Women giving birth at an advanced age and their children : obstetric and neonatal outcomes, health and social support

Abstract: Postponement of parenthood is an increasing trend in Western societies today. Delaying motherhood to a later time in life increases the use of assisted reproduction technology (ART), and the risk for adverse obstetric and neonatal outcomes. Along with postponement of motherhood, the number of women requesting treatment to become solo mothers has increased. The aim of the present thesis was to evaluate the obstetric outcomes and morbidity among mothers and their children, and the association of these outcomes with advanced maternal age, single status and the use of ART.Data from the Medical Birth Register (MBR) pertaining to pregnancy, childbirth and neonatal outcomes were retrieved. In total, 37,558 mothers aged ≥ 40 years formed the index group, which was divided into two subgroups, mothers 40-44 years of age and mothers aged ≥ 45, and compared to a control group of 71,472 mothers age ≤ 39 years (Study I). To investigate the mothers’ morbidity up to five years prior to, and up to five years after childbirth (study II), and their children’s morbidity up to five years of age (study III), data from the MBR and the National Patient Register (NPR) on Swedish women giving birth during 2007-2008 and their children were retrieved. The index group comprised 8203 mothers ≥ 40 years, and the control group comprised 15,569 mothers ≤ 39 years and their children. Diagnosis and number of inpatient and outpatient visits in hospital specialized care units were studied as well as mode of conception i.e., using ART or spontaneously conceived. Civil status, defined as single or cohabiting/married, was also investigated. In study IV, 207 single women accepted for treatment with donor sperm were compared with 256 cohabiting women treated with IVF with their own gametes. The women’s sociodemographic data, their descriptions of their social networks, as well as self-assessment of their social support were investigated through a questionnaire.The results showed an increased risk for an adverse pregnancy outcome in older mothers and the children were more often born preterm, with low birthweight or were small-for-gestational age. In addition, the older mothers had more often used ART, and were more likely to be single, to use less tobacco and to have a higher BMI compared to younger women. Also, the results indicated an increased risk for morbidity among older women, both before and after pregnancy, compared to the younger women. Women of both age groups who had used ART to conceive also had higher morbidity than women who conceived spontaneously. Among mothers and children, morbidity was significantly higher in both mother and child when the mother was single at the time of pregnancy. Children born to older mothers were more often diagnosed with conditions diagnosed in the perinatal period and with congenital malformations, deformations and chromosomal abnormalities compared with children born to younger mothers.Solo women who were to be treated with sperm donation were older compared to cohabiting women. Solo women more often had a higher level of education and full-time employment, and were in a profession with a higher salary compared with cohabiting women. Solo women expected to receive much help, primarily from a parent but also from friends.The significantly increased risk for adverse outcomes in pregnancy and childbirth associated with advanced maternal age and the diagnoses their children were more likely to receive during the first five years of life is perhaps small but will have an impact on the individual. Single parenthood is historically associated with social and economic disadvantages. The results are in part promising concerning the sociodemographic characteristics of solo-mothers-to-be and their high levels of perceived social support. However, the potential risk for long-term morbidity in children born to advanced aged mothers, in combination with maternal single civil status and use of ART, is important to follow closely to provide proper and adequate support and health care to these mothers and their children.

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