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Advanced maternal age (AMA, >35 years at delivery) confers maternal and foetal risks, particularly with age >45 years and nulliparity, but longitudinal comparative data on age- and parity-specific AMA fertility is lacking. We used the Human Fertility Database (HFD), a publicly available, international database, to analyse fertility in US and Swedish women aged 35–54 from 1935 to 2018. Age-specific fertility rates (ASFR), total birth counts, and proportion of AMA births were evaluated across maternal age, parity, and time, and compared to maternal mortality rates during the same time. In the US, total AMA births nadired in the 1970s, and have risen since. Until 1980, most AMA births were to women completing parity 5 or higher; since then, most have been to low parity women. While ASFR in 35 to 39 year olds was highest in 2015, ASFR in women 40–44 and 45–49 were highest in 1935, though they have been rising recently, especially in low-parity women. While the same AMA fertility trends were seen in the US and Sweden from 1970–2018, maternal mortality rates have risen in the US despite remaining low in Sweden. Although AMA is known to contribute to maternal mortality, this discrepancy merits further consideration. [ABSTRACT FROM AUTHOR]

This systematic review aimed to understand the impact of advanced maternal age (AMA) on the neonatal morbidity, based on the available scientific evidence. A systematic search was conducted on 22 November 2021, using the PubMed and Scopus databases to identify studies that compared the morbidity of neonates delivered to AMA mothers with that of neonates delivered to non-AMA mothers. Sixteen studies that evaluated the effect of AMA on the neonatal morbidity were included in this review. Nine of these studies found some association between AMA and increased neonatal morbidity (with two of them only reporting an increase in asymptomatic hypoglycemia, and one only reporting an association in twins), six found no association between AMA and neonatal morbidity and one study found a decrease in morbidity in preterm neonates. The studies that found an increase in overall neonatal morbidity with AMA considered older ages for the definition of AMA, particularly ≥40 and ≥45 years. The current evidence seems to support a lack of association between AMA and the neonatal morbidity of the delivered neonates. However, more studies focusing on the neonatal outcomes of AMA pregnancies are needed to better understand this topic. [ABSTRACT FROM AUTHOR]

To explore the impact of IVF on pregnancy complications and birth outcomes in women of advanced maternal age. In this retrospective study, 3325 women were divided into the ART pregnancy group (n = 241) and the natural pregnancy group (n = 3086). The differences in maternal general conditions, pregnancy complications and birth outcomes were compared between the two groups. The ART group had higher rates of primiparity (78.4% vs 20.4%), cesarean section (90.5% vs 76.2%) and twin births (28.6% vs 2.1%). The risk of gestational hypertension (5.8% vs 2.9%), preeclampsia (5.0% vs 2.3%) and preterm birth [28 ∼ 31 + 6 weeks (2.9% vs 1.1%), 32 ∼ 33 + 6 weeks (5.0% vs 1.4%), 34 ∼ 36 + 6 weeks (15.8% vs 9.4%)] was significantly higher in the ART group than in the natural pregnancy group. Neonates in the ART group had lower birth weights (2882.61 ± 657.70 vs 3223.05 ± 534.28). However, in the singleton-only comparison, only gestational hypertension still showed a statistically significant difference. For women of advanced maternal age, IVF-ET pregnancies may result in higher rates of pregnancy complications and adverse birth outcomes, but this is likely to be due to increased rates of multiple pregnancies. [ABSTRACT FROM AUTHOR]

Objective: To evaluate whether advanced maternal age (35–39 years, AMA)/very advanced maternal age (≥40 years, VAMA) impacts neonatal outcomes of very-low-birth-weight (VLBW) infants. Methods: Data of VLBW infants admitted to our unit were reviewed. Demographic findings and neonatal outcomes were compared among maternal age [(<35 years, not advanced maternal age, n = 329), AMA (n = 209), and VAMA (n = 43)] groups. Univariate and multivariate analyses were performed to identify the associated risk factors for neonatal outcomes. Result: Mortality and overall morbidities showed no significant intergroup differences, except for massive pulmonary hemorrhage (MPH). Multivariate analysis revealed that AMA/VAMA was not significantly associated with MPH development, while ≥ two doses of surfactant administration was. Higher gestational age and antenatal corticosteroid administration were protective. Conclusion: AMA/VAMA is not associated with neonatal mortality and morbidities. Since the proportion of AMA/VAMA mothers is expected to increase, perinatal medicine practitioners should focus on approaches before and immediately after birth of such infants. [ABSTRACT FROM AUTHOR]

Objective: Data regarding the risk factors for obstetrical anal sphincter injury (OASI) among nulliparous advanced maternal age (AMA) women are scarce. We aimed to evaluate the risk factors and the rate of OASI in this population. Methods: A retrospective case-control study of nulliparous women aged ≥35 who delivered vaginally between March 2011 and August 2021. The study cohort included nulliparous AMA women, aged 35 years or older, delivering vaginally a singleton, vertex neonate. We excluded cases with missing data. Maternal and intrapartum characteristics were compared between OASI and no-OASI groups. We matched groups to the earliest gestational age in which OASI has occurred. Results: A total of 3,635 women met inclusion criteria. Mean age of the participants was 38 years (range 35–56, interquartile range 36–39). The oldest age in which an OASI was diagnosed was 45. A total of 55 (1.5%) cases of OASI were diagnosed. Gestational age at delivery was higher in the OASI group compared to the no-OASI group (mean 396/7±12/7 vs. 391/7±23/7 weeks respectively, p=.039). The rate of induction of labor, oxytocin and epidural analgesia, prolonged second stage, mode of delivery, and rate of blood transfusion did not vary between groups. Estimated fetal weight was higher in the OASI group (3,324 ± 308 vs. 3,114 ± 566 g, p<.001). Sonographic abdominal circumference was higher in the OASI group (338 ± 13 vs. 328 ± 28 mm, p<.001). Mean birthweight was higher in the OASI group (3,286 ± 400 vs. 3,059 ± 541 g, p=.002) and the birthweight centile was higher as well (60 ± 26 vs. 52 ± 25, p=.024). In a multivariable regression analysis including birthweight, gestational age, operative vaginal delivery, epidural anesthesia, and hypertensive disorders–birthweight and hypertensive disorder were positively associated with an OASI odds ratio [OR 95% CI 1.6 (1.1–2.32) for every 500 g increase; 2.42 (1.006–5.82), respectively]. Epidural anesthesia was negatively associated with OASI [OR 95% CI 0.49) 0.27–0.87)]. Conclusions: Epidural anesthesia is the only modifiable risk factor and is protective against OASI among nulliparous AMA women. Birthweight and hypertensive disorders are also independent predictors of OASI in this population. [ABSTRACT FROM AUTHOR]

Objective To determine the relationship between maternal age and labor induction duration among nulliparous women. Methods This retrospective cohort study included nulliparous women with non-anomalous, term, singleton pregnancies undergoing labor induction with intact membranes at a tertiary-care academic hospital from January 2015 to April 2017. Maternal age was stratified as follows: <25 years, 25–29 years, 30–34 years, 35–39 years, and ≥ 40 years. The primary outcome was induction duration, defined as the time the first induction agent was administered to time of birth. Secondary outcomes were cesarean delivery, cesarean indication, hemorrhage, blood transfusion, peripartum infection, composite neonatal morbidity, and induction duration among the subset of women who ultimately underwent cesarean. The data were analyzed using chi-squared and Fisher exact tests. Multivariable regression was used to adjust for maternal race/ethnicity, maternal body mass index, gestational age at start of induction, and induction indication. Hazard ratios were used to calculate induction duration among women who underwent cesarean delivery, stratified by age and adjusted by the same variables. Results Among the 955 patients included, the median induction duration was 32.3 h (interquartile range (IQR) 20.4–41.0 h). Women 40 years and older had a slight increase in induction duration (adjusted odds ratio (aOR) 1.03, 95% confidence interval (CI) 1.01–1.05) and a seven-fold increased risk of induction lasting 60 h or longer (adjusted relative risk (aRR) 7.3, CI 1.8–29.9) when compared to those under 25 years of age; otherwise, there was no association between maternal age and labor induction duration. There was no association between age and cesarean delivery, cesarean indication, hemorrhage, transfusion, peripartum infection, or adverse neonatal outcomes. Furthermore, there was no association between maternal age and induction duration even among women who ultimately underwent cesarean. Conclusion We found no association between maternal age and induction duration for women under 40 years of age. For women 40 years of age and older, these was an increased risk of labor induction lasting 60 h or longer. Despite this, we found no association between maternal age and cesarean delivery or other adverse maternal or fetal outcomes. Objective To determine the relationship between maternal age and labor induction duration among nulliparous women. Methods This retrospective cohort study included nulliparous women with non-anomalous, term, singleton pregnancies undergoing labor induction with intact membranes at a tertiary-care academic hospital from January 2015 to April 2017. Maternal age was stratified as follows: <25 years, 25–29 years, 30–34 years, 35–39 years, and ≥ 40 years. The primary outcome was induction duration, defined as the time the first induction agent was administered to time of birth. Secondary outcomes were cesarean delivery, cesarean indication, hemorrhage, blood transfusion, peripartum infection, composite neonatal morbidity, and induction duration among the subset of women who ultimately underwent cesarean. The data were analyzed using chi-squared and Fisher exact tests. Multivariable regression was used to adjust for maternal race/ethnicity, maternal body mass index, gestational age at start of induction, and induction indication. Hazard ratios were used to calculate induction duration among women who underwent cesarean delivery, stratified by age and adjusted by the same variables. Results Among the 955 patients included, the median induction duration was 32.3 h (interquartile range (IQR) 20.4–41.0 h). Women 40 years and older had a slight increase in induction duration (adjusted odds ratio (aOR) 1.03, 95% confidence interval (CI) 1.01–1.05) and a seven-fold increased risk of induction lasting 60 h or longer (adjusted relative risk (aRR) 7.3, CI 1.8–29.9) when compared to those under 25 years of age; otherwise, there was no association between maternal age and labor induction duration. There was no association between age and cesarean delivery, cesarean indication, hemorrhage, transfusion, peripartum infection, or adverse neonatal outcomes. Furthermore, there was no association between maternal age and induction duration even among women who ultimately underwent cesarean. Conclusion We found no association between maternal age and induction duration for women under 40 years of age. For women 40 years of age and older, these was an increased risk of labor induction lasting 60 h or longer. Despite this, we found no association between maternal age and cesarean delivery or other adverse maternal or fetal outcomes. [ABSTRACT FROM AUTHOR]

