Maternal age-specific fetal loss rates in Down syndrome pregnancies.
OBJECTIVE
Pregnancies affected by Down syndrome (DS) have a greater risk of spontaneous fetal loss than those that are unaffected. In this article, we investigate the relationship between maternal age and the risk of spontaneous fetal loss in DS pregnancies.


METHODS
Fetal loss at different maternal ages were estimated by survival analysis using follow-up of 5177 prenatally diagnosed cases. The maternal age effect on loss rate was subsequently confirmed by a re-analysis of published comparisons of the maternal age-specific prevalence of DS at different gestational ages.


RESULTS
The average fetal loss rate between the time of chorionic villus sampling (CVS) and term was 32% (95% CI: 26-38), increasing from 23% (95% CI: 16-31) for women aged 25 to 44% (33-56) for women aged 45. The average fetal loss rate between the time of amniocentesis and term was 25% (21-31), increasing from 19% (14-27) to 33% (26-45) across the same age range.


CONCLUSIONS
The fetal loss rate in DS pregnancies increases with maternal age, and this has consequences when estimating the live birth prevalence of DS in the presence of prenatal diagnosis and termination, and when assessing the performance of prenatal screening techniques.
Savva
George M
GM
Centre for Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, UK.
Morris
Joan K
JK
Mutton
David E
DE
Alberman
Eva
E
D037881:Aborted Fetus; D000022:Abortion, Spontaneous / Q000453:epidemiology*; D000328:Adult; D000649:Amniocentesis / Q000706:statistics & numerical data; D015193:Chorionic Villi Sampling / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D004314:Down Syndrome / Q000175:diagnosis / Q000196:embryology* / Q000401:mortality*; D005260:Female; D005865:Gestational Age; D006801:Humans; D008423:Maternal Age; D008875:Middle Aged; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000379:methods; D012307:Risk Factors; D015996:Survival Rate