Royal College of Obstetricians and Gynaecologists

Question: Are there any difference in maternal and neonatal outcomes in women who delayed childbearing (>=35 years old) compared with women (<35yo)?

Answer: Five recent cohort studies have compared pregnancy outcomes in women aged 35 and over with women aged 34 and below (some studies included women aged 18 or 20 to 34). Adverse outcomes associated with increased age include miscarriage, chromosomal abnormalities, congenital anomalies, gestational diabetes, placenta previa, cesarean delivery, macrosomia, hypertension, preterm delivery, low birth weight, asymptomatic hypoglycemia, and wet lung syndrome. (1-4)

One study among nulliparae(5) found no significant difference in the rate of preterm delivery, postterm delivery, caesarean section rate, low birth weight, macrosomia, still birth rate or birth asphyxia. Marai et al (4) also note that although the rates of poor foetal and neonatal outcome indices seem to increase for the older gravidae, the difference was not statistically significant.

(Evidence level III)

References:

Cleary-Goldman J. Malone FD. Vidaver J. Ball RH. Nyberg DA. Comstock CH. Saade GR. Eddleman KA. Klugman S. Dugoff L. Timor-Tritsch IE. Craigo SD. Carr SR. Wolfe HM. Bianchi DW. D'Alton M. FASTER Consortium. Impact of maternal age on obstetric outcome. Obstetrics & Gynecology. 105(5 Pt 1):983-90, 2005 May. Abstract
Al-Turki HA. Abu-Heija AT. Al-Sibai MH. The outcome of pregnancy in elderly primigravidas. Saudi Medical Journal. 24(11):1230-3, 2003 Nov. Full text
Romero-Maldonado S. Quezada-Salazar CA. Lopez Barrera MD. Arroyo Cabrales LM. [Effect of risk on the child of an older mother (case-control study)]. [Spanish] Ginecologia y Obstetricia de Mexico. 70:295-302, 2002 Jun.Abstract
Marai W. Lakew Z. Pregnancy outcome in the elderly gravida in Addis Ababa. East African Medical Journal. 79(1):34-7, 2002 Jan. Abstract
Eneh AU. Fiebai PO. Anya SE. John CT. Perinatal outcome among elderly nulliparae at the University of Port Harcourt Teaching Hospital. Nigerian Journal of Medicine: Journal of the National Association of Resident Doctors of Nigeria. 13(1):44-7, 2004 Jan-Mar. Abstract

Search date: February 2009

Classification of evidence levels

Ia Evidence obtained from meta-analysis of randomised controlled trials.

Ib Evidence obtained from at least one randomised controlled trial.

IIa Evidence obtained from at least one well-designed controlled study without randomisation.

IIb Evidence obtained from at least one other type of well-designed quasi-experimental study.

III Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlation studies and case studies.

IV Evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities.

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Date published: 25/02/2009