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August 19, 1992, Vol 268, No. 7 >
ARTICLE | August 19, 1992

Delayed Childbearing and Risk of Adverse Perinatal Outcome: Title and subTitle BreakA Population-Based Study FREE

Sven Cnattingius, MD; Michele R. Forman, PhD; Heinz W. Berendes, MD, MHS; Leena Isotalo, MD
[+] Author Affiliations

Reprint requests to Division of Epidemiology, Statistics and Prevention Research, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892 (Dr Berendes).


JAMA. 1992;268(7):886-890. doi:10.1001/jama.1992.03490070068044
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References

Objective.  —To investigate the effect of advancing maternal age on pregnancy outcome among healthy nulliparous women, after adjustment for demographic characteristics, smoking, history of infertility, and other medical conditions.

Design.  —A population-based cohort study was conducted with prospectively collected data from the Swedish Medical Birth Register.

Patients.  —Nulliparous Nordic women (N=173715), aged 20 years and above, who delivered single births at Swedish hospitals from 1983 through 1987.

Outcome Measures.  —Late fetal and early neonatal death rates; rates of very low birth weight (VLBW, <1500 g), moderately low birth weight (MLBW, 1500 through 2499 g), very preterm delivery (≤32 weeks), moderately preterm delivery (33 through 36 weeks), and small-for-gestational-age (SGA) infants (<-2 SDs).

Results.  —Compared with women aged 20 to 24 years, women aged 30 to 34 years had significantly higher adjusted odds ratios (ORs) of late fetal deaths (OR=1.4); VLBW (OR=1.2); MLBW (OR=1.4); very preterm birth (OR=1.2); and SGA infants (OR=1.4). Among women aged 35 to 39 years, the adjusted OR was significantly higher for VLBW (OR=1.9); MLBW (OR=1.7); very preterm birth (OR=1.7); moderately preterm birth (OR=1.2); and SGA infants (OR=1.7). Among women 40 years old and older, the adjusted OR was significantly higher for VLBW (OR=1.8); MLBW (OR=2.0); very preterm birth (OR=1.9); moderately preterm birth (OR=1.5); and SGA infants (OR=1.4).

Conclusions.  —Delayed childbearing is associated with an increased risk of poor pregnancy outcomes after adjustment for maternal complications and other risk factors.(JAMA. 1992;268:886-890)

