title: Age, mode of conception, health service use and pregnancy health: a prospective cohort study of Australian women.
abstract: BACKGROUND
  There is limited evidence about the ways in which maternal age and mode of conception interact with psychological, sociodemographic, health and health service factors in governing pregnancy health. The aim of this study was to establish in what ways maternal age and mode of conception are associated with, health behaviours, health service use and self-rated physical and mental health during pregnancy.
  
  
  METHODS
  A prospective cohort study was conducted in a collaboration between universities, infertility treatment services and public and private obstetric hospitals in Melbourne and Sydney, Australia,. Consecutive cohorts of nulliparous English-literate women at least 28 weeks pregnant who had conceived through ART (ARTC) or spontaneously (SC) in three age-groups: 20-30; 31-36 and at least 37 years were recruited. Data were obtained via structured individual telephone interviews and self-report postal questionnaires at recruitment and four months postpartum. Study-specific questions assessed: sociodemographic characteristics; reproductive health; health behaviours and health service use. Standardized instruments assessed physical health: SF 12 Physical Component Score (PCS) and mental health: SF12 Mental Component Score (MCS); State Trait Anxiety Inventory and Edinburgh Postnatal Depression Scale. The main outcome measures were the SF 12 PCS, SF12 MCS scores and pregnancy-related hospital admissions.
  
  
  RESULTS
  Of 1179 eligible women 791 (67%) participated, 27 had fertility treatment without oocyte retrieval and were excluded and 592/764 (78%) completed all pregnancy assessments. When other factors were controlled speaking a language other than English, having private health insurance and multiple gestation were associated with worse physical health and having private health insurance and better physical health were associated with better mental health. Pregnancy-related hospital admissions were associated with worse physical health and multiple gestation.
  
  
  CONCLUSIONS
  Maternal age and mode of conception are not associated with pregnancy health and health service use when sociodemographic factors are considered.
authors.affiliation: School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia. jane.fisher@monash.edu
authors.forename: Jane
authors.initials: J
authors.lastname: Fisher
authors.forename: Karen
authors.initials: K
authors.lastname: Wynter
authors.forename: Karin
authors.initials: K
authors.lastname: Hammarberg
authors.forename: John
authors.initials: J
authors.lastname: McBain
authors.forename: Frances
authors.initials: F
authors.lastname: Gibson
authors.forename: Jacky
authors.initials: J
authors.lastname: Boivin
authors.forename: Catherine
authors.initials: C
authors.lastname: McMahon
mesh_terms: D000328:Adult; D001315:Australia; D005260:Female; D015438:Health Behavior; D006304:Health Status; D006801:Humans; D007348:Insurance, Health; D008423:Maternal Age; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D008603:Mental Health; D054315:Oocyte Retrieval; D011247:Pregnancy / Q000523:psychology*; D011272:Pregnancy, Multiple; D011446:Prospective Studies; D020554:Sperm Injections, Intracytoplasmic; D011795:Surveys and Questionnaires; D055815:Young Adult
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