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Fertility treatment explains most birth complications of older mums

Healthcare professionals need to spell out the risks, say clinicians

Caroline White

Friday, 02 September 2016

Most of the complications of pregnancy experienced by mothers in their late 40s onwards can be explained by fertility treatment or carrying more than one child, suggests research* published in BJOG: An International Journal of Obstetrics and Gynaecology.

The age of first time mums has steadily increased over the past 40 years. And much older mums are known to be at higher risk of pregnancy complications.

The researchers used national data from the UK Obstetric Surveillance System (UKOSS) to look at pregnancy complications and maternal and neonatal outcomes among 233 women aged between 48 to 61 years old.

They were compared with 454 women aged 16 to 46 who gave birth in UK obstetrician-led maternity units from July 2013 to June 2014.

Of the women of advanced maternal age, three quarters (76%) had become pregnant with the help of assisted conception compared with 4% of the younger group.

They were more likely to be pregnant for the first time, be overweight or obese, have underlying medical conditions, and be carrying a multiple pregnancy.

And they were more likely to have pregnancy complications, a preterm delivery, and to need intensive care.

This group had an 18% greater risk of developing gestational diabetes compared with 4% for the younger women, and they were three times as likely to develop a gestational hypertensive disorder.

They were also around twice as likely to experience heavy bleeding after birth and placental complications.

Furthermore they were 78% more likely to need a caesarean delivery compared with a heightened risk of 33% for the younger women. And they were twice as likely to have a spontaneous preterm delivery.

But most of these complications, with the exception of gestational diabetes, caesarean delivery, and intensive care admission can be explained by the higher rate of multiple pregnancy and use of assisted conception, say the researchers.

Many older women depend on IVF to conceive which in turn leads to an increased chance of multiple births, they point out.

Lead author Marian Knight, Professor of Maternal and Child Population Health at the University of Oxford, said: “Although having a baby at very advanced maternal age is still relatively uncommon in the UK, the advances in assisted reproductive technologies are contributing to increasing numbers of women giving birth outside of the ‘normal’ reproductive age.

“There are also increasing numbers of women giving birth who have health problems or complicated pregnancies. It is therefore more important than ever that woman have access to safe, high-quality maternity services regardless of their age or any other factor.”

Professor Lesley Regan, President Elect for the Royal College of Obstetricians and Gynaecologists (RCOG), added: “While the risks should never be overplayed, women and men should be aware that all reproductive outcomes are poorer in older women. As well as potentially taking longer to get pregnant, later maternity can involve a greater risk of miscarriage, a more complicated labour, and medical intervention at the birth.

“As healthcare professionals, our role is to advise both men and women about the implications that maternal age can have for fertility, pregnancy and birth, and enable couples to make informed decisions about when to plan a family.”

Jacque Gerrard, Royal College of Midwives director for England, said that older motherhood was “nothing new” and that it wasn’t all negative as older mums often had more confidence in their abilities to parent and tended to be more financially stable.

“However, we do acknowledge that older women who become pregnant may require more care throughout their pregnancy and together healthcare professionals, including midwives need to ensure that older mothers receive safe and high quality maternity care,” she said.

She added: “It is also important that women are made aware of the increased potential for pregnancy complications as a result of age and in some cases assisted conception. They can then make informed decisions with their partners about when to have a baby.”


* Fitzpatrick K, et al. Pregnancy at very advanced maternal age: a UK population-based cohort study. BJOG 2016. DOI: 10.1111/1471-0528.14269

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