REFERENCES

1 +
Forman MR, Meirik O, Berendes HW.  Delayed childbearing in Sweden. JAMA . 1984;;262:3135-3139.
2 +
Hansen JP.  Older maternal age and pregnancy outcome: a review of the literature. Obstet Gynecol Surv . 1986;;41:726-742.
3 +
Kane SH.  Advancing age and the primigravida. Obstet Gynecol . 1967;;29:409-414.
4 +
Kiely JL, Paneth N, Susser M.  An assessment of the effects of maternal age and parity in different components of perinatal mortality. Am J Epidemiol . 1986;;123:444-454.
5 +
Ventura SJ.  Trends and variations in first births to older mothers, 1970-86. Vital Health Stat 21 . 1989;:No. (47) .
6 +
Baldwin WH, Winquist Nord C.  Delayed childbearing in the US: facts and fictions. Popul Bull . 1984;;39:14-23.
7 +
Adams MM, Oakley GP, Marks JS.  Maternal age and birth in the 1980s. JAMA . 1982;;247:493-494.
8 +
Williams MA, Goldman MB, Mittendorf R, Monson RR.  Subfertility and the risk of low birth weight. Fertil Steril . 1991;;56:668-671.
9 +
Population Changes 1990, 3: Official Statistics of Sweden . Stockholm, Sweden: Statistics, Sweden; 1992;.
10 +
Ericson A, Eriksson M, Westerholm P, Zetterstrom R.  Pregnancy outcome and social indicators in Sweden. Acta Pediatr Scand . 1984;;73:69-74.
11 +
Cnattingius S, Ericson A, Gunnarskog J, Källén B.  A quality study of a medical birth register. Scand J Soc Med . 1990;;18:143-148.
12 +
 Swedish Standard Classification of Education. 1: Reports on Statistical Coordination [in Sweish] . Stockholm, Sweden: Statistics, Sweden; 1988;: 4.
13 +
Schlesselman JJ. Case-Control Studies: Design, Conduct, Analyses . New York, NY: Oxford University Press; 1982;:354.
14 +
SAS Institute. SAS User's Guide: Statistics: Version 6.03 . Cary, NC: SAS Institute Inc; 1989;.
15 +
SAS Institute Inc. SAS/STAT Software: CALIS and LOGISTIC Procedures, Release 6.04 . Cary, NC: SAS Institute Inc; 1990;. SAS statistical report P-200.
16 +
Niklasson A, Ericson A, Fryer JG, Karlberg J, Lawrence C, Karlberg P.  An update of the Swedish reference standards for weight, length and head circumference at birth for given gestational age (1977-81). Acta Pediatr . 1991;;80:756-762.
17 +
Lindmark G, Cnattingius S.  The scientific basis of antenatal care routines: report from a state-of-the-art conference. Acta Obstet Gynecol Scand . 1991;; 70:105-109.
18 +
Grimes DA, Gross GK.  Pregnancy outcomes in black women aged 35 and older. Obstet Gynecol . 1981;;58:614-620.
19 +
Naeye RL.  Maternal age, obstetrical complications and outcome of pregnancy. Obstet Gynecol . 1983;;61:210-216.
20 +
Barkan SE, Bracken M.  Delayed childbearing: no evidence for increased risk of low birth weight and preterm delivery. Am J Epidemiol . 1987;;125: 101-109.
21 +
Stevens-Simon C, Roghmann KJ,  Mcanarney E. Subfecundity: a prenatal risk factor for adults but not for adolescents. J Adolesc Health Care . 1990;;11:432-436.
22 +
van Noord-Zaadstra BM, Looman CW, Alsbach H, Habbema JD, te Velde ER, Karbaat J.  Delaying childbearing: effect of age on fecundity and outcome of pregnancy. BMJ . 1991;;302:1361-1365.
23 +
Tzoumaka-Bakoula C, Lekea-Karanika V, Matsaniotis NS, Golding J.  The Greek National Perinatal Survey, II: socioeconomic factors and perinatal mortality in Greece. Paediatr Perinat Epidemiol . 1989;;3:41-52.
24 +
Ventura SJ, Hendershot GE.  Infant health consequences of childbearing by teenagers and older mothers. Public Health Rep . 1984;;99:138-146.
25 +
Lin CC, Su SJ, River LP.  Comparison of associated high-risk factors and perinatal outcome between symmetric and asymmetric fetal intrauterine growth retardation. Am J Obstet Gynecol . 1991;; 164:1535-1541.
26 +
Naeye RL.  Maternal body weight and pregnancy outcome. Am J Clin Nutr . 1990;;52:273-279.
27 +
Susser M.  Maternal weight gain, infant birth weight and diet: causal consequences. Am J Clin Nutr . 1991;;53:1384-1396.
28 +
Kirtz DS, Dorchester W, Freeman RK.  Advanced maternal age: the mature gravida. Am J Obstet Gynecol . 1985;;152:7-12.
29 +
Berkowitz GS, Skrovron ML, Lapinski RH, Berkowitz RL.  Delayed childbearing and the outcome of pregnancy. N Engl J Med . 1990;;322: 659-664.

