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Try out PMC Labs and tell us what you think. Learn More. Language: English German. Introduction Improved fertility treatment options and a change in the socio-cultural concept of family planning, especially in industrialized regions, has led to an increasing of births by women of advanced maternal age, which is associated with a higher rate of complications.

The rates of assisted reproduction 34 vs. There was an increased risk of preterm delivery 28 vs. Conclusion Advanced maternal age le to higher rates of fetal and maternal complications. These findings should be taken into when planning assisted reproduction and obstetrical care in women with advanced maternal age. Over the last five decades, the mean maternal age at birth in Germany has increased steadily from an average age of This mirrors the dramatically increasing worldwide rate of women of advanced maternal age giving birth over the last decades 3.

With the introduction of assisted reproduction technologies, women have the possibility of postponing family planning. Especially in industrialized nations, women and couples can decide and have decided to postpone marriage and family planning, mostly for career reasons.

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The prolonged system of education, career priorities, and the fact that contraception is common and easily available have contributed to this recent shift. In the USA the rate of primigravidae aged 35—39 has steadily increased since the s. The rate for women aged 40—44 remained steady in the s and began to increase ificantly later on in the s and has more than doubled from to 4. It is well documented that maternal and fetal complications occur more frequently with advanced maternal age 6.

Furthermore, maternal co-morbidities such as hypertension or diabetes are also more common due to the age-dependent onset of these diseases. Pawde et al. Schoen et al. They concluded that pregnancy-induced hypertension and gestational diabetes were more likely to occur in older gravidae. The subjects were identified electronically in our birth records system.

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Patients who met the criteria for the control group and had given birth in the same time period as the study group were randomly selected from the hospital computer system database. Descriptive analyses were done for continuous and categorical variables. Test selection was based on the evaluation of the variables for normal distribution. Gravidity ranged from 1 to 16 with a mean of 4. Parity ranged from 0 to 13 with a mean of 2. As shown in Table 1the of pregnancies was ificantly lower in the control group. Gravidity ranged from 1 to 8 with a mean of 2. Parity ranged from 0 to 7 with a mean of 1.

Table 1 Patient characteristics and co-morbidities 45 for older woman the study and control groups. One year-old woman had a myocardial infarction and stroke episode; one year-old woman had a pulmonary embolism due to factor V Leiden mutation. Of the 13 women with preexisting hypertension, three had an IUGR and two developed preeclampsia. As shown in Fig. Mode of delivery with statistical analysis of differences between study and control group. We classified the cesarean sections according to the RCOG Royal College of Obstetricians and Gynaecologists guidelines and divided them into 4 groups: I Emergency immediate threat to life of woman or fetus, e.

These differences were not statistically ificant. The birth weight analysis for multiple pregnancies was averaged. As presented in Table 2the mean gestational age of Table 2 Outcome variables such as delivery mode and fetomaternal complications for the study and control groups. Only two preterm pregnancies were multiple gestations. Other indications were HELLP syndrome, growth restriction, twin reverse arterial perfusion, placental abruption and placenta previa.

Two cases with dichorionic twins had electively undergone early selective reduction from a triplet pregnancy. There were singleton pregnancies in the study group and in the control group. There was a statistically higher rate of gravidity 4.

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In the study group there was one case of trisomy 18, one case of trisomy 21 and one fetus with hydrocephalus. In the control group there was one case of transposition of the great arteries. Improved fertility treatment options and a change in the socio-cultural concept of family planning, especially in industrialized regions and big cities with a high availability of reproductive technologies, have led to increasing s of deliveries in women with advanced maternal age.

This study shows that the cesarean rate was ificantly higher in women with advanced maternal age compared to a younger group of year-old women. Luke et al. Greenberg et al. The hypothesis of decreased myometrial contractility is also supported by Elmes et al.

Despite the age differences, in our study there was no difference in elective cesarean sections between groups 41 vs. The incidence of preterm deliveries, particularly early preterm deliveries, was higher in the study group of women with advanced maternal age for both singleton and multiple pregnancies, and birth weights were lower. There was a higher rate of multiple pregnancies in the study group, which is regarded as a risk factor for preterm delivery, premature rupture of membranes, and low birth weight and this could therefore indicate a bias.

However, we hypothesized that the advanced maternal age was in itself a risk factor for preterm delivery. This is in contrast to the study by Dietl et al. Dietl et al. In our study group there was not only an increased risk of an adverse outcome due to placental and endothelial dysfunction such as preeclampsia and HELLP syndrome but 45 for older woman an increased risk of gestational diabetes or premature rupture of membranes PROM. One possible explanation for the higher rate of PROM could be the higher rate of multiple pregnancies with an associated risk of uterine distension; another hypothesis could be the higher rate of GDM in this cohort which could be correlated with an increased susceptibility to infection.

One theory is that on a cellular level, cell death activates collagenase, a catabolic enzyme that can subsequently lead to instability of the membranes. The higher rate of gestational diabetes could be due to a higher rate of primary insulin resistance in older patients or ly undetected early-stage diabetes mellitus.

The higher percentage of preeclampsia is possibly the result of a ly 45 for older woman endothelium or a of higher endothelial vulnerability in older patients, a hypothesis supported by the higher rate of preexisting hypertension in the advanced maternal age group. There were no maternal deaths in our study group of cases. An international study by Laopaiboon et al.

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The impact on the medical, psychological, social and economic aspects of these late pregnancies should be taken into. For instance, it is assumed that women of advanced maternal age tend to be more financially secure and have completed their vocational training, but the increased cost of conception, the increased rate of cesarean section and higher rates of perinatal maternal and fetal complications lead to increased healthcare costs Psychologically, pregnancies in older women can lead to higher scores in psychological distress tests, although few studies have analyzed this aspect It is possible that the rate of women who had fertility treatment in our study group, especially the rate of egg donation, could be underreported due to a feeling of shame or taboo.

Similar to the rest of Europe, German health insurance companies do not bear the cost of fertility treatments in women above the age of 40 years, not just for medical and technical reasons but also from a social point of view Furthermore, egg donation is prohibited in Germany which le to a high of unreported egg donations performed abroad.

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Spandorfer et al. These poor outcomes for fertility treatments in women of advanced maternal age should be made clear to affected women above the age of 40 before starting assisted reproduction. Limitations of this study are a lack of data on race and body mass index. Detailed follow-up neonatal data is not included. The high of IVF patients and multiple pregnancies may also constitute a bias. Despite the limitations, we were interested in this group of women primarily for their age and clinical outcomes as we wanted to identify relevant issues of care.

This does not only include higher pregnancy risks such as preeclampsia, gestational diabetes, and preterm delivery that can result in severe maternal or fetal outcomes, but also higher s of complications during labor and a higher rate of cesarean sections. Women of advanced 45 for older woman age should be treated in a level I hospital to allow them and the fetus to be monitored closely at regular intervals. The possible role of fertility treatment — which is more common in older patients — as an independent risk factor should be examined in further studies with a higher sample size.

Conflict of Interest The authors declare that they have no competing interests. National Center for Biotechnology InformationU. Journal List Geburtshilfe Frauenheilkd v. Geburtshilfe Frauenheilkd.

45 for older woman

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