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Cardiovascular Evaluation and Considerations for Women of Advanced Maternal Age Desiring Pregnancy

  • Women’s Health (A Sarma, Section Editor)
  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Abstract

Purpose of review

Pregnancy in women of advanced maternal age (AMA) is increasingly common. Women of AMA have higher pregnancy risks, including higher risk of cardiovascular complications such as hypertensive disorders of pregnancy. This review highlights recent data comparing pregnancy risks in both younger women and women of AMA, as well as how these risks are influenced using assisted reproductive therapies (ART). It highlights long-term cardiovascular risks in women of AMA and suggestions on how to perform cardiovascular evaluations both preconception and during pregnancy in this group of women. It also highlights the importance of comprehensive cardio-obstetrics care in providing optimal preconception, pregnancy, and postpartum care for women of AMA.

Recent findings

Though data on evaluating pregnancy risk in women of AMA are limited, what data are available suggest higher rates of hypertensive disorders of pregnancy, gestational diabetes, and multiple other cardiovascular complications. The absolute risk however remains low. These risks are amplified by ART use. Increasing attention is being paid to optimizing preconception health, especially preconception obesity and hypertension.

Summary

More work is required to better characterize the risks of AMA in pregnancy and how to optimally care for these patients. What research is available emphasizes the importance of optimizing prepregnancy health. A multidisciplinary cardio-obstetrics may play an especially integral part in optimizing the safety of pregnancy in women of AMA.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Mathews TJ. Mean Age of Mothers is on the Rise: United States, 2000–2014.NCHS Data Brief. 2016;232:1–8.

  2. Laopaiboon M, Lumbiganon P, Intarut N, Mori R, Ganchimeg T, Vogel JP, et al. Advanced maternal age and pregnancy outcomes: a multicountry assessment. BJOG Int J Obstet Gynaecol. 2014;121(s1):49–56.

    Google Scholar 

  3. Yogev Y, Melamed N, Bardin R, Tenenbaum-Gavish K, Ben-Shitrit G, Ben-Haroush A. Pregnancy outcome at extremely advanced maternal age. Am J Obstet Gynecol. 2010;203(6):558.e1–7.

    Google Scholar 

  4. Jackson S, Hong C, Wang ET, Alexander C, Gregory KD, Pisarska MD. Pregnancy outcomes in very advanced maternal age pregnancies: the impact of assisted reproductive technology. Fertil Steril. 2015;103(1):76–80.

    PubMed  Google Scholar 

  5. AlShami HAA, Kadasne AR, Khalfan M, Iqbal SZ, Mirghani HM. Pregnancy outcome in late maternal age in a high-income developing country. Arch Gynecol Obstet. 2011;284(5):1113–6.

    PubMed  Google Scholar 

  6. Mills TA, Lavender T. Advanced maternal age. Obstet Gynaecol Reprod Med. 2014;24(3):85–90.

    Google Scholar 

  7. Walker KF, Thornton JG. Advanced maternal age. Obstet Gynaecol Reprod Med. 2016;26(12):354–7.

    Google Scholar 

  8. Liang TC, Crawford S, Chandra S. Advanced maternal age and perinatal and obstetrical outcomes – a population-based study [37C]. Obstet Gynecol. 2017;129(5):40S.

    Google Scholar 

  9. Luke B, Brown MB. Elevated risks of pregnancy complications and adverse outcomes with increasing maternal age. Hum Reprod. 2007;22(5):1264–72.

    PubMed  Google Scholar 

  10. •• Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, Blomström-Lundqvist C, Cífková R, De Bonis M, et al. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J. 2018;39(34):3165–241. Expert consensus guidelines on the management of cardiovascular disease during pregnancy.

    PubMed  Google Scholar 

  11. •• Hollier LM, et al. ACOG Practice Bulletin No. 212: Pregnancy and heart disease. Obstet Gynecol. 2019;133(5):e320–56. Expert consensus guidelines on the management of cardiovascular disease during pregnancy.

    Google Scholar 

  12. Pregnancy Mortality Surveillance System. Centers for Disease Control and Prevention. 2020. https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm. Accessed July 18 2020.

  13. Hameed AB, Lawton ES, McCain CL, Morton CH, Mitchell C, Main EK, et al. Pregnancy-related cardiovascular deaths in California: beyond peripartum cardiomyopathy. Am J Obstet Gynecol. 2015;213(3):379.e1–379.e10.

    Google Scholar 

  14. Briller J, Koch AR, Geller SE. Maternal cardiovascular mortality in Illinois, 2002-2011. Obstet Gynecol. 2017;129(5):819–26.

    PubMed  Google Scholar 

  15. Delbaere I, Verstraelen H, Goetgeluk S, Martens G, De Backer G, Temmerman M. Pregnancy outcome in primiparae of advanced maternal age. Eur J Obstet Gynecol Reprod Biol. 2007;135(1):41–6.

