As more women give birth over the age of 35, public health messages about contraception need to be put into perspective with information on family planning and age-related reproductive risk, says a new review in The Obstetrician & Gynaecologist (TOG) today.
The mean age of childbearing has risen over the last 40 years from 23 in 1968 to 29.3 in 2008. At the age of 25 just 5% of women take longer than a year to conceive and this rises to 30% in women aged 35.
Older women are at greater risk of miscarriage and other pregnancy complications states the review. They are more likely to have a pregnancy affected by genetic/chromosomal abnormalities, obstetric complications such as gestational diabetes, pre-eclampsia, placenta praevia, caesarean section, fetal growth restriction, premature birth and the risk of stillbirth.
The review also highlights the fact that men are also affected by reproductive ageing and cites one study looking at the link between male age and the time to pregnancy. For men below the age of 25 the average length of time it took for their partners to get pregnant was 4.6 months compared with nearly two years for men over the age of 40.
There has been a significant rise in the incidence of multiple pregnancy, both spontaneous and induced by assisted reproduction technology (ART). Women over 40 are the group with the highest proportion of multiple pregnancies.
The review recommends that simple messages about contraception, normal cycles, the dangers of sexually transmitted diseases and age-related risks should be reinforced through schools, family planning and sexual health clinics and in the media.
David Utting, Specialty Registrar in Obstetrics and Gynaecology at Kingston Hospital NHS Trust and co-author of the review said:
“Clear facts on fertility need to be made available to women of all ages to remind them that the most secure age for childbearing remains 20-35. However women and doctors should remain vigilant to prevent unplanned and unwanted pregnancies.”
TOG’s Editor –in-Chief, Jason Waugh said:
“This review highlights the problems associated with later maternal age. There are a number of reasons why women are leaving it later to start a family, for example, career concerns, financial reasons and finding a suitable partner. However, women should be given more information on the unpredictability of pregnancy and the problems that can occur in older mothers.”
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The Obstetrician & Gynaecologist (TOG) is published quarterly and is the Royal College of Obstetricians and Gynaecologists’ (RCOG) medical journal for continuing professional development. TOG is an editorially independent, peer reviewed journal aimed at providing health professions with updated information about scientific, medical and clinical developments in the specialty of obstetrics and gynaecology.
Utting D, Bewley S. Family planning and age-related reproductive risk. The Obstetrician & Gynaecologist 2011;13:35–41.