Objective: Maternal age, maternal obesity and neonatal sex dimorphism are known to affect pregnancy and neonatal outcome. However, the effects of these factors on specific placental pathology are less well-documented. Study design: Clinical information, placental pathology and neonatal data from singleton delivery were collected at our hospital in March 2020 to October 2021 and correlation studies were performed. Results: A total 3,119 singleton placentas were examined between March 2020 and October 2021 in conjunction with clinical information and neonatal birth data. Advanced maternal age (>35) was significantly associated with a variety of pregnancy complications and placental pathology including preeclampsia/pregnancy induced hypertension (Pre/PIH), gestational diabetes mellitus (GDM2), intrauterine growth restriction (IUGR), and increased maternal body mass index (BMI) at delivery. Maternal obesity (BMI >30 at the time of delivery) was significantly associated with a variety of clinical features and placental pathology including PRE/PIH, GDM2 and decidual vasculopathy (mural arterial hypertrophy). No specific placental pathology was associated with neonatal sex except for more maternal inflammatory response (MIR, chronic deciduitis) in neonates of male sex. Conclusion: Maternal age and maternal obesity were associated with not only clinical complications of pregnancy and neonatal birth weight but also specific placental pathology. Understanding the effects of maternal and environmental factors will help improve pregnancy outcome. [ABSTRACT FROM AUTHOR]

The prevalence of preexisting type 2 diabetes mellitus (T2DM) in the United States is on the rise. Women of advanced maternal age (AMA, ≥35 years) are more likely to have preexisting T2DM in pregnancy because glucose intolerance increases with age. Diabetes in pregnancy is associated with significant maternal and neonatal morbidity and mortality, and earlier treatment initiation improves pregnancy outcomes. However, maternal age is not currently recognized as an independent risk factor that warrants diabetes screening prior to the traditional screen at 24–28 weeks gestation. To evaluate the cost-effectiveness of screening all AMA women with a first trimester fasting plasma glucose (FPG) test for earlier diagnosis and management of preexisting T2DM. A decision-analytic model was created to compare pregnancy outcomes in AMA women who undergo a first trimester FPG test vs third trimester oral glucose tolerance test alone. Probabilities were obtained from the literature. Outcomes examined included preeclampsia, preterm delivery, macrosomia, shoulder dystocia, brachial plexus injury (BPI), intrauterine fetal demise (IUFD), cerebral palsy, and neonatal death. The cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio of the first trimester screening strategy were examined as well. Sensitivity analyses and a Monte Carlo simulation were performed to test the model's robustness. In AMA women, screening for preexisting T2DM in the first trimester with an FPG test resulted in fewer cases of preeclampsia, preterm delivery, BPI, IUFD, cerebral palsy, and neonatal death compared to performing a third trimester oral glucose tolerance test alone, and is cost-effective. Monte Carlo analysis incorporating the distribution of all probabilities showed that first trimester FPG screening remained cost-effective as long as the incremental cost of initiating diabetes treatment in the first trimester was less than $150,000 and the cost of the FPG screen was less than $2700. Compared to third trimester oral glucose tolerance test alone, performing a first trimester FPG screen in AMA women is cost-saving and more effective. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare the depressive symptoms during pregnancy between pregnant women aged over 35 years and those aged less than 35 years and to evaluate the protective effect of social support in early pregnancy against prenatal depressive symptoms. One hundred and seventy one women aged over 35 years and 342 trimester-matched women aged less than 35 years were included from a level III hospital in Shenzhen, China. The self-report Edinburgh Postnatal Depression Scale (EPDS) and Social Support Rating Scale (SSRS) were used to evaluate prenatal depression and social support in early pregnancy. The proportions of women aged over 35 years who screened positive for prenatal depression were 22.8%, 23.4%, and 24.0% in the first, second and third trimesters, respectively. Advanced maternal age (≥35 years) was a positive predictor of prenatal depressive symptoms (β = 0.747, P = 0,008). Social support, especially objective support (β = -0.030, P = 0.002) and subjective support (β = -0.028, P = 0.006) in early pregnancy, had stronger protective effects against prenatal depressive symptoms for women aged over 35 years than younger women. Our findings support that older pregnant women experience more depressive symptoms than younger pregnant women, and social support could serve as a targeted intervention to decrease prenatal depressive symptoms. What is already known on this subject? Depressive symptoms, which are strongly associated with adverse psychosocial and birth outcomes, appear to be prevalent and change in nature. Social support is an important protective factor against prenatal depression. What the results of this study add? Pregnant women of advanced maternal age experienced more depressive symptoms than younger women during the prenatal period. Social support, especially objective support and subjective support, had stronger protective effects against prenatal depression for women aged over 35 years than women aged less than 35 years. What the implications of these findings are for clinical practice? Screening of prenatal depression should be strengthened, especially for women aged over 35 years, and improving subjective support could improve their emotional experience. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the association between deoxyribonucleic acid (DNA) integrity parameters and advanced maternal age (AMA)-related infertility. The granulosa cells and the lymphocytes obtained from 119 infertile women were recruited. Patients were divided into two groups: the AMA group (≥35 years, n = 26) and the non-AMA group (<35 years, n = 93). The tail length, tail moment and tail DNA percentage were evaluated as the DNA integrity parameters using comet assay. Infertility duration (p=.001), luteinising hormone (p=.01) and progesterone levels (p<.0001) were higher and smoking was more prevalent in the AMA group (p=.001). AMA group was stimulated with higher gonadotropin doses (p=.04) and had decreased anti-mullerian hormone levels (p<.0001). All of DNA integrity parameters were distributed homogenously between the groups; however, the tail length of lymphocytes was higher (p=.02) in the AMA group. Fertilisation was lower (p=.02), oocyte quality was tended to be poor (p=.03) and blastocyst transfer was lower in the AMA group (p=.03). Embryo quality was distributed homogenously between the groups. Implantation, clinical pregnancy and live birth rates were similar between the groups. What is already known on this subject? Advanced maternal age (AMA)-related infertility is associated with diminished ovarian reserve and alteration in follicular environment resulting in poor oocyte quality; however, the exact pathophysiologic mechanism is not clear. What do the results of this study add? Tail length, tail deoxyribonucleic acid (DNA) percentage, tail moment of granulosa cells were nonsignificantly higher in the AMA group compared to younger patients. All of the DNA integrity parameters of lymphocytes were nonsignificantly higher; however, only tail length of lymphocytes was statistically higher in the AMA group than the non-AMA group. A positive correlation was observed between DNA integrity parameters of lymphocytes and body mass index. There were no correlations between DNA integrity parameters of granulosa cells and lymphocyte and infertility duration, gonadotropin dose, duration of ovarian stimulation, oocyte score, embryo score, basal hormone levels and anti-mullerian hormone levels. What are the implications of these findings for clinical practice and/or further research? Our findings offer new insight for further understanding the role of granulosa cells in mediating the poor reproductive outcome of ageing patients. Understanding the mechanisms of ovarian ageing and poor oocyte quality in women with AMA may help to identify specific targets for improving oocyte quality with ageing. [ABSTRACT FROM AUTHOR]

