title: The oldest gravidas: a review of pregnancy risks in women over 45.
abstract: As a result of delayed childbearing and increasingly sophisticated assisted reproductive technologies, pregnancy in women aged ≥45 years is becoming more common. Women in this age-group should receive thorough preconception evaluation and counseling about their specific risks in pregnancy. Although many pregnancies in women >45 years old are achieved via assisted reproductive technologies with associated preconception counseling, as many as 45% may be spontaneously conceived. It is therefore important for obstetrician-gynecologists to incorporate education for older women about the risks of pregnancy into routine office visits, and to ask women in this age-group about pregnancy planning. Additionally, many pregnancies in women aged >45 years may be safely managed in a nontertiary care center, avoiding the need for referral and transfer of care to an unfamiliar setting. This review addresses preconception evaluation and counseling, real and perceived risks in older mothers, common pregnancy complications and management of pregnancy in women >45 years old.
  
  
  BACKGROUND
  Obstetricians & Gynecologists, Family Physicians.
  
  
  OBJECTIVE
  After completion of this article, the reader should be better able to counsel women about the risks of pregnancy for women aged ≥45, evaluate older women for common risk factors that may further increase risk in pregnancy, assess pregnancy complications that are more common in women aged >45, and manage otherwise uncomplicated pregnancies in women in this age-group.
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA 94143, USA. salmeenk@obgyn.ucsf.edu
authors.forename: Kirsten
authors.initials: K
authors.lastname: Salmeen
authors.forename: Marya
authors.initials: M
authors.lastname: Zlatnik
mesh_terms: D000013:Congenital Abnormalities / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D003376:Counseling; D005260:Female; D006801:Humans; D008423:Maternal Age; D008875:Middle Aged; D016742:Preconception Care; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control; D011295:Prenatal Care; D012306:Risk