Geburtshilfe Frauenheilkd 2015; 75(08): 827-832
DOI: 10.1055/s-0035-1546109
Original Article
GebFra Science
Georg Thieme Verlag KG Stuttgart · New York

Pregnancy and Obstetrical Outcomes in Women Over 40 Years of Age

Schwangerschaft und Geburt bei Frauen über 40 Jahre
A. Dietl
1   Department of Obstetrics and Gynecology, University of Freiburg i. Br., Freiburg i. Br.
,
S. Cupisti
2   Department of Obstetrics and Gynecology, University of Erlangen, Erlangen
,
M. W. Beckmann
2   Department of Obstetrics and Gynecology, University of Erlangen, Erlangen
,
M. Schwab
3   Department of Obstetrics and Gynecology, University of Würzburg, Würzburg
,
U. Zollner
3   Department of Obstetrics and Gynecology, University of Würzburg, Würzburg
› Author Affiliations
Further Information

Publication History

received 07 December 2014
revised 28 April 2015

accepted 29 April 2015

Publication Date:
31 August 2015 (online)

   Permissions and Reprints

Abstract

Introduction: Delayed childbearing is increasing, and advanced maternal age has been associated with an increased risk of obstetrical complications. The purpose of this study was to evaluate pregnancy outcomes in women with advanced maternal age (≥ 40 years). Methods: Maternal and obstetrical data were collected from the Department of Obstetrics and Gynecology of the University of Wuerzburg for the period from 2006 to 2011. In this retrospective analysis we compared the outcomes for women aged ≥ 40 years (n = 405) with those of three younger subgroups (I: < 30 y; II: 30–34 y; III: 35–39 y). Results: Pregnant women older than 40 years had more chronic diseases such as hypertension, needed medical treatment more frequently and had a higher thrombosis risk. Pregnancy-induced diseases such as gestational diabetes, preeclampsia and pregnancy-associated hypertension occurred more often in women ≥ 40 years of age. Compared to mothers who were younger than 30 years, primiparous women ≥ 40 years had a more than four times higher overall cesarean section rate and four times higher elective cesarean section rate. Furthermore, they required longer hospital stays, both after cesarean section and after vaginal delivery. The preterm birth rate (≤ 32 weeks of gestation) was similar across the different age groups. Conclusions: The outcomes of pregnancy and childbirth and for newborns born to women ≥ 40 years did not vary significantly from those of younger women if the following conditions were met: a) pre-existing chronic diseases were treated medically and dietetically; b) pregnancy-induced morbidity was monitored regularly and controlled medically; c) women attended regular prenatal check-ups; d) a healthy lifestyle was adhered to during pregnancy, and e) delivery occurred in a perinatal center.

Zusammenfassung

Einleitung: Der Trend zur späten Mutterschaft steigt und im Zuge dessen wird fortgeschrittenes mütterliches Alter mit steigendem Risiko für geburtshilfliche Komplikationen verbunden. Ziel dieser Arbeit war es, den Schwangerschaftsausgang bei Frauen im fortgeschrittenen mütterlichen Alter (≥ 40 Jahre) zu untersuchen. Material und Methoden: Mütterliche und geburtshilfliche Daten zwischen 2006 und 2011 der Geburtshilflichen und Gynäkologischen Abteilung der Universitätsfrauenklinik Würzburg wurden analysiert. In einer retrospektiven Untersuchung wurde die Altersgruppe ≥ 40 Jahre (n = 405) mit 3 anderen Subgruppen (I: < 30 Jahre; II: 30–34 Jahre; III: 35–39 Jahre) verglichen. Ergebnisse: Schwangere Frauen älter als 40 Jahre litten häufiger an chronischen Erkrankungen wie Hypertonie, hatten häufiger behandlungsbedürftige Allgemeinerkrankungen und hatten ein höheres Thromboserisiko. Schwangerschaftsinduzierte Erkrankungen wie Gestationsdiabetes, Präeklampsie und schwangerschaftsinduzierte Hypertonie kamen häufiger bei Frauen ≥ 40 Jahre vor. Erstgebärende ≥ 40 Jahre hatten ein mehr als 4-mal höheres Risiko per Sectio und ein 4-mal höheres Risiko per elektiver Sectio zu entbinden als Frauen < 30 Jahre. Des Weiteren blieben diese Frauen sowohl nach Sectio- als auch nach Spontanentbindung länger im Krankenhaus. Die Frühgeburtenrate (≤ 32. SSW) verteilte sich gleichmäßig auf die verschiedenen Altersgruppen. Diskussion: Das Outcome der Schwangerschaft, Geburt und des Neugeborenen einer Frau ≥ 40 Jahre unterscheidet sich nicht signifikant von dem einer jüngeren Schwangeren, wenn folgende Voraussetzungen erfüllt sind: a) vorbestehende chronische Erkrankungen sind medikamentös und/oder diätetisch eingestellt, b) schwangerschaftsinduzierte Erkrankungen werden regelmäßig überwacht oder medikamentös eingestellt, c) die Schwangerschaftsvorsorge wird regelmäßig wahrgenommen, d) ein gesunder Lebensstil wird auch während der Schwangerschaft beibehalten, und e) die Entbindung erfolgt in einem Perinatalzentrum.

