Advanced maternal age and pregnancy.
Advanced maternal age pregnancies are still prevalent due to ignorance and lack of effective contraception. These pregnancies have a poorer maternal and perinatal outcome.
Adult↗
SEARCH · Search PubMed
Results for “Advanced Maternal Age”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Cytogenetic evidence for enhanced selective miscarriage of trisomy 21 pregnancies with advancing maternal age.
The effect of advancing maternal age on the risk of death of fetuses with certain chromosome abnormalities has been tested by comparing their frequency at the time of chorionic villus sampling (CVS) with that at amniocentesis. The frequency of chromosome abnormalities among women whose sole risk factor for a chromosome abnormality was advanced maternal age (> or = 35 years old) was determined in a pooled group of 15,147 CVS cases, of whom > 1/3 were from the initial 7,500 CVS cases at the University of California, San Francisco, and compared with a pooled group of 74,851 amniocentesis cases collected from the literature. The frequency of trisomy 21 not only increased with advancing maternal age as expected, but the slope of the increase was about 25% greater in the CVS group than in the amniocentesis group (P = 0.08 for the difference in slopes by a logistic statistical model and P = 0.04 by a normit model). Similar patterns were seen for trisomies 18 and 13, but the P values for the differences in slopes were much higher. These results suggest that the miscarriage rate of trisomy 21 during the gestational interval studied is selectively greater with advancing maternal age. The basis for the enhanced selective loss of trisomy 21 with maternal age may be a reduced ability of the ageing "maternal compartment" to compensate for abnormal conceptuses.
Abortion, Spontaneous↗
Cost analysis of Down syndrome screening in advanced maternal age.
OBJECTIVE: To analyze the potential cost and efficacy of Down syndrome screening in the population with advanced maternal age. METHODS: Three screening methods defining Down syndrome risk for women with advanced maternal age were analyzed: advanced maternal age; advanced maternal age and maternal serum triple screen; and advanced maternal age, maternal serum triple screen and genetic sonogram. Costs for all tests and procedures were estimated. Procedure-related loss for amniocentesis was assumed to be 1:200. Efficacy was defined as: number of amniocenteses performed, number of Down syndrome cases detected, procedure-related losses, Down syndrome cases detected per fetal loss, cost per Down syndrome case detected and total cost of screening. RESULTS: In 1999 in the USA, there were 530,610 women with advanced maternal age at 16 weeks' gestation carrying an estimated 4,043 fetuses with Down syndrome. Screening by maternal age alone would result in the 100% detection of Down syndrome cases, but would require over 530,000 amniocenteses and result in 2,653 procedure-related losses. Combining age with serum screen and genetic sonogram would detect 97.6% of Down syndrome cases, but would require only 119,791 amniocenteses and result in 599 procedure-related losses. The projected cost per Down syndrome case detected using age screening is 219,109 dollars versus 155,992 dollars using serum screen and genetic sonogram. CONCLUSIONS: The combination of advanced maternal age, maternal serum screen and genetic sonogram would result in the fewest procedure-related losses and lowest cost per Down syndrome case detected.
Adult↗
Genomic risk profiling in advanced maternal age: a Tamil Nadu prenatal study.
BACKGROUND: Advanced maternal age (AMA; > = 35 years) is associated with increased fetal chromosomal risk and is an important indication for invasive prenatal diagnosis. This study evaluates karyotyping and chromosomal microarray analysis (CMA) findings among AMA pregnancies in Tamil Nadu, India. METHODS: In this prospective observational study, 2,200 pregnant women aged ≥35 years who underwent amniocentesis between July 2020 and June 2021 were enrolled. Conventional karyotyping was performed in all cases. CMA was performed as a reflex or complementary test when predefined clinical or cytogenetic criteria were present, including ultrasound abnormalities, high-risk screening/NIPT results, abnormal or uncertain karyotype findings, prior adverse pregnancy history suggestive of genetic etiology, parental chromosomal abnormalities, or patient request after counseling. RESULTS: Numerical chromosomal abnormalities were detected in 76/2200 cases (3.5%), and structural abnormalities were detected in 9/2200 cases (0.4%). The total abnormal cytogenetic yield was therefore 85/2200 cases (3.9%) when numerical and structural abnormalities were considered together. Age-stratified analysis showed an increasing trend in chromosomal abnormalities with advancing maternal age, reaching 10.4% in women aged > = 43 years. Cases with additional clinical indications showed higher abnormality rates than simple AMA. CMA was performed in selected cases and contributed to characterization of clinically relevant genomic abnormalities, supporting its role in indicated high-risk AMA pregnancies. CONCLUSION: The Tamil Nadu cohort provides regional evidence on age-stratified cytogenetic risk in AMA pregnancies and supports the use of clearly defined criteria for integrating CMA with conventional karyotyping in prenatal diagnosis.
