title: Pregnancy outcomes in very advanced maternal age pregnancies: the impact of assisted reproductive technology.
abstract: OBJECTIVE
  To determine whether there are differences in adverse pregnancy outcomes in very advanced maternal age (vAMA) women who conceived with assisted reproductive technologies (ART) compared with spontaneous conceptions.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Academic tertiary care medical center.
  
  
  METHODS
  A total of 472 women aged ≥45 years who delivered at one institution.
  
  
  METHODS
  Mode of conception.
  
  
  METHODS
  Maternal and neonatal outcomes.
  
  
  RESULTS
  For singleton pregnancies, vAMA women who conceived with ART were significantly older (47.0 ± 2.3 vs. 45.6 ± 0.1 years), more likely to be white (88.1% vs. 75.6%), and less parous (0.4 ± 0.9 vs. 1.2 ± 1.8) than vAMA women who conceived spontaneously. They were at significantly increased risk for cesarean delivery (CD) (75.1% vs. 49.7%) and were more likely to undergo elective primary CD without labor (25.4% vs. 9.4%). Risk of retained placenta was also significantly higher (2.7% vs. 0%). Rates of other maternal complications and neonatal outcomes were similar. Subgroup analysis of ART singleton pregnancies did not demonstrate differences in women using autologous oocytes versus donor oocytes.
  
  
  CONCLUSIONS
  Very advanced maternal age women who conceive after ART are more likely to be white, older, primiparous, and are more likely to proceed with an elective CD compared with vAMA women who conceive spontaneously. The increased risk of retained placenta in women who conceive with ART may indicate an underlying risk for placentation defects.
authors.affiliation: Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Sherri
authors.initials: S
authors.lastname: Jackson
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Connie
authors.initials: C
authors.lastname: Hong
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Erica T
authors.initials: ET
authors.lastname: Wang
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Alexander
authors.affiliation: Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Kimberly D
authors.initials: KD
authors.lastname: Gregory
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California. Electronic address: pisarskam@cshs.org.
authors.forename: Margareta D
authors.initials: MD
authors.lastname: Pisarska
mesh_terms: D000328:Adult; D017677:Age Distribution; D002585:Cesarean Section / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000453:epidemiology* / Q000628:therapy*; D015141:Los Angeles; D008423:Maternal Age; D008875:Middle Aged; D018457:Placenta, Retained / Q000453:epidemiology*; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D015995:Prevalence; D027724:Reproductive Techniques, Assisted / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: ART; Very advanced maternal age (AMA); donor oocytes; pregnancy outcomes; retained placenta