For Immediate Release:
January 4, 1999
CONTACT:
Carole Gan
(916) 734-9047
pgr: (916) 762-2089
FIRST CHILDBIRTH AT AGE 40 IS LARGELY SAFE, BUT CAESAREAN RATE IS DOUBLED AND COMPLICATIONS ARE UP AS MUCH AS TENFOLD
Sacramento, Calif. - One of the largest studies to date tracking pregnancy outcomes in women over the age of 40 shows that first childbirth in the fifth decade of life is largely safe and is increasing in frequency, especially in Caucasian women. However, the incidence of maternal high blood pressure and diabetes as underlying conditions, as well as virtually every other complication of pregnancy - from placenta previa to gestational diabetes and pre-eclampsia - is much more common in all women who deliver at age 40 and beyond. These are among the findings of a two-year study of 24,032 childbirths in the state of California in 1992 and 1993, published in the January issue of the journal Obstetrics and Gynecology. "Our study shows that the vast majority of women who delay childbirth until age 40 have babies who are just as healthy as those born to women aged 20 to 29," says William M. Gilbert, chief of the Division of Maternal-Fetal Medicine and Prenatal Diagnosis at the UC Davis School of Medicine and Medical Center. "And although a variety of complications are increased in the older first-time mother, this information should not deter women from considering pregnancy at an advanced maternal age and should help high-risk obstetricians better counsel and monitor women to produce the best possible results."
Of the 1,160,000 women who delivered babies in civilian hospitals in California from January 1, 1992 through December 31, 1993, Gilbert compared hospital records, discharge summaries and birth certificate demographics for 24,032 women who delivered at age 40 and over, and for 625,525 women whose deliveries occurred between the ages of 20 and 29. The older group of women included 4,777 who had never delivered babies (nulliparous) and 19,255 who had previously given birth (multiparous). Older women represented 2.1 percent of the total population, a twofold increase from 10 years ago, with Caucasian women representing the majority (64 percent) of the women delaying first childbirth until age 40.
"First-time mothers who deliver at age 40 and beyond are twice as likely to have a Caesarean section than first-time mothers aged 20-29," says Gilbert. "The increase in C-sections is largely due to the increase in complications of labor and pregnancy."
For example, older first-time mothers had a tenfold increase in placenta previa, fourfold increase in gestational diabetes, 80 percent increase in pre-eclampsia (high blood pressure during pregnancy), 70 percent increase in malpresentation of the fetus (i.e., breech birth), 50 percent increase in fetal disproportion, 48 percent increase in abnormal forces of labor (i.e., inadequate contractions), and a 30 percent increase in prolonged labor. In addition, these older women were five times more likely to have chronic high blood pressure and three times as likely to have diabetes as an underlying health condition before pregnancy than their younger counterparts.
Older multiparous women showed similarly higher rates of complications as compared to younger multiparous women, including fetal disproportion (a 60 percent increase), prolonged labor (a 50 percent increase) and malpresentation of the fetus (a 40 percent increase). These older women also had a threefold increase in pre-eclampsia and in placenta previa. This population of women was also nine times more likely to have chronic high blood pressure and 6.4 times more likely to be diabetic than their younger counterparts.
"Women who delay pregnancy until later in life are often well-educated professionals who visit their doctor for preconception counseling," says Gilbert. "They want to know the risks associated with pregnancy later in life and want as little intervention as possible. Our study quantifies the various complications associated with childbirth later in life, and helps us give our patients a better idea of what they can realistically expect."
Consider Ann Shuman, a dedicated registered nurse for over 15 years who had her first child at age 40 and her second six weeks ago at age 43. While she had problem-free pregnancies, her first child was delivered by C-section because of fetal distress and failure of her cervix to dilate fully. For the birth of her second child, Daniel, she and her physician discussed her options. And with a 70 percent chance of having similar abnormalities of labor, Ann opted to schedule a C-section and worked until the day before her scheduled operation.
"I've led a very active life," says Ms. Shuman. "I've pursued a graduate degree while working full time and have traveled to more than 20 countries. I wasn't ready to start a family until later in life. And although I have been active in sports and stay in a good condition, I didn't want to increase the risk for my baby by trying for a vaginal delivery the second time around. It made more sense to have a C-section."
Ann's situation is a common one. According to Gilbert, women who deliver at age 40 and beyond are more likely to have neonatal complications, with a 60 percent increase in birth asphyxia, 90 percent increase in fetal growth restriction, and 90 percent increase in intraventricular hemorrhage. "While all of these complications were increased, the vast majority of newborns were normal."