title: Maternal age ≥45 years and maternal and perinatal outcomes: a review of the evidence.
abstract: OBJECTIVE
  to examine the evidence in relation to very advanced maternal age (≥45 years) and maternal and perinatal outcomes in high-income countries.
  
  
  BACKGROUND
  this review was conducted against a background of increasing fertility options for women aged ≥=45 years and rising birth rates among this group of women.
  
  
  METHODS
  established health databases including SCOPUS, MEDLINE, CINAHL, EMBASE and Maternity and Infant Care were searched for journal papers, published 2001-2011, that examined very advanced maternal age (VAMA) and maternal and perinatal outcomes. Further searches were based on references found in located articles. Keywords included a search term for maternal age ≥45 years (very advanced maternal age, pregnancy aged 45 years and older) and a search term for maternal complications (caesarian section, hypertension, pre-eclampsia, gestational diabetes) and/or adverse perinatal outcome (preterm birth, low birth weight, small for gestational age, stillbirth, perinatal death). Of 164 retrieved publications, 10 met inclusion criteria.
  
  
  METHODS
  data were extracted and organised under the following headings: maternal age ≥45 years; maternal characteristics such as parity and use of artificial reproductive technology (ART); and pre-existing maternal conditions, such as diabetes and hypertension. Additional headings included: gestational conditions, such as pre-eclampsia and gestational diabetes (GDM); and perinatal outcomes, including fetal/infant demise; gestational age and weight. Study quality was assessed by using the Critical Appraisal Skills Programme (CASP) guidelines.
  
  
  RESULTS
  this review produced three main findings: (1) increased rates of stillbirth, perinatal death, preterm birth and low birth weight among women ≥45 years; (2) increased rates of pre-existing hypertension and pregnancy complications such as GDM, gestational hypertension (GH), pre-eclampsia and interventions such as caesarian section; and (3) a trend of favourable outcomes, even at extremely advanced maternal age (50-65 years), for healthy women who had been screened to exclude pre-existing disease.
  
  
  CONCLUSIONS
  although there is strong evidence of an association between very advanced maternal age and adverse maternal and perinatal outcomes, the absolute rate of stillbirth/perinatal death remains low, at less than 10 per 1000 births in most high-income countries. Therefore, although women in this age group encounter greater pregnancy risk, most will achieve a successful pregnancy outcome. Best outcomes appear to be linked to pre-existing maternal health, and pregnancy care at tertiary centres may also contribute. This information should be used to counsel women aged ≥45 years who are contemplating pregnancy.
authors.affiliation: School of Nursing and Midwifery, St. Alban's Campus, Victoria University, Melbourne 8001, Australia. Mary.carolan@vu.edu.au
authors.forename: Mary
authors.initials: M
authors.lastname: Carolan
mesh_terms: D001723:Birth Rate; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D008423:Maternal Age; D008875:Middle Aged; D018743:Perinatal Care / Q000379:methods; D054238:Perinatal Mortality; D011247:Pregnancy; D011248:Pregnancy Complications / Q000145:classification / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D011256:Pregnancy Outcome; D047928:Premature Birth / Q000453:epidemiology / Q000209:etiology; D050497:Stillbirth / Q000453:epidemiology