Optimal Management of Pregnancy beyond 12 Weeks, Labour and the Puerperium for Women over 40

doi:10.1017/9781009025270.012

Chapter 11 - Optimal Management of Pregnancy beyond 12 Weeks, Labour and the Puerperium for Women over 40

from Section 6 - Obstetric Management beyond 40

Published online by Cambridge University Press: 15 September 2022

Shane Duffy and

Pritha Dasmahapatra

Edited by

Dimitrios S. Nikolaou and

David B. Seifer

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Dimitrios S. Nikolaou: Affiliation:
Chelsea and Westminster Hospital, London
David B. Seifer: Affiliation:
Yale Reproductive Medicine, New Haven, CT

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Summary

This chapter examines the risks of pregnancy for women over 40 and the strategies to optimize the management of pregnancy, labour and puerperium in this age group. In the UK, antenatal care is not usually any different at less than 40 years unless there are other confounding factors. Women at advanced age booking for pregnancy should have a thorough risk assessment to ascertain risk of hypertensive diseases of pregnancy and those at higher risk should be started on 75 mcg aspirin from 12 weeks till until 36 weeks Increased surveillance for GDM is not recommended in the UK based on age alone. However, it should be noted that AMA is associated with an increased background incidence of diabetes and it is our practice to offer a mini glucose tolerance test. Risk of venous thromboembolism should be assessed at booking and at each encounter. Serial growth scans with doppler studies are to be performed starting from 26-28 weeks of gestation in women more than 40 years. Induction of labour is recommended between 39 to 40 weeks when maternal age is more than 40 years. There is insufficient evidence to comment on the possible effect on perinatal mortality and rates of operative delivery from this intervention and this should be mentioned when counselling for induction of labour.

Keywords

Pregnancy over 40 maternal morbidity maternal mortality caesarean section labour prematurity risk assessment hypertensive disorders gestational diabetes VTE growth scans induction of labour

Type: Chapter
Information: Optimizing the Management of Fertility in Women over 40 , pp. 131 - 140

DOI: https://doi.org/10.1017/9781009025270.012 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2022

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References

Dekker, R. Evidence on: Pregnancy at Age 35 and Older. https://evidencebasedbirth.com/advanced-maternal-age/?msclkid=4ab20ad8b01611ecb492f79cf6a22536 Google Scholar

Laopaiboon, M, Lumbiganon, P, Intarut, N, et al. Advanced maternal age and pregnancy outcomes: a multi country assessment. BJOG 2014; 121 Suppl 1:49–56CrossRef Google Scholar

Olusanya, B O, Solanke, OA. Perinatal correlates of delayed childbearing in a developing country. Arch Gynecol Obstet 2012;285(4):951–7CrossRef Google Scholar PubMed

Dildy, GA, Jackson, GM, Fowers, GK, et al. Very advanced maternal age: pregnancy after age 45. Am J Obstet Gynecol. 1996;175(3 Pt 1):668Google Scholar

ONS. Birth Summary Tables, England and Wales, 2013. Office for National Statistics. 2014Google Scholar

Martin, JA, Hamilton, BE, Osterman, M. National Center for Health Statistics Data Brief, no. 318. Natl Cent Heal Stat 2018;318(318):415–6Google Scholar

Matthew, Ts, Hamilton, Be, First births to older women continue to rise. NCHS Data Brief 2014;(152):1–8Google Scholar

Royal College of Obstetricians and Gynaecologists. Reproductive Ageing (Scientific Impact Paper No. 24.2011. https://www.rcog.org.uk/guidance/browse-all-guidance/scientific-impact-papers/reproductive-ageing-scientific-impact-paper-no-24/Google Scholar

Guedes, M, Canavarro, MC. Characteristics of primiparous women of advanced age and their partners: a homogenous or heterogenous group? Birth 2014;41:46–55CrossRef Google Scholar PubMed

Schreinemachers, DM, Cross, PK, Hook, EB. Rates of trisomies 21, 18, 13 and other chromosome abnormalities in about 20,000 prenatal studies compared with estimated rates in live births. Hum Genet 1982;61:318CrossRef Google Scholar

