and none in the younger group (p = 0.063). CONCLUSION: Outpatient management of mild hypertension remote from term in the mature pregnant women was associated with similar maternal outcomes but with a nonstatistically higher stillbirth rate compared with the younger pregnant woman.

Adult↗
PubMed1995

Success rates with gamete intrafallopian transfer and in vitro fertilization in women of advanced maternal age.

OBJECTIVE: To evaluate the effect of maternal age on outcomes for IVF and GIFT in women 40 to 45 years of age. DESIGN: Retrospective. SETTING: Boston IVF, a free-standing university-affiliated IVF and GIFT unit. PATIENTS: A total of 2,931 cycles of IVF and 1,826 cycles of GIFT were analyzed in women undergoing assisted reproductive technologies (IVF or GIFT) using autologous eggs. INTERVENTIONS: Medical records of patient outcomes were reviewed. RESULTS: For patients undergoing IVF, the cancellation rate for initiated cycles showed significant differences in women aged 25 to 39 (38.3%), women aged 40 to 43 (49.5%), and women aged 44 to 45 years (69.5%). A significantly lower delivery rate per stimulation and delivery rate per retrieval was found in women aged 40 to 43 years when compared with women aged 25 to 39 years. No deliveries occurred in 59 cycles in women aged 44 to 45 years, thereby representing a significant difference when compared with both women aged 25 to 39 years and women aged 40 to 43 years. For patients undergoing GIFT, the cancellation rate for initiated cycles was significantly higher in women aged 40 to 43 (25.0%) and 44 to 45 years (31.0%) when compared with women aged 25 to 39 years (15.1%). A significantly lower delivery rate per stimulation and delivery rate per retrieval was found in women aged 40 to 43 and 44 to 45 years when compared with women aged 25 to 39 years. CONCLUSIONS: Success rates for IVF and GIFT decline significantly in women > 40 years old. Women aged > or = 44 years are unlikely to benefit from the use of IVF and GIFT.

Adult↗