Archives of Gynecology and Obstetrics

, Volume 283, Issue 4, pp 755–759 | Cite as

A significant linear association exists between advanced maternal age and adverse perinatal outcome

  • Shimrit Salem Yaniv
  • Amalia Levy
  • Arnon Wiznitzer
  • Gershon Holcberg
  • Moshe Mazor
  • Eyal SheinerEmail author
Materno-Fetal Medicine



The present study was aimed to investigate perinatal outcome of elderly nulliparous patients.

Study design

A retrospective study was performed comparing pregnancy outcomes of nulliparous patients at three age groups: less than 35 years (reference group), 35–40 years, and above 40 years. The linear-by-linear association test was used to examine linear association between advanced maternal age and adverse pregnancy outcomes. A multiple logistic regression model was used to control for confounders.


Out of 45,033 nulliparous women with singleton gestations, 1,036 were of women over the age of 35, and 188 over 40. A significant linear association was documented between advanced maternal age and adverse outcomes, such as intra uterine growth restriction, low birth weight, congenital malformations, and perinatal mortality. Using a multiple logistic regression model, controlling for gestational age, IUGR and malformations, advanced maternal age was not found to be an independent risk factor for perinatal mortality (adjusted odds ratio = 1.04, 95% confidence interval 0.7–1.4).


A significant linear association exists between advanced maternal age and adverse maternal and perinatal outcomes. Nevertheless, in our population, advanced maternal age is not an independent risk factor for perinatal mortality.


Advanced maternal age Perinatal mortality Intra uterine growth restriction Low birth weight 