Although Meghan Markle has been both championed and challenged for negotiating extant representations of marriage and romance, race, class and feminism, more recently the former actress found herself at the centre of a debate over in/fertility and 'geriatric' motherhood. Using Markle as a case in point, the women's magazine, health, beauty and celebrity entertainment sector demonstrated concern for the high alarm strategies being presented in relation to older motherhood. With this in mind, this article will look at the gendered magazine sector and question the ways in which their narratives of advanced maternal age in general, and their commentary on Markle's successful royal pregnancy in particular can be understood as either a productive or problematic step in opening up a debate about advanced maternal age, pregnancy and age-related in/fertility. [ABSTRACT FROM AUTHOR]

The rising caesarean section (CS) rate is a complex issue, particularly in an increasingly heterogenous nulliparous population. The study aim was to stratify the CS rate in nulliparous women by age and BMI to determine if any difference existed. This was a retrospective review of CS procedures of nulliparous women in two centres in Ireland (2014 through 2017). Data were obtained for 17,177 women from the hospital databases and CS procedures determined for each age and BMI category. Significant differences were observed when CS rates were stratified in this manner. The CS rates for women <20 years/BMI < 18.5 was 8.8 versus 57.6% for women 35 − 39 years/BMI 30 − 34 and 76 − 100% for all women >45 years (p<.005). The development of customised charts subdivided by age and BMI may be a useful counselling tool and assist in the comparison of rates between units. What is already known on this subject? It is well known that along with rising CS rates globally, there have also been significant changes in maternal demographics—with increasing maternal age at first birth and increasing maternal BMI. It is well established that both of these factors affect the rate of CS in a population. What do the results of this study add? This study sought to stratify the CS rate in nulliparous women by age and BMI to determine if any difference existed. The results of the study showed an increasing CS rate for increasing age and BMI categories that was statistically significant. What are the implications of these findings for clinical practice and/or further research? Additional research using larger population data sets could allow the development of customised charts for nulliparous women subdivided by age and BMI which could act as a useful counselling tool in clinical practice, as well as assist in the comparison of CS rates between units. [ABSTRACT FROM AUTHOR]

Objective: To determine the impact of maternal age on the rate of cesarean delivery in women undergoing induction at term.Study Design: Retrospective cohort study of term singleton gestations in nulliparous women induced for any indication at Lehigh Valley Health Network from July 2010 to July 2013. Exposure of interest was maternal age. Primary outcome was cesarean delivery. For every one woman ≥35 years of age (exposed), 2-3 women <35 years of age were selected as unexposed subjects for comparison. Statistical analysis included bivariate and multivariable techniques.Results: 406 patients were included; 101 women ≥35 years of age and 305 women <35 years of age. Women in the ≥35 group were more likely to be induced for maternal medical conditions and less likely to be induced for prolonged pregnancy; few inductions were elective. Few women were induced electively in either group. More than half of women in both groups required cervical ripening. Method of cervical ripening and/or induction and percentage of women with a Bishop score <5 were similar between groups. The primary outcome, cesarean delivery, was similar between groups (45.5% in age ≥35 group vs 40.0% in age <35 group, p = .33). After adjustment for potential confounders, the rate of cesarean delivery was not influenced by maternal age (AOR 1.21 [0.76, 1.91], p = .42) but was higher in women with a Bishop score <5 at the time of induction of labor [AOR 1.64 [1.09, 2.47], p = .02].Conclusion: In the wake of several recent trials underscoring the safety and potential maternal and fetal benefit of labor induction, identifying predictors of induction success (and failure) takes on increasing importance. Our findings suggest that maternal age is not an independent risk factor for cesarean delivery in women undergoing induction. [ABSTRACT FROM AUTHOR]

Background: During the last decades, the age of pregnant women significantly increased. The incidence of maternal and labor complications is higher among older women, but conclusive data have not been delivered whether labor epidural analgesia (EA) may affect the duration of labor and delivery outcomes in this population of patients. The aim of this study is to evaluate the effect of EA among women aged over 35 years.Methods: We retrospectively reviewed medical records of all, singleton, at term deliveries, laboring with EA, between December 2011 and October 2017. Women aged ≥35 years (study group) were compared with women aged <35 years (control group) to evaluate EA effects on the duration of labor and neonatal outcome.Results: The study enrolled 459 women with EA: 122 women were included in the study group and 337 in the control group. The multiple regression analysis showed that parity was an independent variable for a shorter dilation period (p = .002), second stage length (p = .0001) and for the total labor duration (p = .0001); neonatal weight was significant for a shorter dilation period (p = .005) and for the total labor duration (p = .002); maternal age and cervical dilatation at the beginning of EA did not influence neither the period of the labor stages nor the total labor duration (p > .05).Conclusions: Results of this study indicate that women aged ≥35 with EA may have labor duration and neonatal short-term outcomes similar to younger women with EA. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate risk for postpartum readmissions and associated severe morbidity by maternal age.Materials and Methods: This retrospective cohort study used the Nationwide Readmissions Database to analyze 60-day all-cause postpartum readmission risk from 2010 to 2014. Risk for severe maternal morbidity (SMM) during readmission was ascertained using criteria from the Centers for Disease Control and Prevention. The primary exposure of interest was maternal age. Outcomes included time to readmission, risk of readmission, and risk for SMM during readmission. Multivariable log linear analyses adjusting for patient, obstetric, and hospital factors were conducted to assess readmission and SMM risk with adjusted risk ratios (aRRs) with 95% confidence intervals (CIs) as measures of effect.Results: Between 2010 and 2014, we identified 15.7 million deliveries, 15% of which were to women aged 35 or older. The 60-day all-cause readmission rate was 1.7%. Of these, 13% were complicated by SMM. Age-stratification revealed that women 35 and older were at increased risk for readmission and increased risk for SMM. The majority of readmissions occurred within the first 20 days regardless of age; although, women 35 and older were more likely to be admitted within the first 10 days of discharge. Patients ages 35-39, 40-44, and >44 years had 9% (95% CI 7-10%), 37% (95% CI 34-39%), and 66% (95% CI 55-79%) significantly higher rates of postpartum readmission when compared to women age 25-29. Women 35-39, 40-44, and >44 years of age had a 15% (95% CI 10-21%), 26% (95% CI 18-34%), and 56% (95% CI 25-94%) higher risk of a readmission with SMM than women 25-29.Conclusions: AMA women are at higher risk for both postpartum readmission and severe morbidity during readmission. Women older than 35 years represent the group most likely to experience complications requiring readmission, with the highest risk age 40 and older. [ABSTRACT FROM AUTHOR]

Objective: To elucidate the efficacy and safety of attempting a vaginal birth and to understand the factors that contribute to the increased risk of operative delivery in women aged 40 years or older.Methods: A database of the Japanese Red Cross Nagoya Daiichi Hospital was reviewed to identify women aged 40 years or older with singleton, vertex, and vital pregnancies who attempted vaginal delivery at and after 37 + 0 gestational weeks between January 2011 and December 2016.Results: A total of 415 women met the criteria for inclusion in this study, including 372 and 43 women who gave birth by vaginal delivery and by intrapartum cesarean section (CS), respectively. Vaginal delivery was observed in 84.1% (201/239) and 97.2% (171/176) of nulliparous and multiparous women, respectively. In a logistic regression model, nulliparity [odds ratio (OR), 5.18; 95% confidence interval (CI), 1.91-14.00], assisted reproductive technology (OR, 2.83; 95% CI, 1.42-5.62), and admission for induction of childbirth (OR, 2.68; 95% CI, 1.08-6.67) were associated with a higher likelihood of intrapartum CS. Of 372 women who delivered vaginally, 62 women needed operative delivery. Operative delivery was necessary for 25.4% (51/201) and 6.4% (11/171) of nulliparous and multiparous women, respectively. A logistic regression model identified nulliparity (OR, 3.91; 95% CI, 1.89-8.08) and administration of ecbolic (OR, 2.49; 95% CI, 1.21-5.10) as being independent factors associated with vacuum extraction.Conclusions: Maternal age 40 years or older should not be a barrier for attempting a vaginal delivery, and those women should be encouraged to attempt a vaginal delivery. [ABSTRACT FROM AUTHOR]

In this paper, I consider the term "Advanced Maternal Age" (AMA), which appears in various avenues of information for pregnant women, including medical literature and more "common knowledge" avenues of communication, such as government websites and online forums. I explore the increasingly routine use of this phrase, and I problematize its usual definition, to mean "35 or older." I argue that this definition—rather than being a neutral, medical fact—is socially constructed, and the number 35 is arbitrarily chosen, in a way that perpetuates stigma against older women and their bodies. The definition ignores many relevant factors for considering medical "risk" and contributes to discourses that continue to frame pregnancy as risky, requiring expert surveillance and intervention. I also argue that the widespread use of this phrase in medical literature as well as other sites of discourse perpetuates the ableist idea that children with disabilities are undesirable or less valuable. [ABSTRACT FROM AUTHOR]