    PubMed  Google Scholar 

  16. Jacobsson B, Ladfors L, Milsom I. Advanced maternal age and adverse perinatal outcome. Obstet Gynecol. 2004;104(4):727–33.

    PubMed  Google Scholar 

  17. 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):e0186287.

    PubMed  PubMed Central  Google Scholar 

  18. Ben-David A, Glasser S, Schiff E, Zahav AS, Boyko V, Lerner-Geva L. Pregnancy and birth outcomes among primiparae at very advanced maternal age: at what price? Matern Child Health J. 2016;20(4):833–42.

    PubMed  Google Scholar 

  19. Hsieh T-T, Liou J-D, Hsu J-J, Lo L-M, Chen S-F, Hung T-H. Advanced maternal age and adverse perinatal outcomes in an Asian population. Eur J Obstet Gynecol Reprod Biol. 2010;148(1):21–6.

    PubMed  Google Scholar 

  20. Khalil A, Syngelaki A, Maiz N, Zinevich Y, Nicolaides KH. Maternal age and adverse pregnancy outcome: a cohort study: maternal age and pregnancy complications. Ultrasound Obstet Gynecol. 2013;42(6):634–43.

    CAS  PubMed  Google Scholar 

  21. Seoud MA-F, Nassar AH, Usta IM, Melhem Z, Kazma A, Khalil AM. Impact of advanced maternal age on pregnancy outcome. Am J Perinatol. 2002;19(01):001–8.

    Google Scholar 

  22. Basky T, Erkan K. Cardiovascular system in preeclampsia and beyond. Hypertension. 2019;73(3):522–31.

    Google Scholar 

  23. Care AS, Bourque SL, Morton JS, Hjartarson EP, Davidge ST. Effect of advanced maternal age on pregnancy outcomes and vascular function in the rat. Hypertension. 2015;65(6):1324–30.

    CAS  PubMed  Google Scholar 

  24. Hoyert DL, Miniño AM. Maternal mortality in the United States: changes in coding, publication, and data release, 2018. Natl Vital Stat Rep. 2020;69(2):1–18.

    PubMed  Google Scholar 

  25. Claramonte Nieto M, Meler Barrabes E, Garcia Martínez S, Gutiérrez Prat M, Serra ZB. Impact of aging on obstetric outcomes: defining advanced maternal age in Barcelona. BMC Pregnancy and Childbirth. 2019;19(1):342.

    PubMed  PubMed Central  Google Scholar 

  26. Cleary-Goldman J, Malone FD, Vidaver J, Ball RH, Nyberg DA, Comstock CH, et al. Impact of maternal age on obstetric outcome. Obstet Gynecol. 2005;105:983–90.

    PubMed  Google Scholar 

  27. Centers for Disease Control and Prevention. Gestational Diabetes. 2019. https://www.cdc.gov/diabetes/basics/gestational.html. Accessed July 26 2020.

  28. Lin J, Fu Y, Han Q, Yan J, Chen R, Zhang H. Gestational weight management and pregnancy outcomes among women of advanced maternal age. Exp Ther Med. 2019;18(3):1723–8.

    PubMed  PubMed Central  Google Scholar 

  29. • De Viti D, Malvasi A, Busardò F, Beck R, Zaami S, Marinelli E. Cardiovascular outcomes in advanced maternal age delivering women. Clinical Review and Medico-Legal Issues. Medicina (Kaunas). 2019;55(10):658. Well-written reviewing highlighting much of the available data regarding cardiovascular outcomes in women of advanced maternal age.

    Google Scholar 

  30. Shan D, Qiu P-Y, Wu Y-X, Chen Q, Li A-L, Ramadoss S, et al. Pregnancy outcomes in women of advanced maternal age: a retrospective cohort study from China. Sci Rep. 2018;8:12239.

    PubMed  PubMed Central  Google Scholar 

  31. Schwartz A, Many A, Shapira U, Rosenberg Friedman M, Yogev Y, Avnon T, et al. Perinatal outcomes of pregnancy in the fifth decade and beyond– a comparison of very advanced maternal age groups. Sci Rep. 2020;10(1):1–6.

    Google Scholar 

  32. Sheen J-J, Wright JD, Goffman D, Kern-Goldberger AR, Booker W, Siddiq Z, et al. Maternal age and risk for adverse outcomes. Am J Obstet Gynecol. 2018;219(4):390.e1–390.e15.