Figures

Tables

Interactive Graphics

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Forman MR, Meirik O, Berendes HW.  Delayed childbearing in Sweden. JAMA . 1984;;262:3135-3139.
2 +
Hansen JP.  Older maternal age and pregnancy outcome: a review of the literature. Obstet Gynecol Surv . 1986;;41:726-742.
3 +
Kane SH.  Advancing age and the primigravida. Obstet Gynecol . 1967;;29:409-414.
4 +
Kiely JL, Paneth N, Susser M.  An assessment of the effects of maternal age and parity in different components of perinatal mortality. Am J Epidemiol . 1986;;123:444-454.
5 +
Ventura SJ.  Trends and variations in first births to older mothers, 1970-86. Vital Health Stat 21 . 1989;:No. (47) .
6 +
Baldwin WH, Winquist Nord C.  Delayed childbearing in the US: facts and fictions. Popul Bull . 1984;;39:14-23.
7 +
Adams MM, Oakley GP, Marks JS.  Maternal age and birth in the 1980s. JAMA . 1982;;247:493-494.
8 +
Williams MA, Goldman MB, Mittendorf R, Monson RR.  Subfertility and the risk of low birth weight. Fertil Steril . 1991;;56:668-671.
9 +
Population Changes 1990, 3: Official Statistics of Sweden . Stockholm, Sweden: Statistics, Sweden; 1992;.
10 +
Ericson A, Eriksson M, Westerholm P, Zetterstrom R.  Pregnancy outcome and social indicators in Sweden. Acta Pediatr Scand . 1984;;73:69-74.
11 +
Cnattingius S, Ericson A, Gunnarskog J, Källén B.  A quality study of a medical birth register. Scand J Soc Med . 1990;;18:143-148.
12 +
 Swedish Standard Classification of Education. 1: Reports on Statistical Coordination [in Sweish] . Stockholm, Sweden: Statistics, Sweden; 1988;: 4.
13 +
Schlesselman JJ. Case-Control Studies: Design, Conduct, Analyses . New York, NY: Oxford University Press; 1982;:354.
14 +
SAS Institute. SAS User's Guide: Statistics: Version 6.03 . Cary, NC: SAS Institute Inc; 1989;.
15 +
SAS Institute Inc. SAS/STAT Software: CALIS and LOGISTIC Procedures, Release 6.04 . Cary, NC: SAS Institute Inc; 1990;. SAS statistical report P-200.
16 +
Niklasson A, Ericson A, Fryer JG, Karlberg J, Lawrence C, Karlberg P.  An update of the Swedish reference standards for weight, length and head circumference at birth for given gestational age (1977-81). Acta Pediatr . 1991;;80:756-762.
17 +
Lindmark G, Cnattingius S.  The scientific basis of antenatal care routines: report from a state-of-the-art conference. Acta Obstet Gynecol Scand . 1991;; 70:105-109.
18 +
Grimes DA, Gross GK.  Pregnancy outcomes in black women aged 35 and older. Obstet Gynecol . 1981;;58:614-620.
19 +
Naeye RL.  Maternal age, obstetrical complications and outcome of pregnancy. Obstet Gynecol . 1983;;61:210-216.
20 +
Barkan SE, Bracken M.  Delayed childbearing: no evidence for increased risk of low birth weight and preterm delivery. Am J Epidemiol . 1987;;125: 101-109.
21 +
Stevens-Simon C, Roghmann KJ,  Mcanarney E. Subfecundity: a prenatal risk factor for adults but not for adolescents. J Adolesc Health Care . 1990;;11:432-436.
22 +
van Noord-Zaadstra BM, Looman CW, Alsbach H, Habbema JD, te Velde ER, Karbaat J.  Delaying childbearing: effect of age on fecundity and outcome of pregnancy. BMJ . 1991;;302:1361-1365.
23 +
Tzoumaka-Bakoula C, Lekea-Karanika V, Matsaniotis NS, Golding J.  The Greek National Perinatal Survey, II: socioeconomic factors and perinatal mortality in Greece. Paediatr Perinat Epidemiol . 1989;;3:41-52.
24 +
Ventura SJ, Hendershot GE.  Infant health consequences of childbearing by teenagers and older mothers. Public Health Rep . 1984;;99:138-146.
25 +
Lin CC, Su SJ, River LP.  Comparison of associated high-risk factors and perinatal outcome between symmetric and asymmetric fetal intrauterine growth retardation. Am J Obstet Gynecol . 1991;; 164:1535-1541.
26 +
Naeye RL.  Maternal body weight and pregnancy outcome. Am J Clin Nutr . 1990;;52:273-279.
27 +
Susser M.  Maternal weight gain, infant birth weight and diet: causal consequences. Am J Clin Nutr . 1991;;53:1384-1396.
28 +
Kirtz DS, Dorchester W, Freeman RK.  Advanced maternal age: the mature gravida. Am J Obstet Gynecol . 1985;;152:7-12.
29 +
Berkowitz GS, Skrovron ML, Lapinski RH, Berkowitz RL.  Delayed childbearing and the outcome of pregnancy. N Engl J Med . 1990;;322: 659-664.

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