Research on first-time motherhood has tended to ignore midlife women, and new mothers over 40 are a particularly understudied group. To fill this research gap, 147 first-time mothers over 40 completed online questionnaires about their postpartum experiences, with 25% of respondents reporting their pregnancies as unplanned. Participants reported fairly high levels of adjustment but also conveyed such challenges as a lack of social support, concerns about mortality, and disconnectedness from younger peer mothers. Results indicate the need for contraceptive counseling and supportive resources specific to this growing population of new mothers. [ABSTRACT FROM AUTHOR]

Objective: The current meta-analysis evaluates the perinatal outcomes of twin pregnancies in pregnant women 35 years or older (advanced maternal age) compared with less than 35 years at the time of delivery.Study design: A search was conducted up to March 2018. Electronic databases that were used in our research included; Embase (NO Medline), Ovid Medline, Cochrane Central Register of Controlled Trials, and Web of Science. Inclusion criteria were twin pregnancies; a comparison between pregnant women aged ≥35 years versus <35 years at the time of delivery and reported perinatal outcomes. Review articles, case reports, and case series were excluded. Data analysis was performed using the Cochrane's Review Manager 5.3 software. Pooled odds ratio for dichotomous outcomes or mean difference for continuous outcomes were calculated using a random effects model. I2 test was performed to assess heterogeneity. The quality of each accepted article was assessed using the Newcastle-Ottawa Scale.Results: Our search yielded 1622 publications, of which 25 were assessed for eligibility. A total of 13 studies met our final inclusion criteria. In twin pregnancies, advanced maternal age was associated with a lower incidence of preterm birth prior to 37 weeks' gestation (OR 0.89 [95% CI 0.83-0.95]) compared with women under 35 years at the time of delivery. Gestational diabetes (OR 1.57 [95% CI 1.24-1.98]) and cesarean deliveries (OR 1.69 [95% CI 1.52-1.87]) were significantly higher among women in the advanced maternal age group. All other measured outcomes, such as preterm delivery before 32 weeks' gestation, hypertension disorders, small for gestational age, birth weight under 2500 or 1500 g, need for neonatal intensive care admission and perinatal death were comparable between the groups.Conclusions: This meta-analysis implies that advanced maternal age mothers in the setting of twin pregnancy is associated with comparable outcomes to nonadvanced maternal age mothers. The only outstanding differences were higher rates of GDM and cesarean deliveries in the advanced maternal age (AMA) group. [ABSTRACT FROM AUTHOR]

Purpose: With the wide implementation of the universal two-child policy in China, the number of pregnant women in advanced maternal age (AMA) will increase gradually. We aimed to assess the association between age at menarche (AAM) and insulin resistance (IR) before delivery in AMA. Methods: A total of 80 pregnant women in AMA were consecutively enrolled before delivery in Zhongda hospital. Pregnant women were stratified into early menarche group and late menarche group according to the age of regular menstruation (about 13 years). At delivery, serum glucose and lipid levels were measured. IR was calculated by the method of homeostasis model assessment 2(HOMA2). Results: The fasting blood insulin (17.68(9.72–36.71) and 10.35(7.76–15.10), respectively; p =.006) and HOMA-IR (2.08(1.18–4.37) and 1.24(0.89–1.78), respectively; p =.005) were higher in early menarche group than in late menarche group. AAM was inversely associated with HOMA-IR in AMA (r= −0.27, p =.014). In the multivariable analysis, AAM in late menarche group was negatively related to the level of HOMA-IR compared to those in early menarche group (β= −2.275, p≤.0001). Conclusions: Taken together, our findings suggest that AAM was inversely associated with HOMA-IR in AMA. Furthermore, pregnant women in AMA with early menarche might have higher HOMA-IR levels than those with late menarche. Clinical trial registration: Chinese Clinical Trial Registry (No. ChiCTR-RRC-16008714), retrospectively registered [ABSTRACT FROM AUTHOR]

Background: Pregnancies at the extremes of maternal age (<20 and >35) are associated with adverse obstetric and perinatal outcomes. There is limited evidence regarding the influence of maternal age on serious neonatal outcomes by mode of delivery. The aim of this study thus was to assess the relationship between maternal age and mode of delivery and its impact on a composite of serious neonatal outcomes.Methods: This was a retrospective cohort study of low risk women birthing at term in Australia's largest maternity hospital over a 7-year period. Intrapartum and perinatal outcomes were collated and a composite of severe adverse neonatal outcomes (SANO) was generated. Multiple regression was applied to adjust for confounders and generate adjusted odds ratios for the risk of SANO according to mode of delivery and maternal age.Results: A total of 84,698 women were included in this study of which 1572 (1.9%) were aged <20 years, 7471 (8.8%) were aged 20-24 years, 20,125 (23.8%) were aged 25-29 years, 31,594 (37.3%) were aged 30-34 years, 19,371 (22.9%) were aged 35-40 years, 4280 (5.1%) were aged 40-44 years and 285 (0.3%) were aged ≥45 years. The incidence of SANO was significantly greater among adolescents compared to all other age groups. Overall, SANO was most likely to occur following Emergency Caesarean Section (EmCS) for severe intrapartum hemorrhage/uterine rupture compared to all other indications. Instrumental delivery was associated with the greatest odds of SANO (adjusted odds ratios (aOR) 3.31, 95% CI 3.08-3.55, p < .001) while spontaneous vaginal delivery (SVD) was associated with the lowest odds (aOR 0.46, 95% CI 0.43-0.48, p < .001). The adjusted odds for SANO was lowest in women aged 30-34 years (aOR 0.92, 95% CI 0.87-0.97, p < .001). The odds of SANO following an SVD increased with maternal age, with women aged 40-44 years having the highest odds. Similarly, the odds of SANO following an instrumental delivery increased with maternal age (age <20 years: aOR 2.21, 95% CI 1.38-3.54, p < .001 versus age 35-39 years: aOR 3.76, 95% CI 3.16-4.48, p < .001).Conclusion: This large retrospective cohort study has demonstrated that maternal age not only affects the mode of delivery and the incidence of adverse neonatal outcomes but that the effect of mode of delivery upon the risk of SANO is not independent of maternal age. [ABSTRACT FROM AUTHOR]

Background:. Diabetes mellitus (DM) during pregnancy increases the risk for many complications such as preeclampsia and cesarean section. Teen (age <20) and advanced maternal age (AMA, age ≥35) pregnancies are both at increased risk for maternal and neonatal morbidity and mortality. Understanding the risks and complications unique to teen and AMA women with pregestational DM is imperative to providing care and improving outcomes.Objective:. This study sought to determine how maternal and neonatal outcomes are affected by pregestational DM in teen and AMA pregnancies.Study design:. This is a retrospective cohort study of 1.58 million pregnancies in California from 2005 through 2008s, of which 10,034 diabetic women with nonanomalous, singleton pregnancies were identified. Women with gestational DM were excluded. Maternal outcomes examined include preeclampsia, placental abruption, chorioamnionitis, preterm delivery, and cesarean section. Neonatal outcomes include size for gestational age, birth weight >4000 g, shoulder dystocia, brachial plexus injury, jaundice, and intrauterine fetal demise (IUFD). Multivariate regression analyses and chi-squared test were used for statistical comparisons and a p-value of less than .05 was used to indicate statistical significance.Results:. Compared to women of age 20-34 years with pregestational DM as the reference group, women <20 years old with DM had higher rates of preeclampsia (aOR 1.72; 95% CI 1.29-2.29; p-value < .001) and lower rates of cesarean delivery (aOR 0.63; 95% CI 0.47-0.85; p < .001). Neonates of teen mothers were more likely to be large for gestational age (LGA; > 90%ile; aOR 1.60; 95% CI 1.14-2.23; p = .006), whereas neonates in the maternal age category of 35-39 years had lower rates of LGA >90%ile (aOR 0.81; 95% CI 0.70-0.92; p = .001). Odds of IUFD were greatest in women age 35-39 years old (aOR 1.73; 95% CI 1.05-2.85; p = .031). Analysis examining women >40 years old showed no statistically significant difference in outcomes.Conclusion: Pregnancy outcomes in women with pregestational diabetes differ depending on maternal age category. Teens are at higher risk for preeclampsia and LGA neonates, but at lower risk for cesarean. Women aged 35-39 years are at higher risk for cesarean delivery, are less likely to have LGA neonates, and more likely to experience IUFD. Understanding the etiologies behind these differences may lead to improvements in these clinical outcomes. [ABSTRACT FROM AUTHOR]

