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RCOG statement on later maternal age

News 15 June 2009

There is a growing trend in the UK for childbearing to occur at a later time in women’s lives.1 This trend is reflected in countries in Western Europe,2 in Australia,3 New Zealand,4 Canada5 and the United States of America.6

The reasons motherhood is postponed are manifold and complex. Common reasons include: the availability of safe, effective contraception; to pursue further education; to build a career; to achieve financial independence, and to be in a stable relationship with a supportive partner.

Women should be supported in their decisions of whether to have children or not and when to plan childbearing. However, they also need to know how fertility and pregnancy outcomes change with age. Biologically, the optimum period for childbearing is between 20–35 years of age. Most women will get pregnant. Within a year, 75% of women aged 30 and 66% of women aged 35 will conceive naturally and have a baby.7 After this, it is increasingly difficult to fall pregnant, and the chance of miscarriage rises. At this stage, women may resort to fertility treatment, sometimes with multiple embryo implantations to improve their pregnancy success rate. Figures show that the live birth rate for women aged less than 35 undergoing IVF is 31%. This rate falls below 5% for women over 42 years of age.8 In some cases, older women have travelled abroad to countries with lax regulations for IVF treatment, to improve their chances of becoming pregnant by acquiring donor eggs from younger women.

Most pregnancies will result in a healthy baby. However, adverse pregnancy outcomes also rise with age, and women over 40 are considered to be at a higher risk of pregnancy complications.9–20 For these reasons, the Royal College of Obstetricians and Gynaecologists (RCOG) and doctors would encourage women to consider having families during the period of optimum fertility.

There is an urgent need for better public information on the issues surrounding later maternity. Women should be supported, rather than constrained, in their life choices. However, both women and society need to be aware of the possible problems that older mothers may encounter. There may also be factors facing the child which need to be addressed.

As more women have babies at a later age, there are implications for the way that such women are cared for in the NHS. Later maternal age is an emerging public health issue and organisations such as the RCOG, NICE and the Centre for Maternal and Child Enquiries (CMACE) must work together with the Department of Health to tackle these new challenges. More research into the social consequences of later maternity is needed to help inform healthcare policy.

Notes

In response to growing concern over the rising incidence of later maternal age in the UK, the RCOG convened a Study Group to discuss the issues.

The RCOG has also recorded a podcast with some of the members of the study group. To listen to the podcast, please click here.

References

1. Statistical Bulletin for Births and deaths in England and Wales 2008, Office for National Statistics.

2. Atlas of Health in Europe, 2nd edition, 2008, World Health Organization, http://www.euro.who.int/en/publications/abstracts/atlas-of-health-in-europe,-2nd-edition-2008

3. Births 2007, Australian Bureau of Statistics, http://www.ausstats.abs.gov.au/ausstats/subscriber.nsf/0/DC32A0611500BAA0CA2574EF00142139/$File/33010_2007.pdf

4. Demographic Trends 2007, Statistics NZ, http://www.stats.govt.nz/browse_for_stats/population/estimates_and_projections/demographic-trends-2007.aspx

5. Tracey Bushnik and Rochelle Garner, The Children of Older First-time Mothers in Canada: Their Health and Development, September 2008, Statistics Canada, http://www.statcan.gc.ca/pub/89-599-m/89-599-m2008005-eng.pdf

6. National Vital Statistics Reports, Births: Final data for 2006, Centre for Disease Control and Prevention, Vol. 57, No. 7, January 2009, http://www.cdc.gov/nchs/data/nvsr/nvsr57/nvsr57_07.pdf

7. Leridon H. Can assisted reproductive technology compensate for the natural decline in fertility with age? A model assessment. Human Reproduction 2004;19(7):1548.

8. Human Fertilisation and Embryology Authority, Facts and Figures 2006: Fertility Problems and Treatment, October 2008.

9. Khoshnood B. Bouvier-Colle MH. Leridon H. Blondel B. Impact of advanced maternal age on fecundity and women's and children's health, Journal de Gynecologie, Obstetrique et Biologie de la Reproduction. 37(8):733-47, 2008 Dec.

10. Delpisheh A. Brabin L. Attia E. Brabin BJ. Pregnancy late in life: a hospital-based study of birth outcomes. Journal of Women's Health. 17(6):965-70, 2008 Jul-Aug.

11. Donoso E. Carvajal JA. Maternal, perinatal and infant outcome of spontaneous pregnancy in the sixth decade of life. Maturitas. 59(4):381-6, 2008 Apr 20.

12. Hoffman MC. Jeffers S. Carter J. Duthely L. Cotter A. Gonzalez-Quintero VH. Pregnancy at or beyond age 40 years is associated with an increased risk of fetal death and other adverse outcomes. American Journal of Obstetrics & Gynecology. 196(5):e11-3, 2007 May.

13. Luke B. Brown MB. Elevated risks of pregnancy complications and adverse outcomes with increasing maternal age. Human Reproduction. 22(5):1264-72, 2007 May.

14. Simchen MJ. Yinon Y. Moran O. Schiff E. Sivan E. Pregnancy outcome after age 50, Obstetrics & Gynecology. 108(5):1084-8, 2006 Nov.

15. Joseph KS. Allen AC. Dodds L. Turner LA. Scott H. Liston R. The perinatal effects of delayed childbearing. Obstetrics & Gynecology. 105(6):1410-8, 2005 Jun.

16. Orji EO. Ndububa VI. Obstetric performance of women aged over forty years. East African Medical Journal. 81(3):139-41, 2004 Mar.

17. Temmerman M. Verstraelen H. Martens G. Bekaert A. Delayed childbearing and maternal mortality. European Journal of Obstetrics, Gynecology, & Reproductive Biology. 114(1):19-22, 2004 May 10

18. Roman H. Robillard PY. Julien C. Kauffmann E. Laffitte A. Gabriele M. Marpeau L. Barau G. Pregnancy beyond age 40 in 382 women: a retrospective study in Reunion Island. Journal de Gynecologie, Obstetrique et Biologie de la Reproduction. 33(7):615-22, 2004 Nov.

19. Jacobsson B. Ladfors L. Milsom I. Advanced maternal age and adverse perinatal outcome. Obstetrics & Gynecology. 104(4):727-33, 2004 Oct.

20. Salihu HM. Shumpert MN. Slay M. Kirby RS. Alexander GR. Childbearing beyond maternal age 50 and fetal outcomes in the United States, Obstetrics & Gynecology. 102(5 Pt 1):1006-14, 2003 Nov.