According to birth reports issued by the National Center for Health Statistics, U.S. Department of Health and Human Services, the birth rate for women at 35-39 increased from 2.1 births per 1,000 women in 1970 to 4.7 in 1986 (1989), 38.3 in 1999 (2001), 43.8 in 2003 (2005), and 47.3 in 2006 (2007). It is reasonable to expect the trend of conceiving at an older age to keep rising in the future. I feel the need to be knowledgeable about delaying childbearing, which is relevant to the general women population nowadays. My research question is: What are the pregnancy outcomes and experiences of women who gave births after 35 (advanced maternal age)? By answering this question, I hope that I can better support this growing group of women including my older relatives and friends.

Older women were more often classified as having “high-risk” pregnancy at initial appointment, and were more likely to have serum screening and amniocentesis (Windridge & Berryman, 1999). In an Australian qualitative study of first mothering over 35 years, the majority of participated women were well-educated (tertiary degree/diploma) career women. Most of these women had decided to delay childbearing to pursue their career goals or other plans (Carolan & Nelson, 2005). In another study which explored health concerns and health-promotion behaviors of pregnant women aged ≥ 35 years, 78% of participants were college educated (Viau, Padula, & Eddy, 2002). So these women were more likely than younger mothers to independently reach for health information, and gained perceptions that they were at risk for adverse pregnancy outcomes.

Women age 35 and over were more likely to have infants with lower birth weights, give birth before 37 week gestation, have multiple birth, and stillborn, compared to women age under 35 (Tough, Newburn-Cook, Johnston, Svenson, Rose, & Belik, 2002). Tough et al. (2002) found that maternal age did not influence the small-for-gestational-age (SMA) rates and suggested that maternal complications played a role in preterm delivery among women aged ≥ 35. In a later study, Newburn-Cook and Onyskiw (2005) did a systematic review to determine whether or not older maternal age is a risk factor for preterm birth and fetal growth restriction. They found that maternal age affected both gestational age and birth weight. However, earlier study of Windridge and Berryman (1999) found no association between maternal age and gestational age at delivery. Another study reported similar SGA and large-for-gestational-age birth rates among women of very advanced maternal age and of general population (Callaway, Lust, & McIntyre, 2005).

Interestingly, Windridge and Berryman discovered that infants who were born to women age 35 and older were more likely to have 1-minute Apgar score of 8 or over. Few maternal age effects were noted in the medical records of these women, so they should have “no objective reasons to have had more serious concerns for their babies’ safety, because of their own age alone, than women in younger age group” (1999).

So there are conflicting conclusions among studies about whether maternal age is linked to gestational age, and pregnancy outcomes. The disparate findings are probably a result of differences in the inclusion criteria. Those studies that reported positive pregnancy outcomes tended to recruit older women who had good general health, uncomplicated pregnancy, and a chromosomally normal fetus.  Newburn-Cook and Onyskiw suggested more studies with adequate control for age-dependent confounders needed to be conducted to determine whether maternal age caused an independent and direct effect on birth outcomes (2005).

There was a significant difference in Caesarean delivery rates between the group of women aged 45 or greater (49%) and the 20-29 year age group (23%) (Callaway, Lust, & McIntyre, 2005). However, in an earlier study, Windridge and Berryman found no age or parity associations with Caesarean deliveries (1999). The likelihood of women at age 45 or over undergoing Caesarean section might depend on whether they could conceive naturally, as this ability possibly was associated with good physical health. The Caesarean section rate was 44.6% in the group of women who conceived naturally, as opposed to 82% of women who required assisted reproductive technology (Callaway, Lust, & McIntyre, 2005).

Carolan (2005) interviewed and analyzed the pregnancy experiences of 22 first-time mothers aged 35 and over. The findings were grouped into five sequential themes: “the project” during pregnancy and prior to conception, “the nightmare of early mothering” 1-4 weeks postpartum, progress with difficulty and uncertainty 1-4 months postpartum, “giving in”/realizing/”finding my own way” 4-6 months postpartum, and “feeling like a mother” 6-8 months postpartum. Most women had tremendously prepared for their conception and pregnancy experiences by gathering information and trying to be as knowledgeable about their health and the available supportive resources as possible to ensure the best pregnancy outcomes. Despite their extensive planning to get pregnant, several women did not prepare supplies for the infant, such as a room, a pram or a cot, as they were unconfident about their infant survival. Younger women also expressed concerns about something might go wrong with the baby (Robb, Alder, & Prescott, 2005).