Objective: To explore the clinical effect of noninvasive prenatal screening (NIPS) for the women at advanced maternal age (AMA) and discuss the relationship between women's age and NIPS effect.Methods: Fourteen thousand thirty-five women at AMA who accepted NIPS from two prenatal diagnosis centers were recruited for this study. NIPS were checked by Illumina Next CN 500. All the AMA women received prenatal genetic counseling, selected prenatal diagnosis and different clinical treatments according to the results of NIPS.Results: A total of 114 cases (0.81%) got the NIPS-positive results of T21/T18/T13. One hundred four cases of them accepted prenatal diagnosis and 87 cases were proved as true positive. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 100, 99.88, 92.55 and 100%, respectively. Seventy-four women (0.53%) showed NIPS-positive results of sex chromosomal aneuploidies (SCAs). After informed consent, 46 women (62.2%) accepted fetus karyotype analysis. Nineteen cases were identified as true positive results, while 27 cases were false positive results. The PPV for SCAs in AMA women was 41.3%. The PPV of T21/T18/T13 in AMA women over 40 was 100%, while it was 81.91% for the women whose age was 35 ∼ 40 years old. There was also rising trend in PPV of fetal sex chromosome with the increased age (62.50 versus 36.84%).Conclusions: NIPS is a good choice for AMA pregnant women. It can not only achieve satisfactory clinical effect, but also greatly reduce invasive prenatal diagnosis. We will get better effect of NIPS by further managing AMA women stratified by their age. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the psychological predictors in Chinese multiparous pregnant women of advanced maternal age (AMA) for choosing aneuploidy screening or diagnostic testing.Methods: A total of 84 pregnant women of AMA were consecutively enrolled from Renming Hospital, Wuhan University. All participants completed three questionnaires: Zung Self-Rating Anxiety Scale (SAS), Zung Self-Rating Depression Scale (SDS), and Pregnancy Stress Rating Scale (PSRS). Demographic information and the choice of noninvasive prenatal testing (NIPT) versus invasive prenatal diagnosis (PND) were also collected.Results: Thirty-seven chose to have invasive PND, and 47 chose NIPT. Choosing invasive PND, as opposed to NIPT, was associated with lower educational background (χ2 = -2.269, p = .023), higher SAS scores (47.62 ± 7.96 versus 44.21 ± 6.10, p = .029), and higher SDS scores (50.41 ± 9.80 versus 45.96 ± 11.05, p = .058). Logistic regression analysis further showed that the decisive predictors for invasive PND are SAS (OR =1.106, p = .008) scores, scores of factor 3 in PSRS and the stress from changes of shape and motility (OR =0.471, p = .038). Subgroup analysis showed that women with previous negative pregnancy experience had higher scores in factor 2-stress (guarantee of maternal-fetal safety: 1.96 ± 0.63 versus 2.49 ± 0.65, p = .004) and total PSRS scores (1.60 ± 0.4 versus 1.83 ± 0.31, p = .044) than those without. Additionally, unemployment post pregnancy was associated with marginally significant higher PSRS scores (p = .083).Conclusions: The decision for invasive PND might be swayed by anxiety and attenuated by pregnancy stress originating from worry about changes in fetal shape and motility (measured by SAS and factor 3 score of PSRS, respectively). [ABSTRACT FROM AUTHOR]

Objective: Increased risk for adverse pregnancy outcomes with advancing maternal age has been described but the strength of association remains debated, particularly in presence of confounding factors such as parity, twin pregnancy and pregnancy from assisted reproductive technologies. The aim of this study was to evaluate pregnancy outcomes in a large cohort of women aged over 40 years. The hypothesis was that advanced maternal age may be an independent risk factor for adverse pregnancy outcome.Study Design: We reviewed the clinical records of 56,211 women who delivered at Sant'Anna University Hospital, Turin, Italy, in the period between 2009 and 2015. Of these, 3798 women aged over 40 years were divided into two age groups (40 - 44 years and ≥45 years). Women of any parity, with singleton or twin pregnancies, or with assisted reproductive technology pregnancies were included. Women aged less than 40 years were considered as controls. Primary outcome measures were maternal and perinatal complications. Comparisons were performed using Chi-square test and Fisher's exact test. Univariate analysis and logistic regression analysis were performed to test the possible independent role of maternal age as a risk factor for adverse pregnancy outcome.Results: Maternal age was an independent risk factor for gestational diabetes (age 40-44 years: odds ratios (OR) 2.10, 95% CI 1.80-2.45; age ≥45 years: OR 2.83, 95% CI 1.79-4.46) and early-onset preeclampsia (age 40-44 years: OR 2.10, 95% CI 1.63-2.70; age ≥45 years: OR 3.16, 95% CI 1.68-5.94). The risk for placenta praevia was higher in the women aged 40-44 years (OR 1.87, 95% CI 1.36-2.57). Neonatal outcomes were similar among groups, except for the rate of birth weight less than 2500 g, which was higher in women aged 40-44 years (OR 1.27, 95% CI 1.12-1.42). However, older women showed an overall higher incidence of preterm birth.Conclusions: Maternal age over 40 years is an independent risk factor for adverse pregnancy outcomes, particularly for the mother. Pregnancies in women over 40 years should be considered at risk and carefully monitored with individualized care protocols. [ABSTRACT FROM AUTHOR]

We explored the strategy of frozen-thawed embryo transfer (FET) in the women with advanced maternal age (AMA). We first determined the age cut-off point of AMA by retrospective analysis of pregnancy outcomes in the patients undergoing FET. The patients with AMA were divided into 3 groups including natural cycle (NC) group, controlled ovarian stimulation (COS) group, and hormone replacement therapy (HRT) group, and simultaneously were divided into 2 groups including cleavage-stage embryo transfer (CET) group and blastocyst-stage embryo transfer (BET) group. The clinical pregnancy, embryo implantation, abortion and live birth rates were compared between the 3 groups and the 2 groups, respectively. We found that in the women aged 38 years or over, the clinical pregnancy rate and live birth rate were all significantly decreased as compared with the younger than 38-year-old women (all P < 0.05), so the women aged 38 years or over were regarded as the patients with AMA in this study. In the patients with AMA, the clinical pregnancy rate and live birth rate were 22.95% and 18.03% in NC group, 23.68% and 15.79% % in COS group as well as 24.58% and 15.92% in HRT group, and there were no significant differences in the clinical pregnancy rate and live birth rate between the 3 groups. However, the clinical pregnancy rate (42.96% vs 15.87%) and embryo implantation rate (32.26% vs 9.67%) were all significantly higher in the BET group than in the CET group (all P < 0.01). We conclude that in the women aged 38 years or over, the choice of endometrial preparation protocols may depend on the individual specific conditions because the endometrial preparation protocols do not affect FET outcome, but BET can obtain better FET outcomes as compared with CET. Abbreviations: AMA: advanced maternal age; FET: frozen-thawed embryo transfer; NC: natural cycle; COS: controlled ovarian stimulation; HRT: hormone replacement therapy; CET: cleavage-stage embryo transfer; BET: blastocyst-stage embryo transfer; LH: luteinizing hormone; HCG: human chorionic gonadotropin; HMG: human menopausal gonadotropin; FSH: follicle-stimulating hormone; BMI: body mass index [ABSTRACT FROM AUTHOR]

Objective: We aimed to evaluate perinatal outcomes of advanced maternal age (AMA) primiparous women seeking scheduled cesarean delivery (CD) versus a trial of labor (TOL).Materials and Methods: This was a retrospective cohort study of primiparous women ≥40 years of age carrying a single fetus, who delivered at a tertiary, university-affiliated medical center (2007-2014). We compared perinatal outcomes of women who chose a scheduled CD with those who chose TOL. Subsequently, we compared women who had successful TOL (sTOL) with those who had a failed TOL (fTOL).Results: Out of 62 102 deliveries during the study period, inclusion criteria were met by 374 women. Of them, 83 (22.2%) women had a scheduled CD, and 291 (77.8%) had TOL. Of the TOL group, 118 women (40.5%) had fTOL and 173 (59.5%) had sTOL. Women in the fTOL had higher rates of 1-min Apgar score <7, neonatal asphyxia and adverse neonatal composite outcome compared with women in the sTOL group (p < .05). After adjusting for potential confounders, compared with sTOL, fTOL was not associated with adverse neonatal composite outcome. Compared with scheduled CD, fTOL was associated with an increased risk for adverse neonatal composite outcome (aOR 2.65, 95% CI 1.13-6.19, p = .03).Conclusion: AMA primiparous women attempting TOL have comparable outcome to those seeking scheduled CD, however, women with fTOL have higher rates of adverse neonatal outcome. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to determine if there is a relationship between non-chromosomal fetal anomalies of various organ systems and advanced maternal age.Materials and Method: This study was conducted in 387 women aged 20-53 years who underwent fetal karyotype testing due to positive prenatal test results or advanced maternal age at the Kanuni Sultan Süleyman Training and Research Hospital between September 2011 and March 2015. Fetuses with chromosomal anomalies were excluded from the study. The relationship between non-chromosomal anomalies and maternal age of women aged <35 or ≥35 years was studied.Results: More than 80% (81.7%) of non-chromosomal anomalies were detected in patients aged <35 years, and 18.3% were found in those ≥35 years. There were no statistically significant differences found between the incidence of non-chromosomal anomalies in women aged over 35 years and those under 35 years. When congenital major anomalies were evaluated with respect to various organ systems, the risk of musculo-skeletal system anomalies decreased with advancing maternal age. However, there was no statistically significant difference between the <35 and ≥35-year age groups in the incidence of central nervous system, craniofacial, cardiac, gastrointestinal system, urogenital, respiratory, and limb anomalies.Conclusion: The incidence of non-chromosomal anomalies does not increase in fetuses of pregnant women aged over 35 years, in contrast to chromosomal anomalies. [ABSTRACT FROM AUTHOR]