Conflict of interest statement



  1. 1.
    Berkowitz GS, Skovron ML, Lapinski RH et al. (1990) Delayed childbearing and the outcome of pregnancy. N Engl J Med 322:659–664Google Scholar
  2. 2.
    Stein ZA (1985) A woman’s age: childbearing and child rearing. Am J Epidemiol 121:327–342PubMedGoogle Scholar
  3. 3.
    Spencer G (1984) Projection of the population of the United States by age, sex and race: 1983–2080. Current population reports-population estimates and projections. Washington (DC): US Department of Commerce. (Series P-25, no 952)Google Scholar
  4. 4.
    Cunningham FG, Leveno KJ (1995) Childbearing among older women message is cautiously optimistic. N Eng J Med 333:1002CrossRefGoogle Scholar
  5. 5.
    Gilbert WM, Nesbitt TS, Danielsen B (1999) Childbearing beyond age 40: pregnancy outcome in 24,032 cases. Obstet Gynecol 93:9–14PubMedCrossRefGoogle Scholar
  6. 6.
    Bianco A, Stone J, Lynch L, Lapinski R, Berkowitz G, Berkowits RL (1996) Pregnancy outcome at age 40 and older. Obstet Gynecol 87:917–922PubMedCrossRefGoogle Scholar
  7. 7.
    Peipert JF, Bracken MB (1993) Maternal age: an independent risk factor for cesarean delivery. Obstet Gynecol 81:200–205PubMedGoogle Scholar
  8. 8.
    Sheiner E, Sheiner EK, Fraser D, Mazor M, Katz M (1997) Pregnancy outcome in Jewish and Bedouin multiparous women aged 40 years or more. Isr J Obstet Gynecol 8:188–193Google Scholar
  9. 9.
    O’reilly-Green C, Cohen WR (1993) Pregnancy in women aged 40 and older. Obstet Gynecol Clin North Am 20:313–331PubMedGoogle Scholar
  10. 10.
    Yuan W, Steffensen FH, Nielsen GL, Moller M, Olsen J, Sorensen HT (2000) A population-based cohort study of birth and neonatal out-come in older primipara. Int J Gynecol Obstet 68:113–118CrossRefGoogle Scholar
  11. 11.
    Buheler JW, Kaunitz AM, Hogue CJR et al. (1986) Maternal mortality in women aged 35 years or older: United States. JAMA 255:53–57Google Scholar
  12. 12.
    Baird PA, Sadovnik AD, Yee IM (1991) Maternal age and birth defects: a population study. Lancet 338:527–530Google Scholar
  13. 13.
    Reddy Uma M, Ko C-W, Willinger M (2006) Maternal age and the risk of stillbirth throughout pregnancy in the United States. Am J Obstet Gynecol 195:764–770Google Scholar
  14. 14.
    Canterino JC, Ananth CV, Smulian J, Harrigan JT, Vintzileos AM (2004) Maternal age and risk of fetal death in singleton gestations: USA, 1995–2000. J Matern Fetal Neonatal Med 15(3):193–197PubMedCrossRefGoogle Scholar
  15. 15.
    Salihu HM, Shumpert MN, Slay M, Kirby RS, Alexander GR (2003) Childbearing beyond maternal age 50 and fetal outcomes in the United States. Obstet Gynecol 102:1006–1014PubMedCrossRefGoogle Scholar
  16. 16.
    Agresti A (1996) Introduction to categorical data analysis. Wiley, NY, pp 231–236Google Scholar
  17. 17.
    Klipstein S, Regan M, Ryley D, Goldman M, Alper M, Reindollar R (2005) One last chance for pregnancy: a review of 2,705 in vitro fertilization cycles initiated in women age 40 years and above. Fertil Steril 84:435–445PubMedCrossRefGoogle Scholar
  18. 18.
    Hansen M, Kurinczuk JJ, Bower C et al. (2002) The risk of major birth defects after intracytoplasmatic sperm injection and in vitro fertilization. N Engl J Med 346:725–730Google Scholar
  19. 19.
    Ziadeh SM (2002) Maternal and perinatal outcome in nulliparous women aged 35 and older. Gynecol Obstet Invest 54:6–10PubMedCrossRefGoogle Scholar
  20. 20.
    Jacobsson B, Ladfors L, Milsom I (2004) Advanced maternal age and adverse perinatal outcome. Obstet Gynecol 104:727–733PubMedCrossRefGoogle Scholar
  21. 21.
    Joseph KS, Allen AC, Dodds L, Turner LA, Scott H, Liston R (2005) The perinatal effects of delayed childbearing. Obstet Gynecol 105:1410–1418PubMedCrossRefGoogle Scholar
  22. 22.
    Cleary-Goldman J, Malone FD, Vidaver J, Ball RH, Nyberg DA, Comstock CH, Saade GR, Eddleman KA, Klugman S, Dugoff L, Timor-Tritsch IE, Craigo SD, Carr SR, Wolfe HM, Bianchi DW, D’Alton M, FASTER Consortium (2005) Impact of maternal age on obstetric outcome. Obstet Gynecol 105:983–990PubMedCrossRefGoogle Scholar
  23. 23.
    Sheiner E, Shoham-Vardi I, Hershkovitz R, Katz M, Mazor M (2001) Infertility treatment is an independent risk factor for cesarean section among nulliparous women aged 40 and above. Am J Obstet Gynecol 185(4):888–892PubMedCrossRefGoogle Scholar
  24. 24.
    Ohel I, Sheiner E (2009) Does oocyte donation equal cesarean delivery? J Matern Fetal Neonatal Med 2:1–4Google Scholar
  25. 25.
    Treacy A, Robson M, O’Herlihy C (2006) Dystocia increases with advancing maternal age. Am J Obstet Gynecol 195:760–763PubMedCrossRefGoogle Scholar
  26. 26.
    Patel RR, Peters TJ, Murphy DJ, ALSPAC Study Team (2005) Prenatal risk factors for Caesarean section. Analyses of the ALSPAC cohort of 12,944 women in England. Int J Epidemiol 34:353–367PubMedCrossRefGoogle Scholar
  27. 27.
    Fretts RC, Schmittdiel J, McLean FH, Usher RH, Goldman MB (1995) Increased maternal age and the risk of fetal death. N Engl J Med 333:953–957PubMedCrossRefGoogle Scholar
  28. 28.
    Tough S, Benzies K, Newburn-Cook C, Tofflemire K, Fraser-Lee N, Faber A, Sauve R (2006) What do women know about the risks of delayed childbearing? Can J Public Health 97:330–334PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Shimrit Salem Yaniv
    • 1
  • Amalia Levy
    • 2
  • Arnon Wiznitzer
    • 1
  • Gershon Holcberg
    • 1
  • Moshe Mazor
    • 1
  • Eyal Sheiner
    • 1
    Email author
  1. 1.Department of Obstetrics and GynecologySoroka University Medical CenterBeershebaIsrael
  2. 2.Epidemiology and Health Evaluation Department, Faculty of Health SciencesBen-Gurion University of the NegevBeershebaIsrael

Personalised recommendations