Gill, SK, Broussard, C, Devine, O, et al. Association between maternal age and birth defects of unknown etiology: United States, 1997–2007. Birth Defects Res A Clin Mol Teratol 2012;94(12):1010CrossRef Google Scholar PubMed

Cleary-Goldman, J, Malone, FD, Vidaver, J, et al. Impact of maternal age on obstetric outcome. Obstet Gynecol 2005;105: 983–90Google Scholar

Kenny, LC, Lavender, T, McNamee, R, et al. Advanced maternal age and adverse pregnancy outcome: evidence from a large contemporary cohort. PloS One 2013;8: e56583CrossRef Google Scholar PubMed

Khalil, A, Syngelaki, A, Maiz, N, et al. Maternal age and adverse pregnancy outcome: a cohort study. Ultrasound Obstet Gynecol 2013;42:634–43Google Scholar PubMed

Salihu, HM, Wilson, RE, Alio, AP, Kirby, RS. Advanced maternal age and risk of antepartum and intrapartum stillbirth. J Obstet Gynaecol Res 2008;34: 843–50Google Scholar

Giri, A, Srivastav, VR, Suwal, A, Tuladhar, AS. Advanced maternal age and obstetric outcome. Nepal Med Coll J 2012;15: 87–90Google Scholar

Bahtiyar, M, Funai, E, Norwitz, E, et al. Advanced maternal age (AMA) is an independent predictor of intrauterine fetal death at term. Am J Obstet Gynecol 2006;195:S209CrossRef Google Scholar

Odibo, AO, Nelson, D, Stamilio, DM, et al. Advanced maternal age is an independent risk factor for intrauterine growth restriction. Am J Perinatol 2006;23:325–8Google Scholar

Lamminpaa, R, Vehvilainen-Julkunen, K, Gissler, M, Heinonen, S. Preeclampsia complicated by advanced maternal age: a registry-based study on primiparous women in Finland 1997–2008. BMC Pregnancy Childbirth 2012;12:47CrossRef Google Scholar

Gabbe, S. Obstetrics: Normal and problem pregnancies. Philadelphia: Elsevier/Saunders; 2012Google Scholar

Page, EW, Christianson, R. The impact of mean arterial pressure in the middle trimester upon the outcome of pregnancy. Am J Obstet Gynecol 1976;125:740–6Google Scholar

Halligan, A, O’Brien, E, O’Malley, K, et al. Twenty-four-hour ambulatory blood pressure measurement in a primigravid population. J Hypertens 1993;11:869–73Google Scholar

Clapp, JF 3rd, Seaward, BL, Sleamaker, RH, Hiser, J. Maternal physiologic adaptations to early human pregnancy. Am J Obstet Gynecol 1988;159: 1456–60Google Scholar

Yılmaz, E, Tosun, ÖA, Tarhan, N, et al. Perinatal outcomes in advanced age pregnancies. J Clin Exp Investig 2016;7(2):157–62CrossRef Google Scholar

El-Gilany, A-H, Hammad, S. Obstetric outcomes of teenagers and older mothers: experience from Saudi Arabia. Int J Collab Res Intern Med Public Health. 2012;4(6):901–9Google Scholar

Mehari, M-A, Maeruf, H, Robles, CC, et al. Advanced maternal age pregnancy and its adverse obstetrical and perinatal outcomes in Ayder comprehensive specialized hospital, Northern Ethiopia, 2017: a comparative cross-sectional study. BMC Pregnancy Childbirth 2020;20:60CrossRef Google Scholar PubMed

Haddad, B, Sibai, BM. Chronic hypertension in pregnancy. Ann Med 1999;31:246–52CrossRef Google Scholar PubMed

Rey, E, Couturier, A. The prognosis of pregnancy in women with chronic hypertension. Am J Obstet Gynecol 1994;171:410–6CrossRef Google Scholar PubMed