The purpose of this study is to determine whether all-blastocyst-culture can benefit advanced maternal age (AMA) patients with low ovarian reserve. We retrospectively analyze AMA patients with low ovarian reserve undergoing IVF/ICSI in Reproductive Medicine Research Center of the Sixth Affiliated Hospital of Sun Yat-sen University from May 2016 to August 2017. We divide them into group A (all-blastocyst-culture) and group B (none-blastocystculture) based on different culture approach of D3 transferrable embryo. We compared the cumulative biochemical pregnancy rate and cumulative clinical pregnancy rate between them. A total of 261 eligible patients are included, with 151 in group A and 110 in group B. The basic conditions of the two groups show no difference. Cumulative biochemical pregnancy rate/clinical pregnancy rate in group A is higher than that of group B, though not statistically significant (p > .05). After removing patients canceling embryo transfer due to failure in blastocyst culture, the cumulative biochemical pregnancy rate/clinical pregnancy rate in group A is significantly higher than group B (p < .05). Multivariate analysis showed that female age and the number of D3 transferrable embryo are risk factors for the failure of blastocyst culture (OR = 0.672 and 2.270, 95%CI 0.511-0.883 and 1.203-4.284, p = .004 and p = .011, respectively). Hence, we drew to conclusion that all-blastocyst-culture will not adversely affect the pregnancy outcome of AMA patients with low ovarian reserve. [ABSTRACT FROM AUTHOR]

Objective: We aimed to determine the relationship between fetal chromosomal abnormalities and maternal age among spontaneous first trimester abortions in women in Northeast China.Methods: We evaluated 497 chorionic villi samples from patients with a history of spontaneous abortion during the first trimester. We divided the samples into five groups according to the maternal age: <25, 25-29, 30-34, 35-39, and ≥40 years. We identified chromosomal abnormalities by fluorescence in situ hybridization.Results: Among the 497 chorionic samples of spontaneous abortion, 180 (36.22%) had fetal chromosomal abnormalities. Patients aged ≥40 years had a significantly higher percentage (60.61%) of fetal chromosomal abnormalities compared with the other groups. More women in the ≥40 and 35- to 39-year groups had a history of three consecutive miscarriages and 10 kinds of abnormalities. The most frequent aneuploidy was trisomy 22, followed by trisomy 16.Conclusions: These results revealed that the kinds of fetal abnormalities, numbers of abortions, and chromosomal abnormality rates increased with increasing maternal age. The most common trisomy types in spontaneous abortions were closely related to maternal age. We hypothesize whether the larger probability of chromosomal abnormalities is due to increased mutation rate with maternal age, or due to a worse in-utero conditions. [ABSTRACT FROM AUTHOR]

Background: Preeclampsia remains an important complication of pregnancy. It is associated with mortality and morbidity for both maternal and fetal/newborn patients. Although major inroads have been made in understanding the pathophysiology of preeclampsia in recent decades, the initial primary cause of its occurrence in some women and not others has escaped clarification.Review: There have been a number of clinical clues pointing to an immune genesis of this disease, including most recently the use of donor gametes in assisted reproductive technology (ART). Despite a number of confounding variables, most studies investigating the addition of donor ova to the ART environment point in the direction of an immune genesis due to the burden of an increasingly foreign fetal allograft on the maternal host. A review of a selection of these studies and a contemporary review of our own Maternal Fetal Medicine practice observations in this regard was completed.Conclusions: This retrospective evidence suggests a highly likely association. A more basic understanding of the immune interactions at the maternal-fetal interface is required before a final solution to this problem will be at hand and targeted remedies can be formulated. [ABSTRACT FROM AUTHOR]

Pregnancy risks rise with age and the average age of first time mothers is rising. This study aimed to assess women's actual knowledge and their perceived knowledge of pregnancy complications relating to advanced maternal age. A cross-sectional survey was administered to primiparous women measuring demographics, knowledge of age-related pregnancy risks, previous counselling and health literacy. Of the 218 women surveyed, the mean knowledge score was not significantly different for women <35 years of age compared to women ≥35 years of age (p = .09). Although there was no difference in knowledge between the two groups, women ≥35 years of age perceived themselves to be more knowledgeable than those under 35 (p < .01). The majority of women (67%) wanted further counselling on this topic and indicated a preference for their doctor to counsel them (76%). Women require counselling informing them of their increased risk of complications if they begin childbearing at older ages. Impact statement What is already known on this subject: The average age of first time mothers is rising worldwide. Pregnancy risks rise with age, especially in first time mothers. Previous studies have shown that knowledge of age-related pregnancy risks correlate with educational level and health literacy. What the results of this study add: This study supports those findings and also demonstrates that perceived knowledge does not correlate with measured knowledge of age-related pregnancy risks. Women ≥35 years of age (higher-risk women) are no more knowledgeable than their younger counterparts though they perceive themselves to be better informed. Greater education regarding these risks may allow women to mitigate some of these risks through lifestyle and diet alteration and will prepare women for what to expect if these risks and complications occur. The majority of women in this study seek pregnancy information on the internet, but desire further counselling from their doctors regarding age-related pregnancy risks. What the implications are of these findings for clinical practice and/or further research: Given these results, physicians must consider making greater efforts to counsel women about pregnancy risks in advanced maternal age and tailor these conversations to suit the educational level and health literacy of each individual patient. [ABSTRACT FROM AUTHOR]

This investigation into the cultural dynamics of gendered, aging bodies attends to a mediated representation of what contemporary biomedicine defines as pregnancy in “advanced maternal age” (AMA). We offer a feminist rhetorical analysis of an episode of TLC’s 19 Kids and Counting entitled “A Duggar Loss,” where 45-year-old matriarch Michelle Duggar experiences pregnancy loss. In the episode, age is reconfigured in discussions of AMA pregnancy through a metonymic substitution and slippage of risk discourses, pre-natal self-care, and technological interaction. Moreover, “A Duggar Loss” mobilizes strategies of expansive affiliation around and through reproductive choice, which appears to align with feminist principles of reproductive autonomy despite the family’s ties to the Quiverfull Movement. This work contributes to feminist studies of aging bodies by suggesting that representations of advanced maternal age pregnancy remain a central, yet undertheorized subject in formulating powerful trans-ideological affiliations that can undermine progressive reproductive politics. [ABSTRACT FROM PUBLISHER]

Objective: To assess if maternal risk profile and Hospital assistential levels were able to influence the inter-Hospitals comparison in the class 1 and 3 of the "The Ten Group Classification System" (TGCS).Methods: A population-based analysis using data from Institutional data-base of an Italian Region was carried out. The 11 maternity wards were divided into two categories: second-level hospitals (SLH), and first-level hospitals (FLH). The recorded deliveries were classified according to the TGCS. To analyze if different maternal characteristics and the hospitals assistential level could influence the cesarean section (CS) risk, a multivariate analysis was done considering separately women in the TGCS class 1 and 3.Results: From January 2011 to December 2013 were recorded 19,987 deliveries. Of those 7,693 were in the TGCS class 1 and 4,919 in the class 3. The CS rates were 20.8% and 14.7% in class 1 (p < 0.0001) and 6.9% and 5.3% (p < 0.0230) in class 3, respectively in the FLH and SLH. The multivariate logistic regression showed that the FLH, older maternal age and gestational diabetes were independent risk factors for CS in groups 1 and 3. Obesity and gestational hypertension were also independent risk factors for group 1.Conclusions: TGCS is a useful tool to analyze the incidence of CS in a single center but in comparing different Hospitals, maternal characteristics and different assistential levels should be considered as potential bias. [ABSTRACT FROM AUTHOR]