India↗
The paradox of declining fertility but increasing twinning rates with advancing maternal age.
BACKGROUND: Advancing female age is associated with declining fertility potential due to decreasing numbers and quality of oocytes but also with a distinct increase in dizygotic twinning rates, a phenomenon that has never been explained. METHOD: An analysis of follicle development was made in 959 spontaneous ovulatory cycles of 507 women. RESULTS: Multiple ovarian follicular development (>1 follicle >14 mm) and, by implication, multiple rather than single ovulations occurred in 105 women whose mean age (36.1 versus 34.6 years) and mean basal FSH concentrations (10.3 versus 7.7 IU/l) were significantly greater than those with monofollicular development (P < 0.01). The prevalence of multifollicular development increased with age. CONCLUSIONS: Dizygotic twinning must be associated with the development of >1 large follicle, which we found to be a significantly more frequent occurrence in older women. It is hypothesized that the response of pituitary release of FSH to the decreased negative feedback induced by impending ovarian failure often 'overshoots', causing multiple follicular development. In the presence of two good-quality oocytes, a twin pregnancy may result.
Adult↗
Differential effect of advanced maternal age on prenatal diagnosis of trisomies 13, 18 and 21.
Nondisjunction associated with advanced maternal age, a well-established factor in the etiology of autosomal trisomy, should equally affect all chromosomes. In this study we evaluate the association of advanced maternal age with the occurrence of potentially viable autosomal trisomies (13, 18 and 21). 275 aneuploid pregnancies were ascertained prenatally and were grouped according to chromosome anomaly diagnosed. Mean maternal age was significantly younger (p = 0.009) in pregnancies affected by trisomy 13 than in pregnancies with trisomy 21. An intermediate mean maternal age was observed in pregnancies affected by trisomy 18. Our study shows a trend of the more severe, but potentially viable, autosomal trisomies to be diagnosed at younger maternal age. This may substantiate the 'relaxed selection hypothesis' proposed to explain the association of aneuploid conceptions with advanced maternal age.
Adult↗
An unexpected high frequency of trisomic fetuses in 229 pregnancies monitored for advanced maternal age.
In 229 pregnancies monitored because of advance maternal age, 16 (7%) abnormal fetal karyotypes were detected. We found 13 cases of trisomy 21, twice a trisomy 18, and once an additional marker chromosome. The frequency of abnormal fetal karyotypes in different maternal age groups was found to increase from 1:20 at 38--40 years, to 1:16 at 41--43 years, and finally to 1:4.5 in women of 44--46 years. The overall incidence of chromosomal aberrations and specifically of trisomy 21 is considerably higher than that described in retrospective studies.
Adult↗
Advanced maternal age and smoking: risk factors for admission to a neonatal intensive care unit.
The aim of this study was to assess if advanced maternal age and cigarette smoking increased the requirement for admission to the neonatal intensive care unit (NICU) and if those factors acted synergistically. Retrospective analysis was made of 3518 singleton pregnancies receiving antenatal care and delivering at King's College Hospital from 1 January 1992 to 31 December 1992. The maternal age was greater than 35 years in 356 women (10.1% of the total) and 49 (13.8%) of those were cigarette smokers. There was an inverse relationship between maternal age and smoking. Two hundred and fifty-nine infants were admitted to the NICU. Logistic regression analysis revealed a significant relationship between maternal age and admission (p < 0.05), but no independent effect of maternal smoking. The proportion of infants from smoking mothers of advanced age (> 35 years) admitted to the NICU, however, was greater than that from young (< or = 35 years) smoking mothers (p < 0.05). Advanced maternal age does increase the requirement for NICU admission and this effect is enhanced by smoking.
Adolescent↗
Impact of advanced maternal age on the outcome of pregnancy.
We assessed the impact of advanced maternal age on the outcome of pregnancy by studying all 1,328 women who were primarily cared for and delivered at our institution between 14 September 1984 and 12 February 1985. Important peripartum maternal complications were no more frequent in women aged 35 years or more than in women 20 to 34 years old, although operative delivery was significantly more common. Similarly, adverse outcomes of infants were no more frequent. Perinatal mortality tended to be lower. In addition, we noted a trend for fewer infants with congenital anomalies to be born among older women. This trend was related, in part, to the choice to terminate the pregnancy by women with fetuses that had documented chromosomal anomalies. We conclude that advanced maternal age was not associated with an excess of adverse pregnancy outcome and suggest that, with early registration and careful surveillance during pregnancy, women aged 35 years or more can experience excellent pregnancy outcomes.