Robb et al. reported no relationship between maternal age and emotional experience in primigravidas, but significant differences might exist between individual women (2005). In another report, women aged over 35 years were more likely than younger women to have concerns for their babies’ safety during labor, more likely to express definite satisfaction with the way staff dealt with arising problems, and less likely to blame the staff to make their pain worse ( Windridge & Berryman, 1999). In contrast with common understandings of advanced mothers as having high anxiety and depression levels postpartum, of 22 women in Carolan & Nelson’s study, only one woman experienced mild postnatal depression (2007).

Although the studies of advanced maternal age pregnancy continue to generate controversy, researchers have shown that the differences in pregnancy outcomes and experiences among older and younger women are less significant than common understandings. The general health of a woman when getting pregnant seems to play an important role as one of the predictors for pregnancy outcomes (such as preterm birth and fetal growth restriction) rather than her age alone. More research needs to be conducted to confirm this implication. As the majority of older pregnant women are well-educated career women and proactive health seekers, nurses need to be knowledgeable about health resources and their accuracy to provide adequate answers to health concerns, establish trust and better support advanced maternal age women.

References

Callaway, L.K., Lust, K., & McIntyre, H.D. (2005). Pregnancy outcomes in women of very advanced maternal age. Australian and New Zealand Journal of Obstetrics and Gynaecology 45, 12-16. Retrieved October 1, 2008, from CINAHL database.

Carolan, M. (2005, October). Doing it properly: The experience of first mothering over 35 years. Health Care for Women International, 26(9), 764-787. Retrieved October 1, 2008, from CINAHL database.

Carolan, M., & Nelson, S. (2007). First mothering over 35 years: Questioning the association of maternal age and pregnancy risk. Health Care for Women International, 28 (6), 534-555. Retrieved October 1, 2008, from CINAHL database.

National Center for Health Statistics (1989). Trends and variations in first births to older women, 1970-86 (DHHS Publication No. (PHS) 89-1925). Hyattsville, Md. US Department of Health and Human Services.

National Center for Health Statistics (2001). Birth: Final Data for 1999. DHHS Publication No. (PHS) 2001-1120). Hyattsville, Md. US Department of Health and Human Services.

National Center for Health Statistics (2005). Birth: Final Data for 2003. Hyattsville, Md. US Department of Health and Human Services, 54 (2).

National Center for Health Statistics (2007). Births: Preliminary Data for 2006. Hyattsville, Md. US Department of Health and Human Services, 56 (7).

Newburn-Cook, C., & Onyskiw, J. (2005, October). Is older maternal age a risk factor for preterm birth and fetal growth restriction? A systematic review. Health Care for Women International, 26(9), 852-875. Retrieved October 02, 2008, from CINAHL database.

Robb, F.V., Alder, E.M., & Prescott, R.J. (2005). Do older primigravidas differ from younger primigravidas in their emotional experience of pregnancy? Journal of Reproductive and Infant Psychology, 23 (2), 135-141. Retrieved October 1, 2008, from Cumulative Index to Nursing and Allied Health (CINAHL) database.

Tough, S.C., Newburn-Cook, C., Johnston, D.V., Svenson, L.W., Rose, S., & Belik, J. (2002). Delayed childbearing and its impact on population rate changes in lower birth weight, multiple birth, and preterm delivery. Pediatrics, 109 (3), 399-403. Retrieved October 1, 2008, from Cumulative Index to Nursing and Allied Health (CINAHL) database.

Viau, P.A., Padula, C.A., & Eddy, B. (2002). An exploration of health concerns and health-promotion behaviors in pregnant women over age 35. MCN The American Journal of Maternal/Child Nursing, 27 (6), 328-334.

Windridge, K., & Berryman, J. (1999, March). Women’s experiences of giving birth after 35. Birth: Issues in Perinatal Care, 26(1), 16-23. Retrieved October 30, 2008, from CINAHL database.