Objectives: To describe the effect of extremely advanced maternal age (EAMA) on maternal/neonatal outcomes.Methods: This was a case-control study in which 127 women ≥40 years at the time of delivery out of 2853 singleton hospital deliveries in Ondokuz Mayis University between 1 January 2008 and 31 August 2010 constituted the study group. One hundred and twenty-seven else were chosen randomly out of 2412, 21-35 years old women, via a computer system as controls. Demographic features of 254 mothers and infants as well as maternal and neonatal complications were recorded.Results: Mean maternal age was 41.5 ± 1.9 (40-49) years in EAMA group and 28.9 ± 4.2 (21-35) years in controls. Primigravidity was 19.6% in the EAMA group, whereas 37.8% in controls (p = 0.003). No difference was found between groups according to route of delivery, stillbirth, preterm birth, congenital abnormalities, gender of babies, NICU admission and respiratory problems (for all p > 0.05). A 5th min Apgar score <7 was more frequent in babies born to EAMA mothers compared to controls (9.8% versus 4.9%, p = 0.004).Conclusion: The present study shows that EAMA mothers and their offsprings have similar peri and neonatal risks compared to younger mothers, except lower 5th minute Apgar scores. We conclude that with good perinatal care, EAMA women and their babies can pass through the perinatal period with similar risks of younger women. [ABSTRACT FROM AUTHOR]

It is well documented that aneuploidy rate in preimplantation embryos increases with the mother’s age, and at the same time the number of oocytes diminishes. Consequently, for patients of advanced maternal age two options are available to overcome these limitations: use of oocytes from young donors, or use of own oocytes coupled with preimplantation genetic screening (PGS) for 24 chromosomes. However, it is not clear which strategy might be more effective. The aim of this retrospective study was to evaluate outcomes of IVF cycles coupled with transfer of vitrified embryos from donor or autologous oocytes, both with or without PGS. Our results demonstrate that while after PGS clinical pregnancy, twin pregnancy and spontaneous abortion rates are similar for embryos from donor and autologous oocytes, these rates are dramatically worse in all cycles without PGS. Therefore, PGS can be recommended as a screening method to all patients of advanced maternal age even when donor oocytes are used. [ABSTRACT FROM PUBLISHER]

Objective: Currently, more women are delaying childbearing until their 40s.This study compared the pregnancy and maternal features, pregnancy and foetal outcomes between multiparous and primiparous patients. We compared the same factors between assisted reproductive technology (ART) and non-ART primiparous patients because of the high proportion of ART used in the primiparous patients. Methods: The study retrospectively examined 1680 patients, 35 years of age and older, between March 2008 and February 2015. Results: Comparing the features of these two groups, there was an increased incidence of employment and the use of ART in primiparous patients, while birthweight tended to be higher in the multiparous group. There were no significant differences in pregnancy complications other than hypertension disorders, such as pre-eclampsia and HELLP syndrome, which were significantly more frequent in primiparous patients. The rates of foetal growth retardation and perinatal death were significantly higher in primiparous women. Comparison of the data between ART and non-ART primiparous patients indicated that the ART group had a higher initial body mass index and a lower smoking rate. No significant differences in pregnancy complications or foetal outcome were observed between these two groups. Conclusion: Primiparity is associated with increased pregnancy and foetal complications in advanced age pregnancies. However, the use of ART in this age group does not seem to be an additional risk factor. [ABSTRACT FROM AUTHOR]

Objective: Compare significant neonatal morbidity frequency differences in advanced maternal age (AMA) versus non-AMA pregnancies, assessing which gestational week is associated with the lowest morbidity risk. Methods: Population-based retrospective cohort study. Adverse neonatal outcome frequency differences were stratified by each week of gestation. Multivariate logistic regression estimated the relative risk (RR) of composite neonatal morbidity for women aged 35–39, 40–44, 45–49 and 50–55 versus 18–34 years, adjusted sequentially for relevant risk factors. Results: Neonatal morbidity decreased with each advancing week of term gestation, lowest at 39 weeks for all the groups. Adverse neonatal outcome risk for births to AMA women increased at 40 weeks: 35–39 yearsadjRR 1.12 [1.01–1.24] and ≥40 years 1.24 [1.01–1.52]. Each older maternal age category had increased risk for overall neonatal morbidity: 35–39 yearsadjRR 1.11 [95% CI 1.08–1.15], 40–44 years 1.21 [95% CI 1.14–1.29] and 45–49 years 1.34 [95% CI 1.05–1.69]. Conclusions: Lowest neonatal morbidity risk is at 39-week gestation with a significantly increased risk observed thereafter, especially in women ≥40 years. [ABSTRACT FROM PUBLISHER]

The aim of this study is to describe obstetric and perinatal complications in pregnancies from oocyte donation (OD) cycles, delivering in our centre and to determine the impact of maternal age. Retrospective observational study of a 225 singleton pregnancies, 113 multiple pregnancies and 447 live birth. Pearson's χ2 test or Fisher's exact test were used for the statistical analysis. A higher incidence of obstetric complications was observed in multiple compared to singleton pregnancies with regard to preeclampsia (24.8% versus 8%), premature rupture of membranes (9.7% versus 1.8%), preterm delivery at <37 weeks (54.9% versus 10.2%) and caesarean section (81.4% versus 64%) (p < 0.05). If the age factor is added, the caesarean sections are higher in the single pregnancy group aged ≥40 years than in the group of <40 years (73.5% versus 49.4%) (p < 0.05). A higher incidence is found in multiple versus singleton pregnancies for low birth weight (<2500 g) (61.1% versus 8.2%), admissions to the intensive care unit (15.2% versus 4.7%) and perinatal mortality (13.5‰ versus 0‰) (p < 0.05). It is necessary to consider preconception counselling prior to an OD cycle to inform patients about the incidence complications observed and recommend to transfer only a single embryo. [ABSTRACT FROM AUTHOR]

Objective: To compare pregnancy outcomes of women ≥35 years to women <35 years with and without gestational diabetes. Methods: The data include 230 003 women <35 years and 53 321 women ≥35 years and their newborns from 2004 to 2008. In multivariate modeling, the main outcome measures were preterm delivery (<28, 28–31 and 32–36 weeks' gestation), Apgar scores <7 at 5 min, small for gestational age (SGA), fetal death, asphyxia, preeclampsia, admission to neonatal intensive care unit (NICU), shoulder dystocia and large for gestational age (LGA). Results: In comparison to women <35 with normal glucose tolerance, preeclampsia (OR 1.57, CI 1.30–1.88), admission to the NICU (OR 3.30, CI 2.94–3.69) and shoulder dystocia (OR 2.12, CI 1.05–4.30) were highest in insulin-treated women ≥35 years. In women ≥35, diet- and insulin-treated gestational diabetes mellitus (GDM) increased the rates of preeclampsia, shoulder dystocia and admission to NICU (OR 3.07 CI 2.73–3.45). The effect of advanced maternal age was observed in very preterm delivery (<28 weeks), fetal death, preeclampsia and NICU. The increase in preeclampsia was statistically significant. Conclusions: GDM at advanced age is a high risk state and, more specifically, the risk caused by age and GDM appear to be increasing in preeclampsia. [ABSTRACT FROM PUBLISHER]

In Western countries today, a growing number of women delay motherhood until their late 30s and even 40s, as they invest time in pursuing education and career goals before starting a family. This social trend results from greater gender equality and expanded opportunities for women and is influenced by the availability of contraception and assisted reproductive technologies (ART). However, advanced maternal age is associated with increased health risks, including infertility. While individual medical solutions such as ART and elective egg freezing can promote reproductive autonomy, they entail significant risks and limitations. We thus argue that women should be better informed regarding the risks of advanced maternal age and ART, and that these individual solutions need to be supplemented by a public health approach, including policy measures that provide women with the opportunity to start a family earlier in life without sacrificing personal career goals. [ABSTRACT FROM AUTHOR]

Objective: To evaluate anesthetic considerations in pregnancy for women at advanced maternal age (≥ 40 years). Methods: A retrospective cohort study of laboring women aged 40 years or above comparing women aged 40-44 years old with those aged ≥45 years, in a single, tertiary, university affiliated medical center. Results: Overall, 39 006 women delivered in our institution during the study period, of them 376 (1%) were eligible for analysis: 278 (74%) were 40-44 years old (control group) and 98 (26%) were 45 years old and above (study group). No differences were found between the groups with regards to analgesia or anesthesia management during labor. Differences were found in obstetrical characteristics such as higher rates of primiparity, preeclampsia, need for magnesium sulphate therapy and chronic hypertension among parturients aged ≥45 years. Of note, parturients aged ≥ 45 years had an approximately eight-fold risk for postpartum hemorrhage. Conclusion: Anesthesia management of parturients aged 45 years and above is comparable to the management of women aged 40-44 years. However, parturients ≥45 are more susceptible to bleeding complications. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to describe the psychosocial adjustment of primiparous women of advanced age and their partners (AMA group) compared to their younger counterparts (comparison group) from the third trimester of pregnancy to six months postpartum and to explore the psychosocial adjustment of the AMA group, depending on infertility history. Background: First-time parenthood at advanced maternal age (AMA) is a growing reproductive trend; however, few longitudinal studies have explored the psychosocial adjustment of couples from pregnancy to the first postpartum months, considering the distinct trajectories that precede this reproductive behaviour. Methods: Fifty-eight couples in the AMA group (≥35 years at the time of delivery) and 41 couples in the comparison group (20–34 years) were consecutively recruited in a Portuguese urban referral hospital. Both partners responded to the Brief Symptom Inventory-18, the EUROHIS-QoL-8 and the Dyadic Adjustment Scale – Revised during the third trimester of pregnancy (T1), at one month (T2) and six months postpartum (T3). Couples also completed visual analogue scales to assess parenting difficulty, competence and gratification at T2 and T3. Results: The psychosocial adjustment of the AMA group and the comparison group over time was more similar than different. Within the AMA group, perceived parenting difficulty decreased over time for previously infertile couples but remained stable for previously fertile couples. Conclusion: Healthcare providers should avoid stereotypical views and normalise the psychosocial adjustment over the transition to first-time parenthood at AMA. Antenatal psychoeducational interventions should promote realistic expectations about the demands of early parenting, especially among previously infertile couples. [ABSTRACT FROM AUTHOR]