Abortion, Induced↗
Second-trimester genetic sonography in patients with advanced maternal age and normal triple screen.
OBJECTIVE: To estimate the value of second-trimester genetic sonography in detecting fetal Down syndrome in patients with advanced maternal age (at least 35 years) and normal triple screen. METHODS: Since July 1999, a prospective collection and recording of all individual triple screen risks for fetal Down syndrome was initiated for all patients with advanced maternal age presenting in our ultrasound unit for second-trimester genetic sonography. Genetic sonography evaluated the presence or absence of multiple aneuploidy markers. Outcome information included the results of genetic amniocentesis, if performed, and the results of pediatric assessment and follow-up after birth. RESULTS: By June 2001, 959 patients with advanced maternal age and normal triple screen were identified. Outcome information was obtained in 768 patients. The median risk for fetal Down syndrome based on maternal age was 1:213 (range 1:37-1:274). The median risk for fetal Down syndrome based on triple screen results was 1:1069 (range 1:275-1:40,000). A total of 673 patients had normal genetic sonography, and none (0%) had Down syndrome; 95 had one or more aneuploidy markers present, and four (4.2%) had fetuses with Down syndrome. The triple screen risks for these four fetuses ranged from 1:319 to 1:833. CONCLUSION: This study suggests that patients with advanced maternal age and normal genetic sonography carried very little risk for Down syndrome. The use of genetic sonography may increase the detection rate of fetal Down syndrome in this group of pregnant women.
Adult↗
Risk of low birth weight associated with advanced maternal age among four ethnic groups in the United States.
OBJECTIVES: To examine and compare the risk of low birth weight associated with delayed childbearing in four ethnic groups using nationally representative data in the United States. METHODS: We compared the risk of low (< 2.5 kg) birth weight among African Americans, Mexican Americans, Puerto Ricans, and non-Hispanic whites using birth data for the United States obtained from the National Center for Health Statistics. Comparisons were done separately for first births and births of second or higher order and in terms of odds ratios, risk differences and attributable fractions of very low (< 1.5 kg), middle low (1.5-2.5) and overall low birth weight. Statistical analysis included use of logistic regression models with likelihood ratio tests for interaction effects. RESULTS: African Americans and Puerto Ricans, and to a lesser extent Mexican Americans, had higher risk differences associated with advanced maternal age. For first births, the risk differences associated with advanced maternal age (> or = 35 years) in low birth weight were 5.3% (95% CI, 4.7-6.0), 4.3% (95% CI, 1.7-6.9), and 3.7% (95% CI, 2.8-4.5) for African Americans, Puerto Ricans, and Mexican Americans, respectively, as compared with 2.6% (95% CI, 2.4-2.7) for non-Hispanic whites. On the other hand, the odds ratios associated with advanced maternal age were more similar across the four ethnic groups. Differences were greater for all ethnic groups in the case of first births as compared with births of second or higher order. CONCLUSIONS: Advanced maternal age appears to be associated with for the most part similarly increased odds of low birth weight for African Americans, Mexican Americans, Puerto Ricans, and non-Hispanic whites. However, the age-related increments in the risk of low birth associated with advanced maternal age are greater for African Americans, Puerto Ricans and, to a lesser extent, Mexican Americans, as compared with non-Hispanic whites.
Adult↗
Advanced maternal age is no longer so advanced.
Explore the source record for details and available documents.
Adult↗
Cytogenetic effects of advanced maternal age and delayed fertilization on first-cleavage mouse embryos.
It has been shown that both advanced maternal age and delayed fertilization may induce chromosomal anomalies. We therefore examined the combined effects of these two factors on chromosomal anomalies in first-cleavage mouse embryos. We set up normal and (6-h) delayed subgroups in two different age groups (young, 3-4 mo; aged, 9-11 mo) and compared the incidence of chromosomal anomalies. In first-cleavage embryos, egg-derived chromosomes can be distinguished from sperm-derived chromosomes. The incidence of maternally derived aneuploidy was highest in the aged-delayed fertilization subgroup. We therefore conclude that advanced maternal age affects the production of aneuploidy more severely when combined with the effect of delayed fertilization.
Aneuploidy↗
Aneuploidy in twin gestations: when is maternal age advanced?
