Advanced maternal age

Delayed childbearing is a growing trend in developed countries. Between 1989 and 2009, the number of live births to UK women over 40 almost trebled. This accelerating demographic shift is of major clinical and public health concern, because advanced maternal age has consistently been associated with adverse pregnancy outcomes. Current evidence suggests a strong association with increased risk of miscarriage, ectopic pregnancy and stillbirth. Most studies also report elevated maternal morbidity resulting from hypertensive disorders and gestational diabetes. Many questions remain unanswered regarding the underlying mechanisms. The contribution of age per sé versus co-morbidities is unclear, as is the age threshold at which increased risks become significant. Despite the increased risks, there are potential psychological and social advantages to delaying childbirth and absolute numbers of complications are small. Further studies are required to develop effective strategies to reduce poor outcomes and provide optimal care for pregnant women of advanced age.