Obstetrical Management of the Older Gravida

Maximilian B Franz; Peter W Husslein

Disclosures

Women's Health. 2010;6(3):463-468. 

In This Article

Stillbirth & Perinatal Mortality

Advanced maternal age is associated with an increased risk of stillbirth. In one of the largest studies to evaluate the influence of maternal age on stillbirth risk, Reddy et al. conducted an analysis of more than 5 million singleton deliveries. In this analysis, advanced maternal age was associated with a higher rate of stillbirth, with a peak risk period for stillbirth occurring among older mothers between 37 and 41 weeks of gestation.[22]

Smith and Fretts presented data from a literature search. They presented an OR for stillbirth of 1.8–2.2 for women between 35 and 39 years of age and an OR of 1.8–3.3 for women over 40 years of age. Other epidemiological risk factors were nulliparity (OR: 1.2–1,4), smoking (OR: 1.7–3.0), obesity (BMI ≥30; OR: 2.1–2.8), having had a previous SGA infant (OR: 2.0–4.6), multiple gestations compared with singleton gestations and black compared with white race (OR: 2.0–2.2).[23]

A total of 6,239,399 singleton pregnancies in the USA were analyzed by Bahtiyar et al. in order to evaluate the influence of advancing maternal age on stillbirth.[24] The ORs were referred to the group of 25–29-year-old mothers who had the lowest stillbirth risk. When compared with this group, the odds of stillbirth at term increased significantly with advancing maternal age (OR for mothers aged 30–34 years: 1.24; OR for mothers aged 35–39 years: 1,45; and OR for mothers aged 40–45 years: 3.04).

Interestingly, the risk of stillbirth for women aged 40–44 years at 39 weeks of gestation is comparable with women aged 25–29 years at 42 gestational weeks.

Therefore, the authors concluded that a strategy of antenatal testing beginning at 38 gestational weeks for women over the age of 40 years may be considered. According to the authors, delivery by 39 weeks may also be considered for women over 40 years of age since the cumulative risk of stillbirth in women aged 40–44 years at 39 weeks is nearly identical to the risk in those aged 25–29 years at 42 weeks.

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