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Original article

Vol. 146 No. 3132 (2016)

Postponed pregnancies and risks of very advanced maternal age

  • Christian Haslinger
  • Bernhard Stoiber
  • Federica Capanna
  • Marie-Kristin Schäffer
  • Roland Zimmermann
  • Leonhard Schäffer
Cite this as:
Swiss Med Wkly. 2016;146:w14330


QUESTIONS UNDER STUDY: To evaluate pregnancy outcome in pregnant women aged ≥45 years, termed very advanced maternal age (VAMA).

METHODS: We retrospectively compared the outcome of pregnancies in VAMA patients with controls aged 30 years at time of delivery. Subgroups of singleton and multiple pregnancies were also analysed. Incidences of maternal and fetal adverse outcomes were measured. Statistical significance was set at p <0.05. Odds ratios (ORs) were adjusted where necessary.

RESULTS: One hundred and twenty-seven VAMA pregnancies and 2066 control pregnancies of women aged 30 years were analysed. VAMA pregnancies had a higher rate of maternal complications such as gestational hypertension (3.9% vs 0.6%; OR 6.5), preeclampsia (14.2% vs 3.0%; OR 5.4, adjusted OR 4.4) and gestational diabetes (12.6% vs 3.6%; OR 3.8). Likewise, increased need for blood transfusion (3.2% vs 0.7%; OR 4.8, adjusted OR 4.4) and prolonged hospitalisation >7 days (37.8% vs 15.1%; OR 3.42) was found. Infant complications such as prematurity (44.9% vs 16.2%; OR 4.2) and low birthweight <5th percentile (11.0% vs 5.6%; OR 2.1) were also increased.

CONCLUSION: Pregnant women of very advanced maternal age (≥45 years) have significantly increased maternal and fetal risks. Women postponing pregnancy or planning a pregnancy in very advanced age should be informed about these risks, in particular before artificial reproductive technologies are applied or “social freezing”.


  1. Martin JA, Hamilton BE, Ventura SJ, Osterman MJ, Mathews T. Births: final data for 2011. Natl Vital Stat Rep. 2013;62:1–69, 72.
  2. Miller DA. Is advanced maternal age an independent risk factor for uteroplacental insufficiency? Am J Obstet Gynecol. 2005;192:1974–1980; discussion 1980–1982. doi:10.1016/j.ajog.2005.02.050
  3. Balayla J, Azoulay L, Assayag J, Benjamin A, Abenhaim HA. Effect of maternal age on the risk of stillbirth: a population-based cohort study on 37 million births in the United States. Am J Perinatol. 2011;28:643–50. doi:10.1055/s-0031-1276739
  4. Canterino JC, Ananth CV, Smulian J, Harrigan JT, Vintzileos AM. Maternal age and risk of fetal death in singleton gestations: USA, 1995–2000. J Matern Fetal Neonatal Med. 2004;15:193–7. doi:10.1080/14767050410001668301
  5. 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;203:558.e1–7. doi:10.1016/j.ajog.2010.07.039
  6. Simchen MJ, Yinon Y, Moran O, Schiff E, Sivan E. Pregnancy outcome after age 50. Obstet Gynecol. 2006;108:1084–8. doi:10.1097/
  7. Dildy GA, Jackson GM, Fowers GK, Oshiro BT, Varner MW, Clark SL. Very advanced maternal age: pregnancy after age 45. Am J Obstet Gynecol. 1996;175:668–74.
  8. Callaway LK, Lust K, McIntyre HD. Pregnancy outcomes in women of very advanced maternal age. Aust N Z J Obstet Gynaecol. 2005;45:12–6. doi:10.1111/j.1479-828X.2005.00333.x
  9. Glasser S, Segev-Zahav A, Fortinsky P, Gedal-Beer D, Schiff E, Lerner-Geva L. Primiparity at very advanced maternal age (≥45 years). Fertil Steril. 2011;95:2548–51. doi:10.1016/j.fertnstert.2011.02.031
  10. Beemsterboer SN, Homburg R, Gorter NA, Schats R, Hompes PG, Lambalk CB. The paradox of declining fertility but increasing twinning rates with advancing maternal age. Hum Reprod. 2006;21:1531–2. doi:10.1093/humrep/del009
  11. Bundesamt für Statistik Schweiz. Lebendgeburten nach Alter der Mutter 1970–2013. 2014.
  12. Carolan MC, Davey M-A, Biro M, Kealy M. Very advanced maternal age and morbidity in Victoria, Australia: a population based study. BMC Pregnancy Childbirth. 2013;13:80. doi:10.1186/1471-2393-13-80
  13. Jacobsson B, Ladfors L, Milsom I. Advanced maternal age and adverse perinatal outcome. Obstet Gynecol. 2004;104:727–33. doi:10.1097/