Objective:This study aimed to: (1) describe the positive and negative childbearing motivations of primiparous women of advanced maternal age and their partners (AMA group) compared with their younger counterparts (comparison group) during pregnancy; (2) identify distinct childbearing motivational patterns in the AMA group; and (3) to explore their correlates.Background:First childbirth at advanced maternal age is a growing social concern, but few studies have explored couples’ childbearing motivational patterns, challenging the stereotypes that presuppose that this reproductive trend reflects ambivalent motivations.Methods:Forty-six couples in the AMA group and 44 couples in the comparison group responded to the Childbearing Motivations Scale during the third trimester of pregnancy.Results:The AMA group differed from the comparison group in positive but not negative childbearing motivations. Two childbearing motivational patterns were identified in the AMA group. The ‘realistic childbearing motivational pattern’ was characterised by highly positive motivations that coexisted with moderate negative motivations. The ‘disengaged childbearing motivational pattern’ was characterised by moderate positive motivations that coexisted with low negative motivations. These two patterns had comparable frequencies for women and men. Women who were less satisfied with their professional life and experienced prior adverse pregnancy outcomes and men who reported a higher deviation from child-timing expectations were more likely to report a ‘realistic childbearing motivational pattern’.Conclusion:Healthcare providers should avoid stereotyped views and develop couple-focused interventions across the reproductive lifespan and during antenatal care to promote satisfactory decisions and to prepare couples for the positive aspects and demands of childrearing. [ABSTRACT FROM PUBLISHER]

The maternal age at the first and repeated deliveries constantly rises in developed countries due to current social trends that favor values of personal achievements upon procreation. Assisted reproduction technologies and especially the availability of oocyte donation programs extend the age of fecundity to the fifth and sixth decades of life. The ability to conceive and deliver at such age raises serious medical, moral, social and legal concerns regarding the health and welfare of the mother and child will be presented and discussed here. [ABSTRACT FROM AUTHOR]

Objective: To investigate prematurity rate in women aged ≥45 carrying a twin pregnancy. Other maternal and neonatal outcomes are also described. Design: Retrospective cohort study. Setting: Women delivering a twin pregnancy at a single tertiary medical center. Population: The study included all women aged 45 years and over carrying a twin pregnancy who delivered at 20 weeks gestation or beyond over a 9-year period from May 2000 to May 2009. Methods: Women aged 45 years and over were identified, all conceived by in vitro fertilization with ovum donation. The study group was compared to a control group of women <40 years with twin pregnancies conceived by IVF who delivered during the same time period. Main outcome measure(s): Maternal complications during pregnancy and neonatal outcome. Results: During the study period 32 women ≥45 years delivered twins. The control group included 109 women. The rate of delivery before 37 weeks as well as before 32 weeks were very high in our study group (65% versus 40%, p = 0.01 and 15% versus 5.0%, p = 0.05, respectively). The rate of maternal life-threatening complications including blood product transfusion and maternal admission to the intensive care unit were also significantly higher in our study group compared to the control group (18% versus 2%, p = 0.018 and 6.3% versus none, p = 0.05). Conclusions: Women ≥45 years old with twin pregnancy carry a higher risk of maternal and perinatal complications. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to investigate if advance maternal age is an independent risk factor for cesarean section in women induced with prostaglandins. Only patients with a single indication for induction of labor were considered. Methods: A matched retrospective cohort study was conducted. A study group of 112 women aged 35 or older was enrolled. The control group included 216 women aged 34 or younger. Multivariate logistical regression models were fitted for the prediction of the cesarean section. Results: There were no statistically significant differences in characteristics of the patients in the study and control groups. However, a higher prevalence of nulliparous women was found in control group ( p = 0.002). The indications of labor induction were homogeneous in the two groups. No significant differences were found in the route of delivery. The median time of labor was significantly shorter in the study group ( p = 0.002), and the birth weight and the placental weight were significantly lower in the study group. Advanced maternal age and newborn weight were directly related, whereas time of labor, Bishop score and parity were inversely related to a higher cesarean rate. Conclusions: When single indication of induction of labor with prostaglandins is considered, advanced maternal age represents a significant independent risk factor for cesarean delivery. [ABSTRACT FROM AUTHOR]

Objective: To determine whether advanced paternal age is associated with increased risk for cesarean delivery. Study design: We used the 1990-2002 US linked live birth and infant death data files restricted to primiparous Caucasian and African-American women that delivered a singleton birth at ≥20 week's gestation (12.5 million). We examined temporal trends and risk ratios of cesarean birth in relation to paternal age before and after adjustments for known confounders. Results: Among Caucasians, the cesarean delivery rates were 21.1%, 26.7% and 31.8% in fathers aged 20-29, 30-39 and ≥40 years, respectively. Among African-Americans, the corresponding rates were 24.1%, 33.2%, and 38.1%, respectively. These increased cesarean delivery rates persisted in analyses stratified by maternal age before and after adjustment for a variety of confounders. Conclusions: These findings suggest that increasing paternal age may be associated with an increased risk for cesarean delivery in primiparous women. [ABSTRACT FROM AUTHOR]

Objective: To investigate prematurity rate in women aged ≥45 carrying a singleton pregnancy. Other maternal and neonatal outcomes are also described. Design: Retrospective cohort study. Setting: Women delivering a singleton pregnancy at a single tertiary medical center. Population: The study included all women aged 45 years and over who delivered at 20 weeks gestation or beyond over a 9-year period from May 2000 to May 2009. Methods: Women aged 45 years and over were identified. The study group was compared to a control group of women <40 years with singleton pregnancies conceived by in vitro fertilization (IVF) who delivered during the same time period. Main Outcome Measure(s): Maternal complications during pregnancy and neonatal outcome. Results: During the study period 278 women ≥45 years delivered a singleton pregnancy. The control group included 304 women. The rate of delivery before 37 weeks as well as before 32 weeks were very high in our study group (18.7 vs. 10.9%, p = 0.009 and 5.4 vs. 2.0%, p = 0.04, respectively). In multivariate analysis, older maternal age was not independently related to prematurity. Chronic hypertension (HTN) was found to be a major risk factor associated with prematurity in advanced maternal age. Conclusions: Women ≥45-years-old with a singleton pregnancy carry a higher risk of maternal and perinatal complications. Preterm birth is a significant complication in this age group and is associated with preexisting chronic HTN. [ABSTRACT FROM AUTHOR]

Objective: To determine the prevalence of abnormal karyotype results in women undergoing chorionic villus sampling (CVS) for abnormal first trimester screening compared to CVS for historical indications (advanced maternal age (AMA) or prior aneuploidy). Methods: Retrospective cohort of all patients undergoing CVS at Oregon Health & Science University from January 2006 to June 2010. Patients were separated based on CVS indication: (1) positive ultrasound (U/S) or serum screening; or (2) AMA or prior aneuploidy with normal or no screening. Prevalence of abnormal karyotype results were compared between groups. Results: Fetal karyotyping was successful in 500 of 506 CVS procedures performed. 203 CVS were performed for positive screening with 69 abnormal karyotypes (34.0%). 264 CVS were performed for historical indications with 11 abnormal karyotypes (4.2%). This difference was statistically significant (χ2 71.9, p < 0.001; OR 11.8 [95% CI 5.8, 24.6]). There were two age-related aneuplodies in AMA women without positive screening. 42 out of 44 AMA women diagnosed with aneuploidy (95.5%) had abnormal U/S and/or serum screening (35 U/S, 4 serum, 3 U/S and serum). Conclusions: Combined ultrasound and serum screening should be recommended to all women, including AMA women, prior to undergoing invasive testing to improve risk-based counseling and minimize morbidity. [ABSTRACT FROM AUTHOR]