OBJECTIVE: To determine the maternal age at which twin gestations have a risk of fetal aneuploidy comparable to that of singleton pregnancies at maternal age 35, accounting for variation in dizygotic twinning rates by maternal age and race. METHODS: Known aneuploidy risks and rates of dizygotic twinning by maternal age and race were used to calculate the risk of fetal aneuploidy at term and in the second trimester by maternal age and race in twin gestations, using previously published calculations. RESULTS: The risk of at least one aneuploid twin at term is 1/193 at maternal age 31 for both white and African-American women, which is comparable to the risk of 1/192 for an aneuploid singleton term pregnancy at maternal age 35. The risk of at least one aneuploid twin at amniocentesis at maternal age 31 is 1/190 for white and 1/187 for African-American women, which is slightly lower than the rate in singletons of 1/135. CONCLUSION: Invasive prenatal diagnosis for detection of fetal aneuploidy should be offered to all women with twin gestations at age 31, regardless of race.
Adult↗
Second-trimester minor ultrasound anomalies: impact on the risk of aneuploidy associated with advanced maternal age.
OBJECTIVE: To determine the impact of the presence or absence of minor ultrasound anomalies for the risk of aneuploidy in patients already at high risk because of advanced maternal age. METHODS: Eleven hundred forty-four women having amniocentesis for advanced maternal age were divided into those with minor ultrasound anomalies (n = 62) and those without (n = 1082). Two hundred fifty-nine women younger than 35 years but with minor anomalies on ultrasound were also included. RESULTS: Fetal aneuploidy was found in six of 62 (9.7%) women of advanced maternal age with minor ultrasound anomalies, in five of 1082 (0.5%) women older than 35 years with normal ultrasound results, and in five of 259 (1.9%) women younger than 35 years with minor ultrasound anomalies. CONCLUSION: Minor ultrasound anomalies increase considerably the risk of aneuploidy in women older than 35 years, and their absence lowers that risk slightly. Minor ultrasound anomalies in the fetuses of women younger than 35 raises their risk to that of a 39-year-old women in her second trimester. Ultrasound can be used to modify genetic risks at counseling and may help patients in their decision to have invasive testing.
Adult↗
Reproductive behaviour and prenatal diagnosis following genetic termination of pregnancy in women of advanced maternal age.
One hundred and fifty-one women of advanced maternal age who underwent genetic termination of pregnancy (TOP) were studied for their reproductive behaviour and the type of procedure for prenatal diagnosis in a subsequent pregnancy. A total of 59 women (39 per cent) had a further pregnancy. In all continuing pregnancies prenatal diagnosis was performed, of which 75 per cent consisted of chorionic villus sampling (CVS). Reproductive behaviour following a genetic termination was negatively correlated with maternal age and parity. Both reproductive behaviour and the choice to undergo a diagnostic procedure in the next pregnancy were independent of the type of diagnostic procedure in the previous affected pregnancy.
Abortion, Therapeutic↗
Ethnic differences in the impact of advanced maternal age on birth prevalence of Down syndrome.
OBJECTIVES: This study explored whether ethnic differences in the impact of advanced maternal age on the risk of Down syndrome might reflect differences in use of prenatal diagnostic technologies. METHODS: Maternal age-specific odds of Down syndrome and amniocentesis use were compared among African Americans, Mexican Americans, and non-Hispanic Whites via birth data for the years 1989 to 1991. RESULTS: The odds ratio and population attributable risk of Down syndrome due to maternal age of 35 years or older were highest for Mexican Americans, intermediate for African Americans, and lowest for non-Hispanic Whites. CONCLUSIONS: Advanced maternal age has a greater impact on the risk of Down syndrome for African American and, particularly, Mexican American women than for non-Hispanic White women. This difference in impact might reflect lower availability or use of prenatal diagnostic technologies.
Adult↗
Effect of chorionic villus sampling on utilization of prenatal diagnosis in women of advanced maternal age.
The effect of the introduction of chorionic villus sampling on the utilization rate of prenatal diagnosis in advanced maternal age was studied during the period 1 January 1985-1 January 1991. On the first of January 1985, the age limit for prenatal diagnosis in The Netherlands was lowered from 38 to 36 years of age. The overall uptake rate during the studied period increased significantly, but only because of the increased uptake rate in the group 36 and 37 years. In the maternal age group of 42 years and older, an uptake rate as low as 15.9% was established. This was mainly determined by the relatively high percentage (73.0%) of women from ethnic minorities in this age group. The number of CVS procedures increased significantly during the study period, but the utilization rate was not influenced, since the number of amniocenteses decreased accordingly. An increase in acceptability of prenatal diagnosis by women of advanced maternal age due to early testing and early termination of pregnancy could not be substantiated in the present study.
Adult↗