McCowan, LM, Buist, RG, North, RA, Gamble, G. Perinatal morbidity in chronic hypertension. Br J Obstet Gynaecol 1996;103:123–9Google Scholar

Steer, PJ, Little, MP, Kold-Jensen, T, et al. Maternal blood pressure in pregnancy, birth weight, and perinatal mortality in first births: prospective study. BMJ 2004;329:1312CrossRef Google Scholar PubMed

Orbach, H, Matok, I, Gorodischer, R, et al. Hypertension and antihypertensive drugs in pregnancy and perinatal outcomes. Am J Obstet Gynecol 2013;208:301 e1–6Google Scholar

Livingston, JC, Sibai, BM. Chronic hypertension in pregnancy. Obstet Gynecol Clin N Am 2001;28:447–64CrossRef Google Scholar PubMed

Aliyu, MH, Salihu, HM, Wilson, RE, et al. The risk of intrapartum stillbirth among smokers of advanced maternal age. Arch Gynecol Obstet 2008;278:39.CrossRef Google Scholar PubMed

Paulson, RJ, Boostanfar, R, Saadat, P, et al. Pregnancy in the sixth decade of life: obstetric outcomes in women of advanced reproductive age. JAMA 2002;288:2320.CrossRef Google Scholar PubMed

Duley, L, Meher, S, Hunter, KE, et al. Antiplatelet agents for preventing pre-eclampsia and its complications. Cochrane Database Syst Rev 2019;10:CD004659.Google Scholar

Rashed, HEM, Maria Awaluddin, S, Ahmad, NA, et al. Advanced maternal age and adverse pregnancy outcomes in Muar, Johor. Malays Sains Malaysiana 2016;45(10):1537–42Google Scholar

Koo, Y-J, Ryu, H-M, Yang, J-H, et al. Pregnancy outcomes according to increasing maternal age. Taiwan J Obstet Gynecol 2012;51:60–5Google Scholar

Ashrafi, M, Gosili, R, Hosseini, R, et al. Risk of gestational diabetes mellitus in patients undergoing assisted reproductive techniques. Eur J Obstet Gynecol Reprod Biol 2014;176:149–52Google Scholar

National Institute for Health and Care Excellence (NICE). Diabetes in pregnancy: management from preconception to the postnatal period. NICE guideline NG3. London: NICE; 2015Google Scholar

GBD 2016 Mortality Collaborators. Global, regional, and national under‐5 mortality, adult mortality, age‐specific mortality, and life expectancy, 1970–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2017;390:1084–150Google Scholar

Gelson, E, Gatzoulis, M, Steer, P, Johnson, M. Heart disease – why is maternal mortality increasing? BJOG 2008;116:609–11Google Scholar

Sultan, AA, West, J, Tata, LJ, et al. Risk of first venous thromboembolism in and around pregnancy: a population-based cohort study. Br J Haematol 2012;156:366–73Google Scholar

Lindqvist, P, Dahlbäck, B, MarŜál, K. Thrombotic risk during pregnancy: a population study. Obstet Gynecol 1999;94:595–9Google Scholar

Liu, S, Rouleau, J, Joseph, KS, et al. Epidemiology of pregnancy-associated venous thromboembolism: a population-based study in Canada. J Obstet Gynaecol Can 2009;31:611–20Google Scholar

Simpson, EL, Lawrenson, RA, Nightingale, AL, Farmer, RD. Venous thromboembolism in pregnancy and the puerperium: incidence and additional risk factors from a London perinatal database. BJOG 2001;108:56–60Google Scholar

Royal College of Obstetricians and Gynaecologists. Reducing the Risk of Venous Thromboembolism during Pregnancy and the Puerperium Green-top Guideline No. 37a April 2015Google Scholar

Franklin, SS, Larson, MG, Khan, SA, et al. Does the relation of blood pressure to coronary heart disease risk change with aging? Circulation 2001;103:1245CrossRef Google Scholar PubMed

