Pregnancy in the Older Woman

Abstract

In industrialised countries worldwide women are delaying childbearing. In fertility and maternity terms, those women aged 35 years and older are considered to be of an advanced age. By this time there are usually dramatic reductions in both the fecundity rates for spontaneous conception and the success rates with assisted conception. These declines are thought to be mainly due to oocyte ageing and the established success of oocyte donation from younger individuals to older recipients supports this. Of those who conceive at an advanced maternal age there is a higher likelihood of aneuploidy (assuming conception with their own oocytes), hypertensive and other medical disorders, Caesarean birth and maternal mortality. However, most of the complications arising with advanced maternal age are caused by age-related confounding variables and older premenopausal women in good health do not require special attention. The data on perinatal mortality rates are encouraging and in the absence of congenital abnormalities are probably not much increased, if at all, in older mothers. For postmenopausal women pregnancy is now possible with oocyte donation. However, these individuals have a significantly higher likelihood of cardiovascular ageing and should be considered at increased risk of vascular complications during pregnancy.