Pregnancy at Age 35 Years or Older

Abstract

Centers for Disease Control and Prevention data from 2020 demonstrate the continued upward trend in the mean age of pregnant individuals in the United States. Observational studies demonstrate that pregnancy in older individuals is associated with increased risks of adverse pregnancy outcomes-for both the pregnant patient and the fetus-that might differ from those in a younger pregnant population, even in healthy individuals with no other comorbidities. There are several studies that suggest advancing age at the time of pregnancy is associated with greater disparities in severe maternal morbidity and mortality. This document seeks to provide evidence-based clinical recommendations for minimizing adverse outcomes associated with pregnancy with anticipated delivery at an advanced maternal age. The importance and benefits of accessible health care from prepregnancy through postpartum care for all pregnant individuals cannot be overstated. However, this document focuses on and addresses the unique differences in pregnancy-related care for women and all those seeking obstetric care with anticipated delivery at age 35 years or older within the framework of routine pregnancy care. This Obstetric Care Consensus document was developed using an a priori protocol in conjunction with the authors listed above. BACKGROUND PurposeCenters for Disease Control and Prevention (CDC) data from 2020 demonstrate the continued upward trend in the mean age of pregnant individuals in the United States. Nearly 19% of all pregnancies and 11% of all first pregnancies in the United States were in women aged 35 years and older (1). The mean age of women having their first birth in 2020 was 27.1 years compared with 21.4 years in 1970 (1, 2). This trend is not unique to the United States. Globally there has been a trend toward initiating pregnancy later, with most countries noting an increasing age at first pregnancy (3, 4), thereby supporting the importance of addressing the risks associated with pregnancy later in life. Observational studies demonstrate that pregnancy in older individuals is associated with increased risks of adverse pregnancy outcomes-for both the pregnant patient and the fetus-that might differ from a younger pregnant population, even in healthy individuals with no other comorbidities.This document seeks to provide evidence-based clinical recommendations for minimizing adverse outcomesThe American College of Obstetricians and Gynecologists (ACOG) reviews its publications regularly; however, its publications may not reflect the most recent evidence. A reaffirmation date is included in the online version of a document to indicate when it was last reviewed. The current status and any updates of this document can be found on ACOG Clinical at acog.org/lot. This information is designed as an educational resource to aid clinicians in providing obstetric and gynecologic care, and use of this information is voluntary. This information should not be considered as inclusive of all proper treatments or methods of care or as a statement ...

The Effect of 2016 Chinese second-child policy and different maternal age on pregnancy outcomes in Hebei Province, China

“…Women with AMA may have an increased risk for maternal and infant complications during pregnancy including: preeclampsia (PE), gestational diabetes mellitus (GDM), postpartum hemorrhage (PPH), fetal growth restriction (FGR), placental abruption, and preterm birth [ 3 , 9 – 11 ]. In addition, a systematic review and meta-analysis showed that AMA was associated with an increased risk of cesarean section [ 4 , 12 ], and stillbirth [ 5 , 13 ]. In this context, we aimed to evaluate the effect of the 2016 Chinese second child policy and different maternal ages on adverse perinatal outcomes in Hebei Province China from 2013 to 2021.…”