The older obstetric patient

The past few decades have seen a changing demographic phenomenon with many women electing to delay childbearing. With changes in societal norms, women have sought to achieve their educational and career aspirations before embarking on motherhood. Assisted reproduction techniques, including ovum donation, have increased the options for women choosing this delay. This article aims to review recent published studies to understand the risks associated with delaying childbearing – both maternal and fetal. The review includes papers published since the last update and looks at complications of early pregnancy, including ectopic pregnancy, miscarriage and chromosomal abnormality. It also reviews maternal morbidity, including complications of hypertensive diseases and diabetes. It aims to seek both advantages and disadvantages to delaying childbearing, so that both patient and obstetrician are fully informed. In previous reviews the authors have been positive with regards to the risks of delaying childbearing. However, the burden of evidence now suggests that pregnancy in this age group has higher risks – to both the mother and her fetus. This increased risks, however, must be weighed against the potential advantages of delaying childbearing – both financial and emotional, and must also be considered in the context of the small absolute numbers of complications. The majority of older mothers have low risk and uneventful pregnancies. With good antenatal and obstetric care it should be possible to achieve obstetric outcomes for many older mothers similar to those of younger mothers.