    Google Scholar 

  33. Sauer MV. Reproduction at an advanced maternal age and maternal health. Fertil Steril. 2015;103(5):1136–43.

    PubMed  Google Scholar 

  34. Frederiksen LE, Ernst A, Brix N, Braskhøj Lauridsen LL, Roos L, Ramlau-Hansen CH, et al. Risk of adverse pregnancy outcomes at advanced maternal age. Obstet Gynecol. 2018;131(3):457–63.

    PubMed  Google Scholar 

  35. Nilsen ABV, Waldenström U, Hjelmsted A, Rasmussen S, Schytt E. Characteristics of women who are pregnant with their first baby at an advanced age. Acta Obstet Gynecol Scand. 2012;91(3):353–362x.

    PubMed  Google Scholar 

  36. Haakstad LAH, Voldner N, Bø K. Pregnancy and advanced maternal age—the associations between regular exercise and maternal and newborn health variables. Acta Obstet Gynecol Scand. 2020;99(2):240–8.

    PubMed  Google Scholar 

  37. Smilowitz NR, Gupta N, Guo Y, Zhong J, Weinberg CR, Reynolds HR, et al. Acute myocardial infarction during pregnancy and the Puerperium in the United States. Mayo Clin Proc. 2018;93(10):1404–14.

    PubMed  PubMed Central  Google Scholar 

  38. Tarlatzis BC, Zepiridis L. Perimenopausal conception. Ann N Y Acad Sci. 2003;997:93–104.

    PubMed  Google Scholar 

  39. Guedes M, Canavarro MC. Characteristics of Primiparous women of advanced age and their partners: a homogenous or heterogenous group? Birth. 2014;41(1):46–55.

    PubMed  Google Scholar 

  40. Luke B, Gopal D, Cabral H, Stern JE, Diop H. Pregnancy, birth, and infant outcomes by maternal fertility status: the Massachusetts Outcomes Study of Assisted Reproductive Technology. Am J Obstet Gynecol. 2017;217(3):327.e1–327.e14.

    Google Scholar 

  41. Udell JA, Lu H, Redelmeier DA. Long-term cardiovascular risk in women prescribed fertility therapy. J Am Coll Cardiol. 2013;62(18):1704–12.

    PubMed  Google Scholar 

  42. Källén B, Finnström O, Nygren KG, Olausson PO, Wennerholm U-B. In vitro fertilisation in Sweden: obstetric characteristics, maternal morbidity and mortality. BJOG Int J Obstet Gynaecol. 2005;112(11):1529–35.

    Google Scholar 

  43. Mahalingaiah S, Sun F, Cheng JJ, Chow ET, Lunetta KL, Murabito JM. Cardiovascular risk factors among women with self-reported infertility. Fertil Res Pract. 2017;3:7.

    PubMed  PubMed Central  Google Scholar 

  44. Wild RA. Polycystic ovary syndrome: a risk for coronary artery disease? Am J Obstet Gynecol. 2002;186(1):35–43.

    PubMed  Google Scholar 

  45. Grundy E, Tomassini C. Fertility history and health in later life: a record linkage study in England and Wales. Soc Sci Med. 2005;61(1):217–28.

    PubMed  Google Scholar 

  46. Dayan N, Lanes A, Walker MC, Spitzer KA, Laskin CA. Effect of chronic hypertension on assisted pregnancy outcomes: a population-based study in Ontario, Canada. Fertil Steril. 2016;105(4):1003–9.

    PubMed  Google Scholar 

  47. Martin AS, Monsour M, Kissin DMM, Jamieson DJM, Callaghan WMM, Boulet SLD. Trends in severe maternal morbidity after assisted reproductive technology in the United States, 2008-2012. Obstet Gynecol. 2016;127(1):59–66.

    PubMed  Google Scholar 

  48. Cooke C-LM, Davidge ST. Advanced maternal age and the impact on maternal and offspring cardiovascular health. Am J Phys Heart Circ Phys. 2019;317(2):H387–94.

    CAS  Google Scholar 

  49. Qureshi AI, Saeed O, Malik AA, Suri MFK. Pregnancy in advanced age and the risk of stroke in postmenopausal women: analysis of Women’s Health Initiative Study. Am J Obstet Gynecol. 2017;216(4):409.e1–6.

    Google Scholar 

  50. Alonzo AA. Long-term health consequences of delayed childbirth: NHANES III. Womens Health Issues. 2002;12(1):37–45.

    PubMed  Google Scholar 

  51. Jaffe D, Kogan L, Manor O, Gielchinsky Y, Dior U, Laufer N. Influence of late-age births on maternal longevity. Ann Epidemiol. 2015;25(6):387–91.

    PubMed  Google Scholar 

  52. Morton JS, Care AS, Kirschenman R, Cooke CL, Davidge ST. Advanced maternal age worsens postpartum vascular function. Front Physiol. 2017;8:465.

