Advanced Maternal Age
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- No universal definition for advanced maternal age because effects of aging exist as a continuum rather than threshold
- Generally accepted definition is at least 35 years of age or estimated delivery date age >35.
- Advanced maternal age has a significant independent association with decreased fertility as well as increase in fetal and obstetric complications (1,2).
Rate of live birth for older women has been rising significantly over past three decades, as people are delaying childbearing due to cultural and sociologic changes.
- From 1990 to 2008, birth rate per 1,000 women age 35 to 44 years increased from 18.7 to 28.7 (3).
In 2008, about 15% of pregnancies occurred in women age >35 years (3).
Etiology and Pathophysiology
- Decline in fertility with age due to gradual decrease in quantity and quality of oocytes within the ovaries
- As women age, there is a progressive loss of oocytes from fetal life through menopause (4).
- Increased risk for aneuploidy and spontaneous abortion is due to changes in the meiotic spindle that predisposes to nondisjunction. However, no association has been found between nonaneuploid structural defects and maternal age (1,4).
- Use of assisted reproductive techniques and ovulation induction has significantly contributed to increased rate of twin and triplet births, which further contributes to complications during pregnancy (1).
Premenopausal women not desiring pregnancy should be offered contraception.