Karami, M, Jenabi, E, Fereidooni, B. The association of placenta previa and assisted reproductive techniques: a meta-analysis. J Matern Fetal Neonatal Med 2018;31(14):1940–7Google Scholar

Amarin, V. Effect of maternal age on pregnancy outcome: a hospital based study. J Med Res 2013;1(4):28–31Google Scholar

Salem Yaniv, S, Levy, A, Wiznitzer, A, et al. A significant linear association exists between advanced maternal age and adverse perinatal outcome. Arch Gynecol Obstet 2011;283:755–9CrossRef Google Scholar PubMed

Wang, Y, Tanbo, T, Abyholm, T, Henriksen, T. The impact of advanced maternal age and parity on obstetric and perinatal outcomes in singleton gestations. Arch Gynecol Obstet 2011;284:31–7Google Scholar

Carolan, M, Davey, MA, Biro, MA, Kealy, M. Older maternal age and intervention in labor: a population-based study comparing older and younger first-time mothers in Victoria, Australia. Birth 2011;38:24–9Google Scholar

Hoffman, MC, Jeffers, S, Carter, J, et al. Pregnancy at or beyond age 40 years is associated with an increased risk of fetal death and other adverse outcomes. Am J Obstet Gynecol 2007;196:11–3Google Scholar

Hoque, ME. Advanced maternal age and outcomes of pregnancy: a retrospective study from South Africa. Biomed Res 2012;23(2):281–5Google Scholar

Cnattingius, S, Forman, MR, Berendes, HW, Isotalo, L. Delayed childbearing and risk of adverse perinatal outcome. A population-based study. JAMA 1992;268(7):886Google Scholar

Almeida, NK, Almeida, RM, Pedreira, CE. Adverse perinatal outcomes for advanced maternal age: a cross-sectional study of Brazilian births. J Pediatr (Rio J) 2015;91(5):493–8CrossRef Google Scholar PubMed

Jacobsson, B, Ladfors, L, Milsom, I. Advanced maternal age and adverse perinatal outcome. Obstet Gynecol 2004;104:727Google Scholar

Huang, L, Sauve, R, Birkett, N, et al. Maternal age and risk of stillbirth: a systematic review. CMAJ 2008;178:165–72Google Scholar

Lean, SC, Derricott, H, Jones, RL, Heazell, AEP. Advanced maternal age and adverse pregnancy outcomes: A systematic review and meta-analysis. PLoS ONE 2017;12(10):e0186287Google Scholar

Hilder, L, Costeloe, K, Thilaganathan, B. Prolonged pregnancy: evaluating gestation-specific risks of fetal and infant mortality. Br J Obstet Gynaecol 1998;105:169–73CrossRef Google Scholar PubMed

Haavaldsen, C, Sarfraz, AA, Samuelsen, SO, Eskild, A. The impact of maternal age on fetal death: does length of gestation matter? Am J Obstet Gynecol 2010;203:554:1–8Google Scholar

Nybo Andersen, AM, Wohlfahrt, J, Christens, P, et al. Maternal age and fetal loss: population based register Linkage study. BMJ 2000;320:1708–12.Google Scholar

Flenady, V, Koopmans, L, Middleton, P, et al. Major risk factors for stillbirth in high-income countries: a systematic review and meta-analysis. Lancet 2011;377:1331–40Google Scholar

Lean, SC, Heazell, AEP, Dilworth, MR, et al. Placental dysfunction underlies increased risk of fetal growth restriction and stillbirth in advanced maternal age women. Sci Rep 2017;7(1):9677CrossRef Google Scholar PubMed

Miller, DA. Is advanced maternal age an independent risk factor for uteroplacental insufficiency? Am J Obstet Gynecol 2005;192:1974–80Google Scholar

Wyatt, PR, Owolabi, T, Meier, C, Huang, T. Age-specific risk of fetal loss observed in a second trimester serum screening population. Am J Obstet Gynecol 2005;192:240–6Google Scholar

Hunt, PA, Hassold, TJ. Human female meiosis: what makes a good egg go bad? Trends Genet 2008;24:86–93Google Scholar