Key words

pregnancy - advanced maternal age - gestational diabetes - hypertension - cesarean section

Schlüsselwörter

Gestationsdiabetes - Schwangerschaft - Reproduktionsmedizin - Geburt - Plazenta - Präeklampsie
 
  • 1 Heino A, Gissler M. The statistics on assisted fertility treatments. Helsinki: THL 2012 (The National Institute for Health and Welfare).
    Google Scholar
  • 2 Bertram H, Bujard M, Rösler W. Rush-hour des Lebens: Geburtenaufschub, Einkommensverläufe und familienpolitische Perspektiven. Journal für Reproduktionsmedizin und Endokrinologie 2011; 8: 91-99
    Google Scholar
  • 3 Cohen W. Does maternal age affect pregnancy outcome?. BJOG 2014; 121: 252-254
    CrossrefGoogle Scholar
  • 4 Newburn-Cook CV, Onyskiw JE. Is older maternal age a risk factor for preterm birth and fetal growth restriction? A systematic review. Health Care Women Int 2005; 26: 852-875
    CrossrefGoogle Scholar
  • 5 Tough SC, Newburn-Cook C, Johnston DW et al. Delayed childbearing and its impact on population rate changes in lower birth weight, multiple birth, and preterm delivery. Pediatrics 2002; 109: 399-403
    CrossrefPubMedGoogle Scholar
  • 6 Ritzinger P. Mutterschaft mit 40 – ovarielle Reserve und Risiken. Gynäkologe 2013; 46: 29-36
    CrossrefGoogle Scholar
  • 7 Ritzinger P, Dudenhausen JW, Holzgreve W. Späte Mutterschaft und deren Risiken. J Reproduktionsmed Endokrinol 2011; 8: 112-122
    Google Scholar
  • 8 Huang L, Sauve R, Birkett N et al. Maternal age and risk of stillbirth: a systematic review. CMAJ 2008; 178: 165-172
    CrossrefGoogle Scholar
  • 9 Joseph KS, Allen AC, Dodds L et al. The perinatal effects of delayed childbearing. Obstet Gynecol 2005; 105: 1410-1418
    CrossrefPubMedGoogle Scholar
  • 10 Bianco A, Stone J, Lynch L et al. Pregnancy outcome at age 40 and older. Obstet Gynecol 1996; 87: 917-922
    CrossrefGoogle Scholar
  • 11 Wang Y, Tanbo T, Abyholm T et al. The impact of advanced maternal age and parity on obstetric and perinatal outcomes in singleton gestations. Arch Gynecol Obstet 2011; 284: 31-37
    CrossrefPubMedGoogle Scholar
  • 12 Metzger BE, Gabbe SG, Persson B et al. International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care 2010; 33: 676-682
    Google Scholar
  • 13 Kanungo J, James A, McMillan D et al. Advanced maternal age and the outcomes of preterm neonates: a social paradox?. Obstet Gynecol 2011; 118: 872-877
    CrossrefGoogle Scholar
  • 14 Usta IM, Nassar AH. Advanced maternal age. Part I: obstetric complications. Am J Perinatol 2008; 25: 521-534
    Article in Thieme ConnectGoogle Scholar
  • 15 Cleary-Goldman J, Malone FD, Vidaver J et al. Impact of maternal age on obstetric outcome. Obstet Gynecol 2005; 105 (5 Pt 1) 983-990
    CrossrefPubMedGoogle Scholar
  • 16 Kjos SL, Buchanan TA. Gestational diabetes mellitus. N Engl J Med 1999; 341: 1749-1756
    CrossrefPubMedGoogle Scholar
  • 17 Di Cianni G, Volpe L, Lencioni C et al. Prevalence and risk factors for gestational diabetes assessed by universal screening. Diabetes Res Clin Pract 2003; 62: 131-137
    CrossrefGoogle Scholar
  • 18 Kleinwechter H. Gestationsdiabetes. Neue Leitlinie Schwangerschaftsdiabetes – Sichtweise des Diabetologen. Geburtsh Frauenheilk 2013; 73: 110-113
    Article in Thieme ConnectGoogle Scholar
  • 19 Yogev Y, Melamed N, Bardin R et al. Pregnancy outcome at extremely advanced maternal age. Am J Obstet Gynecol 2010; 203: 558.e1-558.e7
    CrossrefGoogle Scholar
  • 20 Timofeev J, Reddy UM, Huang C et al. Obstetric complications, neonatal morbidity, and indications for cesarean delivery by maternal age. Obstet Gynecol 2013; 122: 1184-1195
    CrossrefGoogle Scholar
  • 21 Balasch J, Gratacos E. Delayed childbearing: effects on fertility and the outcome of pregnancy. Fetal Diagn Ther 2011; 29: 263-273
    CrossrefPubMedGoogle Scholar
  • 22 Taddei S, Virdis A, Ghiadoni L et al. Endothelium, aging, and hypertension. Current Science Inc 2006; 8: 84-89
    CrossrefGoogle Scholar