    PubMed  PubMed Central  Google Scholar 

  53. Atrash H, Jack BW, Johnson K, Coonrod DV, Moos M-K, Stubblefield PG, et al. Where is the “W”Oman in MCH? Am J Obstet Gynecol. 2008;199(6):S259–65.

    PubMed  Google Scholar 

  54. Anderson JE, Ebrahim S, Floyd L, Atrash H. Prevalence of risk factors for adverse pregnancy outcomes during pregnancy and the preconception period—United States, 2002–2004. Matern Child Health J. 2006;10(S1):101–6.

    PubMed Central  Google Scholar 

  55. •• Brown HL, Warner JJ, Gianos E, Gulati M, Hill AJ, Hollier LM, et al. Promoting risk identification and reduction of cardiovascular disease in women through collaboration with obstetricians and gynecologists: a presidential advisory from the American Heart Association and the American College of Obstetricians and Gynecologists. Circulation. 2018;137(24):e843–52. Important call-to-action for joint efforts between both cardiology and obstetrician societies to optimize the approach to caring for women with cardiovascular disease during pregnancy.

    PubMed  Google Scholar 

  56. Berghella V, Buchanan E, Pereira L, Baxter JK. Preconception care. Obstet Gynecol Surv. 2010;65(2):119–31.

    PubMed  Google Scholar 

  57. Thornburg LL. Antepartum obstetrical complications associated with obesity. Semin Perinatol. 2011;35(6):317–23.

    PubMed  Google Scholar 

  58. Sibai BM, Ewell M, Levine RJ, Klebanoff MA, Esterlitz J, Catalano PM, et al. Risk factors associated with preeclampsia in healthy nulliparous women. The calcium for preeclampsia prevention (CPEP) study group. Am J Obstet Gynecol. 1997;177(5):1003–10.

    CAS  PubMed  Google Scholar 

  59. Marsh CA, Hecker E. Maternal obesity and adverse reproductive outcomes: reducing the risk. Obstet Gynecol Surv. 2014;69(10):622–8.

    PubMed  Google Scholar 

  60. Berg CJM, Callaghan WMM, Syverson CC, Henderson Z. Pregnancy-related mortality in the United States, 1998 to 2005. Obstet Gynecol. 2010;116(6):1302–9.

    PubMed  Google Scholar 

  61. Joseph KS, Allen AC, Dodds L, Turner LA, Scott H, Liston R. The perinatal effects of delayed childbearing. Obstet Gynecol. 2005;105(6):1410–8.

    CAS  PubMed  Google Scholar 

  62. Sanghavi M, Rutherford JD. Cardiovascular physiology of pregnancy. Circulation. 2014;130(12):1003–8.

    PubMed  Google Scholar 

  63. Robson SC, Dunlop W, Moore M, Hunter S. Haemodynamic changes during the puerperium: a Doppler and M-mode echocardiographic study. BJOG Int J Obstet Gynaecol. 1987;94(11):1028–39.

    CAS  Google Scholar 

  64. Liu S, Liston RM, Joseph KS, Heaman M, Sauve R, Kramer MS. Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term. CMAJ. 2007;176(4):455–60.

    PubMed  PubMed Central  Google Scholar 

  65. Ruys TPE, Roos-Hesselink JW, Pijuan-Domènech A, Vasario E, Gaisin IR, Iung B, et al. Is a planned caesarean section in women with cardiac disease beneficial? Heart. 2015;101(7):530–6.

    PubMed  Google Scholar 

  66. Bayrampour H, Heaman M. Advanced maternal age and the risk of cesarean birth: a systematic review. Birth. 2010;37(3):219–26.

    PubMed  Google Scholar 

  67. Chan BC-P, Lao TT-H. Effect of parity and advanced maternal age on obstetric outcome. Int J Gynecol Obstet. 2008;102(3):237–41.

    Google Scholar 

  68. Attali E, Yogev Y. The impact of advanced maternal age on pregnancy outcome. Best Pract Res Clin Obstet Gynaecol. 2020. https://doi.org/10.1016/j.bpobgyn.2020.06.006.

  69. Ezra Y, McParland P, Farine D. High delivery intervention rates in nulliparous women over age 35. Eur J Obstet Gynecol Reprod Biol. 1995;62(2):203–7.

    CAS  PubMed  Google Scholar 

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  1. Department of Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA

    Anna C. O’Kelly MD

  2. Department of Medicine, Division of Cardiology, Massachusetts General Hospital, 55 Fruit St, Yawkey 5B, Boston, MA, 02114, USA

    Nandita S. Scott MD

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O’Kelly, A.C., Scott, N.S. Cardiovascular Evaluation and Considerations for Women of Advanced Maternal Age Desiring Pregnancy. Curr Treat Options Cardio Med 22, 71 (2020). https://doi.org/10.1007/s11936-020-00857-3

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