Younis, JS, Laufer, N. Oocyte donation is an independent risk factor for pregnancy complications: the implications for women of advanced age. J Womens Health (Larchmt) 2015;24(2):127–30Google Scholar

Alio, AP, Salihu, HM, McIntosh, C, et al. The effect of paternal age on fetal birth outcomes. Am J Mens Health 2012;6:427–35Google Scholar

Reddy, UM, Ko, CW, Willinger, M. Maternal age and the risk of stillbirth throughout pregnancy in the United States. Am J Obstet Gynecol 2006;195(3):764CrossRef Google Scholar PubMed

Bell, JS, Campbell, DM, Graham, WJ, et al. Do obstetric complications explain high caesarean rates among women over 30? A retrospective analysis. BMJ 2001;322:894–5Google Scholar

Gilbert, WM, Nesbitt, TS, Danielsen, B. Childbearing beyond age 40: Pregnancy outcome in 24,032 cases. Obstet Gynecol 1999;93:9–14Google Scholar

Patel, RR, Peters, TJ, Murphy, DJ, ALSPAC Study Team. Prenatal risk factors for Caesarean section. Analyses of the ALSPAC cohort of 12 944 women in England. Int J Epidemiol 2005;34:353–67CrossRef Google Scholar

Ecker, JL, Chen, KT, Cohen, AP, et al. Increased risk of cesarean delivery with advancing maternal age: Indications and associated factors in nulliparous women. Am J Obstet Gynecol 2001;185:883–7CrossRef Google Scholar PubMed

Smith, GC, Cordeaux, Y, White, IR, et al. The effect of delaying childbirth on primary cesarean section rates. PLoS Med 2008;5:e144Google Scholar

Yogev, Y, Melamed, N, Bardin, R, et al. Pregnancy outcome at extremely advanced maternal age. Am J Obstet Gynecol 2010;203:558:1–7Google Scholar

Nove, A, Matthews, Z, Neal, S, Camacho, AV. Maternal mortality in adolescents compared with women of other ages: evidence from 144 countries. Lancet Glob Health 2014;2(3):e155Google Scholar

Nybo Andersen, AM, Wohlfahrt, J, Christens, P, et al. Maternal age and fetal loss: population based register linkage study. BMJ 2000;320:1708–12Google Scholar

Delbaere, I, Verstraelen, H, Goetgeluk, S, et al. Pregnancy outcome in primiparae of advanced maternal age. Eur J Obstet Gynecol Reprod Biol 2007;135:41–6Google Scholar

National Institute for Health and Care Excellence (NICE). Hypertension in pregnancy: diagnosis and management. NICE guideline NG133. London: NICE; 2019Google Scholar

National Institute for Health and Care Excellence (NICE). Antenatal care for uncomplicated pregnancies (CG62). London 2016Google Scholar

Public Health England. Fetal Anomaly Screening Programme. 2015. https://www.gov.uk/government/publications/fetal-anomaly-screening-programme-handbook?msclkid=480d63b4b02911ecbd2db90bf6d6a1b6 Google Scholar

The Investigation and Management of the Small–for–Gestational–Age Fetus Green–top Guideline No. 31 2nd Edition | February 2013 | Minor revisions – January 2014. https://rcog.org.uk/media/t3lmjhnl/gtg_31.pdf Google Scholar

Reddy, UM, Ko, CW, Willinger, M. Maternal age and the risk of stillbirth throughout pregnancy in the United States. Am J Obstet Gynecol 2006;195:764–70Google Scholar

Royal College of Obstetricians and Gynaecologists. Induction of Labour at Term in Older Mothers (Scientific Impact Paper No. 34). 2013. https://www.rcog.org.uk/guidance/browse-all-guidance/scientific-impact-papers/induction-of-labour-at-term-in-older-mothers-scientific-impact-paper-no-34/Google Scholar

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Chapter 11 - Optimal Management of Pregnancy beyond 12 Weeks, Labour and the Puerperium for Women over 40

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