  • 23 Salihu HM, Shumpert MN, Slay M et al. Childbearing beyond maternal age 50 and fetal outcomes in the United States. Obstet Gynecol 2003; 102 (5 Pt 1) 1006-1014
    CrossrefPubMedGoogle Scholar
  • 24 Berkowitz GS, Skovron ML, Lapinski RH et al. Delayed childbearing and the outcome of pregnancy. N Engl J Med 1990; 322: 659-664
    CrossrefPubMedGoogle Scholar
  • 25 Simchen MJ, Yinon Y, Moran O et al. Pregnancy outcome after age 50. Obstet Gynecol 2006; 108: 1084-1088
    CrossrefGoogle Scholar
  • 26 Callaway LK, Lust K, McIntyre HD. Pregnancy outcomes in women of very advanced maternal age. Aust N Z J Obstet Gynaecol 2005; 45: 12-16
    CrossrefGoogle Scholar
  • 27 Wang JX, Knottnerus A, Schuit G et al. Surgically obtained sperm, and risk of gestational hypertension and pre-eclampsia. Lancet 2002; 359: 673-674
    CrossrefGoogle Scholar
  • 28 Bellamy L, Casas J, Hingorani AD et al. Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis. BMJ 2007; 335: 974
    CrossrefGoogle Scholar
  • 29 Maas R, Baschat A, Hecher K et al. Asymmetrisches Dimethylarginin (ADMA): Ein endogener Hemmstoff der NO-Synthase – und auch ein Risikomarker der Präeklampsie?. Geburtsh Frauenheilk 2007; 67: 611-619
    Article in Thieme ConnectGoogle Scholar
  • 30 Nafee TM, Farrell WE, Carroll WD et al. Epigenetic control of fetal gene expression. BJOG 2008; 115: 158-168
    Google Scholar
  • 31 Krause B, Sobrevia L, Casanello P. Epigenetics: new concepts of old phenomena in vascular physiology. CVP 2009; 7: 513-520
    CrossrefGoogle Scholar
  • 32 Karlstrom A, Lindgren H, Hildingsson I. Maternal and infant outcome after caesarean section without recorded medical indication: findings from a Swedish case-control study. BJOG 2013; 120: 479-486 discussion 486
    CrossrefGoogle Scholar
  • 33 Hayles J, Parisaei M. PLD.06 Obstetric outcomes of pregnancies in women over 40 years of age in an inner London hospital. Arch Dis Child Fetal Neonatal Ed 2014; 99 (Suppl. 01) A107
    Google Scholar
  • 34 Vaughan DA, Cleary BJ, Murphy DJ. Delivery outcomes for nulliparous women at the extremes of maternal age – a cohort study. BJOG 2014; 121: 261-268
    CrossrefGoogle Scholar
  • 35 Reiter B, Windbichler G. Motive für den Wunsch nach einer electiven Sectio ohne medizinische Indikation. Geburtsh Frauenheilk 2010; 70: 28
    Google Scholar
  • 36 Klemetti R, Gissler M, Sainio S et al. Associations of maternal age with maternity care use and birth outcomes in primiparous women: a comparison of results in 1991 and 2008 in Finland. BJOG 2014; 121: 356-362
    CrossrefGoogle Scholar
  • 37 Zasloff E, Schytt E, Waldenstrom U. First time mothersʼ pregnancy and birth experiences varying by age. Acta Obstet Gynecol Scand 2007; 86: 1328-1336
    CrossrefGoogle Scholar
  • 38 Aasheim V, Waldenstrom U, Hjelmstedt A et al. Associations between advanced maternal age and psychological distress in primiparous women, from early pregnancy to 18 months postpartum. BJOG 2012; 119: 1108-1116
    CrossrefGoogle Scholar
  • 39 Lisonkova S, Sheps SB, Janssen PA et al. Effect of older maternal age on birth outcomes in twin pregnancies: a population-based study. J Perinatol 2011; 31: 85-91
    CrossrefGoogle Scholar
  • 40 Kyrklund-Blomberg NB, Granath F, Cnattingius S. Maternal smoking and causes of very preterm birth. Acta Obstet Gynecol Scand 2005; 84: 572-577
    CrossrefPubMedGoogle Scholar
  • 41 Scholz R, Voigt M, Schneider K et al. Analysis of the German perinatal survey of the years 2007–2011 and comparison with data from 1995–1997: maternal characteristics. Geburtsh Frauenheilk 2013; 73: 1247-1251
    Article in Thieme ConnectGoogle Scholar
  • 42 Cnattingius S, Lambe M. Trends in smoking and overweight during pregnancy: prevalence, risks of pregnancy complications, and adverse pregnancy outcomes. Semin Perinatol 2002; 26: 286-295
    CrossrefGoogle Scholar
  • 43 Khalil A, Syngelaki A, Maiz N et al. Maternal age and adverse pregnancy outcome: a cohort study. Ultrasound Obstet Gynecol 2013; 42: 634-643
    CrossrefGoogle Scholar